Quality Indicators for the Screening and Care of Urinary Incontinence in Vulnerable Elders

Published in: Journal of the American Geriatrics Society, v. 55, no. S2, Oct. 2007, p. S443-S449

Posted on RAND.org on January 01, 2007

by Constance Fung, Benjamin A. Spencer, Michelle Eslami, Carolyn Crandall

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Urinary incontinence (UI) is a common condition that affects many community-dwelling elderly people. Studies estimate the prevalence of UI in noninstitutionalized persons to be approximately 30% of community-dwelling elderly women and 15% to 28% of men. UI often causes poor quality of life, social isolation and significant psychological distress in persons affected and their family and caregivers. Despite the effects of UI, studies demonstrate that many patients do not disclose its symptoms to their healthcare providers and many healthcare providers do not routinely ask elderly patients about UI symptoms. This article reviews the available evidence for quality indicators (QIs) that could be applied when evaluating and treating vulnerable elders (VEs) for UI. Although symptoms of urgency and nocturia in the absence of UI are also important problems for VEs, this articles focuses on UI. METHODS: A total of 348 articles were considered in this review: 29 identified using a Web search, 62 through reference mining, 253 through the Assessing Care of Vulnerable Elders (ACOVE)-3 literature searches, and one from reference mining the ACOVE-1 monograph; 60 additional articles were included after peer review. UI is defined as the complaint of any involuntary leakage of urine when the term is used in the QI's denominator (i.e., the IF statement). When UI is used in the QI's numerator, as is the case for QIs #1 and #2, a broader definition is used: the complaint of any involuntary leakage of urine, the leakage of urine on physical examination, or a urodynamic observation consistent with UI. This conceptualization of UI provides greater specificity during indicator implementation and reduces the chance that physicians would be incorrectly penalized for not treating UI appropriately. RESULTS: Of the 15 potential QIs, the expert panel process judged 14 to be valid; one was rejected. One additional indicator related to elevated postvoid residual (PVR) management developed in the benign prostatic hyperplasia (BPH) condition is listed here. The literature that supports each of the indicators judged to be valid in the expert panel process is described.

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