The management of urinary incontinence in nursing homes: a scoping review

Abstract

The aim of the research was to identify interventions for the management of urinary incontinence (UI) in nursing homes. A scoping review was conducted with methods adapted from The Joanna Briggs Institute reviewers’ manual 2015 methodology for conducting scoping reviews and reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. Findings were synthesised without meta-analysis. Databases that were searched were MEDLINE, Embase, PsychINFO, CINAHL, JBI Evidence-Based Practice Database and the Cochrane Database of Systematic Reviews from 2010 to September 2021. The search was augmented with hand searching. A total of 3,885 records were located. After exclusions and screening of 370 full-text articles, 30 publications were included – seven systematic reviews, 15 randomised-controlled trials, seven quasi-experimental studies and one cohort study. Studies addressed toileting assistance programs, exercise programs, drug therapies, technology-based interventions, education programs and multi-component interventions. Multi-component interventions facilitated by specialist healthcare professionals offer the strongest evidence. Evidence about exercise programs was limited and inconsistent, as was evidence for anticholinergics. Transcutaneous posterior tibial nerve stimulation is unlikely to reduce rates of UI in nursing homes with residents with high rates of cognitive impairment. Further evidence is required on the use of telemonitoring systems. Education programs for staff that provide on-site support and competency-based learning, led by specialist healthcare professionals, improve staff knowledge, attitudes and compliance with assessments, toileting and documentation. Education about person-centred approaches is required to provide appropriate care for residents living with dementia. We conclude that a multicomponent approach led by a specialist such as a nurse with advanced clinical and leadership skills offers the most benefit. Nursing home policies and practices should focus on education programs for staff, with interventions that increase residents’ choice, activity level, nutritional status, hydration and toileting opportunities.