The primary aims of this project are: P1) to determine the prevalence and distribution of urinary incontinence and its psychosocial and behavioral sequelae in the elderly. P2) To determine the incidence of urinary incontinence and the association between continence status and subsequent institutionalization. P3) To establish the characteristic clinical and urodynamic features of continent and incontinent elderly and to establish the values and limitations of the urodynamic tests in evaluating incontinent elderly. P4) To determine the most effective pharmacologic strategy in the treatment of complex (urge and stress) urinary incontinence in the elderly. The program project will be done in Washtenaw County, Michigan, and will involve a multi-stage probability sample of households developed by screening over 10,000 households to find and interview approximately 2100 seniors 60 years and older who will be designated as study respondents. An intensive household interview of demographics, health history, knowledge and beliefs related to incontinence, social and mental health, and state of urine control will be undertaken (P1). The continent respondents will be followed for four years to identify new incontinents and to determine the fate of these elderly with regard to urine control. Subsequent institutionalization of baseline sample members will also be identified, so that the relationship between continence status and institutionalization can be quantified (P2). All incontinents and a proportion of the various continent subjects from the baseline survey component as well as the new incontinents discovered from the incidence component will be invited for intensive clinical and urodynamic studies (P3). All incontinents from the baseline study discovered to have complex urinary incontinence will be invited to the pharmacologic intervention study (P4). This program hopes to answer the questions posed in the various projects to improve the lives of the elderly, reduce the burden on the individual, his family and society, and to provide care providers with improved knowledge on the many aspects of bladder control problems to help them combat urinary incontinence in the elderly.
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