Fall 2009

Helping to manage urinary 
incontinence in older adults

Urinary incontinence remains significantly under-reported and under-diagnosed for adults age 65 and older, according to the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA). Behavioral and pharmacotherapy strategies can make tangible differences in improving outcomes for patients.

As part of your routine screenings, initiate a dialogue with your patients about urinary incontinence for early identification at the earliest possible stage when pharmacologic or other treatments are most effective. For women, make it a part of the comprehensive screening that they already undergo for breast cancer, cervical cancer and diabetes. For men, make it part of a regular screening program for prostatitis, benign prostatic hyperplasia, prostate cancer and diabetes.

Here are five simple questions that you can use with your patients to help assist with your assessment and diagnosis of urinary incontinence and/or related problems:

1. Many people experience problems with urinary incontinence, the leakage of urine. In the past 6 months, have you accidentally leaked urine?
2. How much of a problem, if any, is the urine leakage for you?
3. How have you been dealing with your urinary incontinence?
4. Would you like to talk more about your urine leakage problem?
5. Would you like to discuss ways to treat it?

The 2008 Medicare Health Outcomes Survey indicated 54.6 percent of respondents who had urine leakage problems reported that they discussed their problem with their providers and only 38.8 percent of respondents reported they received treatment for their urine leakage problem.

Urinary urgency, frequency and incontinence are important symptoms that may be indicative of other serious diseases including diabetes, benign prostatic hyperplasia, prostatitis, prostate cancer, bladder cancer, urinary tract infections and an overactive bladder. Urinary incontinence may also cause a wide range of morbidities including cellulites, pressure ulcers, urinary tract infections, falls with fractures, sleep deprivation, social withdrawal, depression and sexual dysfunction. Many men and women experience urologic symptoms but fail to seek medical help for them because of embarrassment or the misconception that urologic changes are normal and an inevitable part of aging.

If you have any questions, call Joanne Keenan at (800) 555-8228, extension 87329.