CASE-FINDING INCONTINENCE IN THE OVER-75S

Background. The under-reporting of incontinence in older persons is we ll known. However, the general practitioner's (GP's) knowledge of inco ntinence in this population is less well documented. Aim. To examine t he knowledge of Irish GPs regarding incontinence in patients aged over 75, and to examine the relationship between incontinence and cognitiv e function in this age group. Method Sixty-four GPs from six faculties of the Irish College of General Practitioners (ICGP) spread geographi cally over Ireland, administered a questionnaire to 10 of their patien ts, selected from the General Medical Services list, as part of the IC GP 1993 Care of the Elderly Study. A short test of cognitive function, the AMTS, was administered followed by RCGP (Royal College of General Practitioners) screening questions for incontinence, plus questions w ith regard to patients' prior reporting of incontinence. GPs were also asked to state their prior knowledge of the incontinence status of th e patient and to choose from a list of management options including re ferral, assigning to a public health nurse, and hospital surgical serv ice. Results. Data were analysed an 527 patients aged over 75 years. F orty-four per cent of persons over 75 years reported having experience d urinary incontinence; 9% reported having experienced faecal incontin ence. GPs reported full knowledge of the incontinence status in only 3 3% of their patients. The effects of low cognitive function, sex, and age on the probability of wetting were analysed using logistic regress ion modelling. Female sex and low cognitive score increased the likeli hood of ever wetting; increasing age increased the likelihood of daily wetting. Poor sensitivities for these models limit their usefulness i n clinical practice. Conclusion. GPs should have a high index of suspi cion for incontinence in persons aged over 75. Thorough history taking , physical examination, and examinations of therapeutic options for in dividual cases are recommended.