HEARTS, minds and souls-it is time for geriatricians to bring more to continence management

Urinary incontinence (UI), the involuntary loss of urine, is a common health condition that may decrease the quality of life and which increases in incidence and prevalence with age. Recent epidemiologic data suggest an overall prevalence of 38% in women older than 60 years, increasing to 77% in older women living in nursing homes. Despite this high prevalence, incontinence remains underdiagnosed and undertreated in this age group. In a representative population of 7,000 participants drawn from the Irish Longitudinal Study of Ageing, 750 had UI of whom 285 (38%) had not sought the help of a health care professional. The reasons that older people do not seek help for incontinence are complex and multiplex. Stigma surrounding diagnosis, a sense of futility coupled to a notion that incontinence is a part of normal ageing and the fact that incontinence simply gets 'lost' in the midst of multimorbidity and frailty have all been shown to play a role. Active case finding has therefore been highlighted as a cornerstone of effective care in serial international guidelines.