Bladder training and related therapies for urinary incontinence in older people.

In recent years, several studies have reported that bladder training, a behavioral intervention in which the interval between voluntary voidings is gradually extended, is an effective therapy for "urge" urinary incontinence (incontinence often associated with inability to inhibit detrusor contractions). Related behavioral therapies may also be effective for incontinence associated with impaired mobility and cognitive status. Because all of these types of incontinence are particularly common among older persons, the effectiveness of these therapies in this age group deserves attention. However, few well-controlled trials have been conducted with older subjects. There are many pathophysiologic types of incontinence among the older population, which is also heterogeneous in important clinical and functional characteristics that affect response to treatment. Hence, clinical trials that characterize subjects' urodynamic, neurologic, cognitive, and functional status, as well as the presence of other diseases and medication use, are needed to determine which elderly persons are likely to respond to particular behavioral regimens for urinary incontinence.