Review Article
Urinary incontinence in frail elderly persons: Report from the 5th International Consultation on Incontinence
Adrian Wagg,
William Gibson,
Joan Ostaszkiewicz,
Theodore Johnson III, Alayne Markland,
Mary H. Palmer,
George Kuchel,
George Szonyi,
Ruth Kirschner-Hermanns,
Corresponding Author
Adrian Wagg
University of Alberta, Edmonton, Alberta, Canada
Correspondence to: Adrian Wagg, Department of Medicine, University of Alberta, 1-116 Clinical Sciences Building, 11350 83 Avenue, Edmonton, Alberta, Canada. E-mail: [email protected]Search for more papers by this authorWilliam Gibson
Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorJoan Ostaszkiewicz
Deakin University, Melbourne, Australia
**Correction added on June 14, 2014, after first online publication: the third author, Joan Ostaszkiewicz, was included.Search for more papers by this authorAlayne Markland
Geriatric Medicine, University of Birmingham Center for Aging, Birmingham, Alabama
Search for more papers by this authorMary H. Palmer
The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Search for more papers by this authorGeorge Kuchel
Division of Geriatrics, University of Connecticut Health Center, Farmington, Connecticut
Search for more papers by this authorGeorge Szonyi
Royal Prince Alfred Hospital Balmain, NSW, Australia
Search for more papers by this authorRuth Kirschner-Hermanns
Department of Neuro-Urology, University Hospital Bonn, Bonn, Germany
Search for more papers by this authorAdrian Wagg,
William Gibson,
Joan Ostaszkiewicz,
Theodore Johnson III, Alayne Markland,
Mary H. Palmer,
George Kuchel,
George Szonyi,
Ruth Kirschner-Hermanns,
Corresponding Author
Adrian Wagg
University of Alberta, Edmonton, Alberta, Canada
Correspondence to: Adrian Wagg, Department of Medicine, University of Alberta, 1-116 Clinical Sciences Building, 11350 83 Avenue, Edmonton, Alberta, Canada. E-mail: [email protected]Search for more papers by this authorWilliam Gibson
Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorJoan Ostaszkiewicz
Deakin University, Melbourne, Australia
**Correction added on June 14, 2014, after first online publication: the third author, Joan Ostaszkiewicz, was included.Search for more papers by this authorAlayne Markland
Geriatric Medicine, University of Birmingham Center for Aging, Birmingham, Alabama
Search for more papers by this authorMary H. Palmer
The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Search for more papers by this authorGeorge Kuchel
Division of Geriatrics, University of Connecticut Health Center, Farmington, Connecticut
Search for more papers by this authorGeorge Szonyi
Royal Prince Alfred Hospital Balmain, NSW, Australia
Search for more papers by this authorRuth Kirschner-Hermanns
Department of Neuro-Urology, University Hospital Bonn, Bonn, Germany
Search for more papers by this authorChristopher Chapple led the peer-review process as the Associate Editor responsible for the paper.
Conflict of interest: Dr. Wagg has Received monies for consultancy, speaker fees, and research from Astellas Pharma, Pfizer Corp, SCA, and Watson Pharma.
Abstract
Background
Evidence based guidelines for the management of frail older persons with urinary incontinence are rare. Those produced by the International Consultation on Incontinence represent an authoritative set of recommendations spanning all aspects of management.
Aims
To update the recommendations of the 4th ICI.
Materials and Methods
A series of systematic reviews and evidence updates were performed by members of the working group in order to update the 2009 recommendations. The resulting guidelines were presented at the 2012 meeting of the European Associatioon of Urology.
Results
Along with the revision of the treatment algorithm and accompanying text. There have been significant advances in several areas including pharmacological treatment of overactive bladder.
Discussion
The committee continue to notes the relative paucity of data concerning frail older persons and draw attention to knowledge gaps in this area. Neurourol. Urodynam. 34:398–406, 2015. © 2014 Wiley Periodicals, Inc.
REFERENCES
- 1 Baltes PB, Smith J. New frontiers in the future of aging: From successful aging of the young old to the dilemmas of the fourth age. Gerontology 2003; 49: 123–35.
- 2 Martin LG, Schoeni RF, Andreski PM. Trends in health of older adults in the United States: Past, present, future. Demography 2010; 47: S17–40.
- 3 McMurdo ME, Roberts H, Parker S., et al. Improving recruitment of older people to research through good practice. Age Ageing 2011; 40: 659–65.
- 4
Fonda D,
Resnick NM,
Colling J, et al.
Outcome measures for research of lower urinary tract dysfunction in frail older people.
Neurourol Urodyn
1998;
17: 273–81.
10.1002/(SICI)1520-6777(1998)17:3<273::AID-NAU12>3.0.CO;2-L CAS PubMed Web of Science® Google Scholar
- 5 DuBeau CE, Kuchel GA, Johnson T, II. et al. Incontinence in the frail elderly: Report from the 4th International Consultation on Incontinence. Neurourol Urodyn 2010; 29: 165–78.
- 6 Ferrucci L, Guralnik JM, Studenski S, et al. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: A consensus report. J Am Geriatr Soc 2004; 52: 625–34.
- 7 Fried L, Tangen C, Walston J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–56.
- 8 Health, United States. 2003. With Chartbook on Trends in the Health of Americans. (Accessed June 11, 2004, at http://www.cdc.gov/nchs/products/pubs/pubd/hus/highlits.pdf)
- 9 Thom DH, Haan MN, Van Den Eeden SK. Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality. Age Ageing 1997; 26: 367–74.
- 10 Inouye SK, Studenski S, Tinetti ME, et al. Geriatric syndromes: Clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc 2007; 55: 780–91.
- 11 DuBeau CE. Beyond the bladder: Management of urinary incontinence in older women. Clin Obstet Gynecol 2007; 50: 720–34.
- 12 Griffiths D, Derbyshire S, Stenger A, et al. Brain control of normal and overactive bladder. J Urol 2005; 174: 1862–7.
- 13 Tadic SD, Griffiths D, Schaefer W, et al. Abnormal connections in the supraspinal bladder control network in women with urge urinary incontinence. Neuroimage 2008; 39: 1647–53.
- 14 Griffiths D, Tadic SD. Bladder control, urgency, and urge incontinence: Evidence from functional brain imaging. Neurourol Urodyn 2008; 27: 476–8.
- 15 Hof PR, Morrison JH. The aging brain: Morphomolecular senescence of cortical circuits. Trends Neurosci 2004; 27: 607–13.
- 16 Andrews-Hanna JR, Snyder AZ, Vincent JL, et al. Disruption of large-scale brain systems in advanced aging. Neuron 2007; 56: 924–35.
- 17 Schroder A, Abrams P, Andersson K-E, et al. Guidelines on urinary incontinence: European Association of Urology; 2010.
- 18Urinary Incontinence in Women. 2013. (Accessed at http://guidance.nice.org.uk/CG171/NICEGuidance/pdf/English.)
- 19 Fung CH, Spencer B, Eslami M, et al. Quality indicators for the screening and care of urinary incontinence in vulnerable elders. J Am Geriatr Soc 2007; 55: S443–9.
- 20 Schnelle JF, Smith RL. Quality indicators for the management of urinary incontinence in vulnerable community-dwelling elders. Ann Intern Med 2001; 135: 752–8.
- 21 Wagg A, Potter J, Peel P, et al. National audit of continence care for older people: Management of urinary incontinence. Age Ageing 2008; 37: 39–44.
- 22 Wagg A, Mian S, Lowe D, et al. National audit of continence care for older people: Results of a pilot study*. J Eval Clin Pract 2005; 11: 525–32.
- 23 Wagg A, Duckett J, McClurg D, et al. To what extent are national guidelines for the management of urinary incontinence in women adhered? Data from a national audit. BJOG 2011; 118: 1592–600.
- 24 Resnick NM, Yalla SV. Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients. JAMA 1987; 257: 3076–81.
- 25 Irwin DE, Milsom I, Kopp Z, et al. Symptom bother and health care-seeking behavior among individuals with overactive bladder. Eur Urol 2008; 53: 1029–37.
- 26 Ouslander JG. Intractable incontinence in the elderly. BJU Int 2000; 85: 72–8; discussion 81–2.
- 27 Nicolle LE. Urinary tract infections in the elderly. Clin Geriatr Med 2009; 25: 423–36.
- 28 Fonda D. Improving management of urinary incontinence in geriatric centres and nursing homes. Victorian Geriatricians Peer Review Group. Aust Clin Rev 1990; 10: 66–71.
- 29 DuBeau CE. Urinary incontinence management: New questions from old assumptions. J Am Geriatr Soc 2001; 49: 829–30.
- 30 Houghman GW, Sachs GA, Danner D, et al. Empirical research on informed consent with the cognitively impaired. IRB 2003; Suppl 25: S26–32.
- 31 Mezey M, Teresi J, Ramsey G, et al. Decision-making capacity to execute a health care proxy: Development and testing of guidelines. J Am Geriatr Soc 2000; 48: 179–87.
- 32 Pfisterer MH, Johnson TM, II. Jenetzky E, et al. Geriatric patients' preferences for treatment of urinary incontinence: A study of hospitalized, cognitively competent adults aged 80 and older. J Am Geriatr Soc 2007; 55: 2016–22.
- 33 DuBeau C, Simon S, Morris J. Impact of urinary incontinence on quality of life in nursing home residents. J Am Geriatr Soc 2006; 54: 1325–33.
- 34 Brown CT, Van Der Meulen J, Mundy AR, et al. Lifestyle and behavioural interventions for men on watchful waiting with uncomplicated lower urinary tract symptoms: A national multidisciplinary survey. BJU Int 2003; 92: 53–7.
- 35 Kincade JE, Dougherty MC, Carlson JR, et al. Randomized clinical trial of efficacy of self-monitoring techniques to treat urinary incontinence in women. Neurourol Urodyn 2007; 26: 507–11.
- 36 Landefeld CS. Pragmatic approaches that improve care for geriatric conditions: Balancing the promise and the peril of quality indicators. J Am Geriatr Soc 2009; 57: 556–8.
- 37 Landefeld CS, Bowers BJ, Feld AD, et al. National Institutes of Health state-of-the-science conference statement: Prevention of fecal and urinary incontinence in adults. Ann Intern Med 2008; 148: 449–58.
- 38 Schnelle JF, Leung FW, Rao SS, et al. A controlled trial of an intervention to improve urinary and fecal incontinence and constipation. J Am Geriatr Soc 2010; 58: 1504–11.
- 39 Dowd TT, Campbell JM, Jones JA. Fluid intake and urinary incontinence in older community-dwelling women. J Community Health Nurs 1996; 13: 179–86.
- 40 Spangler PF, Risley TR, Bilyew DD. The management of dehydration and incontinence in nonambulatory geriatric patients. J Appl Behav Anal 1984; 17: 397–401.
- 41 Roe B, Ostaszkiewicz J, Milne J, et al. Systematic reviews of bladder training and voiding programmes in adults: A synopsis of findings from data analysis and outcomes using metastudy techniques. J Adv Nurs 2007; 57: 15–31.
- 42 Palmer MH. Effectiveness of prompted voiding for incontinent nursing home residents. In: B. M Melnyk EF-O, editor. Evidence-based practice in nursing & healthcare: A guide to the best practice. Philadelphia, PX, USA: Lippincott Williams & Williams; 2005. 20–30.
- 43 Palmer MH. Use of health behavior change theories to guide urinary incontinence research. Nurs Res 2004; 53: S49–55.
- 44 Roe B, Milne J, Ostaszkiewicz J, et al. Systematic reviews of bladder training and voiding programmes in adults: A synopsis of findings on theory and methods using metastudy techniques. J Adv Nurs 2007; 57: 3–14.
- 45 Ostaszkiewicz J, Johnston L, Roe B. VTimed voiding for the management of urinary incontinence in adults. J Urol 2005; 173: 1262–3.
- 46 Schnelle JF, MacRae PG, Ouslander JG, et al. Functional incidental training, mobility performance, and incontinence care with nursing home residents. J Am Geriatr Soc 1995; 43: 1356–62.
- 47 van Houten P, Achterberg W, Ribbe M. Urinary incontinence in disabled elderly women: A randomized clinical trial on the effect of training mobility and toileting skills to achieve independent toileting. Gerontology 2007; 53: 205–10.
- 48 Booth J, Kumlien S, Zang Y. Promoting urinary continence with older people: Key issues for nurses. Int J Older People Nurs 2009; 4: 63–9.
- 49 Dingwall L. Promoting effective continence care for older people: A literature review. Br J Nurs 2008; 17: 166–72.
- 50 Wright J, McCormack B, Coffey A, et al. Evaluating the context within which continence care is provided in rehabilitation units for older people. Int J Older People Nurs 2007; 2: 9–19.
- 51
Vinsnes AG,
Harkless GE,
Nyronning S.
Unit-based intervention to improve urinary incontinence in frail elderly.
Nord J Nurs Res Clin Stud
2007;
27: 53.
10.1177/010740830702700312 Google Scholar
- 52 Cheater FM. Overcoming the barriers to optimum continence care: The need for an expanded approach to implementation. Int J Older People Nurs 2009; 4: 70–5.
- 53 Hagglund D. A systematic literature review of incontinence care for persons with dementia: The research evidence. J Clin Nurs 2010; 19: 303–12.
- 54 Perrin L, Dauphinee SW, Corcos J, et al. Pelvic floor muscle training with biofeedback and bladder training in elderly women: A feasibility study. J Wound Ostomy Continence Nurs 2005; 32: 186–99.
- 55 Diokno AC, Sampselle CM, Herzog AR, et al. Prevention of urinary incontinence by behavioral modification program: A randomized, controlled trial among older women in the community. J Urol 2004; 171: 1165–71.
- 56 Ostaszkiewicz J, Roe B, Johnston L. Effects of timed voiding for the management of urinary incontinence in adults: Systematic review. J Adv Nurs 2005; 52: 420–31.
- 57 Kraus SR, Bavendam T, Brake T, et al. Vulnerable elderly patients and overactive bladder syndrome. Drugs Aging 2010; 27: 697–713.
- 58 Bates-Jensen BM, Alessi CA, Al-Samarrai NR, et al. The effects of an exercise and incontinence intervention on skin health outcomes in nursing home residents. J Am Geriatr Soc 2003; 51: 348–55.
- 59 Simmons SF, Schnelle JF. Effects of an exercise and scheduled-toileting intervention on appetite and constipation in nursing home residents. J Nutr Health Aging 2004; 8: 116–21.
- 60 Colling J, Owen TR, McCreedy M, et al. The effects of a continence program on frail community-dwelling elderly persons. Urol Nurs 2003; 23: 117–22, 27–31.
- 61 Engberg S, Sereika SM, McDowell BJ, et al. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs 2002; 29: 252–65.
- 62 Narayanan S, Cerulli A, Kahler K, et al. Is drug therapy for urinary incontinence used optimally in long-term care facilities? J Am Med Dir Assoc 2007; 8: 98–104.
- 63 Dubeau CE, Kraus SR, Griebling TL, et al. Effect of fesoterodine in vulnerable elderly subjects with urgency incontinence: A double-blind, placebo controlled trial. J Urol 2014; 191: 395–404.
- 64 Wagg A, Khullar V, Marschall-Kehrel D, et al. Flexible-dose fesoterodine in elderly adults with overactive bladder: Results of the randomized, double-blind, placebo-controlled study of fesoterodine in an aging population trial. J Am Geriatr Soc 2013; 61: 185–93.
- 65 Paquette A, Gou P, Tannenbaum C. Systematic review and meta-analysis: Do clinical trials testing antimuscarinic agents for overactive bladder adequately measure central nervous system adverse events? J Am Geriatr Soc 2011; 59: 1332–9.
- 66 Sink KM, Thomas J, III. Xu H, et al. Dual use of bladder anticholinergics and cholinesterase inhibitors: Long-term functional and cognitive outcomes. J Am Geriatr Soc 2008; 56: 847–53.
- 67 Wagg A, Khullar V, Marscall-Kehrel D, et al. Assessment of fesoterodine treatment in older people with overactive bladder: Results of SOFIA, a double blind, placebo controlled pan-European trial [abstract]. Presented at the 2011 Annual Meeting of the European Association of Urology.
- 68 Wagg A, Verdejo C, Molander U. Review of cognitive impairment with antimuscarinic agents in elderly patients with overactive bladder. Int J Clin Pract 2010; 64: 1279–86.
- 69 Whalley LJ, Sharma S, Fox HC, et al. Anticholinergic drugs in late life: Adverse effects on cognition but not on progress to dementia. J Alzheimers Dis 2012; 30: 253–61.
- 70 Fox C, Livingston G, Maidment ID, et al. The impact of anticholinergic burden in Alzheimer's dementia-the LASER-AD study. Age Ageing 2011; 40: 730–5.
- 71 Fox C, Richardson K, Maidment ID, et al. Anticholinergic medication use and cognitive impairment in the older population: The medical research council cognitive function and ageing study. J Am Geriatr Soc 2011; 59: 1477–83.
- 72 Gomes T, Juurlink DN, Ho JM, et al. Risk of serious falls associated with oxybutynin and tolterodine: A population based study. J Urol 2011; 186: 1340–4.
- 73 Carriere I, Fourrier-Reglat A, Dartigues JF, et al. Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: The 3-city study. Arch Intern Med 2009; 169: 1317–24.
- 74 Kay GG, Messer WS Jr, Murphy DG, et al. Antimuscarinic drugs for overactive bladder and their potential effects on cognitive function in older patients. J Am Geriatr Soc 2005; 53: 2195–201.
- 75 Lu CJ, Tune LE. Chronic exposure to anticholinergic medications adversely affects the course of Alzheimer disease. Am J Geriatr Psychiatry 2003; 11: 458–61.
- 76 Hopcraft MS, Tan C. Xerostomia: An update for clinicians. Aust Dent J 2010; 55: 238–44; quiz 353.
- 77American Dental Association 2011. (Accessed at http://www.ada.org/sections/newsAndEvents/pdfs/ltr_dry_mouth_110427.pdf.)
- 78 Kessler TM, Bachmann LM, Minder C, et al. Adverse event assessment of antimuscarinics for treating overactive bladder: A network meta-analytic approach. PLoS ONE 2011; 6: e16718.
- 79 Herschorn S, Pommerville P, Stothers L, et al. Tolerability of solifenacin and oxybutynin immediate release in older (>65 years) and younger (≤65 years) patients with overactive bladder: Sub-analysis from a Canadian, randomized, double-blind study. Curr Med Res Opin 2011; 27: 375–82.
- 80 Kraus SR, Ruiz-Cerda JL, Martire D, et al. Efficacy and tolerability of fesoterodine in older and younger subjects with overactive bladder. Urology 2010; 76: 1350–7.
- 81 Chapple CR, Nilvebrant L. Tolterodine: Selectivity for the urinary bladder over the eye (as measured by visual accommodation) in healthy volunteers. Drugs R D 2002; 3: 75–81.
- 82 Delancey JO. Why do women have stress urinary incontinence? Neurourol Urodyn 2010; 29: S13–7.
- 83 DeLancey JO, Trowbridge ER, Miller JM, et al. Stress urinary incontinence: Relative importance of urethral support and urethral closure pressure. J Urol 2008; 179: 2286–90; discussion 90.
- 84 Solomon DH, LoCicero J, III. Rosenthal RA. New frontiers in geriatrics research:An agenda for surgical and related medical specialties. New York: American Geriatrics Society; 2004.
- 85 Lo TS, Huang HJ, Chang CL, et al. Use of intravenous anesthesia for tension-free vaginal tape therapy in elderly women with genuine stress incontinence. Urology 2002; 59: 349–53.
- 86 Sevestre S, Ciofu C, Deval B, et al. Results of the tension-free vaginal tape technique in the elderly. Eur Urol 2003; 44: 128–31.
- 87 Karantanis E, Fynes MM, Stanton SL. The tension-free vaginal tape in older women. BJOG 2004; 111: 837–41.
- 88 van Kerrebroeck P, Abrams P, Chaikin D, et al. The standardisation of terminology in nocturia: Report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21: 179–83.
- 89 Tikkinen KA, Johnson TM, II. Tammela TL, et al. Nocturia frequency, bother, and quality of life: How often is too often? A population-based study in Finland. Eur Urol 2010; 57: 488–96.
- 90 Chen FY, Dai YT, Liu CK, et al. Perception of nocturia and medical consulting behavior among community-dwelling women. Int Urogynecol J 2007; 18: 431–6.
- 91 Vaughan C, Eisenstein R, Endeshaw Y, et al. Self-rated sleep characteristics and bother from nocturia. Int J Clin Pract 2012; 66: 369–73.
- 92 Dubeau CE, Tsui JF. Nocturia in the elderly. In: JP Weiss, JG Blaivas, PEV Van kerrebroeck, AJ Wein, editors. Nocturia: Causes, consequences, and clinical approaches. New York: Springer; 2012; 147–55.
- 93 Weatherall M. The risk of hyponatremia in older adults using desmopressin for nocturia: A systematic review and meta-analysis. Neurourol Urodyn 2004; 23: 302–5.
- 94 Minassian VA, Ross S, Sumabat O, et al. Randomized trial of oxybutynin extended versus immediate release for women aged 65 and older with overactive bladder; lessons learned from conducting a trial. J Obstet Gynaecol Can 2007; 29: 726–32.
- 95 Sand P, Zinner N, Newman D, et al. Oxybutynin transdermal system improves the quality of life in adults with overactive bladder: A multi-centre community based, randomized study. BJU Int 2007; 99: 836–44.
- 96 Lackner TE, Wyman JF, McCarthy TC, et al. Randomized, placebo-controlled trial of the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired nursing home residents with urge urinary incontinence. J Am Geriatr Soc 2008; 56: 862–70.
- 97 Chapple C, DuBeau C, Ebinger U, et al. Darifenacin treatment of patients >or = 65 years with overactive bladder: results of a randomized, controlled, 12-week trial Curr Med Res Opin 2007; 23: 2347–58.
- 98 DuBeau CE, Kraus SR, Griebling TL, et al. Effect of fesoterodine in vulnerable elderly subjects with urgency incontinence: A double-blind, placebo-controlled. Trial J Urol 2014; 191: 395–404.
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