Incontinence in the elderly

Geriatric incontinence is a prevalent problem, morbid, costly and has effects that are devastating, causing psychological dysfunction, which often leads to isolation and early admission to a residential care facility. The reported prevalence of urinary incontinence (UI) in the elderly varied widely between 10% and 70% in those over 65 years of age. There is evidence that less than half of the patients with UI consult their healthcare provider. Incontinence is associated with significant anxiety and depression which has negative effect on self perception. Continence depends on multiple factors - mental state, mobility, manual dexterity, health status and motivation - as well as urinary function. The aetiology and risk factors of incontinence in older people are little different from those in younger age groups but the elderly are more prone to physiological, pharmacological and psychological factors that may affect their incontinence status. Assessment of elderly patients with UI should follow a holistic approach; it must include transfer ability, mobility, balance, arm strength and body flexibility, manual dexterity, eyesight and toileting ability. Simple conservative measures such as general lifestyle advice are all that is needed in many cases. Primary care team including continence advisors play important role in treating these patients. Pelvic-floor exercise, bladder retraining and biofeedback are useful first-line management, but they require intact cognitive function and motivation. Due to the side effects, older people should be observed carefully when given new medications, and polypharmacy should be avoided at all cost. Age in itself is not a barrier to surgical treatment, especially if performed under local anaesthesia. Environmental measures are an essential part of the treatment package. Preventive strategies should be used, when possible, to reduce the burden of incontinence on elderly sufferers and enhance their quality of life.