Geriatría

Clinical Review
Care of the Elderly Series

Office management of urinary
incontinence among older patients
Christopher Frank

MD FCFP

Agata Szlanta

MD CCFP

Case
Mrs M.A. is an 84-year-old lady with mild
Alzheimer dementia. She lives at home and
is cared for by her 87-year-old husband. They
come in together for an appointment, and he
comments that his wife’s urinaryincontinence
(UI) is worsening and is causing increased caregiver stress.
She has had occasional incontinence for
more than 5 years, but during the past 6 months
she has had at least 3 episodes of urine loss
daily, at least 1 of these during the night. He is
doing more laundry than before, and they are
restricting social activities to minimize embarrassment.
Mrs M.A. minimizes the concern andreports
only occasional urine loss. She is independent
in self-care but needs assistance with shopping
and complex meal preparation. She was started
on donepezil 7 months ago and is currently
taking 10 mg daily. She also takes 30 mg of
extended-release nifedipine daily and 25 mg of
hydrochlorothiazide daily for hypertension, 81
mg of enteric-coated acetylsalicylic acid, and 30
mg of oxazepam atbedtime as needed for sleep.

Urinary incontinence is a challenging clinical
condition to treat in family medicine. Although it
is common, many family physicians have received
minimal training in management. Patients underreport the presence of UI and physicians do not commonly ask about it in routine questioning, leading
to undertreatment. A survey of family physicians in
20021 found thatonly 37% of respondents thought
they had an organized approach to management,
and a similar percentage reported feeling comfortable with management. Almost 50% of respondents
managed patients by making referrals, most commonly to urology. Knowledge of resources such as
Nurse Continence Advisors was minimal. Despite
these concerns, it has been shown that family physicians can improve symptomsand quality of life for
those with UI.2

This article has been peer reviewed.
Cet article a fait l’objet d’une révision par des pairs.
Can Fam Physician 2010;56:1115-20

Abstract

OBJECTIVE To provide family physicians with a guide to office
management of urinary incontinence (UI) among older patients.

SOURCES OF INFORMATION Ovid MEDLINE and the Co-

chrane database were searchedusing the terms urinary incontinence, stress incontinence, overactive bladder, urge incontinence,
elderly, and geriatrics.

MAIN MESSAGE A variety of conditions affecting the nervous
system and the lower urinary tract can affect bladder function and
UI. Among older patients the effects of decreased cognition and
impaired mobility can be substantial, and environmental barriers
can play arole. When managing older patients with UI, emphasis
on treating concurrent conditions, optimizing medications, and
working on lifestyle and behavioural factors is at least as important
as pharmacologic treatment. Medications are relevant, but the
potential for adverse effects increases among older patients.

CONCLUSION Various resources are available to support family
physicians in officemanagement of UI, and family physicians can
improve symptoms and the quality of patients’ lives by screening
for and helping patients to manage incontinence.

Résumé

OBJECTIF Fournir au médecin de famille un guide pour le traitement,
au bureau, de l’incontinence urinaire (IU) chez la personne âgée.

SOURCES DE L’INFORMATION On a consulté les bases de

données Ovid et Cochrane à l’aide desrubriques urinary incontinence, stress incontinence, overactive bladder, urge incontinence,
elderly et geriatrics.

PRINCIPAL MESSAGE Diverses conditions affectant le système nerveux et les voies urinaires inférieures peuvent modifier
l’activité de la vessie et causer une IU. Chez le patient âgé, les
problèmes cognitifs et la perte de mobilité sont souvent des
facteurs importants, et les...