The quality of care provided to vulnerable older community-based patients with urinary incontinence

J Am Med Dir Assoc. 2004 May-Jun;5(3):141-6. doi: 10.1097/01.JAM.0000123026.47700.1A.


Objective: The objective of this study was to assess the quality of care provided to vulnerable older community-based patients with urinary incontinence (UI).

Design: We conducted an observational study using medical record review and patient (or proxy) interview.

Participants: We studied 372 randomly selected community-dwelling older patients enrolled in two senior managed care plans identified by interview to be at increased risk for functional decline or death.

Measurements: Percentage of quality indicators passed for patients with UI.

Results: Thirty-six percent of the patients reported having UI, and during a 13-month period, 32 (7%) presented to their physician with new or worsening UI. Analysis of medical records for these 32 patients revealed that characteristics of voiding were documented for 75% of the patients with new or worsening UI, but importance of the problem, toileting function, and prior treatment were rarely addressed. Pelvic examination was performed for 20% of female patients and a rectal examination for 42% of men. Only 38% had a urinalysis performed and 16% had a postvoid residual. Drug treatment was prescribed for 50% of the patients but behavioral intervention for only 13%. Compared with patients seen by primary care providers alone, patients seen in consultative care received more comprehensive evaluation and treatment of UI.

Conclusion: Quality of care for UI provided to vulnerable older patients, particularly by primary care providers alone, is inadequate. Despite the proven effectiveness of patient-dependent behavioral treatments, physicians rarely prescribe these interventions for UI.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Behavior Therapy / statistics & numerical data
  • California / epidemiology
  • Cohort Studies
  • Continuity of Patient Care / standards*
  • Continuity of Patient Care / statistics & numerical data
  • Family Practice / standards*
  • Family Practice / statistics & numerical data
  • Female
  • Health Services for the Aged / standards*
  • Health Services for the Aged / statistics & numerical data
  • Humans
  • Male
  • Managed Care Programs / standards*
  • Managed Care Programs / statistics & numerical data
  • Medical Records
  • Physician-Patient Relations
  • Quality Assurance, Health Care
  • Quality Indicators, Health Care*
  • Surveys and Questionnaires
  • Time Factors
  • Urinary Incontinence / epidemiology
  • Urinary Incontinence / therapy*