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Date: Tuesday, March 5, 1996 FOR IMMEDIATE RELEASE Contact: (301) 594-1364, Karen Migdail x174, Karen Carp x177, Paula Zeller x148
Today there is more help available for millions of Americans who suffer from urinary incontinence (UI), or the involuntary loss of urine. The Agency for Health Care Policy and Research (AHCPR) today released an updated version of its clinical practice guideline first issued in March of 1992, which shows that 80 percent of cases can be improved or cured by following the recommendations. The new report has expanded sections on diagnosis and behavioral therapies, as well as a new chapter on treating chronic UI in long-term and home care settings.
AHCPR also announced a partnership with the American Medical Directors Association (AMDA) and the American Health Care Association (AHCA) to develop new educational materials to be used by caregivers to reduce the incidence of UI. Urinary incontinence is one of the primary contributing reasons that people enter nursing facilities. Use of the guideline may help people stay at home longer and improve the quality of life for persons at home or in facilities. The first of these new educational products will be available this spring.
"This updated guideline, which replaces the first version, reaffirms the work of the 1992 panel which showed that urinary incontinence is treatable and that people don't have to suffer in silence," AHCPR Administrator Clifton R. Gaus, Sc.D., said. "The new guideline continues to emphasize that patients must feel free to discuss the problem with their doctor or nurse, and all clinicians must take the problem seriously, so they can get the help that is available and regain control of their lives."
Researchers estimate the nation spends at least $16 billion a year to care for people with urinary incontinence, up from $10 billion in 1990. Urinary incontinence is estimated to affect more than 13 million adults -- most of them older women -- but actual prevalence may be higher because it is widely underreported and underdiagnosed.
"We made a good start with the first guideline by bringing this problem out into the open and telling people there is help for incontinence," said Andrew J. Fantl, M.D., professor and vice-chair of the Obstetrics, Gynecology, and Reproductive Medicine Department at SUNY at Stonybrook School of Medicine, and co-chair of the guideline update panel. "Now we have the opportunity to strengthen the message and provide clinicians with a more user-friendly tool to really make a difference in the quality of their patients' lives."
As with the first version, this updated guideline, developed by a private sector, multidisciplinary panel of clinicians and a consumer, emphasizes aggressive diagnosis to determine the underlying cause of the problem. Incontinence can be caused by pelvic muscle instability, as a side-effect of medications or caffeine, or other conditions such as a urinary tract infection or constipation. It also can be caused by not being able to reach the bathroom in time due to a lack of mobility.
Many younger women experience incontinence after childbirth, but don't report it because they feel it is an inevitable result of the birthing process, or are embarrassed. Older men with prostate problems or recovering from prostate surgery often suffer from incontinence, but they are more likely to ask for, and receive, help for the condition.
"Surveys have shown that women tend to accept incontinence as their personal burden, while men understand that this is not normal and should be treated," said Diane Kaschak Newman, R.N.C., M.S.N., F.A.A.N., president of Access to Continence Care & Treatment in Philadelphia, and co-chair of the guideline update panel. "As clinicians we need to make a stronger effort to ask women about incontinence and treat it aggressively."
The guideline is written for the primary care provider and covers various types of incontinence, provides a framework for selecting appropriate behavioral, pharmacologic, and surgical treatments, and evaluates the use of alternative treatments such as catheters and bladder support devices. The caregiver guide being developed by AHCPR, AMDA, and AHCA will be written specifically for certified nursing assistants in nursing facilities and home health aides. A companion piece will be written for directors of nursing to help them train caregivers.
"The guideline will make an important contribution to improving the quality of life for so many people suffering needlessly from urinary incontinence," said Lorraine Tarnove, executive director of the American Medical Directors Association.
"We are committed to helping create and disseminate other products from this guideline which can do even more for the residents in nursing facilities."
A quick reference guide for clinicians, Managing Acute and Chronic Urinary Incontinence, and consumer guide (available in English or Spanish), Understanding Incontinence, are available free of charge from the AHCPR Publications Clearinghouse. Call toll-free 800-358-9295, or write to Urinary Incontinence Update, AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907. They also are available 24 hours a day, 7 days a week, through AHCPR InstantFax, 301-594-2800. When the caregiver guide is completed, it also will be available through the Clearinghouse and InstantFax.
The full guideline, Urinary Incontinence in Adults: Acute and Chronic Management, as well as the quick reference and consumer pieces, will be available on Internet through the AHCPR Home Page. Access the guideline by using a Web browser, specifying URL www.ahcpr.gov/guide/ and clicking on "Clinical Practice Guidelines Online." Single and bulk copies may be purchased from the U.S. Government Printing Office by calling 202/512-1800.
The American Medical Directors Association is a national professional organization representing physicians who practice in long-term care facilities as medical directors or attending physicians. An AHCPR spokesperson will be speaking about dissemination of the UI guideline at the AMDA annual conference, March 7-10, in New Orleans. For further information, call Joanne Kaldy at 703/841-4987.
The American Health Care Association is a federation of 51 state associations representing more than 11,000 long-term care facilities nationwide, caring for more than a million elderly, chronically ill, and convalescent Americans.
Note to Editors: Print interviews with the panel chairs or AHCPR spokesperson can be arranged by contacting Richard Mullen at 301/594-1364 x194; radio interviews can be arranged through Susan Metcalf at 207/439-9907.
Note to TV Producers: AARP's VNR will be sent March 5 and again on March 7 from 1:30-2 p.m. The coordinates are Telstar 402, Channel 13.