[Analysis of the effectiveness of urinary incontinence management in a geriatric rehabilitation]. / Analyse der Wirksamkeit des Harninkontinenzmanagements in einer geriatrischen Rehabilitationsklinik.

BACKGROUND: Urinary incontinence is a widespread health-related problem predominately occurring in older adults. The aim of the study was to evaluate the effectiveness of the management of urinary incontinence in routine care in a geriatric rehabilitation clinic. METHODS: A prospective observational study without a control group was conducted between 7 February 2018 and 7 June 2018. All patients included in the study (N = 32) received individualized guideline-conform measures to improve the symptoms of incontinence during the rehabilitation period. To assess the change in symptoms, the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was used at admission (T0) and discharge (T1). Assessment of patient satisfaction was conducted at T1 using the benefit, satisfaction, and willingness to continue treatment questionnaire (BSW). RESULTS: The total score of the ICIQ-UI SF improved by an average of 3.4 points (p = 0.004) due to a decrease in the frequency of incontinence episodes and in a reduction in the urine volume lost. Furthermore, there was a decrease in the number of patients who lost a large amount of urine from 9.4% at T0 to 3.1% at T1. The proportion of patients with incontinence several times a day, decreased from 68.6% to 31.3% during the intervention. Of the patients 80% received a guideline-conform treatment during the time of rehabilitation and 64% of the patients were satisfied with the treatment. CONCLUSION: The guideline-conform treatment of urinary incontinence in geriatric patients led to an improvement in the symptoms. A large number of patients benefited from the management of urinary incontinence during the rehabilitation period.

[Management of urinary incontinence in a geriatric rehabilitation department : Global urinary incontinence assessment incorporating the International Consultation on Incontinence Questionnare - Urinary Incontinence Short Form (ICIQ-UI SF)]. / Management der Harninkontinenz in einer geriatrischen Rehabilitationsklinik : Globales Harninkontinenz-Assessment unter Einbeziehung des International Consultation on Incontinence Questionnare ­ Urinary Incontinence Short Form (ICIQ-UI SF).

Although it is generally agree that older people have a high prevalence of urinary incontinence with a significant influence on health and quality of life, there is no standardized generally accepted assessment. The pathophysiology of urinary incontinence in frail elderly people requires a broad medical and functional scope to address the multifactorial nature of urinary incontinence, especially to identify treatable, potentially reversible conditions. To incorporate the multiple aspects into the daily routine, we developed a global urinary incontinence assessment at the Clinic for Geriatric Rehabilitation of the Robert Bosch Hospital including the validated International Consultation on Incontinence Questionnare - Urinary Incontinence Short Form (ICIQ-UI SF), a symptom score and results of a comprehensive geriatric assessment for mobility and cognition. In the years 2013-2015 this strategy was pursued for 728 geriatric patients and individually adapted interventions were initiated depending on the triggering cause. The experiences are presented.

[Urinary Continence and Mobility - two sides of the same coin]. / Kontinenz und Mobilität ­ zwei Seiten einer Medaille?

Urinary incontinence and gait disorders are common health related problems that occur especially in old age. Therefore they are called geriatric syndromes. Do they develop independently or is there an association? Do improvements of urinary incontinence result in reduced gait disorders and vice versa? It seems, that there is an interrelation between urinary incontinence and gait disorders. And further, both syndroms seem to interact closely and can be influenced by improvements of each other. Knowing and recognizing the interaction of micturition and physical performance is essential to working towards prevention of UI and to improving quality of treatment and quality of life.

[S2e guideline "Urinary incontinence in geriatric patients": a summary]. / S2e-Leitlinie "Harninkontinenz bei geriatrischen Patienten" ­ eine Zusammenfassung.

In 2009, the first complete guideline for the diagnostic evaluation and treatment of urinary incontinence in geriatric patients, commissioned by the German Society of Geriatrics, was developed by the working group Urinary Incontinence and published in the guideline registry of the AWMF (Association of the Scientific Medical Societies in Germany). We are presenting an up-to-date summary of the most recent update published as an "S2e" guideline in January 2019. This is the only valid, up-to-date and complete guideline on urinary incontinence in German language. Each chapter was reviewed with a special focus on matters relevant to very old patients, i. e. multimorbid patients over 75 years of age or patients older than 80 years, all of whom, due to their particular vulnerability, are at risk of chronification and loss of autonomy. The chapters "Assessments", "Medicinal therapy", "Behavioural intervention", "Physiotherapeutic interventions" and "Therapeutic appliances" have been revised completely. In addition, the guideline now also includes an evaluation of the ß3-mimetic drug Mirabegron as well as a chapter on long-term urinary bladder drainage with a suprapubic or transurethral catheter including a review on the differential indication and possible consequences or complications.

[Urinary incontinence in geriatric patients: Continence products, specialized continence nurses and indwelling catheter]. / Harninkontinenz bei geriatrischen Patienten: Hilfsmittel, qualifizierte Pflegekraft und Harnblasenlangzeitdrainage.

INTRODUCTION: 1/2019 we presented an update of the AWMF guideline 'urinary incontinence in frail elderly - diagnostics and therapy'. Since its introduction in 2015 the guideline has been under a continuous revision process by the working group 'Incontinence' of the German Society for Geriatrics (DGG). From this guideline which is accredited as an official guideline of the DGG we present here the chapter about continence products, specialized continence nurses and indwelling catheter. METHODS: A profound literature search was done in a structured evaluation process in the context of a 'frail elderly'. Most medical societies define a 'frail elderly' as someone older than 70 years and multimorbide or older than 80y. We focused on randomized, double blind, placebo controlled studies as well as already published guidelines in this field. In the case no studies were available or not feasible other publications such as not randomized studies or case reports were taken into consideration for our guideline. Recommendations resulted from a structured voting process and the results are stated as percentage of members who agreed. RESULTS: In case of failed or not wanted incontinence treatment, options like an indwelling transurethral or suprapubic catheter or a condom catheter in men maybe the best transient or definite solution. Trained specialized continence nurses have proven to be beneficial in conservative treatment modalities, such as toilet training or measuring residual urine. They can further consult patients and carers to enhance physical environment to reduce incontinence. CONCLUSION: Especially in institutions caring for frail elderly a coordinated care of specialized a multidisciplinary setting of continence nurses and doctors are beneficial for those affected. Under certain conditions palliative treatment should be included in geriatric incontinence care.

[Urinary incontinence in geriatric patients: behavioral therapy, toilet training and physiotherapy]. / Harninkontinenz bei geriatrischen Patienten: Verhaltensintervention, Toilettentraining und physiotherapeutische Interventionen.

INTRODUCTION: 1/2019 we presented an update of the AWMF guideline 'urinary incontinence in frail elderly - diagnostics and therapy. Since its introduction in 2015 the guideline has been under a continuous revision process by the working group 'Incontinence' of the German Society for Geriatrics (DGG). From this guideline which is accredited as an official guideline of the DGG we present here the chapter about 'behavioral therapy', 'toilet training' and 'physiotherapy'. METHODS: A profound literature search was done in a structured evaluation process in the context of a 'frail elderly'. Most medical societies define a 'frail elderly' as someone older than 70 years and multimorbide or older than 80y. We focused on randomized, double blind, placebo controlled studies as well as already published guidelines in this field. In the case no studies were available or not feasible other publications such as not randomized studies or case reports were taken into consideration for our guideline. Recommendations resulted from a structured voting process and the results are stated as percentage of members who agreed. RESULTS: Considering the vulnerability of frail elderly and the limitations of pharmacological and surgical treatment any conservative treatment modalities get a special meaning. All behavioral treatment approaches, however, are only successful if the patient is to some extent compliant and mobile. Keeping these limitations in mind we looked at effect and feasibility of weight loss, fluid management, use of diuretics, bowel regulation and toilet training as well as active and passive phsiotherapeutical interventions. CONCLUSION: Behavioral treatment, toilet training, and phsiotherapeutical interventions are indispensable modules in the multifaceted approach to improve continence in frail elderly. Caring for multimorbide frail elderly requires carefully outweighing risks of pharmacological and surgical treatment against benefits of low risk interventions such as conservative therapy. Frail elderly often benefit from conservative treatment alone or in combination with other treatment modalities.

[Urinary incontinence in geriatric patients: pharmacological Therapy]. / Harninkontinenz bei geriatrischen Patienten: Medikamentöse Therapie.

INTRODUCTION: 1/2019 we presented an update of the AWMF guideline 'urinary incontinence in frail elderly - diagnostics and therapy'. Since its introduction in 2015 the guideline has been under a continuous revision process by the working group 'Incontinence' of the German Society for Geriatrics (DGG). From this guideline which is accredited as an official guideline of the DGG we present here the chapter about pharmacological therapy. METHODS: A profound literature search was done in a structured evaluation process in the context of a 'frail elderly'. Most medical societies define a 'frail elderly' as someone older than 70 years and multimorbide or older than 80y. We focused on randomized, double blind, placebo controlled studies as well as already published guidelines in this field. In the case no studies were available or not feasible other publications such as not randomized studies or case reports were taken into consideration for our guideline. Recommendations resulted from a structured voting process and the results are stated as percentage of members who agreed. RESULTS: Pharmacological therapy of OAB, stress incontinence and overflow incontinence as well as unspecific treatment with antidiuretics was evaluated with special focus on vulnerable, potentially cognitively impaired frail elderly. We took a closer look on special side effect profile of the above mentioned drugs with regard to the individual multimorbidity and multimedication. CONCLUSION: Pharmacological therapy of urinary incontinence in frail elderly needs strict indication. Knowledge about drug metabolization and substance interactions as well as close monitoring of possible side effects are indispensable in this vulnerable group of patients.