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Urinary incontinence is associated with the risk of depression among the elderly

Elderly Americans who are incontinent often experience shame, disgust, embarrassment, and reduced social life that may lead to depression. In fact, elderly people who suffer from urinary incontinence (UI) are more likely to have symptoms of depression than those without UI. What's more, the degree of depression is linked to the severity of incontinence (amount of urine lost with each "accident"), concludes a study supported in part by the Agency for Healthcare Research and Quality (HS08716).

Principal investigator Stuart J. Cohen, Ed.D., and his colleagues studied 668 adults (93 percent white, 78 percent female, average age 72.5) who had at least one visit in the previous 60 days to a primary care provider (PCP) at one of 41 primary care practices in North Carolina. Some PCPs were instructed about the detection and management of UI based on a practice guideline for urinary incontinence in adults, and they were given educational materials for themselves and patients, office system support, and academic detailing. Other PCPs (controls) were not assisted in this way.

Symptoms of depression were assessed with a standard eight-item screen. Results showed that UI was associated with moderate to severe depression (43 percent of UI patients vs. 30 percent of patients without UI). About 35 percent of UI patients reported some depressive symptoms, which is slightly higher than the national average. On seven of eight items in the depression scale, patients with UI reported significantly more distressed responses than did continent adults.

About 30 percent of adults with UI indicated that incontinence interfered with their day-to-day lives. The frequency of UI episodes and the perception that UI interfered with life were significantly correlated with depressive symptoms in these patients. Also, loss of more urine per episode was associated with more depressive symptoms. Depressive symptoms appeared to be influenced by sex (more women than men) and physical health to a greater degree than UI. Nevertheless, the depression associated with UI makes it more difficult to persuade the patient to perform pelvic muscle exercises and bladder retraining, which are necessary to reduce UI episodes.

Details are in "The association of depressive symptoms and urinary incontinence among older adults," by Elizabeth Dugan, Ph.D., Dr. Cohen, Deirdre R. Bland, M.D., and others, in the April 2000 Journal of the American Geriatrics Society 48, pp. 413-416.

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