Continence in the very aged

1. Continence in the very aged Mark Weatherall University of Otago, Wellington

2. Introduction • Very advanced aged usually means aged over 85 years • 2006 census 56,667 over age 85, of 495,600 over age 65 (11.4%) • Medium projections are by 2031 156,300 over age 85, of 1,079,600 (14.5%) University of Otago, Wellington

3. General consequences • Increased prevalence and incidence of disease, impairment, and activity limitation • Limitations of current knowledge from cohort effect and cross-sectional studies • It is possible that older people in 25 years will be fitter and have less disease than the current cohort University of Otago, Wellington

4. Some diseases and related consequences University of Otago, Wellington

5. Some diseases and related consequences University of Otago, Wellington

6. Common Impairments • Vision and hearing impairments are very common • Indirect consequences, navigating and using toilets, hearing health care advice • Cognitive impairment affects practical abilities, planning toileting, locating toilets, using toilets including undressing • Associated diseases lead to detrusor over-activity University of Otago, Wellington

7. Common Activity Limitations • Mobility limitation and falls very common • About 40% of over 85’s fall each year • Decreased mobility means decreased speed of access to toilets • Advanced activities often affected such as shopping, housework, bathing. Flow on effects: Access product, laundry, skin care University of Otago, Wellington

8. Lower urinary tract changes with age • Increased prevalence of detrusor over-activity • Bladder outflow obstruction from prostate disease leads to urinary symptoms, possibly reduced bladder emptying and detrusor over-activity • Decreases urethral sphincter function in women • Decreased bladder capacity, increased residual urine, increased nocturnal urine production University of Otago, Wellington

9. Social consequences • 75% of over aged 85 live in private dwellings although many people live alone • 25% of over aged 85 live in residential care, continence problems affect more than half • Older adults with activity limitation are very reliant on family members: Informal carers University of Otago, Wellington

10. UI: Prevalence and type • Overall about 40% have some UI, probably more detrusor over-activity than younger people • Mixed problems common e.g. detrusor over-activity and reduced detrusor muscle contraction strength • Men and women more likely to have had lower urinary tract surgery University of Otago, Wellington

11. Assessment • Careful individual assessment, older adults are a very diverse group • Impairments and activities of daily living, especially cognitive function, dexterity, and mobility • Try and define the lower urinary tract problem • Bowel function, close anatomical relationship University of Otago, Wellington

12. Management • Impairments/Activities of daily living, may need multi-disciplinary approach • Cognitive function determines the range of management strategies e.g. bladder retraining versus scheduled toileting • Treatment of lower urinary tract University of Otago, Wellington

13. Management • Difficulties with medication e.g. anti-cholinergic agents with dry mouth, cognitive impairment, constipation • Importance of social continence University of Otago, Wellington

14. Conclusions • A growing proportion of our patients • Challenging to assess and manage • Rewarding to improve the quality of life University of Otago, Wellington