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Incontinence in the elderly

Continence is the capacity to pass urine in socially and hygienically acceptable circumstances. It is a complex behaviour that depends upon the functional and anatomical integrity of different physiological systems, which may be the target of pathological conditions highly prevalent in older persons. Even in old age, incontinence can occur in otherwise healthy individuals and the strategy for assessment is usually similar to that adopted in younger adults. However, in frail older patients incontinence is often caused by the presence of multiple, simultaneous and interactive problems (comorbidity), which also cause impairments of cognition. mobility and manual dexterity; these affect the individual's capacity to cope with environmental requirements for continence. Further factors, e.g. depression, and social and environmental factors also modulate the severity of incontinence. The complexity and redundancy of continence control result in a large reserve capacity and a wide repertoire of responses, thus allowing the individual to respond appropriately to challenges and insults. Redundancy also enables the individual to compensate for impairments. However, as several impairments accumulate, this redundancy and thus compensatory capability are reduced, making the individual vulnerable to additional insults and damage. This increased vulnerability, resulting from impairments in multiple systems, defines frailty, thus explaining why frail elderly persons are at particular risk of experiencing urinary incontinence and other geriatric syndromes [1]. The components of the basic evaluation of urinary incontinence in frail older adults are similar to those of basic evaluation in younger adults and include history, physical examination, measurement of postvoid residual urine volume. and urine analysis. However, given the characteristics of incontinence in frail elderly persons, greater emphasis is placed on identifying transient causes of incontinence, comorbid diseases, and mental, functional, social and environmental status [2.3]. In elderly frail patients, urinary incontinence is associated with (but probably not the cause of) worse health-related quality-of-life and health status, and increased risk of death. The 'transient' causes of incontinence are the most evident manifestations of this