Evaluation and management of urinary incontinence in nursing home residents: unique considerations for an at-risk population

Overactive bladder (OAB) is a common diagnosis in the nursing home (NH) population, with up to 77% of NH residents having OAB or associated incontinence. NH residents have high rates of medical comorbidities that can impact OAB, such as frailty, decreased cognitive function, and lower functional status. Aside from understanding medical comorbidities, the clinician must also be aware of the nuanced social and structural factors at play due to the NH environment and interactions with nursing staff and caretakers. The American Urological Association and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction have outlined three lines of treatment for OAB: conservative treatment, medical management, and procedural treatments. Care for NH residents differs from the general population, however, due to the unique medical and sociological backgrounds of this population. Functional incontinence concerns should be considered as well. While conservative measures are considered the first-line treatment for OAB, complex structural challenges affect their implementation in NHs. Medical management can be a good option, however anti-cholinergic medications should be limited in the elderly and frail, and beta-3 agonist medications should be favored if no contraindications exist. Lastly, procedural treatments may be appropriate for NH residents and should still be considered in appropriately selected individuals. The aim of this review is to highlight the special considerations for evaluating and managing OAB in the NH population, with a focus on how the NH environment can both impact OAB treatment and patient perceptions regarding urinary symptoms.