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Older adults may not want to talk about it. But we do!

Marcel SALIVE,
Health Scientist Administrator,
Division of Geriatrics and Clinical Gerontology (DGCG)
.

It's one of those things that no one really wants to talk about. People are often uncomfortable and embarrassed to mention it to their physician or other primary care provider. It's also one of the most common medical conditions among older people, affecting more than half of women and more than a quarter of men age 65 and older, according to the CDC. In fact, up to 80 percent of long-term care residents have this condition.

Yes, we're talking about urinary incontinence (UI). And, we want to talk about it further with you, when I hope you will join us for a conference this coming February, to discuss research to help individualize UI treatments, thereby improving treatment outcomes.

Older adults with UI have a hard time. Quality of life suffers. Risk of depression increases. Too many become socially isolated. And risk of disabling falls increases. Incontinence is also associated with loss of independence and ultimately institutionalization. Sadly, UI is both underreported and undertreated.

Talking about patient-centered solutions

Our colleagues at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) support a large portfolio of research on UI. In March of 2017, they sponsored the first of two meetings on "Individualizing Treatment – Broadening the Framework for Urinary Incontinence Research." Participants reviewed many biologic and non-biologic factors that may influence individual treatment success and identified hypotheses and research questions to build the knowledge base that will enable better targeting of existing treatments to appropriate people with UI.

In a couple of months, we'll be looking for many of you at the second meeting in this series—on February 1–2, 2018, on the NIH campus in Bethesda, Maryland. The goals of this meeting are to build on the ideas generated by the first, and to develop fundable, interdisciplinary, investigator-initiated research proposals that will lead to better outcomes for current UI treatments by individualizing them to each patient. This broad research framework is designed to enhance interdisciplinary thinking among specialties and professionals in UI research, including pelvic medicine and reconstructive surgeons, urologists, urogynecologists, geriatricians, scientists, engineers, nurses, physical therapists, occupational therapists, administrators, and economists.

The conference agenda is available on NIDDK's website. NIA and other NIH Institutes will be participating, along with other federal agencies. We encourage you to invite your colleagues with diverse areas of expertise to facilitate interdisciplinary research planning. It's not necessary to have attended the March 2017 meeting to attend this one.

You can register online for the February conference. Information on travel and lodging is also available online.

NIA, AGS shed light on UI

NIA has also been studying UI. With the American Geriatrics Society (AGS), we've been supporting a series of bench-to-bedside conferences over the past 10 years. Recently, the series addressed three common geriatric syndromes—delirium, sleep disturbances, and urinary incontinence. Research has shown that these conditions share a number of common risk factors and physiological mechanisms.

In October 2016, NIA and AGS sponsored "Urinary Incontinence in the Older Adult: A Translational Research Agenda for a Complex Geriatric Syndrome." More than 75 basic and clinical investigators attended this meeting, which reviewed the current state of the science in three areas:

  • overlap with other geriatric conditions and potentially sharing common pathways,
  • mechanisms of bladder and lower urinary tract function from the perspectives of both basic and clinical science, and
  • interventions including models of care delivery.

At the conference's conclusion, participants identified and prioritized several research gaps in the above areas that could inform future research. Priority areas included developing a better understanding of causes of incontinence; the relationship of incontinence to falls, depression and other problems of older adults; and designing effective treatments. The meeting summary was published online on December 4 in the Journal of the American Geriatrics Society.

How do you think we can move research and dialogue on this topic forward toward better clinical solutions?

Clinical Research Meetings

Comments

Submitted by Carol Halberstadt on December 30, 2017

Is it possible that UI may be a long-term side effect of chemotherapy (such as benadamustine) and/or immunotherapy (such as rituximab) in elderly patients, specifically treated for B-cell follicular lymphoma?

Submitted by Mahesh on January 04, 2018

I am eagerly waiting for this programme. It will help some old people like my grandfather.
Your's Sincerely,
Mahesh