Outpatient Evaluation and Management Visits for Urinary Incontinence in Older Women.

The aim of this investigation was to examine how often outpatient visits addressing urinary incontinence among women with self-reported incontinence symptoms occur and to explore characteristics associated with having an outpatient visit for incontinence.

We studied 18,576 women from the Nurses' Health Study, ages 65 years and older, who reported prevalent incontinence symptoms in 2012 on a mailed questionnaire and were linked with Medicare utilization data. We compared women with and without claims for outpatient visits for urinary incontinence, including considering demographic, personal, and clinical characteristics. We controlled for potential confounding factors including age, race, parity, body mass index, medical co-morbidities, smoking status, health seeking behavior, disability, physical function, and geographic region, using logistic regression models.

In this linkage between symptom report and insurance claims data, we found that only 16% of older women with current incontinence symptoms also had an outpatient visit addressing incontinence in the prior 2 years. In multivariable-adjusted models, incontinence severity (OR=3.75, 95% CI:3.10-4.53 comparing women with severe vs. slight) and type of incontinence (OR=1.80, 95% CI:1.56-2.08 comparing women with urgency vs. stress) were the strongest predictors of having an outpatient evaluation.

Overall, only a small percentage of women who report urinary incontinence symptoms also have medical outpatient visits for incontinence, a marker of care-seeking. Our study highlights the discordance between the high prevalence of incontinence in older women and the lack of clinical assessment despite symptoms, even among nurses with high healthcare literacy.

The Journal of urology. 2019 Mar 13 [Epub ahead of print]

Elisabeth Erekson, Kaitlin A Hagan, Andrea Austin, M Div Donald Carmichael, Vatche A Minassian, Francine Grodstein, Julie Pw Bynum

Department of Obstetrics and Gynecology at the Geisel School of Medicine at Dartmouth , Hanover , NH., Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston , MA., The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth , Hanover , NH., Division of Urogynecology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital , Boston , MA.