Joseph G. Ouslander, MD Professor of Medicine Director, Division of Geriatric Medicine and Gerontology Chief of Medicine Wesley Woods Center on Aging at Emory University Atlanta, Georgia

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		What kind of impact do these symptoms have on people's lives, especially in the elderly population?

Jump to bottom of the page The impact of the symptom complex associated with overactive bladder is tremendous. First of all, if you know that you're going to get a strong, precipitant urge to urinate at frequent times throughout the day, that is going to impair your ability to do things you might want to do, to even travel in a car for a certain distance, or to go out shopping or to go somewhere with a friend. If you're not confident that you're going to be around a toilet and you leak, that can be a devastating event, so that many people with urgency and urge incontinence and daytime frequency will alter their behavioral lifestyle and even isolate themselves because they're afraid that they won't be around a toilet. That symptom complex and that phenomenon has also been associated with depression in older people and it probably is a cascade of not being able to do the kinds of things you want to do, social isolation, and that can exacerbate any tendency toward depression. Now nocturia is an extremely bothersome problem, as are nocturnal urgency and incontinence. First of all, just being a 46-year old adult now, I frequently have to get up once a night to urinate, or early in the morning before I normally get up. And I really don't like that because often I can't fall asleep. Now if you're an older person who has to get up 3 or 4 times, that can be extremely disruptive to sleep and that can affect your daytime emotional and physical state. Sleep is already disrupted in older people to begin with, and nocturia is just another factor that contributes. But there's even more problematic consequences. And that is that if you're dealing with 80- and 90-year-old frail older people who are often on cardiovascular medications that predispose them to hypertension; who may have a gait and balance disorder; who may have taken a hypnotic to go to sleep; who wake up 3 or 4 times a night and wobble with their walker to the toilet. There is an extremely high risk of falling and injuring themselves and that can result in hip fracture, and I've seen that happen in patients that I've cared for. They've woken up and had to go to the toilet, they're rushing, they actually urinate on the floor, slip and fall and injure themselves. The consequences can range from modifying one's daytime schedule to actually a devastating event like a hip fracture at night.

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