An interdisciplinary approach to the assessment and behavioral treatment of urinary incontinence in geriatric outpatients

B J McDowell, K L Burgio, M Dombrowski, J L Locher, E Rodriguez
Journal of the American Geriatrics Society 1992, 40 (4): 370-4

OBJECTIVE: To test the effectiveness of an interdisciplinary assessment and behavioral treatment of persistent urinary incontinence in geriatric outpatients.

DESIGN: Prospective case series in which frequency of incontinence was measured before and after intervention.

SETTING: We established an interdisciplinary continence program within an existing academic center, the Benedum Geriatric Center.

PATIENTS: 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).

INTERVENTION: Behavioral treatment consisted of biofeedback, pelvic floor muscle exercise, scheduled voiding, and other strategies for preventing accidental urine loss.

OUTCOME MEASURE: Outcome of treatment was measured by comparing bladder diaries completed in the 2 weeks immediately following treatment to those completed in the pretreatment phase.

RESULTS: 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.

CONCLUSION: We conclude that older adults who are able and willing to participate in behavioral treatment can benefit significantly despite other health problems or disabilities.

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