Case-finding incontinence in the over-75s

The under-reporting of incontinence in older persons is well known. However, the general practitioner's (GP's) knowledge of incontinence in this population is less wall documented.

To examine the knowledge of Irish GPs regarding incontinence in patients aged over 75, and to examine the relationship between incontinence and cognitive function in this age group.

Sixty-four GPs from six faculties of the Irish College of General Practitioners (ICGP), spread geographically over Ireland, administered a questionnaire to 10 of their patients, selected from the General Medical Services list, as part of the ICGP 1993 Care of the Elderly Study. A short test of cognitive function, the AMTS, was administered followed by RCGP (Royal College of General Practitioners) screening questions for incontinence, plus questions with regard to patients' prior reporting of incontinence. GPs were also asked to state their prior knowledge of the incontinence status of the patient and to choose from a list of management options including referral, assigning to a public health nurse, and hospital surgical service.

Data were analysed on 527 patients aged over 75 years. Forty-four per cent of persons over 75 years reported having experienced urinary incontinence; 9% reported having experienced faecal incontinence. GPs reported full knowledge of the incontinence status in only 33% of their patients. The effects of low cognitive function, sex, and age on the probability of wetting were analysed using logistic regression modelling. Female sex and low cognitive score increased the likelihood of ever wetting; increasing age increased the likelihood of daily wetting. Poor sensitivities for these models limit their usefulness in clinical practice.

GPs should have a high index of suspicion for incontinence in persons aged over 75. Thorough history-taking, physical examination, and examinations of therapeutic options for individual cases are recommended.