Geriatric urinary incontinence in women is defined as the syndrome featuring moderate to severe urinary incontinence (UI) symptoms presenting concomitantly with geriatric impairments, either physical, cognitive, or sensory. To date, targeted treatments for this syndrome are non-existent.  To facilitate the development of non-surgical treatment for this geriatric syndrome, we conducted a qualitative study to determine current attitudes towards non-surgical and surgical treatments for geriatric incontinence and the perceived impact of geriatric impairments on UI evaluation and treatments.

We conducted semi-structured interviews to assess: (1) attitudes towards evaluation measures for UI, (2) priorities for treatment of UI symptoms, (3) perceived barriers to therapy, (4) preferences and attitudes towards treatment delivery (group-based vs. individual, in-person vs. virtual), and (5) solutions to perceived barriers. Targeted participants were women 70 years or older, with a diagnosis of geriatric incontinence syndrome based on confirmation of severe UI symptoms and gait speed of slower than 1 meter/second on a 4 meter/second (m/s) usual gait speed assessment. Interviews were conducted in a private office.  Caregivers were allowed to be present if desired. All interviews were audio recorded and transcribed, and transcripts were cleaned for accuracy and imported into Dedoose for coding and data management. We developed a codebook using a combined inductive-deductive approach, and two researchers independently coded transcripts. The coded text was reviewed iteratively and synthesized into themes.

Of the 40 women that we approached between September 2022 and February 2023, 21 were ineligible due to a gait speed faster than 1 m/s.  Of the 19 women enrolled, the mean age ± standard deviation was 73±4.6; 95% of our subjects were Non-Hispanic White, and 5% were Black or Hispanic.

Regarding the evaluation of UI, all components of the standard UI evaluation were acceptable to the majority of participants. Most participants thought that a mobility evaluation would be useful as a component of the standard UI evaluation. Only a few participants thought that cognitive or sensory evaluations were important, largely because they did not perceive a link between cognitive dysfunction, sensory impairments, and their UI symptoms.  

Regarding treatment priorities, participants prioritized eliminating or significantly reducing UI symptoms to enable greater freedom to participate in activities they enjoyed, primarily travel, recreational activities (e.g., swimming, hiking), and spending time with grandchildren. Participants also wished to decrease their pad use, as they found pads bulky and did not want to always have to wear one. 

Conservative treatments were valued by the majority of participants. The primary barriers to exercise treatment included concern about being able to do global physical exercises due to mobility limitations. There was also concern about the frequency of visits to the clinic for exercise treatment, either because the participant had a ‘busy-life’, because they lived far from the clinic, and/or because of dependable transportation. The primary barriers to medication management included concern about side effects, particularly among participants who had experienced side effects from previous medications. Concerns about efficacy were expressed by participants who had tried medications for UI in the past and had poor efficacy. 

The primary barriers to surgical procedures for UI symptoms included: concern about the recovery period, concern about being immobilized, or participants feeling they were too old for surgery. Many participants expressed a need to understand the efficacy of various treatments. Concerns about the efficacy of the procedure were important as the social influence of the participant’s environment (i.e., prior personal history of the procedure or knowing of someone who had undergone a procedure for UI that had not worked) seemed to weigh heavily on their decision to pursue surgical treatments.

Women with the geriatric incontinence syndrome phenotype of UI prioritize significant improvement in their UI symptoms to increase their confidence in leaving their homes for daily life activities. While conservative treatments were preferred, participants were willing to undergo procedure-based treatments to meet their goal of improved continence.

Women with geriatric urinary incontinence may limit their participation in exercise-based treatments due to mobility impairments, concerns about efficacy, and feasibility of participation. Adapting a program for home implementation and/or virtual follow-up may improve feasibility of exercise-based treatments.