Management of urinary incontinence in Medicare managed care beneficiaries
Review of: Mardon RE, Halim S, Pawlson LG, Haffer SC. Arch Intern Med 2006 May 22;166(10):1128-1133.
The authors report the analysis of cross-sectional data from the 2004 Medicare Health Outcomes Survey on the frequency of urinary incontinence. The total economic burden of urinary incontinence in the US has been estimated to amount to 12-16 billion US$ per year. This data analysis is based on over 101,000 baseline surveys completed in 2004 with 59,000 follow-up surveys completed by the end of 2004. Selfreported urinary incontinence, the subjective severity of incontinence problems, medical treatment and overall health (36-SF health survey) were assessed. Institutionalized individuals and those younger than 65 years were excluded from analysis. Overall, over 145,000 questionnaires were analysed, 16% were excluded for missing values. The overall incidence of urinary incontinence (UI) in non-institutionalized people over the age of 65 years was 37% (43% in women, 27.9% in men) and increased with age (13.6% in those aged 65-69 years, 27% in those aged 90-94 years). 58.8% characterized UI as a small problem, 17.3% as a big problem. Urinary incontinence was clearly associated with a poorer overall health status (reported by 42% with poor health status vs. by 7.4% with an excellent health status). 55% had talked to their physician about their UI problem; with men being more likely to do so than women (58% of men with UI vs. 53% of women had discussed their UI problem with their physician during the last 6 months). Of those who had, 56% had received treatment for their UI, women being more likely to receive treatment (58% vs. 54% in men). The treatment rate was inversely associated with age: 60% of those aged 65-69 years vs. 46% of those aged 90-94 years).
The authors conclude that among older non-institutionalized people, urinary incontinence is common, still underdiagnosed, underreported and under treated. It is also associated with substantial functional impairment. This study represents one of the largest community studies investigating UI and its impact on quality of life. Clearly, there is room for improvement in the care for elderly people regarding the common problem of urinary incontinence.
