Urinary incontinence in older people in the community: a neglected problem?

Background: The prevalence and impact of urinary incontinence has been inve stigated much less in older men than in older women. It is suggested that t hose who perceive that their daily lives are affected should have priority for services. However, many people do not seek medical help, even though th ey may be severely affected. Aim: To investigate unmet need in relation to the prevalence and impact on everyday life of urinary incontinence in men and women over the age of 65 y ears. Design of study: Cross-sectional survey to measure prevalence of urinary in continence, the impact on people's lives, use of protection, and health ser vices. Setting: Stratified random sample of 2000 community-living elderly (equal n umbers of men and women, aged 65 to 74 years and over 75 years) in 11 gener al practices in a British city. Results: The response rate was 79%. The overall prevalence of incontinence in the previous month was 31% for women and 23% for men. Women generally ha d more severe frequency of incontinence and a greater degree of wetness tha n men. Protection use was greater in women than in men. Only 40% of men and 45% of women with incontinence had accessed health services. Significant p redictors of the use of health services were: incontinence reported as a pr oblem, increased frequency of incontinence, and greater degree of wetness. About one-third of people who leaked with severe frequency or who reported that it was a problem had not accessed the NHS services for incontinence. Conclusions: Urinary incontinence is a common problem older men and women l iving in the community and can have a deleterious effect on their lives. Th ere is the opportunity to improve the lives of many older people with urina ry incontinence, probably by a combination of increased public, patient and professional awareness that should lead to earlier presentation and initia tion of effective care.