Quality Indicators for the Management of Urinary Incontinence in Vulnerable Community-Dwelling Elders

by John Schnelle, Rick L. Smith

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The prevalence of urinary incontinence in noninstitutionalized persons older than 60 years of age is 15% to 35%; of these, 25% to 30% have frequent episodes of urinary incontinence. The significance of urinary incontinence may vary from minimal to severe, with extreme activity limitation and social isolation. For example, several reports have linked urinary incontinence in community-dwelling elders with fall and depression. Urinary incontinence also imposes significant psychosocial distress on family, friends, and caregivers. Urinary incontinence is even more prevalent in the nursing home than in the community. In nursing homes, however, urinary incontinence is known to be very treatable with assisted toileting programs. Nursing home residents are older and frailer than community-dwelling elders and have caregivers available 24 hours per day. As a result, major differences exist in how incontinence can be assessed and treated in the nursing home compared with the community. This paper describes incontinence quality indicators that can be applied to vulnerable community-dwelling elders who may be treated across the spectrum of care, from primary care physicians to surgical specialists.

Originally published in: Annals of Internal Medicine, v.135, no. 8, pt. 2, October 16, 2001, pp. 752-758.

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