Conservative interventions for incontinence in people with dementia or cognitive impairment, living at home: a systematic review

Abstract

BackgroundDementia is a distressing and disabling illness with worldwide estimates of increased numbers of people with the condition. Two thirds of people with dementia live at home and policies in many countries seek to support more people for longer in this setting. Incontinence both contributes to carer burden and is also a significant factor in the decision to move into care homes. A review was conducted for evidence of effectiveness for conservative interventions, which are non-pharmacological and non-surgical interventions, for the prevention or management of incontinence in community dwelling people with dementia.MethodFourteen electronic databases were searched, including MEDLINE, EMBASE and CINAHL (from inception to 2012). Assessments of risk of bias were made. Meta-analysis was inappropriate due to the heterogeneity of the interventions and outcome measurements. A narrative analysis was undertaken.ResultsFrom 427 identified abstracts, 56 studies were examined but only three met the inclusion criteria, all more than a decade old. All three focused on urinary incontinence. Two studies were exploratory or pilot studies. All had a control arm. The interventions were of advice for the carer to implement. Two included toileting education of prompted voiding or an individualised toileting schedule. There was insufficient evidence to support or rule out effectiveness of any of these interventions. Some interventions were unacceptable for some carers. None specifically reported the perspective of the person with dementia.ConclusionsThere was insufficient evidence from any studies to recommend any strategies. There remains an urgent need for both research and also clinical guidance for health professionals tailored to community settings where the majority of people with dementia live.

Managing Urinary Incontinence in Patients with Dementia: Pharmacological Treatment Options and Considerations

“…Even in adequately staffed institutions, evidence suggests that for those who need toileting, the average number of toilet assists per resident is around two per day, sadly short of that which might be needed [41,42]. A recent systematic review examining the evidence for conservative management approaches for those with dementia living at home concluded, unsurprisingly, that evidence was insufficient to make any recommendation; little, if any, specific guidance for practice in the community exists [43,44]. The NICE guideline on incontinence in those with neurological disease recommends that treatment be tried on an individual basis [45].…”

Interprofessional education in the care of people diagnosed with dementia and their carers: a systematic review

“…10 However, in most cases, the burden of caring for patients with dementia rests with the informal caregivers, for example, family and friends. [11][12][13] In the USA, for example, carers provide ∼80% of the care for people with Alzheimer's disease and other dementias.…”

Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM)

“…148 The study of individualised scheduled toileting presented statistics indicating a significant reduction in UI in the intervention arm 149 but on our re-analysis of the data provided this was not confirmed. 151 Using the intention-to-treat method the PV study found no statistical differences between groups on any UI outcome but noted there were clinically significant reductions in episodes of UI for some patients. 150 The results in full detail have been published previously.…”