J Korean Med Assoc.  2017 Jul;60(7):542-549. 10.5124/jkma.2017.60.7.542.

Management of urinary incontinence in geriatric hospitals

• Kim HJ

• KMID: 2386594
• DOI: http://doi.org/10.5124/jkma.2017.60.7.542

Abstract

Urinary incontinence (UI) is one of the most common urologic conditions that afflict the elderly in a rapidly aging world. The prevalence of UI increases in both sexes as aging progresses. Additionally, the prevalence of UI is higher in patients of nursing facilities, including geriatric hospitals and sanatoriums, than in the general population because most of them have chronic diseases such as dementia and stroke that can cause neurogenic bladder dysfunction. UI in nursing facilities is often overlooked or neglected, as it may be regarded as a natural part of the aging process. However, UI can have significant negative impacts on self-esteem and has been associated with increased rates of depression. UI also affects quality of life and activities of daily living. In many cases, treating UI can improve patients' quality of life and reduce the costs associated with UI itself and its complications. For this purpose, the initial assessment of patients entering a nursing home should include an item on UI, and when a patient exhibits UI, it should be treated as an important disease. The purpose of this review is to provide an overview of the causes, classification, evaluation, and management of geriatric UI in nursing facilities.

Keyword

Urinary incontinence; Geriatrics; Nursing

MeSH Terms

Activities of Daily Living
Aged
Aging
Chronic Disease
Classification
Dementia
Depression
Geriatrics
Humans
Nursing
Nursing Homes
Prevalence
Quality of Life
Stroke
Urinary Bladder, Neurogenic
Urinary Incontinence*

Reference

1. Ezeh AC, Bongaarts J, Mberu B. Global population trends and policy options. Lancet. 2012; 380:142–148.

2. Ory MG, Wyman JF, Yu L. Psychosocial factors in urinary incontinence. Clin Geriatr Med. 1986; 2:657–671.

3. Collerton J, Davies K, Jagger C, Kingston A, Bond J, Eccles MP, Robinson LA, Martin-Ruiz C, von Zglinicki T, James OF, Kirkwood TB. Health and disease in 85 year olds: baseline findings from the Newcastle 85+ cohort study. BMJ. 2009; 339:b4904.

4. Statistics Korea. Current status of medical institution [Internet]. Daejeon: Statistics Korea;2017. cited 2017 Jun 28. Available from: http://kosis.kr/statHtml/statHtml.do?orgId=354&tblId=DT_MIRE01&conn_path=I3.

5. Peet SM, Castleden CM, McGrother CW. Prevalence of uri-nary and faecal incontinence in hospitals and residential and nursing homes for older people. BMJ. 1995; 311:1063–1064.

6. Lee SH, Suh J, Kim HS, Lee YJ, Lee SR, Kim KH, Jeong CW. Prevalence and management status of urologic diseases in geriatric hospitals in South Korea: a field research. Investig Clin Urol. 2017; 58:70–76.

7. Shin CW, Kim SD, Cho WY. The prevalence and management of urinary incontinence in elderly patients at sanatorium in Busan area. Korean J Urol. 2009; 50:450–456.

8. Lee YS, Lee KS, Jung JH, Han DH, Oh SJ, Seo JT, Lee JG, Park HS, Choo MS. Prevalence of overactive bladder, urinary incontinence, and lower urinary tract symptoms: results of Korean EPIC study. World J Urol. 2011; 29:185–190.

9. Diokno AC, Brock BM, Brown MB, Herzog AR. Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly. J Urol. 1986; 136:1022–1025.

10. Milsom I, Coyne KS, Nicholson S, Kvasz M, Chen CI, Wein AJ. Global prevalence and economic burden of urgency urinary incontinence: a systematic review. Eur Urol. 2014; 65:79–95.

11. Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. Nor-wegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trondelag. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trondelag. J Clin Epidemiol. 2000; 53:1150–1157.

12. Samuelsson E, Mansson L, Milsom I. Incontinence aids in Sweden: users and costs. BJU Int. 2001; 88:893–898.

13. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A. Standardisation Subcommittee of the International Continence Society. The standardisation of terminology of lower urinary tract fun-ction: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002; 21:167–178.

14. Kim YS, Kim HJ, Kang DI. Urinary incontinence. Korean Urological Association. Urology. 5th ed. Seoul: Ilchokak;2014. p. 444–454.

15. Inouye SK. Delirium in older persons. N Engl J Med. 2006; 354:1157–1165.

16. Elliott RA, Castleden CM, Miodrag A, Kirwan P. The direct effects of diethylstilboestrol and nifedipine on the contractile responses of isolated human and rat detrusor muscles. Eur J Clin Pharmacol. 1992; 43:149–155.

17. McGrother C, Resnick M, Yalla SV, Kirschner-Hermanns R, Broseta E, Muller C, Welz-Barth A, Fischer GC, Mattelaer J, McGuire EJ. Epidemiology and etiology of urinary incon-tinence in the elderly. World J Urol. 1998; 16:Suppl 1. S3–S9.

18. Voytas J. The role of geriatricians and family practitioners in the treatment of overactive bladder and incontinence. Rev Urol. 2002; 4:Suppl 4. S44–S49.

19. British Geriatrics Society. Continence care in residential and nursing homes [Internet]. London: British Geriatrics Society;2010. cited 2017 Jun 28. Available from: http://www.bgs.org.uk/bladdersnbowels/subjectreference/bladderbowel/continencenursinghomes.

20. Han JH. Incontience. In : Moon GH, Lee SC, Gam SC, editors. Geriatric Urology. Seoul: Thewithin;2017. p. 39–49.

21. Fantl JA, Wyman JF, McClish DK, Harkins SW, Elswick RK, Taylor JR, Hadley EC. Efficacy of bladder training in older women with urinary incontinence. JAMA. 1991; 265:609–613.

22. Durrant J, Snape J. Urinary incontinence in nursing homes for older people. Age Ageing. 2003; 32:12–18.

23. Papenberg G, Backman L, Fratiglioni L, Laukka EJ, Fastbom J, Johnell K. Anticholinergic drug use is associated with episodic memory decline in older adults without dementia. Neurobiol Aging. 2017; 55:27–32.

24. Ness J, Hoth A, Barnett MJ, Shorr RI, Kaboli PJ. Anticholi-nergic medications in community-dwelling older veterans: prevalence of anticholinergic symptoms, symptom burden, and adverse drug events. Am J Geriatr Pharmacother. 2006; 4:42–51.

25. Pagoria D, O'Connor RC, Guralnick ML. Antimuscarinic drugs: review of the cognitive impact when used to treat over-active bladder in elderly patients. Curr Urol Rep. 2011; 12:351–357.

26. Schneidinger CS, Umek W, Bohmdorfer B. The problem of polypharmacy in female patients with overactive bladders: cross-sectional study in a specialist outpatient department. Geburtshilfe Frauenheilkd. 2016; 76:1318–1324.

27. Tannenbaum C. How to treat the frail elderly: the challenge of multimorbidity and polypharmacy. Can Urol Assoc J. 2013; 7:9-10 Suppl 4. S183–S185.

28. Jung HB, Kim HJ, Cho ST. A current perspective on geriatric lower urinary tract dysfunction. Korean J Urol. 2015; 56:266–275.

29. Cody JD, Richardson K, Moehrer B, Hextall A, Glazener CM. Oestrogen therapy for urinary incontinence in post-menopa-usal women. Cochrane Database Syst Rev. 2009; (4):CD001405.

30. White WM, Pickens RB, Doggweiler R, Klein FA. Short-term efficacy of botulinum toxin a for refractory overactive bladder in the elderly population. J Urol. 2008; 180:2522–2526.

31. Ulmsten U, Petros P. Intravaginal slingplasty (IVS): an ambu-latory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol. 1995; 29:75–82.

32. Webb RJ, Lawson AL, Neal DE. Clean intermittent self-cathe-terisation in 172 adults. Br J Urol. 1990; 65:20–23.

33. Stohrer M, Blok B, Castro-Diaz D, Chartier-Kastler E, Del Popolo G, Kramer G, Pannek J, Radziszewski P, Wyndaele JJ. EAU guidelines on neurogenic lower urinary tract dysfunc-tion. Eur Urol. 2009; 56:81–88.

34. Golji H. Complications of external condom drainage. Paraplegia. 1981; 19:189–197.

35. Lee SH, Kang JS, Kim JW, Lee SJ. Incontinence pad usage in medical welfare facilities in Korea. Int Neurourol J. 2013; 17:186–190.

36. Kim MS, Lee SH. Prevalence rate and associated factors of urinary incontinence among nursing home residents. Taehan Kanho Hakhoe Chi. 2008; 38:92–100.