The effect of conservative non-pharmacological interventions on the management of urinary incontinence in older adults living with frailty: Systematic review and meta-analysis

Background: Urinary incontinence (UI) is highly prevalent among older adults with frailty, impacting function, quality of life and risk of long-term care admission. Objective: To systematically review and synthesise the results of randomised controlled trials (RCTs) investigating the effect of conservative non-pharmacological interventions on the management of UI in older adults aged ≥ 65 years living with frailty. Methods: Five databases (Cochrane Library, Medline (EBSCO), CINAHL (EBSCO), Embase (OVID), PsycINFO (EBSCO)) were searched from inception to April 2024 for RCTs that evaluated conservative non-pharmacological interventions for UI in older adults living with frailty. Two independent reviewers screened records, assessed methodological quality using the Cochrane Risk of Bias (RoB 2.0) Tool and Level of Evidence was summarised using GRADE guidelines. A meta-analysis using a random-effects model or narrative synthesis were performed as appropriate. Results: Twelve RCTs, including 1,580 participants, with medium to high risk of bias were included. Conservative non-pharmacological interventions (categorised as single component or multicomponent interventions) resulted in a non-statistically significant reduction of objective measures of UI (6 RCTs, g = -0.39, p = 0.090; pooled effect size, with CI = -0.39 [-0.832, 0.060], I2 = 85.26%, with very low certainty of evidence). Improvements in functional ability were not found to be statistically significant (5 RCTs, g = 0.20, p = 0.39, pooled effect size, with CI = 0.20 [- 0.251, 0.642], I2 = 85.87%, and very low certainty of evidence). The interventions did not result in adverse events. Studies did not evaluate caregiver quality of life. Conclusions: Very low-quality evidence found that conservative non-pharmacological interventions had beneficial but not statistically significant effects on objective UI and functional ability. Due to the high incidence of intervening illnesses and mortality in older adults living with frailty, it is recommended that future studies assess the effect of implementing tailored interventions addressing modifiable risk factors using more appropriate study design and outcome measures. Registration: This review was prospectively registered on the International Prospective Register of Systematic Reviews, PROSPERO (CRD42022316287; https://www.crd.york.ac.uk/prospero/).