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

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

Method: Fourteen 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.

Results: From 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.

Conclusions: There 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.
dementia, cognitive impairment, incontinence, community dwelling, review, carer/caregiver
1471-2318
1-10
Drennan, Vari M.
373625b0-3e73-48f7-bfd4-034ddcef4f32
Greenwood, Nan
2f837458-acac-4c95-b401-0c98c8d306cc
Cole, Laura
0ae5beea-1fc2-45f1-952b-0e9ba1eb3ece
Fader, Mandy
c318f942-2ddb-462a-9183-8b678faf7277
Grant, Robert
59eea914-af4f-447e-a68a-4293e4c82244
Rait, Greta
3e94907b-5910-4e73-bb85-54f306109da1
Iliffe, Steve
3608ad54-c5c6-44c3-8ea8-011412b6c78d
Drennan, Vari M.
373625b0-3e73-48f7-bfd4-034ddcef4f32
Greenwood, Nan
2f837458-acac-4c95-b401-0c98c8d306cc
Cole, Laura
0ae5beea-1fc2-45f1-952b-0e9ba1eb3ece
Fader, Mandy
c318f942-2ddb-462a-9183-8b678faf7277
Grant, Robert
59eea914-af4f-447e-a68a-4293e4c82244
Rait, Greta
3e94907b-5910-4e73-bb85-54f306109da1
Iliffe, Steve
3608ad54-c5c6-44c3-8ea8-011412b6c78d

Drennan, Vari M., Greenwood, Nan, Cole, Laura, Fader, Mandy, Grant, Robert, Rait, Greta and Iliffe, Steve (2012) Conservative interventions for incontinence in people with dementia or cognitive impairment, living at home: a systematic review. BMC Geriatrics, 12 (77), 1-10. (doi:10.1186/1471-2318-12-77). (PMID:23272951)

Record type: Article

Abstract

Background: Dementia 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.

Method: Fourteen 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.

Results: From 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.

Conclusions: There 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.

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Accepted/In Press date: 12 December 2012
Published date: 28 December 2012
Keywords: dementia, cognitive impairment, incontinence, community dwelling, review, carer/caregiver
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 385770
URI: http://eprints.soton.ac.uk/id/eprint/385770
ISSN: 1471-2318
PURE UUID: 1ab37de3-91cc-4d5e-9123-23094e293a29

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Date deposited: 22 Jan 2016 10:35
Last modified: 14 Mar 2024 22:22

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Contributors

Author: Vari M. Drennan
Author: Nan Greenwood
Author: Laura Cole
Author: Mandy Fader
Author: Robert Grant
Author: Greta Rait
Author: Steve Iliffe

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