Specialist Practices for Managing Persons Living with Dementia and Urinary Incontinence

Although persons living with dementia (PLWD) often experience urinary incontinence (UI), little is known about physician practice patterns across specialties treating these individuals. This study is aimed at assessing practice patterns across urologists, gynecologists, and geriatricians to highlight opportunities to support PLWD with UI and their caregivers.

A vignette-based questionnaire was developed and sent to the members of the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), the American Urogynecologic Society (AUGS), and the American Geriatrics Society (AGS) in this cross-sectional study. ANOVA and Chi-squared tests were used to compare responses between urologists, gynecologists, and geriatricians. Thematic analysis generated inductive themes from free-text responses.

The 273 respondents included 55 urologists, 173 gynecologists, and 45 geriatricians in the SUFU, AUGS, and AGS. Gynecologists and urologists were more likely to endorse treating PLWD with UI with beta-3 adrenergic receptor agonists and percutaneous tibial nerve stimulation and less likely to endorse discontinuing cholinesterase inhibitors than geriatricians (all p < 0.05). Geriatricians were more likely to agree with alleviating caregiver burden than urologists or gynecologists (all p < 0.05). Overall, 37% of urologists, 29% of gynecologists, and 61% of geriatricians felt prepared to care for these patients (p < 0.05). Thematic analysis of responses revealed four themes: medication changes, further work-up of symptoms, nonmedical care, and procedural interventions.

This study identified differences in practice patterns between urologists, gynecologists, and geriatricians treating PLWD and UI, highlighting opportunities for cross-disciplinary learning to better care for these patients and their caregivers.