URINARY INCONTINENCE IN THE ELDERLY FEMALE
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Urinary incontinence is a common condition in the rapidly aging U.S. population. The incidence and prevalence of incontinence is increasing in the elderly, in no small part due to the greater recognition of its signs and symptoms and the subsequent negative impact on quality of life. Elderly women are different from their younger counterparts, due not only to several physiologic changes in the urinary tract, but also to concomitant morbidity and polypharmacy. While the elderly have the same treatment options as younger women, they may experience a greater incidence of adverse events due to urologic and nonurologic factors. The objective of this review is to elucidate the unique changes in the elderly population and summarize the treatment options. (Annals of Long-Term Care: Clinical Care and Aging 2009;17[10]:41-45)
Introduction
In 2003, a panel convened by the International Continence Society (ICS) defined the signs, symptoms, urodynamic observations, and conditions associated with lower urinary tract symptoms (LUTS) and urodynamic studies.1 The symptoms of LUTS were categorized into several distinct types of incontinence. Stress urinary incontinence (SUI) refers to involuntary leakage on effort, exertion, or other increases in intra-abdominal pressure.1 Urge urinary incontinence (UUI) is involuntary leakage accompanied or immediately preceded by urgency, while mixed urinary incontinence (MUI) refers to incontinence with symptoms of both SUI and UUI.1
Several emerging trends are germane to a discussion of incontinence in the elderly woman. First, the population is aging. A report by the U.S. Census Bureau noted that, while the total U.S. population has increased twofold in the past century, the population of Americans age 60 years and older increased tenfold to 35 million in the year 2000.2 Additionally, the number of Americans over age 80 is expected to increase by nearly 70% from 2000 to 2030. Second, incontinence is an increasingly common problem in the aging population. An analysis of more than 3100 responses to a medical questionnaire showed that the estimated incidence of incontinence increased steadily with age, especially through ages 25-29 and 45-49.3 By the age of 59 years, 30% and 18% of individuals were estimated to have had one or more episodes of incontinence in general and incontinence as defined by the ICS, respectively.
The prevalence of different types of incontinence is also considerable. A U.S. national telephone survey using a clinically validated interview of 5204 adults revealed that the prevalence of UUI in women increased with age from 2.0% to 19%, with a marked increase after 44 years of age.4 The prevalence of SUI has been reported to be as high as 40% in women after age 70, with one-third of these women classifying their incontinence as severe.5,6
Additionally, the most common type of incontinence may change with age. Once the prevalence rates of different types of incontinence were stratified by frequency and age, 55% of women under 60 years of age were found to have pure SUI, while 20% and 25% had UUI and MUI, respectively. In comparison, SUI accounted for only 30% of incontinence cases in the over-60-year-old female, while UUI and MUI each accounted for 35% of cases.7
Incontinence may also make a significant impact on a woman’s quality of life (QoL).
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