IMPROVING OUTCOMES IN GERIATRIC URINARY URGE INCONTINENCE

尿失禁（UI）是老年人的主要问题，威胁着 独立生活的能力，每年产生150亿美元的成本， 超过了整个国家卫生研究院的预算 最常见的老年UI类型 通常与不自主膀胱相关联 收缩-一种被称为逼尿肌过度活动（DO）的状况。 甚少 已知关于冲动性UI或DO的发病机制， 他们之间的关系有问题。 此外，尚不清楚如何 药物治疗对他们有效，对谁有效，如何有效， 患者自己是否认为改善显著。 基于 我们的试点数据，我们假设有一个双峰响应，与许多 有显著改善的患者， 恶化。 此外，这些数据首次表明， 和生理变量可以预测结果， 重要的是，提供了对改进机制的深入了解。 建议的干预发展研究的具体目的是：1） 设计并验证UI特定的生活质量测量，以补充 传统的以及更新的生理参数预测治疗 社区居住老年人的结局（对照安慰剂反应）; 和3）鉴定哪些参数介导药物和安慰剂反应。 为了实现这些目标，我们将首先设计和完善一个基于患者的 尿失禁相关生活质量测量，然后入组250例急迫性尿失禁患者 奥昔布宁随机对照试验中的社区居住老年人。 结果测量将包括尿失禁频率、尿动力学 参数和新的结果工具。 通过设计一个基于病人的结果 工具，评估新的生理测试，确定结果预测因子， 提供对治疗反应机制的见解，以及 确定社区居住老年人的疗效估计， 安慰剂和最常用的DO治疗的失败率， 这项研究应该为确定性的随机试验奠定基础， 奥昔布宁和其他膀胱松弛剂。 此外，生理学的见解 这一发现将促进我们对冲动的病理生理学的理解 与DO相关的失禁，从而促进新的 对提高老年人的独立性至关重要的治疗选择。

Urinary incontinence (UI) is a major problem for the elderly, threatening the ability to live independently and engendering a $15 billion annual cost that exceeds the entire NIH budget. The most common type of geriatric UI is urge UI, which is generally associated with involuntary bladder contractions-a condition known as detrusor overactivity (DO). Yet little is known about the pathogenesis of either urge UI or DO and the relationship between them is problematic. Moreover, it remains unclear how well drug therapy works for them, in whom it works, how it works, and whether patients themselves consider the improvement significant. Based on our pilot data, we postulate that there is a bimodal response, with many patients experiencing significant improvement while an equal proportion worsen. In addition, these data suggest for the first time that clinical and physiological variables may allow prediction of outcome, and significantly, provide insight into the mechanisms of improvement. The specific aims of the proposed Intervention Development Study are to: 1) devise and validate a UI-specific quality of life measure to supplement the traditional as well as newer physiological parameters predict treatment outcome in community-dwelling elderly (controlling for placebo response); and 3) identify which parameters mediate both drug and placebo responses. To accomplish these goals we will first devise and refine a patient-based UI-related quality of life measure, and then enroll 250 urge incontinent community-dwelling elderly in a randomized controlled trial of oxybutynin. Outcome measures will include changes in incontinence frequency, urodynamic parameters, and the new outcome tool. By devising a patient-based outcome tool, evaluating newer physiological tests, identifying outcome predictors, providing insights into the mechanism(s) of treatment response, and determining estimates in community-dwelling elderly of the efficacy and failure rates of both placebo and the most commonly-used therapy for DO, the study should set the stage for a definitive randomized trial of oxybutynin and other bladder relaxants. Moreover, the physiologic insights gained should advance our understanding of the pathophysiology of urge incontinence associated with DO, thereby facilitating development of new therapeutic options essential to improving independence in older adults.