American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of therapy is recommended to reduce urinary incontinence in older patients with dementia?

1. Medications only

2. Behavioral therapy utilizing prompted voiding

3. Surgical intervention

4. Biofeedback therapy

The correct answer is: Behavioral therapy utilizing prompted voiding

Behavioral therapy utilizing prompted voiding is highly recommended for reducing urinary incontinence in older patients with dementia due to its effectiveness in this population. This method involves regular scheduled prompts for the patient to void, which helps to retrain the bladder and increase awareness of the need to urinate, ultimately leading to a decrease in incontinence episodes. It considers the cognitive limitations often present in patients with dementia, allowing for a structured approach that does not rely solely on the patient's ability to self-report. In contrast, medications might not address the underlying issues related to cognitive impairment in these patients and could have potential side effects that complicate their care. Surgical interventions are typically reserved for cases where other treatments have failed and would not be suitable as a first-line approach, especially considering the potential risks involved in older populations. Biofeedback therapy, while beneficial in some contexts, may not be as effective in patients with dementia due to their compromised ability to engage with the feedback or understand the process. Therefore, prompted voiding emerges as the most practical and effective intervention for enhancing bladder control in this specific demographic.