Systematic review of care intervention studies for the management of incontinence and promotion of continence in older people in care homes with urinary incontinence as the primary focus (1966-2010).

The aim of this paper was to compare published studies of care interventions for the management and promotion of continence, with urinary incontinence as the primary focus, in older care home residents. Incontinence is a prevalent and serious problem amongst older people in care homes, with an increasing international focus. MEDLINE and CINAHL searches via OVID (January 1966 to May 2010) were carried out, with studies limited to English language publications only. Included in this search were studies investigating urinary and fecal incontinence in people aged 65 years or older in care homes. Studies on surgical or pharmacological interventions or fecal incontinence alone were excluded. A total of 33 interventional studies were identified. Toileting programs and incontinence pads are the mainstays of treatment, with some studies implying significant economic and labor costs. Drug therapy as an adjunct to toileting programs has so far shown only moderate benefits. Combined physical therapy/behavioral therapies have shown effective short-term improvements. Adaptations to physical environment and staff training techniques might also be paramount. Exercise and Functional Incidental Training programs, although expensive, might provide additional benefit by reducing wetness rates and improving appropriate toileting rates. Combined complex behavioral interventions are now a common feature and their effectiveness for the management of urinary incontinence should be determined in future studies. Studies including long-term effectiveness on maintaining continence with full economic evaluation are also warranted in this population.