Managing Special Populations: The Elderly

Physiological and pathologic factors contribute to the increased prevalence of incontinence in the elderly. In view of the expanding elderly population, the problem of incontinence is likely to represent an increasing challenge to health care services. In women, the prevalence of mixed and urgency incontinence increases with age, whereas in men, the combination of outflow obstruction and detrusor overactivity is the most common cause of incontinence in later life. In both sexes, functional incontinence plays an increasing role because of the disabling effects of conditions such as dementia, stroke, and arthritis, whether or not underlying lower urinary tract disease is present. Polypharmacy may also increase the risk of continence problems due to their effects on fluid retention and output. Conservative and pharmacologic therapies, such as antimuscarinic agents, appear to be as equally effective and well tolerated in the elderly as they are in younger patients. In the elderly, significant benefits are also seen as a consequence of the psychological support included in conservative treatment, even when improvements in objective measures of incontinence are small. Thus, holistic management has an important role in the elderly. Future research is needed to identify holistic interventions that are clinically effective for the majority of elderly patients, in terms of symptom control, disease variables, and quality of life to allow patients to regain normal bladder habits as much as is possible, whatever the environment in which they live.