**4.1 Acute or transient incontinence**

Acute or transient incontinence it refers to cases of short course incontinence (lasting less than four weeks), including those situations in which loss of continence is considered to be functional, without any associated structural disorder. This clinical type of UI is very common in the frail elderly, especially in the more complex elderly and with higher disability. In these cases, the medical history and physical examination will often suggest the cause. The use of mnemonic rules (DRIP or DIAPPERS), has been proposed in order to memorize the possible causes (Schröder et al, 2009; Griebling, 2009). (Table 4).


Table 4. Transient causes of urinary incontinence, based on mnemonic rules

Geriatric Urinary Incontinence – Special Concerns on the Frail Elderly 119

(urge, frequency), as well as obstructive type (incomplete voiding, urinary retention). Characteristically, post-voiding residual urine volumes are pathological. Although DHIC generally presents with urge incontinence, it may also manifest with symptoms of obstruction, stress or overflow incontinence. This form of bladder hyperactivity is the second commonest cause of incontinence in institutionalized patients. An episode of urinary retention may occur when some other factor (drugs, immobility, and fecal impaction)

Functional incontinence: many social and environmental factors, such as lack of carers to assist with toileting, and physical barriers, including bed-restraints, may be responsible for incontinence. However, a diagnosis of functional incontinence should only be accepted by

Mixed incontinence: many frail older people with chronic incontinence have a combination of different type of incontinence. A combination of urge incontinence and stress is very common. Another type of specific mixed incontinence in the frail elderly is the DHIC as

From the reports of the main epidemiological studies there have been identified several potential risk factors for UI depending of the characteristics of adult populations. However, the majority of studies have been cross-sectional in design which provides data only on risk factors for prevalent incontinence. Many of these studies are national population-based surveys on the general health of a particular population, and they are limited by the variables included in the study. Longitudinal studies incorporating multivariate analyses that provide data on the risk factors for incident incontinence are scarce. So, the data from

In older women, modifiable risk factors included obesity, vaginal trauma, and vaginal prolapse. In general, the risk factors for the various types of UI (stress, urge, and mixed) also vary. Aging tends to be associated with changing risk profiles associated with UI and urge incontinence type. With limited evidence (level IIA from prospective cohort studies), appears that increased body mass index, diabetes mellitus, comorbidities, cognitive decline, and hormone therapy were associated with developing UI in community dwelling females. In men, consistent published evidence (level IIb-III) suggested that poor general health, limitation in daily activities, stroke, diabetes mellitus, and treatments for prostate cancer (mainly surgery) were associated with higher risk of UI in older men

Through the analysis of the studies performed in long term care (nursing homes), we know that the prevalence of UI increased with the length of stay, since 39 percent at 2 weeks to 44 percent at 1 year after admission. In that way, the majority of residents with cognitive

further alters bladder contractility (Verdejo, 2004).

exclusion, once other mechanisms have been ruled out.

**5. Risks factors of the UI in the frail elderly** 

studies which included frail population are very few.

**4.2.4 Functional incontinence** 

**4.2.5 Mixed incontinence** 

(Shamliyan et al, 2007).

previously has been exposed above.

### **4.2 Chronic or established incontinence**

Chronic or established incontinence: it is associated with structural disorders, either in the urinary tract or outside of it, like in the nervous system. Usually the duration of this type of incontinence is over four weeks and some complementary examinations (ultrasounds, urodynamic) will be required to discover its etiology. It is important to emphasize that some transient causes of incontinence may contribute to an established form and that mixed incontinence is more common in the frail elderly population than in other groups of patients.

Mechanisms that are responsible for greater frequency of established incontinence in elderly people are:
