Physiotherapeutic care for urinary incontinence in the context of age, sex, care situation, and informal provider networks – A longitudinal German claims data analysis

Background

Urinary incontinence affects 5% to 35% of the older adult population. Untreated urinary incontinence is associated with reduced quality of life, amongst others. Pelvic floor muscle training is the first-line treatment. Existing evidence on the proportion of physiotherapy care remains limited, particularly regarding men with urinary incontinence, and insufficiently accounts for care situation- or age-specific disparities. This study investigated the proportion of physiotherapy care, differentiated by age, sex, care situation, informal provider networks, and temporal trends, to address these evidence gaps.

Method

We analysed health insurance fund claims data covering a period of 9 years (2008–2016), from up to 6,433,070 individuals aged 65+, and applied a network approach to identify patient sharing networks. We calculated the proportion of physiotherapy care on a quarterly basis.

Results

The proportion of physiotherapy care remained relatively stable over time. In the first quarter of 2016, it was 10.5% for people with incident urinary incontinence in total, 7.9% for those without care, 11.9% for people with home care, and 14.0% for nursing home residents. The lowest proportion of physiotherapy care (3.5%) was found among men with incident urinary incontinence in the 85 to 89 age group receiving no care, and the highest proportion (19.3%) among women with incident urinary incontinence in the age group 70 to 74 years living in a nursing home. The variation in the proportion of physiotherapy care between patient sharing networks was the highest for women and men in nursing homes (SD 9.7% and 9.2%, respectively).

Conclusions

These findings indicate a systematic underuse of physiotherapy services for both sexes across all age groups and care situations. Older men without care needs are particularly at risk for underuse.