ObjectivesThe primary objective of this cluster randomised controlled trial was to compare the effectiveness of the three experimental continence promotion interventions against a control intervention on urinary symptom improvement in older women with untreated incontinence recruited from community organisations. A second objective was to determine whether changes in incontinence-related knowledge and new uptake of risk-modifying behaviours explain these improvements.Setting71 community organisations across the UK.Participants259 women aged 60 years and older with untreated incontinence entered the trial; 88% completed the 3-month follow-up.InterventionsThe three active interventions consisted of a single 60 min group workshop on (1) continence education (20 clusters, 64 women); (2) evidence-based self-management (17 clusters, 70 women); or (3) combined continence education and self-management (17 clusters, 61 women). The control intervention was a single 60 min educational group workshop on memory loss, polypharmacy and osteoporosis (17 clusters, 64 women).Primary and secondary outcome measuresThe primary outcome was self-reported improvement in incontinence 3 months postintervention at the level of the individual. The secondary outcome was change in the International Consultation on Incontinence Questionnaire (ICIQ) from baseline to 3-month follow-up. Changes in incontinence-related knowledge and behaviours were also assessed.ResultsThe highest rate of urinary symptom improvement occurred in the combined intervention group (66% vs 11% of the control group, prevalence difference 55%, 95% CI 43% to 67%, intracluster correlation 0). 30% versus 6% of participants reported significant improvement respectively (prevalence difference 23%, 95% CI 10% to 36%, intracluster correlation 0). The number-needed-to-treat was 2 to achieve any improvement in incontinence symptoms, and 5 to attain significant improvement. Compared to controls, participants in the combined intervention reported an adjusted mean 2.05 point (95% CI 0.87 to 3.24) greater improvement on the ICIQ from baseline to 3-month follow-up. Changes in knowledge and self-reported risk-reduction behaviours paralleled rates of improvement in all intervention arms.ConclusionsContinence education combined with evidence-based self-management improves symptoms of incontinence among untreated older women. Community organisations represent an untapped vector for delivering effective continence promotion interventions.Trial registrationClinicalTrials.gov ID number NCT01239836.

Background The long-term effectiveness of group continence promotion delivered via community organisations on female urinary incontinence, falls and healthy life expectancy remains unknown. Methods A pragmatic cluster randomised trial was conducted among 909 women aged 65–98 years with urinary incontinence, recruited from 377 community organisations in the UK, Canada and France. A total of 184 organisations were randomised to an in-person 60-min incontinence self-management workshop (461 participants), and 193 to a control healthy ageing workshop (448 participants). The primary outcome was self-reported incontinence improvement at 1-year. Falls and gains in health utility were secondary outcomes. Results A total 751 women, mean age 78.0, age range 65–98 completed the trial (83%). At 1-year, 15% of the intervention group versus 6.9% of controls reported significant improvements in urinary symptoms, (difference 8.1%, 95% confidence intervals (CI) 4.0–12.1%, intracluster correlation 0.04, number-needed-to-treat 13) and 35% versus 19% reported any improvement (risk difference 16.0%, 95% CI 10.4–21.5, number-needed-to-treat 6). The proportion of fallers decreased from 42% to 36% in the intervention group (−8.0%, 95% CI −14.8 – −1.0) and from 44% to 34% in the control group (−10.3%, 95% CI −17.4 – −3.6), no difference between groups. Both intervention and control groups experienced a gain in health utility (0.022 points (95% CI 0.005–0.04) versus 0.035 (95% CI 0.017–0.052), respectively), with no significant difference between groups. Conclusion Community-based group continence promotion achieves long-term benefits on older women’s urinary symptoms, without improvement in falls or healthy life expectancy compared with participation in a healthy ageing workshop.

Stringent social restrictions imposed during 2020 to counter the spread of the COVID-19 pandemic could significantly affect the wellbeing and quality of life of people with dementia living in the community and their family carers. We explored the impact of COVID-19 restrictions on people with dementia and family carers in England and considered how negative effects might be mitigated. We conducted semi-structured telephone interviews with 11 people with dementia and 11 family carers who were ongoing participants in the IDEAL cohort during the initial ‘lockdown’ period in May and June 2020, and follow-up interviews with five people with dementia and two carers as restrictions were eased in July. We analysed interview data and triangulated the findings with issues raised in dementia-specific online forums. Findings showed some people with dementia were coping well, but others experienced a range of negative impacts, with varying degrees of improvement as restrictions were eased. The need for clear personalised information relating to COVID-19 and the value of support in the form of regular ‘just checking’ phone calls was emphasised. This exceptional situation provides a natural demonstration of how social and psychological resources shape the potential to ‘live well’ with dementia. While some support is recommended for all, a personalised approach to determine needs and coping ability would ensure that further practical and emotional support is targeted effectively.

Abstract:Purpose: We evaluated the performance of the smart underwear in detecting urine leakage from continence pads, their acceptability to users, and their effect on health related quality of life and psychosocial factors. Design: Prototype product evaluation. Subjects and Setting: Participants (females; pilot study: 8; mean age 62 years: main study 72; mean age 67 years)were recruited between October 2010 and February 2012 from out-patient clinics, GP surgeries, community Continence Services and through charities and networks. Methods: The Tact 3 project developed and manufactured prototype smart underwear designed to alert the wearer to a pad leak before it reached outer clothing or furniture.The clinical study was conducted in 2 stages: a pilot/feasibility study to assess general performance and acceptability of the smart underwear and a larger study to measure its performance, acceptability to users, health related quality of life and psychosocial impact. Participants were asked to wear the smart underwear for a period of two weeks, keeping a daily diary of leakage events for the first seven days. Health related quality of life questionnaires were completed before and after the trial period, and evaluation and psychosocial impact questionnaires completed at the end. Results: On average, 86% of the time participants were alerted to pad leakage events, and over 90% of participants thought the smart underwear to be "good" or "OK" and that it would or could give them more confidence. No symptom changes were recorded using the International Consultation on Incontinence Questionnaire -Urinary Incontinence Short Form; a significant difference was found in ability to travel using the International Consultation on Incontinence Questionnaire -Lower Urinary Tract Symptoms quality of life measure. The smart underwear were found to have a positive psychosocial impact using the self-reported PIADS tool. Conclusion: The smart underwear is an effective device in alerting pad wearers to leakage before it is visible to others, and is acceptable to users. Modifications are required to make the device suitable for a wider population of pad wearers who fear pad leakage.