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Questions and Answers
Which medication is effective in reducing stress urinary incontinence but is not approved for this indication in the United States?
Which medication is effective in reducing stress urinary incontinence but is not approved for this indication in the United States?
What is the effect of oral estrogen on stress urinary incontinence in women?
What is the effect of oral estrogen on stress urinary incontinence in women?
What class of drugs is described as moderately effective for urge urinary incontinence and related conditions?
What class of drugs is described as moderately effective for urge urinary incontinence and related conditions?
Why is routine monitoring of post-void residual (PVR) not necessary with drug treatment of urge urinary incontinence?
Why is routine monitoring of post-void residual (PVR) not necessary with drug treatment of urge urinary incontinence?
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What should be checked in patients experiencing worsening urinary incontinence while on antimuscarinics?
What should be checked in patients experiencing worsening urinary incontinence while on antimuscarinics?
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What is the main symptom of urinary incontinence (UI)?
What is the main symptom of urinary incontinence (UI)?
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Which of the following is NOT a type of urinary incontinence commonly observed in older persons?
Which of the following is NOT a type of urinary incontinence commonly observed in older persons?
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What approach to treatment is described as more effective for urinary incontinence?
What approach to treatment is described as more effective for urinary incontinence?
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Which condition can contribute to urinary incontinence in older adults?
Which condition can contribute to urinary incontinence in older adults?
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What is a common behavioral therapy for managing urinary incontinence?
What is a common behavioral therapy for managing urinary incontinence?
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What is the recommended action for older persons regarding urinary incontinence (UI)?
What is the recommended action for older persons regarding urinary incontinence (UI)?
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Which surgical treatment is indicated for older women suffering from stress urinary incontinence?
Which surgical treatment is indicated for older women suffering from stress urinary incontinence?
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What is the significance of a multifactorial approach in treating urinary incontinence in older adults?
What is the significance of a multifactorial approach in treating urinary incontinence in older adults?
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What is considered the only evidence-based lifestyle intervention for urinary incontinence in moderately obese younger-old women?
What is considered the only evidence-based lifestyle intervention for urinary incontinence in moderately obese younger-old women?
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Which type of incontinence can be treated with behavioral therapy as a first-line therapy?
Which type of incontinence can be treated with behavioral therapy as a first-line therapy?
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What is the purpose of bladder training?
What is the purpose of bladder training?
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Which intervention is targeted specifically at stress urinary incontinence?
Which intervention is targeted specifically at stress urinary incontinence?
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What is the primary method used in pelvic muscle exercises (PMEs)?
What is the primary method used in pelvic muscle exercises (PMEs)?
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What outcome is expected from successful bladder training?
What outcome is expected from successful bladder training?
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What is the effect of combining behavioral therapy with pharmacological treatments for urge incontinence?
What is the effect of combining behavioral therapy with pharmacological treatments for urge incontinence?
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Which type of interventions are considered minimally invasive for refractory urge incontinence?
Which type of interventions are considered minimally invasive for refractory urge incontinence?
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What level of evidence supports the effectiveness of behavioral therapy for urge incontinence?
What level of evidence supports the effectiveness of behavioral therapy for urge incontinence?
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What should a caregiver do to assist patients with dementia who have urinary incontinence?
What should a caregiver do to assist patients with dementia who have urinary incontinence?
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Which of the following is NOT a recommended lifestyle intervention for urinary incontinence?
Which of the following is NOT a recommended lifestyle intervention for urinary incontinence?
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Pelvic muscle exercises require which of the following from patients?
Pelvic muscle exercises require which of the following from patients?
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What is the key to bladder training success?
What is the key to bladder training success?
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Which therapy is indicated to be more effective than pharmacological treatments for stress incontinence?
Which therapy is indicated to be more effective than pharmacological treatments for stress incontinence?
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What is the primary cause of urge urinary incontinence (UI) in older persons?
What is the primary cause of urge urinary incontinence (UI) in older persons?
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Which type of incontinence is characterized by a combination of urge and stress physiology?
Which type of incontinence is characterized by a combination of urge and stress physiology?
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What is often a contributing factor to urinary incontinence in frail older adults?
What is often a contributing factor to urinary incontinence in frail older adults?
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What does detrusor hyperactivity with impaired contractility (DHIC) indicate?
What does detrusor hyperactivity with impaired contractility (DHIC) indicate?
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Which medical condition can impair bladder sensation and lead to urinary incontinence?
Which medical condition can impair bladder sensation and lead to urinary incontinence?
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What role does mobility play in urinary incontinence among older adults?
What role does mobility play in urinary incontinence among older adults?
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Which class of medications is commonly associated with impairment in bladder emptying?
Which class of medications is commonly associated with impairment in bladder emptying?
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What is the effect of ACE inhibitors on urinary incontinence in older adults?
What is the effect of ACE inhibitors on urinary incontinence in older adults?
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What is the primary purpose of urinalysis in patients with urinary incontinence?
What is the primary purpose of urinalysis in patients with urinary incontinence?
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What does overflow incontinence typically result from?
What does overflow incontinence typically result from?
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Which condition is commonly associated with urinary urgency due to detrusor overactivity?
Which condition is commonly associated with urinary urgency due to detrusor overactivity?
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What defines nocturnal polyuria?
What defines nocturnal polyuria?
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Which factor is commonly associated with nocturnal polyuria?
Which factor is commonly associated with nocturnal polyuria?
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In managing urinary incontinence, which factor must be considered as a potential external influence?
In managing urinary incontinence, which factor must be considered as a potential external influence?
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In patients with urinary incontinence, which condition may warrant measurement of post-void residual (PVR) volume?
In patients with urinary incontinence, which condition may warrant measurement of post-void residual (PVR) volume?
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What is commonly observed in older men with benign prostate disease in relation to UI?
What is commonly observed in older men with benign prostate disease in relation to UI?
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Which factor significantly differentiates urinary incontinence in older persons from that in younger persons?
Which factor significantly differentiates urinary incontinence in older persons from that in younger persons?
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What is the recommended approach for treating urinary incontinence in older adults?
What is the recommended approach for treating urinary incontinence in older adults?
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Which symptom frequently coexists with urinary incontinence?
Which symptom frequently coexists with urinary incontinence?
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What common issue can arise from the interaction with multiple medications in older adults?
What common issue can arise from the interaction with multiple medications in older adults?
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What could be a potential cause of nocturia in older adults aside from bladder issues?
What could be a potential cause of nocturia in older adults aside from bladder issues?
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What is a common method for assessing nocturnal polyuria?
What is a common method for assessing nocturnal polyuria?
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For a patient with nocturia and urinary incontinence, what is an appropriate initial management step?
For a patient with nocturia and urinary incontinence, what is an appropriate initial management step?
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Why might patients with a high burden of anticholinergic medications need PVR measurement?
Why might patients with a high burden of anticholinergic medications need PVR measurement?
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Which of the following medications is typically recommended for patients with osteoporosis?
Which of the following medications is typically recommended for patients with osteoporosis?
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What is a key goal in managing urinary incontinence for older adults?
What is a key goal in managing urinary incontinence for older adults?
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How often should bladder diary entries be made in evaluating nocturia?
How often should bladder diary entries be made in evaluating nocturia?
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In terms of weight management, which recommendation was given to Mrs. Roberts?
In terms of weight management, which recommendation was given to Mrs. Roberts?
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What type of urinary incontinence is characterized by leaking urine during activities like coughing or sneezing?
What type of urinary incontinence is characterized by leaking urine during activities like coughing or sneezing?
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Which symptom is NOT associated with urge incontinence?
Which symptom is NOT associated with urge incontinence?
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What assessment should be done during the annual evaluation of older adults regarding urinary incontinence?
What assessment should be done during the annual evaluation of older adults regarding urinary incontinence?
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What common risk factor for urinary incontinence is associated with both gender and age?
What common risk factor for urinary incontinence is associated with both gender and age?
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What physiological component is crucial for maintaining urinary continence?
What physiological component is crucial for maintaining urinary continence?
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How does the autonomic nervous system contribute to urinary continence?
How does the autonomic nervous system contribute to urinary continence?
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Which of the following is a rationale for the World Health Organization's recommendation regarding urinary incontinence screening?
Which of the following is a rationale for the World Health Organization's recommendation regarding urinary incontinence screening?
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Which testing tool has a positive likelihood ratio of 4.2 for identifying urge incontinence symptoms?
Which testing tool has a positive likelihood ratio of 4.2 for identifying urge incontinence symptoms?
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What is a key characteristic of functional incontinence?
What is a key characteristic of functional incontinence?
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Which group is recommended to be screened for urinary incontinence by the USPSTF?
Which group is recommended to be screened for urinary incontinence by the USPSTF?
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Which of the following is the main function of the micturition center in the pons?
Which of the following is the main function of the micturition center in the pons?
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What is a common misconception regarding urinary incontinence in frail elderly individuals?
What is a common misconception regarding urinary incontinence in frail elderly individuals?
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Which of the following statements accurately describes the role of the urothelium?
Which of the following statements accurately describes the role of the urothelium?
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What is NOT a recommended evaluation procedure for urinary incontinence before therapy is initiated?
What is NOT a recommended evaluation procedure for urinary incontinence before therapy is initiated?
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What is the primary initial step after a patient acknowledges urinary incontinence (UI)?
What is the primary initial step after a patient acknowledges urinary incontinence (UI)?
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What could indicate an acute onset of urinary incontinence that warrants quick referral to specialists?
What could indicate an acute onset of urinary incontinence that warrants quick referral to specialists?
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Which factors may prompt the consideration of a postvoid residual (PVR) test?
Which factors may prompt the consideration of a postvoid residual (PVR) test?
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What is the Urogenital Distress Index-6 primarily used for?
What is the Urogenital Distress Index-6 primarily used for?
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Which of the following assessments is recommended for all patients with urinary incontinence?
Which of the following assessments is recommended for all patients with urinary incontinence?
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What is a common symptom that should be evaluated before treating urinary incontinence?
What is a common symptom that should be evaluated before treating urinary incontinence?
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Which examination method is useful for checking for pelvic organ prolapse?
Which examination method is useful for checking for pelvic organ prolapse?
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What is NOT a reason to consider a detailed neurologic examination in patients with UI?
What is NOT a reason to consider a detailed neurologic examination in patients with UI?
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What can the frequency of pad changes indicate in a UI patient?
What can the frequency of pad changes indicate in a UI patient?
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Which symptom may lead patients to underestimate their condition's severity?
Which symptom may lead patients to underestimate their condition's severity?
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What type of medication switch is recommended for treating urgency incontinence?
What type of medication switch is recommended for treating urgency incontinence?
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Why is the assessment of the quality of life important in UI management?
Why is the assessment of the quality of life important in UI management?
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What might a significant bladder distension during abdominal examination indicate?
What might a significant bladder distension during abdominal examination indicate?
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Which of the following conditions should be assessed for its relationship to the onset of urinary incontinence?
Which of the following conditions should be assessed for its relationship to the onset of urinary incontinence?
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What is the most common type of urinary incontinence in older adults?
What is the most common type of urinary incontinence in older adults?
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What symptom is associated with urgency incontinence?
What symptom is associated with urgency incontinence?
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Which factor could contribute to urinary incontinence according to common symptoms?
Which factor could contribute to urinary incontinence according to common symptoms?
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Which statement accurately relates to urinary incontinence prevalence?
Which statement accurately relates to urinary incontinence prevalence?
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What is an example of a precipitant for urinary urgency?
What is an example of a precipitant for urinary urgency?
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Which symptom is a primary indicator of overactive bladder?
Which symptom is a primary indicator of overactive bladder?
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What is a common misconception about urinary incontinence?
What is a common misconception about urinary incontinence?
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Which condition is often caused by untreated urinary incontinence?
Which condition is often caused by untreated urinary incontinence?
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The prevalence of urinary incontinence among women in nursing homes can be as high as:
The prevalence of urinary incontinence among women in nursing homes can be as high as:
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What percentage of older adults with urinary incontinence report it to their care providers?
What percentage of older adults with urinary incontinence report it to their care providers?
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What is a characteristic of stress incontinence?
What is a characteristic of stress incontinence?
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What is the financial impact of urinary incontinence estimated to be by 2020?
What is the financial impact of urinary incontinence estimated to be by 2020?
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What is an important aspect of improving quality of life for patients with urinary incontinence?
What is an important aspect of improving quality of life for patients with urinary incontinence?
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What is a symptom that indicates a potential bladder dysfunction?
What is a symptom that indicates a potential bladder dysfunction?
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Study Notes
Urinary Incontinence in Older Adults
- Urinary incontinence (UI) is common but not normal in older adults. Routine screening is crucial.
- UI etiology is typically multifactorial, involving age-related changes, medical conditions, medications, and functional impairments.
- Behavioral and pharmacologic therapies are effective, particularly when tailored to an individual's function and cognition. A combination approach is often more beneficial than either alone.
- Surgical treatment is indicated in older women with stress incontinence.
Prevalence and Impact of UI
- UI prevalence rises with age in both men and women. Community prevalence among women varies greatly (15-70% depending on the setting, from community to nursing home). Men show similar prevalence in older adults.
- UI significantly impacts health-related quality of life, self-esteem, activities, and sexuality. Social interactions are especially hindered by UI among frail nursing home residents.
- Morbidity associated with UI includes UTIs, skin breakdown, falls, fractures, and caregiver burden, potentially leading to depression and nursing home admission. UI incurs substantial economic costs for individuals and the healthcare system.
Screening for UI
- Routine annual screening is recommended for all older adults.
- Screening aims to address underreporting and the common quality gaps in treatment.
- Standardized questioning is key (see specific examples in attached text)
Risk Factors for UI
- UI shares risk factors with other geriatric syndromes (falls, dependence).
- Key factors include: functional impairment, age, female gender, obesity, diabetes, stroke, depression, fecal incontinence, hysterectomy, cognitive impairment. Nursing home residents with UI often have these risk factors.
Pathophysiology of UI
- UI results from interactions between lower urinary tract issues, neurological control, multimorbidity, medications, and functional deficits.
- Primary types of UI include urge, stress, mixed, and overflow, but usually caused by multiple factors in older persons.
- Age, especially, impacts UI by influencing factors beyond the lower urinary tract itself (mobility, environment, medications).
Evaluation of UI
- Characterize UI types (urge, stress, mixed), frequency, and volume (e.g., number of pad changes).
- A detailed UI evaluation must include patient-reported quality of life and bother based on validated tools like the Urogenital Distress Index-6 for the best assessment.
- Examine for contributing comorbidities (cardiovascular, metabolic, musculoskeletal, neurologic, etc).
- Medications need review.
- A physical examination, including pelvic exams for women and genital exams for men, is essential.
- Urinalysis (with reflex culture if indicated), PVR (optional, indicated based circumstances), and functional and cognitive assessments are valuable.
Nocturia Management
- Nocturia frequently coexists with UI.
- Nocturia drivers vary (e.g., excessive fluid intake, medications, pedal edema, heart failure, sleep apnea).
- Nocturia and fluid intake need thorough investigation when related. A bladder diary can aid in assessment.
- Sleep apnea is a significant driver of nocturia in older adults and should be considered in the evaluation.
Management of UI
- UI treatment is a tiered approach.
- Initial stages involve addressing contributing medical conditions, lifestyle interventions (e.g., weight loss, limiting fluids), and behavioral therapies.
- Moderate to severe UI may need pharmacologic treatment (anticholinergics, beta-3 agonists) or minimally invasive or surgical interventions.
- Complete cure is uncommon; management focuses on symptom reduction.
Behavioral Therapies for UI
- Bladder training and pelvic muscle exercises (PMEs) are effective (with varying strengths of evidence) for urge, stress or mixed UI.
- Prompted voiding is a successful approach for dementia patients.
Medications for UI
- Pharmacologic therapy is for patients unresponsive to behavioral therapies for urge and mixed incontinence.
- Antimuscarinics and beta-3 agonists are commonly used.
- A thorough evaluation of medications can lead to a reduction in UI's severity.
- Certain medications trigger/worsen incontinence, and need careful observation and adjustment
- Consider other treatment options if the meds are not working as expected.
Additional Considerations
- Older adults with UI may underreport the issue to clinicians.
- Clinicians must actively screen for UI and tailor treatment approaches to patient preferences and needs, which can vary based on cognitive and functional status.
- Team-based approaches are useful to encompass nurses and medical assistants for better screening, assessment, and monitoring.
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Description
This quiz focuses on the common yet often overlooked issue of urinary incontinence (UI) in older adults. It covers the prevalence, impact, and treatment options available, emphasizing the need for routine screening and tailored therapies. Test your understanding of the multifactorial causes and approaches to managing UI in this age group.
