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A Critical Evaluation of the Assessment Technology for Urinary Continence in Older Persons

Urinary incontinence is a major geriatric problem, creating substantial personal, medical, and social difficulties. The magnitude and significance of these problems has stimulated the development of numerous diagnostic options and therapeutic strategies. However, despite these advances, more knowledge is needed if we are to provide optimal care for incontinent older persons. Most studies of urinary incontinence have dealt almost exclusively with young patients who were afflicted with nongeriatric illnesses. This information, while important, is of limited value to providers and policy makers concerned with geriatric health care. Inasmuch as elderly individuals have a higher prevalence of chronic urinary symptoms, physical abnormalities, and neurologic dysfunction, the specificity of clinical findings may be appreciably less than that documented in younger patients.! The complex interactions between the presence of multiple, disease-related physical limitations and the possible causes of incontinence can make the evaluation of elderly patients especially problematic. In addition, the spectrum of underlying urinary pathophysiology may well differ between young and old populations. These differences may have important diagnostic, therapeutic, and economic implications. This paper will critically review our present knowledge of assessment of urinary continence, focusing on three domains: epidemiology and natural history, clinical evaluation, and therapeutic options. This organization was chosen because most of the investigative work that has been done can be viewed from one of these perspectives. Within each domain four general areas are reviewed: the specific components and data elements of that domain; the principal instruments used to measure those elements; the critical evidence regarding the validity of the principal instruments; and the utility of the instruments for various clinical purposes.