Study design, materials and methods
A scoping review with methods adapted from the Joanna Briggs Institute Methodology for JBI Scoping Reviews (2015). Electronic databases (MEDLINE, EMBASE, PsychINFO, CINAHL, JBI Evidence-Based Practice Database, and The Cochrane Database of Systematic Reviews) were searched from 2010 to September 2021. Search results were supplemented by scanning the references of relevant reviews. Three reviewers independently screened the titles and abstracts of all identified sources, while five reviewers completed a full-text review of the remaining material and abstracted data from the relevant studies.
Results
A total of 3,885 records were located through the database search and one additional study was found through citations. After exclusions and screening of 370 full-text articles, 30 publications about interventions in this setting were included in the final analysis: 7 systematic reviews, 15 randomised-controlled trials, and 8 quasi-experimental studies.
Interventions evaluated included: toileting assistance programs, physical activity and functional training, drug therapies, technology-based interventions, staff education/training, and multi-component interventions for the management of urinary incontinence in nursing homes. Two randomised controlled trials and one quasi-experimental study demonstrated support for prompted voiding. Despite strong association between functional status and incontinence in nursing home residents, evidence for interventions to reduce rates of urinary incontinence through exercise programs was limited and inconsistent. Evidence for anticholinergics in this population was also inconsistent, with concerns expressed about an increased risk of adverse effects (i.e. dry mouth, constipation, hip fractures and decline in cognitive performance). Two studies offered evidence for use of technology-based interventions, namely (i) a telemonitoring system to detect the onset of wetness episodes and transcutaneous posterior tibial nerve stimulation.
Eleven studies evaluated interventions to improve staff knowledge, attitudes or practice, including 7 randomised controlled trials and 4 quasi-experimental studies. As outcomes differed between studies, the effects of education/training were unable to be pooled. Education/training was delivered either directly or indirectly. In general, where nursing home staff received direct education/training, there were improvements in continence outcomes such as reductions in urinary leakage, improvements in residents’ quality of life, staff knowledge and attitudes, and increased staff compliance with assessments, toileting and documentation. In studies where training was indirect, evidence was inconsistent.
Multi-component interventions such as physical activity combined with prompted voiding and increases in food and fluid intake facilitated by one or more specialist healthcare professional produced improvements in urinary incontinence in nursing home residents.
Interpretation of results
Further research should focus on multi-component interventions that aim to maintain or improve nursing home residents’ functional status and reduce their care dependence. Improvements in staff knowledge, attitudes and continence care practices in nursing homes are possible, particularly when led by specialist healthcare professionals. Direct forms of education for nursing home staff about urinary incontinence and its management appear more effective than passive learning approaches. The use of anticholinergics for urinary incontinence in frail older adults should be approached cautiously due to adverse effects.