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Management of Urinary Incontinence in Medicare Managed Care Beneficiaries
Results From the 2004 Medicare Health Outcomes Survey
Russell E. Mardon, PhD;
Shaheen Halim, PhD;
L. Gregory Pawlson, MD;
Samuel C. Haffer, PhD
Arch Intern Med. 2006;166:1128-1133.
Background Despite the high prevalence of urinary incontinence (UI) among older persons and the existence of effective treatments, UI remains underreported by patients and underdiagnosed by clinicians. We measured the occurrence of UI problems in Medicare managed care beneficiaries, frequency of physician-patient communication regarding UI, and frequency of UI treatment.
Methods We used cross-sectional data from the 2004 Medicare Health Outcomes Survey, which measured self-reported UI (accidental leakage of urine) and UI problems in the past 6 months, 36-Item Short-Form Health Survey health measures, discussions of UI with a health care provider, and receipt of UI treatment.
Results The overall incidence of UI within the past 6 months was 37.3%, consistent with previous estimates. Problems with UI were strongly associated with poorer self-reported health. Mean 36-Item Short-Form Health Survey physical and mental health scores were lower by more than 5 points (on a 100-point scale, P<.001) for respondents with major UI problems when controlling for age, sex, race, Hispanic ethnicity, and major comorbidities. These differences were among the largest of any condition measured. Only 55.5% of those with self-reported UI problems reported discussing these problems during their recent visit to a physician or other health care provider. The rate of patient-reported UI treatment was 56.5% and was lower (P<.001) for older individuals (eg, 46.3% for those aged 90-94 years) or those with poor self-reported health status (50.5%).
Conclusions Among older persons, UI is common, underdiagnosed, and associated with substantial functional impairment. There appears to be considerable opportunity to mitigate the effects of UI on health and quality of life among community-dwelling older persons.
Author Affiliations: National Committee for Quality Assurance, Washington, DC (Drs Mardon, Halim, and Pawlson), and Centers for Medicare and Medicaid Services, Baltimore, Md (Dr Haffer). Dr Mardon is now with Westat, Rockville, Md.
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