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Male urinary incontinence (UI) is most prevalent in older men, with one in three men aged 65 and above having problems maintaining continence. Addressing health inequalities, male-female disparities in continence services, and low health-seeking among men emphasizes the necessity for co-creating an intervention that empowers them to self-manage their UI. We aim to co-create a self-management intervention with an older men and Health care provider (HCP) group and assess its usability and/or acceptability among older men with UI. The intervention mapping (IM) framework, a co-creation strategy, will be used to co-create a self-management tool, followed by usability and/or acceptability testing. The study will be guided by the first four IM steps: the logic model of the problem, the logic model of change, program/intervention design, and program/intervention production, followed by preliminary testing. A participatory group of older men with UI recruited from an existing group of patient partners, and continence care experts will be involved in all steps of the IM process. Usability and/or acceptability testing will be conducted on a sample of 20 users recruited through seniors’ associations and retirement living facilities. After accessing the self-management tool for a week, participants will complete a product usability testing scale (aka System Usability Scale-SUS) and/or an acceptability test, depending on the preferred mode(s) of intervention delivery. Data will be analyzed using descriptive statistics. A benchmark overall mean usability score of 70 represents a good/usable product, based on the large database of SUS scores.

Urinary incontinence (UI), characterized by involuntary urine leakage is a chronic, embarrassing and stigmatizing condition that is under-reported and under-treated). UI is under-prioritized and under-researched, particularly in older men (defined here as men 65+), and there have been calls for more targeted research focusing on this specific group. No existing self-management interventions focus on the needs of older men and none incorporate the perspectives of older men into their development. Furthermore, health inequalities and disparities in continence services for men, and a low level of health seeking behavior in men with UI make it crucial to incorporate their perspectives into intervention development to ensure optimal outcomes. The study will identify risk factors for UI that are potentially amenable to self-management in older men, assess their self-efficacy in managing UI, and determine what modifiable risk factors older men feel are pragmatic to include as part of a self-management program. We will conduct and report a sequential multi-method design consisting of a Delphi study among healthcare experts and a survey among older men with UI, according to the Guidance on Conducting and Reporting Delphi Studies (CREDES) Checklist and the Checklist for Reporting Of Survey Studies (CROSS). A geographically dispersed, multidisciplinary group of 30 health care professionals (urologists, geriatricians, family physicians, and nurses) involved in continence care and a representative sample of at least 128 ethnically diverse older men will participate in a Delphi survey and an older men’s survey respectively. The healthcare experts will evaluate an evidence-synthesized list of UI risk factors to determine those potentially amenable to self-management. Delphi rounds will be repeated until consensus threshold of 75% is reached. Thereafter, older men recruited via stratified sampling of population subgroups will rate a list of expert-identified potentially modifiable risk factors to indicate which factors they deem practicable and can prioritize. Older men’s survey questionnaires will capture information on patients’ characteristics (socio-demographics and UI-related items). The Geriatric Self-Efficacy Index for UI (GSE-UI Index) as well as a Likert scale to assess perceived capability and willingness to modify the expert-identified UI modifiable risk factors will be included. Data will be analyzed quantitatively and qualitatively.

The aim of this study was first, to introduce a comprehensive, de-novo health economic (HE) model incorporating the full range of activities involved in toileting and containment care (T&CC) for people with incontinence, capturing all the potential benefits and costs of existing and future Digital Health Technologies (DHT) aimed at improving continence care, for both residential care and home care. Second, to use this novel model to evaluate the cost-effectiveness of the DHT TENA SmartCare Identifi in the implementation of person-centred continence care (PCCC), compared with conventional continence care for Canadian nursing home residents. The de-novo HE model was designed to evaluate technologies across different care settings from the perspective of several stakeholders. Health states were based on six care need profiles with increasing need for toileting assistance, three care stages with varying degrees of toileting success, and five levels of skin health. The main outcomes were incremental costs and quality-adjusted life years. The effectiveness of the TENA SmartCare Identifi was based primarily on trial data combined with literature and expert opinion where necessary. Costs were reported in CAD 2020. After 2 years, 21% of residents in the DHT group received mainly toileting as their continence care strategy compared with 12% in the conventional care group. Conversely, with the DHT 15% of residents rely mainly on absorbent products for incontinence care, compared with 40% with conventional care. On average, residents lived for 2.34 years, during which the DHT resulted in a small gain in quality-adjusted life years of 0.015 and overall cost-savings of $1,467 per resident compared with conventional care. Most cost-savings were achieved through reduced costs for absorbent products. Since most, if not all, stakeholders gain from use of the DHT-assisted PCCC, widespread use in Canadian residential care facilities should be considered, and similar assessments for other countries encouraged.

There is a well-recognised but unexplained association between lower urinary tract symptoms including urgency and urgency incontinence and falls in older people. It has been hypothesised that urinary urgency acts as a source of divided attention, leading to gait changes which increase falls risk. This study aimed to assess whether urinary urgency acts as a source of divided attention in older adults with overactive bladder (OAB). 27 community-dwelling adults aged 65 years and over with a clinical diagnosis of OAB underwent 3-Dimensional Instrumented Gait Analysis under three conditions; bladder empty, when experiencing urgency, and when being distracted by the n-back test. Temporal-spatial gait and kinematic gait data were compared between each condition using repeated measures ANOVA. Gait velocity decreased from 1.1ms-1 in the bladder empty condition to 1.0ms-1 with urgency and 0.9ms-1 with distraction (p = 0.008 and p<0.001 respectively). Stride length also decreased, from 1.2m to 1.1m with urgency and 1.0m with distraction (p<0.001 for both). The presence of detrusor overactivity did not influence these results (p = 0.77). In older adults with OAB, urinary urgency induced similar changes in gait to those caused by a distracting task. These gait changes are associated with increased fall risk. This may be part of the explanation for the association between falls and lower urinary tract symptoms in older people. Future research should examine the effect of pharmacological treatment of OAB on gait and on the effect of dual-task training on gait when experiencing urgency.

IntroductionUrinary incontinence is associated with social isolation, deconditioning, depression, falls and early mortality. It impairs quality of life, even in residents of nursing homes, and, in the community, increases the risk of institutionalisation. Care focused on the preservation of dignity during intimate care is important in the care of older adults. Despite this, there are few data which seek to define the quality of care or desired outcomes of care from the older adult’s perspective. This scoping review aims to assess the research literature addressing the question of what is known about the quality of continence care from the perspective of older adults (>65 years old) in long-term care and from those in receipt of home care to identify gaps in the literature and direct further research.Methods and analysisThe Joanna Briggs Institute (JBI) method will be followed. The CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, PROSPERO, Web of Science and JBI Evidence Synthesis databases will be searched using keywords for publications within the last 20 years without restriction on publication type or language. A search of grey literature and websites will be conducted. Reference lists of the retrieved articles will be used to identify additional literature. A preliminary search of MEDLINE was performed (21 November 2023), to identify articles. Search results will be exported into a management tool for screening and analysis. Article screening will be undertaken by two authors, and a third will be included if needed to resolve any differences. Data analysis will be guided by theoretical frameworks. The protocol for this study was registered at Open Science Framework (https://osf.io/bprq9/).Potential impactInformation on what constitutes quality of care or desired outcomes of care from the perspective of this segment of the population is lacking. This review will synthesise knowledge and provide research direction. Findings can potentially lead to new directions in the provision of care for vulnerable older adults.Ethics and disseminationFormal ethics approval for a scoping review is not required. The results will be published in a high-impact journal with a focus on open access publication.

IntroductionUrinary incontinence (UI) is a common condition among older adults with adverse consequences to health and well-being. Shame, stigma and cultural perspectives can prevent treatment-seeking behaviour. Although there is an abundance of studies in the health research literature that explore the physiological basis of UI, there is limited evidence on the role culture plays in shaping knowledge of, attitudes to and beliefs about UI. This review aims to answer what is known about the role of culture in shaping the attitudes and beliefs on UI to identify gaps in the literature and direct future research.Methods and analysisThe Joanna Briggs Institute method for scoping reviews will be used to conduct the review, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The MEDLINE, Embase, PsycINFO, Cumulated Index in Nursing and Allied Health Literature, EBSCOhost, Scopus databases and WHO Index Medicus databases will be searched, without any restriction on language and publication date, enhancing the comprehensiveness and inclusivity of the review. A preliminary search of MEDLINE was conducted (09 February 2024) to identify articles. The screening and analysis of the search results from the databases will be managed using Covidence software. Two authors will screen articles, with a third involved as needed to resolve any differences. Findings will be organised using tables and key themes will be identified.Ethics and disseminationFormal ethics approval is not required for this review as it does not involve any human or animal participants. Findings will be disseminated in a high-impact peer-reviewed journal with a focus on open-access publication at conferences and used to inform studies on the development of culturally sensitive management programmes for UI with the full involvement of patients.Trial registrationOpen Science Framework https://osf.io/3d97f

Urinary (UI) and fecal incontinence (FI) are troublesome conditions for many in society; both UI and FI increase in prevalence with increasing age. Despite well-recognized effects on health, well-being and quality of life, incontinence is often seen by care providers and payers as a social problem, rather than a health related one. Nurses are in a key position to assist those affected by UI. Nurses have the potential to identify people with incontinence, establish appropriate interventions and provide valuable education to empower patients. Indeed, nurses are ideally placed to perform the initial assessment and management of incontinence, that portion of the care pathway which is crucial, but often poorly done. Unfortunately, this is not always easily implemented; nursing staff have identified environmental barriers, such as lack of time at work, and consider UI a low priority that prevents the facilitation of interventions. This article reviews the evidence on nursing involvement, or lack of it, in continence care and suggests a strategy to improve the situation, involving a complex intervention of knowledge translation.

Background Although codes of conduct, guidelines and standards call for healthcare practitioners to protect patients’ dignity, there are widespread concerns about a lack of attention to the dignity of older people who need assistance with toileting, incontinence or bladder or bowel care in health or social care settings that provide long-term care. Incontinence and care dependence threatens patient dignity. The aim of this research was to explore, describe and explain the concept of dignity as it relates to continence care for older people requiring long-term care. Methods The first four steps of Rodgers evolutionary method of concept analysis were followed. First, a comprehensive and systematic search of databases and key guidelines about continence care was undertaken to identify empirical research about dignity and continence care in older people in facilities that provide permanent residential or inpatient care of older people for day-to-day living. Data were extracted on the authors, date, sample, country of origin, and key definitions, attributes, contexts and consequences from each included record. Findings were inductively analysed and grouped according to whether they were the key attributes and antecedents of dignity in relation to continence care or the consequences of undignified continence care. Results Of 625 articles identified, 18 were included in the final analysis. Fifty individual attributes were identified that were categorised in 6 domains (respect, empathy, trust, privacy, autonomy and communication). A further 15 were identified that related to the environment (6 physical and 9 social). Key consequences of undignified continence care were also identified and categorised into 3 levels of impact (resident/family member, staff or organisation). Conclusions This research resulted in a conceptual understanding of dignity that can be used as a value or guiding principle in an ethic of care for older people who need assistance with toileting, incontinence or bladder or bowel care in long-term care settings.

IntroductionCare aides are health workers who deliver hands-on care to patients across the healthcare continuum. The use of technology in healthcare delivery is increasing, and evidence regarding how care aides’ attitudes may either facilitate or hinder the adoption of healthcare technologies is lacking.The aim of the proposed scoping review is to examine available evidence regarding care aides’ attitudes towards the adoption of innovation and factors that may influence the sustainable use of technology in healthcare delivery. Published studies, grey literature and review articles that identify a method for the review, conference abstracts and website publications regarding the attitude, uptake and sustainable use of technology in care delivery by care aides will be included. For abstracts that have resulted in publications, the full publications will be included. The search for evidence commenced in June 2023 and will end in March 2024.Methods and analysisThe Joanna Briggs Institute (JBI) method will be used to conduct the review. The CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, PROSPERO, Web of Science and JBI Evidence Synthesis databases will be searched using keywords for publications within the last 20 years to examine trends in health technology and attitudes of care aides towards innovation over the last two decades. A search of grey literature and websites will be conducted. The reference list of the retrieved articles will be used to identify additional literature. The search results will be exported into a literature management tool for screening and analysis. Article screening will be performed by two authors and if a third is needed to resolve any differences. Data analysis will be guided by two theoretical frameworks.Ethics and disseminationNo ethics approval is required. The findings will be disseminated in a peer-reviewed journal and presented in conferences.Registration detailshttps://doi.org/10.17605/OSF.IO/CZQUP

Background Most epidemiological studies have not systematically identified or categorized risk factors for urinary incontinence (UI) in older men, despite a higher prevalence than in younger men. Considering the burden of UI, an understanding of risk factors can inform cost-effective prevention/treatment programs. This scoping review aimed to identify and categorise risk factors for UI in older men, identify gaps in the evidence, and opportunities for future research. Methods The Joanna Briggs Institute (JBI) method for scoping reviews guided the conduct and reporting of this review alongside the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews checklist. JBI’s Population, Concept, and Context approach framed the inclusion criteria (all evidence sources on UI risk factors that included older men [65 +]). We employed JBI’s three-step search strategy, which included a limited initial search in Ovid MEDLINE, a detailed comprehensive database search, and a search of reference lists of included studies, Google Scholar and grey literature. There were no restrictions on language, study type, or publication date. Two independent reviewers screened, selected, and extracted eligible studies. Data were analyzed using descriptive statistics and qualitative content analysis. Results Forty-seven articles that met the inclusion criteria identified 98 risk factors across six categories. Behavioural risk factors, reported by only two studies, were the least investigated of all the categories, whereas medical factors/diseases were the most investigated. No genetic factors were documented. The top five risk factors were increasing age/advanced age ( n  = 12), Benign Prostatic Hyperplasia ( n  = 11), Diabetes Mellitus ( n  = 11), Detrusor overactivity ( n  = 10), limitation in physical function/ADL disability ( n  = 10), increased Body Mass Index (BMI)/overweight/obesity ( n  = 8), Dementia ( n  = 8), and Parkinson’s disease ( n  = 7). Conclusion There is a dearth of evidence to describe the role behavioural risk factors have in UI in older men. These factors may play a role in health promotion and disease prevention in this area. Registration A protocol detailing the methods was developed and published, and is registered in the Open Science Framework [Feb 07 2023; https://osf.io/xsrge/ ].