Solutions to the Aging Puzzle

By Matt Windsor and Charles Buchanan

Balance issues, driving troubles, continence problems—whatever their study focus, UAB's geriatric researchers share a common belief: Although aging may be inevitable, the consequences don't have to be. Unfortunately, this is an article of faith that hasn't always been shared by other members of the health-care profession.

During the early part of her career in the 1980s, Kathryn Burgio remembers hearing from "many, many patients who had already gone to their doctor" with an incontinence problem and had been rebuffed with a similar line: "Well, what do you expect? You're 83!" The attitude, she says, was that "since there is nothing you can do about getting older, there must be nothing you can do about your bladder."

It's true that, even today, surgical and pharmaceutical treatments for incontinence can be difficult for aging bodies to tolerate. But Burgio has had remarkable success in applying behavioral interventions to the problem—simple, inexpensive therapies such as biofeedback and electrical stimulation that help patients regain control of their bladder muscles. Her team has achieved an 80 percent recovery rate for patients with urinary incontinence; they are now hoping to boost those numbers even more by finding the optimum combination of behavioral, surgical, and medical interventions. "When somebody comes in to our geriatric practice, we're thinking, ‘What is the least invasive treatment we can offer this person?'" says Burgio. "Many older patients are in a delicate balance, so we want to intervene as little as we can."

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As with most aging-related conditions, the course to proper treatment for incontinence is obscured by maddening gray areas. In many cases, the trouble has nothing to do with the bladder, says Richard Allman, M.D., director of UAB's Center for Aging. Elderly patients are often taking many different medications, and everything from sleeping pills to heart drugs can be the source of the problem. A drop in estrogen levels post-menopause is another common culprit. "Even something as simple as restricted mobility" may be to blame, says Allman. "If somebody gets an attack of gout in their great toe, they may not be able to get to the bathroom in time. So you don't start treating the incontinence by focusing on the bladder—you've got to treat the gout."

The same thing is true for most aging conditions, he notes. "Things are not always what they appear. A daughter may come in with her aging mother and say, ‘Momma's not doing as well as she used to.' And that could mean anything from bacterial sepsis to the loss of a best friend," Allman says.

"Physicians like complexity. They like puzzles. And there is no more complex puzzle than trying to help an older adult remain active and independent in the community."