Wolff Gillian F, Kuchel George A, Smith Phillip P
Division of Urology, Department of Surgery, University of Connecticut Health Center, Farmington, CT, USA.
UConn Center on Aging, University of Connecticut Health Center, Farmington, CT, USA.
Res Rep Urol. 2014 Oct 3;6:131-8. doi: 10.2147/RRU.S41843. eCollection 2014.
Overactive bladder (OAB) is a common problem that may occur in individuals of all ages. It has a considerable impact on patient quality of life, and although moderately effective management strategies do exist, this condition often remains undiagnosed and untreated. OAB needs to be viewed as a symptom complex. Its presentation and management are complicated in the vulnerable elderly by the presence of baseline frailty and multiple coexisting chronic conditions. Furthermore, and beyond a simple understanding of symptomatology, providers must address patient goals and motivations as well as the expectations of caretakers. These multiple levels of perception, function, expectations, and treatment efficacy/risks must be tailored to the individual patient. While the vulnerable elderly patient may often have evidence of urinary tract dysfunction, OAB and urge urinary incontinence in this population must be understood as a multifactorial geriatric syndrome and viewed in the context of medical and functional baseline and precipitating risk factors. Expectations and goals must be tailored to the resources of vulnerable elderly patients and their caregivers, and care must be coordinated with other medical care providers. The management of OAB in the vulnerable elderly often poses significant management challenges. Nonetheless, with a thoughtful approach and an aim towards future research specifically for this population, significant reductions in morbidity and mortality long with enhancement in health-related quality of life are possible.
膀胱过度活动症（OAB）是一个常见问题，可能发生在所有年龄段的人群中。它对患者的生活质量有相当大的影响，尽管确实存在一些中度有效的管理策略，但这种情况往往仍未得到诊断和治疗。OAB需要被视为一种症状复合体。由于存在基线虚弱和多种并存的慢性病，其在脆弱的老年人中的表现和管理变得复杂。此外，除了简单了解症状学之外，医疗服务提供者还必须关注患者的目标和动机以及护理人员的期望。这些多层次的认知、功能、期望和治疗效果/风险必须针对个体患者进行调整。虽然脆弱的老年患者通常可能有尿路功能障碍的证据，但必须将该人群中的OAB和急迫性尿失禁理解为一种多因素的老年综合征，并结合医疗和功能基线以及诱发风险因素来考虑。期望和目标必须根据脆弱老年患者及其护理人员的资源进行调整，并且护理必须与其他医疗服务提供者进行协调。在脆弱的老年人中管理OAB往往带来重大的管理挑战。尽管如此，通过深思熟虑的方法以及针对该人群的未来研究目标，有可能大幅降低发病率和死亡率，并提高与健康相关的生活质量。
