Table 1.

Factors that can cause or contribute to UI in older adults living with frailty

FACTORS	COMMENTS	IMPLICATIONS FOR MANAGEMENT
Diabetes mellitus	Poor control can cause polyuria and precipitate or exacerbate incontinence; also associated with increased likelihood of urgency UI and diabetic neuropathic bladder	Better control of diabetes can reduce osmotic diuresis and associated polyuria and improve UI
Degenerative joint disease	Can impair mobility and precipitate urgency UI	Optimal pharmacologic and nonpharmacologic pain management can improve mobility and toileting ability
Chronic pulmonary disease	Associated cough can worsen stress UI	Cough suppression can reduce stress incontinence and cough-induced urgency UI
Congestive heart failure, lower extremity venous insufficiency	Increased nighttime urine production can contribute to nocturia and UI	Optimizing pharmacologic management of congestive heart failure, sodium restriction, support stockings, leg elevation, and a late-afternoon dose of a rapid-acting diuretic may reduce nocturnal polyuria and associated nocturia and nighttime UI
Sleep apnea	May increase nighttime urine production by increasing production of atrial natriuretic peptide	Diagnosis and treatment of sleep apnea, usually with continuous positive airway pressure devices, may improve the condition and reduce nocturnal polyuria and associated nocturia and UI
Severe constipation and fecal impaction	Associated with “double” incontinence (urinary and fecal)	Appropriate use of stool softeners Adequate fluid intake and exercise Disimpaction if necessary
Neurologic and psychiatric conditions
Stroke	Can precipitate urgency UI and less often urinary retention; also impairs mobility	UI after an acute stroke often resolves with rehabilitation; persistent UI should be further evaluated Regular toileting assistance is essential for those with persistent mobility impairment Optimizing management may improve mobility and improve UI
Parkinson disease	Associated with urgency UI; also causes impaired mobility and cognition in late stages	Regular toileting assistance is essential for those with mobility and cognitive impairments in late stages
Normal pressure hydrocephalus	Presents with UI, along with gait and cognitive impairments	Patients presenting with all 3 symptoms should be considered for brain imaging to rule out this condition, as it may improve with a ventricular-peritoneal shunt
Dementia (Alzheimer disease, multi-infarct, others)	Associated with urgency UI; impaired cognition and apraxia interfere with toileting and hygiene	Regular toileting assistance is essential for those with mobility and cognitive impairment in late stages
Depression	May impair motivation to be continent; may also be a consequence of incontinence	Optimizing pharmacologic management of depression may improve UI
Medications	See Table 2 for more information^12,13	Discontinuation or modification of drug regimen
Functional impairments Impaired mobility Impaired cognition	Impaired mobility or cognition due to a variety of conditions listed above and others can interfere with the ability to toilet independently and precipitate UI	Regular toileting assistance is essential for those with severe mobility or cognitive impairment
Environmental factors Inaccessible toilets Unsafe toilet facilities Unavailable caregivers for toileting assistance	Frail, functionally impaired persons require accessible, safe toilet facilities and in many cases human assistance to be continent	Environmental alterations may be helpful; supportive measures such as pads may be necessary if caregiver assistance is not regularly available

UI—urinary incontinence.
Adapted with permission from the International Continence Society.¹³