An Interdisciplinary Approach to the Assessment and Behavioral Treatment of Urinary Incontinence in Geriatric Outpatients

Abstract

To test the effectiveness of an interdisciplinary assessment and behavioral treatment of persistent urinary incontinence in geriatric outpatients. Prospective case series in which frequency of incontinence was measured before and after intervention. We established an interdisciplinary continence program within an existing academic center, the Benedum Geriatric Center. Convenience sample of 70 non-demented outpatients aged 56 to 90 years. Behavioral treatment was provided to 29 patients including many with multiple medical problems (Mean = 6.0 problems). Behavioral treatment consisted of biofeedback, pelvic floor muscle exercise, scheduled voiding, and other strategies for preventing accidental urine loss. Outcome of treatment was measured by comparing bladder diaries completed in the 2 weeks immediately following treatment to those completed in the pretreatment phase. Following an average 5.6 treatment sessions, the mean weekly frequency of accidents was reduced from 16.9 to 2.5 (P less than 0.01). Individual reductions ranged from 30.8% to 100% with an average of 81.6% improvement. Ten patients achieved continence. Patients with mixed incontinence had greater improvement than those with urge incontinence alone (P less than 0.05), and patients who reported previous evaluation or treatment had a poorer outcome than those coming for their first evaluation (P = 0.05). Degree of improvement was not significantly related to age, duration of symptoms, baseline frequency of accidents, number of treatment sessions, number of other medical diagnoses, or urodynamic findings. We conclude that older adults who are able and willing to participate in behavioral treatment can benefit significantly despite other health problems or disabilities.