Identification and Intervention for Urinary Incontinence by Community Physicians and Geriatric Assessment Teams

Abstract

To determine the difference in the recognition and intervention/referral rates for urinary incontinence (UI) by out-patient Geriatric Assessment Units (GAUs) and private physicians in community-based practices (CMDs). A multi-site, randomized, controlled study where block randomization was utilized to assign subjects 65 years of age and older to either a GAU or a CMD for assessment. One academic and three hospital-based GAUs and CMDs in private practice in a large metropolitan area. Three hundred sixty-four community-dwelling frail men (14%) and women (86%) with a mean age of 75 years. The independent variable was the type of out patient care, either CMD or GAU, to which the subjects were randomized. The dependent variables were recognition of UI by the health care providers and intervention or referral for the problem of UI once it was identified. Instruments included a structured in-home interview performed before randomization designed to uncover health problems such as urinary incontinence, as well as a medical record review form used post-assessment to ascertain recognition rates and intervention for UI by CMDS and GAUs. Both of the instruments were developed and piloted by the investigators in a preliminary study. Of the 364 subjects, 151 (41.5%) reported UI during the in-home interviews. Recognition rates for UI were significantly better for GAUs (48 of 81, 59.3%) than CMDs (11 of 70, 15.7%) (P < 0.001). This was true for mild (< 3 times/week) 44.2% vs 2.1% (P < 0.000005) as well as severe UI (> 3 times/week) 86.2% vs 43.5% (P = 0.00111) for GAUs and CMDs, respectively. There were no significant differences in the rate of referral/intervention for recognized cases of UI by GAUs or CMDs. GAUs referred/treated five (21.7%) cases of mild UI and 10 (40%) cases of severe UI while CMDs referred/treated three (30%) cases of severe UI but did not offer intervention for the one recognized case of mild UI. GAUs were more likely to refer to Continence Programs (12, 25%) compared with CMDs who were more likely to refer (3, 100%) to a urologist. A majority of the subjects with UI did not receive treatment or referral for their problem (8, 72.7% CMDs and 33, 68.6% of GAUs). GAUs out performed CMDs in the identification of subjects with both mild and severe UI. However, the intervention/referral rates were low for both GAUs and CMDs. The outcome of this study points to the need for increased emphasis on UI in curriculum preparing physicians and other health providers as well as the need for continuing education for those already in practice.