[Incontinence in old age: a social and economic problem]. / Inkontinenz im Alter. Ein Soziales und ökonomisches Problem.

Being afflicted with urinary incontinence in old age represents manifold medical, social, and economic problems and restrictions. The objective loss of control and decreased self-confidence result in reduced social interactions and lead to isolation and ostracism accompanied by withdrawal and depression. Giving up leisure time activities, losing social contacts, and the increasing need for long-term care often lead inevitably to a higher degree of dependency and institutionalization. In addition, the taboo still placed on this problem by those affected as well as by the attending physicians has resulted in too few patients receiving adequate diagnosis and being offered sensible treatment options. These problems can only be solved by an interdisciplinary approach. Further information, continuing education, and sensitivity toward these aspects are needed. Only then can incontinence in old age as a social and economic problem exacerbated by the demographic changes be improved.

Sleep disordered breathing in the elderly: a three year longitudinal cohort study.

The objective of this investigation was to assess the association between the presence of sleep disordered breathing (SDB) and daytime sleepiness, body mass index, hospitalisation, and survival. To this end, a prospective longitudinal study was conducted in the elderly population consisting of 80 patients of either sex over the age of 65 years admitted to a city hospital in Germany without any history of SDB. All patients met the following exclusion criteria: age <65 yr, heart failure, and chronic obstructive lung disease. Baseline anthropometric and cardiorespiratory (one-night portable polygraphic recording) data, and a standardized sleep and sleepiness-questionnaires (Epworth Sleepiness Scale, ESS) were obtained in 1999. A second screening was conducted in 2003. Thirty one women and 34 men completed the follow-up after 3 years. These patients were divided into two subgroups: (i) no clinically relevant SDB and (ii) SDB (apnea-hypopnea index, AHI, >or=5 plus excessive day time sleepiness, ESS, >9). Six men and 3 women fulfilled the criteria of SDB. Thirty three percent of patients with SDB and 20% of patients without SDB died during the follow-up period. Duration of hospital stay was 35 days for the SDB patients and 20 days for patients without it. Body weight and sleepiness did not change significant over the 3-year period between the two cohorts. We conclude that the presence of SDB was associated with a 1.5-fold higher mortality and longer hospital stay in elderly patients over a period of 3 years even in persons without previous history of SDB. Daytime sleepiness was a better predictor than AHI or BMI for death.

[Treatment options for bladder disorders in the aged]. / Therapieoptionen bei Blasenfunktionsstörungen im Alter.

Urinary incontinence in the elderly is caused primarily by multiple factors such as physiologic changes of old age connected with multimorbidity and functional deficiencies, polypharmacology, psychosociological influences as well as conditions of the milieu. All these factors have to be carefully considered for therapy to be effective. Continence should be the goal of such therapy. Active participation in daily life can also be achieved by using auxiliary devices to improve the impaired quality of life. Temporary incontinence demands the search for its cause, while chronic incontinence calls for a differentiated form of therapy according to the kind of incontinence encountered. Conservative treatment consists of behavior therapy, such as toilet-(habit)-training and pelvic floor exercises. The use of drugs and auxiliary devices are equally important.

1999 rerun of the 1996 German Urinary Incontinence Survey: will doctors ever ask?

The German Incontinence Relief Society and supporting companies have been conducting numerous urinary incontinence awareness and continuing medical education campaigns. However, comparison of results from an epidemiologic survey involving 6,607 over-50-year-old patients in 1996 and a similar investigation among 6,481 patients in the same age group in 1999 reveals that German physicians are now even less likely to address this taboo subject, thus withholding appropriate care from incontinent patients. Possible reasons for this alarming development include the financial restraints imposed on German doctors in private practice and a lack of appreciation of the problems associated with incontinence among health policymakers.

[Incontinence, dementia and multiple morbidity--predictive factors for nursing care requirement and nursing home admission]. / Inkontinenz, Demenz und Multimorbidität-prädiktive Faktoren für Pflegebedürftigkeit und Heimunterbringung.

The present survey monitored all new admissions to 4 homes for the aged/nursing homes in the area of Velbert/Neviges (Nordrhein-Westphalia, Germany) over a 12-month period in 1996 and 1997, respectively. The study concentrated on the importance of incontinence, dementia and comorbidity when predicting need of care and removals to nursing homes. The statistical evaluation reveals a net coherence between dementia, nursing level and incontinence, and stresses the importance of these factors for the nursing home situation in Germany as the position increasingly develops into providing for and serving a clientele which is dement and heavily in need of care. Furthermore, the evaluation clearly shows that incontinence is still taboo to doctors as well as to their patients, and that, in spite of the medical and economical importance, the affected and their relatives are generally poorly informed. The described results imply a change in how to treat incontinence, dementia and comorbidity and should lead to renewed therapeutical concepts.