Dépistage et évaluation de l'incontinence urinaire chez les patients âgés complexes : étude exploratoire en gériatrie aiguë

To optimize our practices by developing an interdisciplinary program for screening and management of functional urinary disturbances with urinary incontinence (UI), this prospective study was conducted to assess the qualitative and quantitative needs of our elderly, polymorbid, and polymedicated patients. All patients with spontaneous urination who were hospitalized in the CHUV acute care for the elderly unit between February 1st and March 31st, 2016 were evaluated using the ICIQ-UI-SF. During the period, 87 patients were enrolled (mean age 86.4 ± 6.7 years; 78.2% women); 41 had urinary losses among whom 23 had incontinence episodes ≥ 1/day (56.1%). For 20, the amounts involved were estimated as moderate to large (48.8%). On average the ICIQ-UI-SF score was 12.3 ± 4.2 (min = 0, max = 21). More than half of the incontinent patients reported symptoms suggestive of stress incontinence; 53.6% reported losses before they got to the toilet, while at this stage, it was not possible to distinguish cases of overactive bladder of functional origin. In 11 patients, episodes of nocturnal urinary incontinence were reported. Compared to the others, patients with UI were older (87.7 ± 4.8 vs. 85.5 ± 7.8 years, P < 0.05) and had more geriatric syndromes (2.1 ± 0.6 vs. 1.8 ± 0.8, P < 0.05). Gait and balance disorders, cognitive impairment, and the risk of protein-energy malnutrition were significantly more frequent. Although patients with IU were taking significantly more medication (9.1 ± 4.0 vs. 8.4 ± 3.5, P < 0.05), no differences were noted in the prevalence of potentially inappropriate prescriptions according to STOPP/START criteria. This study provides answers to the initial aims of the study, and it has led to the development of an interdisciplinary protocol and therapeutic recommendations tailored to the vulnerability profile of the patients identified.