Report From NIA-Sponsored Conference Asks: What Don’t We Know About Bladder Control?

Nearly 40% of older women and up to 35% of older men live with distressing symptoms associated with urinary health, including difficulty with bladder control and voiding. While these concerns often compromise quality of life and overall health, we still lack safe and effective therapies.¹ But why? 

Primarily because of insufficient knowledge of the biology behind urinary control, the impact of aging and disease on urinary control, and the relationships of symptoms to overall well-being, according to researchers reporting on a prestigious conference hosted by the American Geriatrics Society (AGS) and funded by a grant from the National Institute of Aging (NIA) to George A. Kuchel, MD, FRCP, AGSF, Director of the UConn Center on Aging and Travelers Chair in Geriatrics and Gerontology at UConn Health.¹ A summary report from the conference, published late last year and now available for free from the Journal of the American Geriatrics Society, emphasizes that the meeting—the third in a series on common geriatric syndromes like incontinence, delirium, and sleep disturbances—holds promise for pin-pointing gaps in knowledge and building a better research agenda to improve care for older adults across all care settings.¹  

“Despite its prevalence among older adults, incontinence remains underreported and undertreated, a reality for many of the conditions addressed through the AGS-NIA conference series,” noted Phillip P Smith, MD, Associate Professor of Surgery at UConn Health, an NIA-funded Beeson scholar and a coauthor of the report. “Bringing renowned leaders together to look critically at what we know, what we don’t know, and how we can bridge that divide will not only lead to better treatments but also will help model the way to high-quality, person-centered care for all older adults.”

That process begins by identifying gaps in clinicians’ understanding of serious health concerns like incontinence, according to the panel of conference attendees. Principal among these gaps, for example, are unanswered questions about social, health, and personal factors that contribute to urinary control failures such as overactive bladder, voiding symptoms, and urinary retention.¹  

Focusing on urinary incontinence, a leading cause of social isolation and distress for older adults, the panel highlighted research questions not typically included in clinical data sets that drive new and better treatments.¹ In this context, conference experts from many disciplines reported on the current state of urinary incontinence research across four critical areas: basic science, translation of discoveries from the bench to the clinic, health care delivery, and the frequent yet underrecognized clinical overlap between incontinence and other common geriatric syndromes in the same individual—a critical focus of the AGS-NIA conference series.¹ 

“Risk factors common to all geriatric syndromes include older age, decline in functional independence, impaired mobility, and impaired cognition,” notes the conference report.¹ “Identifying common shared risk factors and pathophysiological mechanisms [will be key to] future research efforts.”¹ 

Among other highlights, the conference report notes that behavioral therapy has emerged as one of the most successful treatment options for addressing bladder control, though it still is not offered to most older people.¹ Lack of provider awareness may be one reason for the gap, along with reimbursement models that fail to account for the time it takes to teach behavioral therapy skills. Future goals for treating urinary incontinence should include improving behavioral training to make it more effective, as well as offering that training more widely. 

Reference

1. Vaughan CP, Markland AD, Smith PP, Burgio KL, Kuchel GA; the American Geriatrics Society/National Institute on Aging Urinary Incontinence Conference Planning Committee. Report and research agenda of the American Geriatrics Society and National Institute on Aging bedside-to-bench conference on urinary incontinence in older adults: A translational research agenda for a complex geriatric syndrome. [published online December 4, 2017] J Am Geriatr Soc. doi:10.1111/jgs.15157

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