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Elderly Health

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Older adults often view incontinence as a normal part of aging and don't bother to discuss it with their doctors

Urinary incontinence (UI) affects more than 13 million Americans. Without proper medical attention, UI can become progressively worse and can cause rashes, pressure sores, and skin and urinary tract infections, as well as decreased social activity and quality of life. Incontinence can be improved, if not cured, in 8 out of 10 cases, but fewer than half of adults with UI mention the problem to their doctors. Apparently, it's not embarrassment or lack of awareness of treatment options that prevent older adults from discussing incontinence. Rather, they do not see UI as abnormal or a serious medical condition, concludes Stuart J. Cohen, Ed.D., of the University of Arizona.

In a study supported by the Agency for Healthcare Research and Quality (HS08716), Dr. Cohen and his colleagues surveyed 49 community-dwelling adults (age 60 and older) with UI who had recently seen a primary care physician (PCP) at one of 41 primary care practice sites. The participants had not been asked about UI, and they did not raise the issue. Of 149 patients with UI who were not screened for UI by their PCPs, only 31 percent initiated a discussion with their doctor about UI, while nearly 70 percent did not.

Adults who did not discuss UI were older, had less frequent leaking accidents and fewer nighttime voids, and were less bothered by UI than those who did. Even adults with a fairly high frequency of UI (average of 1.7 episodes per day) did not view UI as abnormal or a serious medical condition. The two main reasons why patients did not seek help were the perception that UI is not a big problem (45 percent) and is a normal part of aging (19 percent). These findings indicate that patient education is needed to address the view that UI is a normal part of aging and a problem of minimal importance, concludes Dr. Cohen.

More details are in "Why older community-dwelling adults do not discuss urinary incontinence with their primary care physicians," by Elizabeth Dugan, Ph.D., Christine P. Roberts, B.A., Dr. Cohen, and others, in the April 2001 Journal of the American Geriatrics Society 49, pp. 462-465.

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