Urinary Incontinence in Frail Older Adults

Sandra Engberg; Hongjin Li


Urol Nurs. 2017;37(3):119-125. 

In This Article


The prevalence of both UI and frailty increases with age. These two geriatric syndromes often co-exist and may share common risk factors. Older adults presenting with either syndrome should be assessed for the other. The etiology of UI in frail older adults is multifactorial and contributing factors extend beyond the lower urinary tract. Both assessment and treatment of UI in the population must take the many contributing factors into consideration.

The treatment of UI starts with the assessment, treatment, and reevaluation of potentially treatable conditions. Lifestyle and behavioral interventions are recommended as the initial treatment for unresolved UI followed by consideration of a trial of pharmacotherapy in appropriately selected patients. The goals of treatment need to consider patients' level of frailty, comorbid conditions, and expectations. Complete continence may not be a realistic goal for some frail older individuals.

Nurses working in many clinical settings care for frail older adults. It is important to be aware that urinary incontinence is a common problem in this population and to include questions about bladder function is the assessment of frail individuals. The most appropriate firstline treatments for the majority of frail elders with UI are nursing interventions. It is important for nurses to be knowledgeable about these treatment options and to work with their frail patients and their families to identify the most appropriate option for each patient. Given the multiple factors that often contribute to incontinence in frail older adults, the best outcomes are generally achieved when interprofessional teams (e.g., nursing, medicine, physical therapy) work together to develop and implement treatment programs. It is also important for the nurse to be an active member of the team as care is planned and delivered to this patient population. While complete continence may not be a realistic goal for some frail elders, bladder function and the impact of UI on the quality of our patients' lives can be improved for almost all patients.