AN INTERDISCIPLINARY APPROACH TO THE ASSESSMENT AND BEHAVIORAL TREATMENT OF URINARY-INCONTINENCE IN GERIATRIC OUTPATIENTS

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 < 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 < 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.