Optimizing care for LUTS in older patients: Diagnostics, challenges of frailty and patient priorities—NOPIA meeting (ICI-RS 2024)

As the global population ages, the prevalence of lower urinary tract symptoms (LUTS) in older adults is increasing, with frailty adding complexity to this challenge. There is a recognized paucity of data addressing LUTS in older adults with frailty.

This literature review, summarizing insights from a panel of experts at the 2024 NOPIA — Nocturia and Polyuria research group meeting at the International Consultation on Incontinence-Research Society (ICI-RS) congress in Bristol, addresses the need to optimize care for LUTS in older adults by refining diagnostics, adapting approaches for frail patients, considering patient priorities and identify indicators and predictors for LUTS.

The concept of lifelong LUTS underscores the persistence of urinary dysfunction across life stages, highlighting the importance of distinguishing age-related changes from pathology for accurate diagnosis. Due to age-related physiological changes, comorbidities, and cognitive decline, traditional diagnostics like frequency-volume charts may be challenging, emphasizing the value of a holistic, patient-centered approach. Treatments in frail populations require caution, as common medications can pose increased risks, often lacking safety data for this group, emphasizing the need for tailored approaches. Recognizing predictors and indicators of LUTS helps to prevent complications, understand progression and to aid in early intervention. Key patient priorities include effective symptom relief, low-risk management, and clear communication, with a strong preference for shared decision-making to accommodate individual needs, considering possible health illiteracy.

In conclusion, managing LUTS in older, frail adults requires a comprehensive approach that includes improving diagnostics, recognizing frailty’s impact, and aligning treatment with patient expectations. Future research should develop frailty-specific strategies to enhance quality of life, while a multidisciplinary, patient-centered approach can better address the complex needs of this population.