When addressing lower urinary tract symptoms in an aging population, clinicians must be sensitive to the different complications and risk factors that can contribute to incontinence with aging, not the least of which are cognitive decline and dementia.
Three experts will discuss several clinical challenges of treating elderly patients during a 20-minute panel discussion on Monday titled Dementia, Cognition and the Aging Bladder, which will begin at 1:10 p.m. in Ballroom East of the Boston Convention and Exhibition Center during the Prime Time II plenary session.
“Voiding disorders occur at all ages, but elderly patients are particularly vulnerable,” said panelist George Kuchel, MD, FRCP, Chief of the Division of Geriatric Medicine at the University of Connecticut Health Center and Director of the UCONN Center on Aging. “They also have unique concerns, and when we focus on the frail elderly, the issues become especially challenging. Because the care of seniors is a big portion of the general urologist’s practice, it’s important to stay up-to-date on specific issues related to elder care.”
Dr. Kuchel will be joined on the panel by Eric S. Rovner, MD, professor of Urology at the Medical University of South Carolina, and Sender Herschorn, BSc, MDCM, FRCSC, professor of Surgery and Urology at the University of Toronto.
“With an older patient who doesn’t have issues such as frailty or dementia, the treatment is fairly straightforward,” Dr. Herschorn said. “But as people age, dementia and frailty are more common. When people are frail, they become dependent. Mobility is impaired. Strength is impaired. Response time is impaired.”
During the discussion, Dr. Kuchel will review what it means to be frail, the issues with incontinence that become obvious in this vulnerable population and risk factors that can contribute to incontinence with aging.
“In younger patients, we typically categorize the major issues as urgency, stress, obstruction or retention problems,” Dr. Kuchel said. “In the elderly we see issues outside the bladder complicating the clinical presentation and the management of the problem. For example, elderly patients may experience fluid balance issues. They may lose the ability to sense when the bladder fills. Or their ability to get to the bathroom in time may be compromised by mobility issues.”
Drs. Kuchel and Herschorn will also review considerations for treatment options for older patients.
“The use of anticholinergic medications in the elderly comes with a higher risk of toxicity,” Dr. Kuchel said. “We have to be concerned about worsening cognitive function in an older person who receives an anticholinergic for overactive bladder. The effects are usually small but, when we do use these medications, we need to prescribe carefully to minimize potential side effects.”
Because of these concerns, Dr. Kuchel said behavioral and multi-component interventions play a major role when treating elderly patients, particularly in older adults who have underlying dementia.
“Interventions that involve behavioral strategies, such as timed or prompted voiding combined with exercise, sometimes work better than medications in this population,” Dr. Kuchel said. “Surgery may also play a role, but decisions regarding surgery should be based on biological age and overall health status rather than chronological age alone. There’s no reason not to operate on a 92-year-old patient if she’s well enough to undergo surgery and it will improve her quality of life.”