JAGS 50:733–737, 2002 © 2002 by the American Geriatrics Society 0002-8614/02/$15.00 Informal Caregiving Time and Costs for Urinary Incontinence in Older Individuals in the United States Kenneth M. Langa, MD, PhD,* †‡# Nancy H. Fultz, PhD, ‡ Sanjay Saint, MD, MPH,* †# Mohammed U. Kabeto, MS, § and A. Regula Herzog, PhD ‡¶ OBJECTIVES: To obtain nationally representative esti- mates of the additional time, and related cost, of informal caregiving associated with urinary incontinence in older individuals. DESIGN: Multivariate regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people aged 70 and older (N = 7,443). SETTING: Community-dwelling older people. PARTICIPANTS: National population-based sample of community-dwelling older people. MEASUREMENTS: Weekly hours of informal caregiv- ing, and imputed cost of caregiver time, for community- dwelling older people who reported (1) no unintended urine loss, (2) incontinence that did not require the use of absorbent pads, and (3) incontinence that required the use of absorbent pads. RESULTS: Thirteen percent of men and 24% of women reported incontinence. After adjusting for sociodemo- graphics, living situation, and comorbidities, continent men received 7.4 hours per week of care, incontinent men who did not use pads received 11.3 hours, and incontinent men who used pads received 16.6 hours ( P  .001). Women in these groups received 5.9, 7.6, and 10.7 hours ( P  .001), respectively. The additional yearly cost of in- formal care associated with incontinence was $1,700 and $4,000 for incontinent men who did not and did use pads, respectively, whereas, for women in these groups, the ad- ditional yearly cost was $700 and $2,000. Overall, this represents a national annual cost of more than $6 billion for incontinence-related informal care. CONCLUSIONS: The quantity of informal caregiving for older people with incontinence and its associated eco- nomic cost are substantial. Future analyses of the costs of incontinence, and the cost-effectiveness of interventions to prevent or treat incontinence, should consider the signifi- cant informal caregiving costs associated with this condi- tion. J Am Geriatr Soc 50:733–737, 2002. Key words: urinary incontinence; older; disability; infor- mal caregiving; cost of illness U nintended urine loss is a common symptom among older adults. Between 20% and 30% of older com- munity residents 1–3 and at least 40% of nursing home residents 4,5 are incontinent of urine. Overall, this condition may affect up to 10 million people in the United States. Urinary incontinence is associated with physical and be- havioral factors that can impair the quality of a person’s life. 6 Specifically, this common disorder can lead to psy- chological distress, 7 disrupted social relationships, 8 skin breakdown, urinary tract infection, 9 frequent hospitaliza- tions, 10 and nursing home admission. 10 Furthermore, indi- viduals are often embarrassed and frustrated by their in- continence. The economic costs of urinary incontinence are sub- stantial. The direct medical costs for urinary incontinence have recently been estimated at over $25 billion, or ap- proximately $3,500 per incontinent person per year. 11 In the nursing home, urinary incontinence accounts for 3% to 8% of total costs, 12 with the average nursing time spent managing a patient’s urinary incontinence being nearly 1 hour per day. 13 The time and associated cost of informal (unpaid) care- giving for urinary incontinence have not been well de- scribed or consistently accounted for in prior studies. 11,14 Because several interventions aimed at better managing patients with urinary incontinence are time or resource in- From the *Division of General Medicine Department of Medicine, Univer- sity of Michigan Medical School, Ann Arbor, Michigan; † Department of Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, Michigan; ‡ Institute for Social Research, § Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies,  Department of Psychology, and ¶ Institute of Gerontology, University of Michigan, Ann Arbor, Michigan; and # Patient Safety Enhancement Program, University of Michigan Health System, Ann Arbor, Michigan. The National Institute on Aging provided funding for the Asset and Health Dynamics Study (No. U01 AG09740), data from which were used in this analysis. Address correspondence to Kenneth M. Langa, MD, PhD, Division of General Medicine, University of Michigan Health System, 300 North Ingalls Building, Room 7E01, Box 0429, Ann Arbor, Michigan 48109. E-mail: klanga@umich.edu