Urinary Incontinence in Frail Older Adults

Sandra Engberg; Hongjin Li


Urol Nurs. 2017;37(3):119-125. 

In This Article

Assessment of UI in Frail Older Adults

Given the multifactorial nature of UI in frail older adults, the assessment of UI in this population must be comprehensive with the goal of identifying all potential contributing factors. Older adults with UI should be screened for frailty. The Vulnerable Elders Survey, a short self-report frailty screening measure available to healthcare providers, is recommended as a possible tool by the Frailty Committee of the 5th International Consultation on Incontinence (Wagg et al., 2013). In addition, it is important to screen frail older adults for UI. Many people will not report this common health problem unless asked (Gibson & Wagg, 2014). Once UI is identified in frail older adults, assessment should include:

  • A comprehensive assessment to identify comorbid conditions that may be contributing to UI (see Table 1) or that can affect treatment options.

  • A targeted UI history to a) establish type and severity of incontinence; b) identify associated symptoms (urinary frequency and urgency, bothersome nocturia, enuresis, difficulty or incomplete bladder emptying, fecal incontinence, constipation, symptoms suggesting a urinary tract infection); c) assess toileting ability and access; d) determine the amount, type, and frequency of fluid intake; e) identify current or previous treatments for UI and their effectiveness and tolerability; and f) assess the impact of UI on personal and social life.

  • A focused physical examination (abdominal, rectal, neurologic, pelvic, and mobility assessment) is recommended in most UI guidelines; however, high-quality evidence to support its value is lacking (Syan & Bucker, 2015).

  • Determination of the individual's preferences in relation to treatments, as well as their outcome expectations.

  • Additional diagnostic tests may be indicated (Wagg et al., 2013). These include urinalysis and culture when a UTI is suspected, cough stress test when stress UI is suspected, post-void residual urine when incomplete bladder emptying is suspected based on history or physical examination (supra-pubic dullness after voiding), and urodynamic testing when results are likely to influence treatment decisions.