Comorbidity and Underlying Medical Disease

  • Camille P. VaughanEmail author
  • Theodore M. JohnsonII


Because the number of adults over the age of 65 in the USA will double in the coming years, the proportion of geriatric patients who seek urologic care will continue to grow. In addition to age-related changes to the lower urinary tract, more than half of older adults have more than one comorbid medical condition. Cardiovascular, metabolic, and neurologic diseases are the most common medical conditions which are also frequently associated with urological conditions. Careful consideration of comorbidity, in addition to other factors such as polypharmacy, cognition, and functional status, helps to reduce the potential for adverse events related to surgical interventions and pharmacologic therapies. Coordination of care within the context of a multidisciplinary team for certain patients with urologic symptoms may provide additional benefit. This chapter will explore how comorbid disease impacts the care of older adults with urologic conditions and will provide practical considerations for maximizing symptom relief while reducing the potential for adverse events.


Obstructive Sleep Apnea Urinary Incontinence Erectile Dysfunction Stress Urinary Incontinence Parkinson Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Tinetti ME, Kumar C. The patient who falls. JAMA. 2010;303(3):258–66.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Ginger VAT, Yang CC. The diagnosis and treatment of patients with neurologic dysfunction of the urinary bladder. In: Low PA, Benarroch EE, editors. Clinical autonomic diseases. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008.Google Scholar
  3. 3.
    Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The Mini-Cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15(11):1021–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Department of Health and Human Services, Administration on Aging Projected Future Growth of the Older Population. Accessed 13 Apr 2012.
  5. 5.
    Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162(20):2269–76.PubMedCrossRefGoogle Scholar
  6. 6.
    American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Guiding Principles for the Care of Older Adults with Multimorbidity: An Approach for Clinicians. J Am Geriatr Soc. 2012;60:E1–E25.Google Scholar
  7. 7.
    Hung W, Ross J, Boockvar K, Siu A. Recent trends in chronic disease, impairment and disability among older adults in the United States. BMC Geriatr. 2011;11(1):47.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Burgio KL, Johnson 2nd TM, Goode PS, et al. Prevalence and correlates of nocturia in community-dwelling older adults. J Am Geriatr Soc. 2010;58(5):861–6.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Johnson TM, Sattin RW, Parmelee P, Fultz NH, Ouslander JG. Evaluating potentially modifiable risk factors for prevalent and incident nocturia in older adults. J Am Geriatr Soc. 2005;53(6):1011–6.PubMedCrossRefGoogle Scholar
  10. 10.
    McKeigue PM, Reynard JM. Relation of nocturnal polyuria of the elderly to essential hypertension. Lancet. 2000;355(9202):486–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Goldman N, Lin IF, Weinstein M, Lin Y-H. Evaluating the quality of self-reports of hypertension and diabetes. J Clin Epidemiol. 2003;56(2):148–54.PubMedCrossRefGoogle Scholar
  12. 12.
    Vaughan CP, Endeshaw Y, Nagamia Z, Ouslander JG, Johnson TM. A multicomponent behavioural and drug intervention for nocturia in elderly men: rationale and pilot results. BJU Int. 2009;104(1):69–74.PubMedCrossRefGoogle Scholar
  13. 13.
    Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358(18):1887–98.PubMedCrossRefGoogle Scholar
  14. 14.
    Oates DJ, Berlowitz DR, Glickman ME, Silliman RA, Borzecki AM. Blood pressure and survival in the oldest old. J Am Geriatr Soc. 2007;55(3):383–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Mukai S, Gagnon M, Iloputaife I, Hamner JW, Lipsitz LA. Effect of systolic blood pressure and carotid stiffness on baroreflex gain in elderly subjects. J Gerontol Biol Sci Med Sci. 2003;58(7):M626–30.CrossRefGoogle Scholar
  16. 16.
    James MA, Potter JF. Orthostatic blood pressure changes and arterial baroreflex sensitivity in elderly subjects. Age Ageing. 1999;28(6):522–30.PubMedCrossRefGoogle Scholar
  17. 17.
    American Geriatrics Society, British Geriatrics Society. Clinical practice guidelines: prevention of falls in older persons. J Am Geriatr Soc. 2011;59:148–57.Google Scholar
  18. 18.
    Fine SR, Ginsberg P. Alpha-adrenergic receptor antagonists in older patients with benign prostatic hyperplasia: issues and potential complications. J Am Osteopath Assoc. 2008;108(7):333–7.PubMedGoogle Scholar
  19. 19.
    Dhaliwal AS, Habib G, Deswal A, et al. Impact of alpha 1-adrenergic antagonist use for benign prostatic hypertrophy on outcomes in patients with heart failure. Am J Cardiol. 2009;104(2):270–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Ekundayo OJ, Markland A, Lefante C, et al. Association of diuretic use and overactive bladder syndrome in older adults: a propensity score analysis. Arch Gerontol Geriatr. 2008;49(1):64–8.PubMedCentralPubMedGoogle Scholar
  21. 21.
    Ouslander JG. Management of overactive bladder. N Engl J Med. 2004;350(8):786–99.PubMedCrossRefGoogle Scholar
  22. 22.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–41.PubMedCrossRefGoogle Scholar
  23. 23.
    FitzGerald MP, Mulligan M, Parthasarathy S. Nocturic frequency is related to severity of obstructive sleep apnea, improves with continuous positive airways treatment. Am J Obstet Gynecol. 2006;194(5):1399–403.PubMedCrossRefGoogle Scholar
  24. 24.
    Hajduk I, Strollo PJ, Jasani R, Atwood CJ, Houck P, Sanders M. Prevalence and predictors of nocturia in obstructive sleep apnea-hypopnea syndrome - a retrospective study. Sleep. 2003;26(1):61–4.PubMedGoogle Scholar
  25. 25.
    Parsons JK, Sarma AV, McVary K, Wei JT. Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions. J Urol. 2009;182(6 Suppl):S27–31.PubMedCrossRefGoogle Scholar
  26. 26.
    Subak LL, Wing R, West DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360(5):481–90.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Burgio KL, Richter HE, Clements RH, Redden DT, Goode PS. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol. 2007;110(5):1034–40.PubMedCrossRefGoogle Scholar
  28. 28.
    Lawrence JM, Lukacz ES, Liu I-LA, Nager CW, Luber KM. Pelvic floor disorders, diabetes, and obesity in women. Diabetes Care. 2007;30(10):2536–3541.PubMedCrossRefGoogle Scholar
  29. 29.
    Brown JS, Vittinghoff E, Lin F, Nyberg LM, Kusek JW, Kanaya AM. Prevalence and risk factors for urinary incontinence in women with type 2 diabetes and impaired fasting glucose. Diabetes Care. 2006;29(6):1307–12.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Kaplan SA, Te AE, Blaivas JG, McGuire EJ. Urodynamic findings in patients with diabetic cystopathy. J Urol. 1995;153(2):342–4.PubMedGoogle Scholar
  31. 31.
    Zhanel GG, Nicolle LE, Harding GKM, The Manitoba Diabetic Urinary Infection Study Group. Prevalence of asymptomatic bacteriuria and associated host factors in women with diabetes mellitus. Clin Infect Dis. 1995;21(2):316–22.PubMedCrossRefGoogle Scholar
  32. 32.
    Boyko EJ, Fihn SD, Scholes D, Chen C-L, Normand EH, Yarbro P. Diabetes and the risk of acute urinary tract infection among postmenopausal women. Diabetes Care. 2002;25(10):1778–83.PubMedCrossRefGoogle Scholar
  33. 33.
    Romeo JH, Seftel AD, Madhun ZT, Aron DC. Sexual function in men with diabetes type 2: association with glycemic control. J Urol. 2000;163(3):788–91.PubMedGoogle Scholar
  34. 34.
    Jackson RAM, Vittinghoff EP, Kanaya AMM, et al. Urinary incontinence in elderly women: findings from the Health, Aging, and Body Composition Study. Obstet Gynecol. 2004;104(2):301–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Phelan S, Kanaya AM, Subak LL, et al. Prevalence and risk factors for urinary incontinence in overweight and obese diabetic women: action for health in diabetes (Look Ahead) study. Diabetes Care. 2009;32(8):1391–7.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Brown JS, Wing R, Barrett-Connor E, et al. Lifestyle intervention is associated with lower prevalence of urinary incontinence. Diabetes Care. 2006;29(2):385–90.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Klein R, Klein BEK, Moss SE. Ten-year incidence of self-reported erectile dysfunction in people with long-term type 1 diabetes. J Diabetes Complications. 2005;19(1):35–41.PubMedCrossRefGoogle Scholar
  38. 38.
    Wessells H, Penson DF, Cleary P, et al. Effect of intensive glycemic therapy on erectile function in men with type 1 diabetes. J Urol. 2011;185(5):1828–34.PubMedCentralPubMedGoogle Scholar
  39. 39.
    Brown JS, Wessells H, Chancellor MB, et al. Urologic complications of diabetes. Diabetes Care. 2005;28(1):177–85.PubMedCrossRefGoogle Scholar
  40. 40.
    Sakakibara R, Hattori T, Yasuda K, Yamanishi T. Micturitional disturbance after acute hemispheric stroke: analysis of the lesion site by CT and MRI. J Neurol Sci. 1996;137(1):47–56.PubMedCrossRefGoogle Scholar
  41. 41.
    Pettersen R, Stien R, Wyller TB. Post-stroke urinary incontinence with impaired awareness of the need to void: clinical and urodynamic features. BJU Int. 2007;99(5):1073–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Kuchel GA, Moscufo N, Guttmann CR, et al. Localization of brain white matter hyperintensities and urinary incontinence in community-dwelling older adults. J Gerontol Biol Sci Med Sci. 2009;64A(8):902–9.CrossRefGoogle Scholar
  43. 43.
    Fowler CJ, Dalton C, Panicker JN. Review of neurologic diseases for the urologist. Urol Clin North Am. 2010;37(4):517–26.PubMedCrossRefGoogle Scholar
  44. 44.
    Patel M, Coshall C, Rudd AG, Wolfe CDA. Natural history and effects on 2-year outcomes of urinary incontinence after stroke. Stroke. 2001;32(1):122–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Thomas L, Cross S, Barrett J, et al. Treatment of urinary incontinence after stroke in adults. Cochrane Database Syst Rev. 2008;1(CD004462).Google Scholar
  46. 46.
    Wikander B, Ekelund P, Milsom I. An evaluation of multidisciplinary intervention governed by functional independence measure (FIM SM) in incontinent stroke patients. Scand J Rehabil Med. 1998;30(1):15–21.PubMedCrossRefGoogle Scholar
  47. 47.
    Joseph C, Chassan JB, Koch M-L. Levodopa in Parkinson disease: a long-term appraisal of mortality. Ann Neurol. 1978;3(2):116–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Gallagher DA, Lees AJ, Schrag A. What are the most important nonmotor symptoms in patients with Parkinson’s disease and are we missing them? Mov Disord. 2010;25:2493–500.PubMedCrossRefGoogle Scholar
  49. 49.
    Winge K, Skau A-M, Stimpel H, Nielsen KK, Werdelin L. Prevalence of bladder dysfunction in Parkinsons disease. Neurourol Urodyn. 2006;25(2):116–22.PubMedCrossRefGoogle Scholar
  50. 50.
    Campos-Sousa RN, Quagliato E, da Silva BB, de Carvalho RM, Jr Ribeiro SC, de Carvalho DFM. Urinary symptoms in Parkinson’s disease: prevalence and associated factors. Arq Neuropsiquiatr. 2003;61(2B):359–63.PubMedCrossRefGoogle Scholar
  51. 51.
    Brusa L, Petta F, Pisani A, et al. Acute vs chronic effects of l-dopa on bladder function in patients with mild Parkinson disease. Neurology. 2007;68(18):1455–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Uchiyama T, Sakakibara R, Hattori T, Yamanishi T. Short-term effect of a single levodopa dose on micturition disturbance in Parkinson’s disease patients with the wearing-off phenomenon. Mov Disord. 2003;18(5):573–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Zesiewicz TA, Sullivan KL, Arnulf I, et al. Practice parameter: treatment of nonmotor symptoms of Parkinson disease: report of the quality standards subcommittee of the American Academy of Neurology. Neurology. 2010;74(11):924–31.PubMedCrossRefGoogle Scholar
  54. 54.
    Vaughan CP, Juncos JL, Burgio KL, Goode PS, Wolf RA, Johnson 2nd TM. Behavioral therapy to treat urinary incontinence in Parkinson disease. Neurology. 2011;76(19):1631–4.PubMedCrossRefGoogle Scholar
  55. 55.
    Aarsland D, Kurz MW. The epidemiology of dementia associated with Parkinson disease. J Neurol Sci. 2010;289(1–2):18–22.PubMedCrossRefGoogle Scholar
  56. 56.
    Ehrt U, Broich K, Larsen JP, Ballard C, Aarsland D. Use of drugs with anticholinergic effect and impact on cognition in Parkinson’s disease: a cohort study. J Neurol Neurosurg Psychiatry. 2010;81(2):160–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Balash Y, Peretz C, Leibovich G, Herman T, Hausdorff JM, Giladi N. Falls in outpatients with Parkinson’s disease: frequency, impact and identifying factors. J Neurol. 2005;252(11):1310–5.PubMedCrossRefGoogle Scholar
  58. 58.
    Roth B, Studer UE, Fowler CJ, Kessler TM. Benign prostatic obstruction and Parkinson’s disease—should transurethral resection of the prostate be avoided? J Urol. 2009;181(5):2209–13.PubMedGoogle Scholar
  59. 59.
    Winge K, Fowler CJ. Bladder dysfunction in Parkinsonism: mechanisms, prevalence, symptoms, and management. Mov Disord. 2006;21(6):737–45.PubMedCrossRefGoogle Scholar
  60. 60.
    Khan F, Pallant JF, Pallant JI, Brand C, Kilpatrick TJ. A randomised controlled trial: outcomes of bladder rehabilitation in persons with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2010;81(9):1033–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Veterans AffairsBirmingham/Atlanta Geriatric Research Education and Clinical CenterAtlantaUSA
  2. 2.Division of General Medicine and GeriatricsEmory University School of MedicineAtlantaUSA
  3. 3.Atlanta VA Medical CenterDecaturUSA
  4. 4.Emory Division of General Medicine and Geriatrics, Department of MedicineAtlanta VA Medical CenterDecaturUSA

Personalised recommendations