Urinary incontinence: basic evaluation and management in the primary care office.

With the increasing number of older adults in the population, the office-based clinician can expect to see more people with UI. Continued UI research is warranted, especially research that includes older adults who reside in the community and frail elderly women who are still living in the community. Better outcome measures should be developed to assess the effectiveness of interventions for UI. Reliance on information obtained from voiding diaries is used extensively, yet the reliability and validity for any specific instrument have not been tested with older adults. Hopelessness and spiritual distress, as precursors to health decline and how they impact on quality of life, should be studied in older adults with UI. Given the prevalence of UI, should it be considered a public health problem for which population-based interventions are used? What is known is that older adults demonstrate significant improvement in symptoms of UI when education, counseling, support, and encouragement in behavior management and lifestyle interventions are provided. When motivated and positive, even frail older adults experience improvement in the severity of urine leakage. Perhaps the single most important action that the office-based clinician can take is to start asking every older adult about UI and to follow with the basic approaches to evaluation and management described in this article.