Outcome Measures for Research of Lower Urinary Tract Dysfunction in Frail Older People

The aim of this paper is primarily to provide a framework for investigators conducting research on incontinence in frail older people. Since it is difficult to precisely define ‘‘frailty,’’ the definition used in this paper is ‘‘any person over age 65 years with incontinence of urine who does not leave their place of residence without assistance of others, or a person with dementia, or a person who has been admitted to a long-term care facility.’’ These people usually suffer from multiple medical conditions and disabilities (comorbidity), which results in them becoming homebound or institutionalized. Because they require the assistance of others to perform some or all of the most basic activities of daily living (ADLs), including bathing, dressing, toileting, and ambulating, results from younger populations or from older people without disabilities cannot necessarily be extrapolated to this population. For this population there is little validated research showing long-term efficacy of treatment for urinary incontinence. If incontinence develops in healthy older people, its management is generally similar to the approach taken in younger individuals, except that greater caution should be taken when pharmacological intervention is being considered because of the susceptibility of older people to adverse drug reactions. This paper therefore does not focus on the fit older person, and in the absence of data to the contrary, the same outcome measures should be used as for adults of the same sex [Mattiasson et al., 1998]. This paper deals with lower urinary tract dysfunction with a major emphasis on incontinence. Nocturia is a significant problem for older people, and the principles alluded to in this paper cover this area. Because of the frailty of this population, all patients being considered for entry into a research protocol should be assessed for coexisting reversible or modifiable