**7. Clinical approach of the urinary incontinence in the frail elderly**

Nowadays, there are several evidences about the need of the early detection of UI in older persons, especially in the frail elderly, due to the low index consultation (about 30-50 % of patients), as well as the number of elderly people that received an effective treatment, in spite of the valid alternatives. In this sense, the Assessing Care of Vulnerable Elders, the Fourth Consultation on Incontinence, and the Guidelines on UI recently published by the European Association of Urology recommends its assessment (Grade A) (DuBeau et al, 2010).

It is very important to highlight that the extent of the clinical approach and the diagnostic process in the frail elderly incontinent is not well established. In general, healthy older persons should receive the same diagnostic schedule as younger patients. By contrast, in frail older persons an individual assessment is required, and it should include: medical and functional status; the incontinence's impact; the preferences of the patient; the life's expectancy and also the true chances to improve after a wide evaluation.

Currently, it is accepted that the clinical assessment of the elderly incontinent has two different steps, one basic and another further.

#### **7.1 Basic step**

Basic step the basic step should be done in every incontinent patient and the general practitioner can successfully do it, with several main objectives: to detect transient causes of incontinence; to exclude serious underlying diseases; to identify patients who need further evaluation and finally to decide the appropriate treatment.

Basic step has included different components of the clinical assessment, all of them very important to know the characteristics of the incontinent frail elderly.

Basic step should include:

#### **7.1.1 Medical history**

Medical history with the follow components (Abrams et al, 2010):


clinical evaluation. The information can be obtained from the patient or caregiver, and in the majority of the cases, probably a three day diary is usually sufficient. It is important to comment that in cases of high frailty, cognitive impairment or mental problems, we can use a register of the leakages and their amounts instead a formal diary. The level of recommendation of the voiding diaries is grade A.

