How to screen for urinary incontinence in geriatric patients?

Screening for Urinary Incontinence in Geriatric Patients

All geriatric patients should be routinely screened for urinary incontinence during annual evaluations, as this condition is commonly unreported by patients and undetected by providers, yet significantly impacts quality of life. 1

Initial Screening Approach

• Use direct questioning about urinary incontinence symptoms during routine geriatric assessment, as patients rarely volunteer this information 1
• The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) is recommended as the most sensitive and specific screening tool for detecting urinary incontinence in elderly patients 2
• Avoid relying solely on the "continence" item of Katz's Activities of Daily Living (ADL) scale, which has inadequate sensitivity (50.9%) for detecting urinary incontinence in vulnerable elderly patients 2
• Annual screening is recommended, particularly for patients with diabetes mellitus who are at higher risk for urinary incontinence 1

Key Components of Urinary Incontinence Screening

• Ask specifically about the following urinary symptoms:

  • Frequency, urgency, and incontinence episodes 1
  • Nocturia and changes in urinary output 3
  • Dysuria or suprapubic pain 1
  • Changes in urine color, odor, or clarity 1

• Assess for risk factors that predispose to urinary incontinence in geriatric patients:

  • Diabetes mellitus (particularly in women) 1
  • Polyuria or glycosuria 1
  • Neurogenic bladder and autonomic insufficiency 1
  • Medication use, especially those with sedating effects 1
  • Restricted mobility 1
  • Cognitive impairment 1

Evaluation Following Positive Screening

When screening identifies potential urinary incontinence:

• Perform targeted evaluation to identify the specific type of incontinence (urge, stress, overflow, mixed, or functional) 4

• Use the 3 Incontinence Questions or similar validated questionnaire to help determine incontinence type 4

• Consider implementing a 24-hour voiding diary to document:

  • Timing and volume of fluid intake 3
  • Frequency and volume of urination 3
  • Timing and circumstances of incontinence episodes 3
  • Post-void residual patterns 3

• Conduct focused physical examination to identify:

  • Urinary tract infection (UTI) 1
  • Urine retention 1
  • Fecal impaction 1
  • Atrophic vaginitis or vaginal candidiasis in women 1
  • Prostate issues in men 5

• Perform basic laboratory testing:

  • Urinalysis to check for infection, glycosuria, or hematuria 4
  • Assessment of post-void residual urine volume 4

When to Refer to Specialists

• Refer to a urologist or urogynecologist when:
  • Initial evaluation cannot determine the type of incontinence 4
  • Red flags are present (hematuria, obstructive symptoms, recurrent UTIs) 4
  • Patient has not responded to initial management strategies 6
  • There is suspicion of underlying bladder pathology 6

Common Pitfalls to Avoid

• Assuming urinary incontinence is a normal part of aging—it never is 5
• Failing to screen for urinary incontinence due to time constraints or discomfort with the topic 1
• Using inadequate screening tools that miss many cases of incontinence 2
• Overlooking the significant impact of urinary incontinence on quality of life, including social isolation, depression, falls, and fractures 1
• Neglecting to evaluate for treatable causes before assuming chronic incontinence 4
• Placing indwelling catheters for management of incontinence without proper indications, which increases risk of infection 1

By implementing systematic screening for urinary incontinence in geriatric patients, clinicians can identify this common but often overlooked condition and initiate appropriate evaluation and management, significantly improving patients' quality of life.