Non-pharmacological, non-surgical interventions for urinary incontinence in older persons: A systematic review of systematic reviews. The SENATOR project ONTOP series

Background: Urinary incontinence is especially common in older age. Non-pharmacological therapies are particularly desirable in this group. Objective: To define optimal evidence-based non-pharmacological, non-surgical therapies for urinary incontinence in older persons. Methods: A Delphi process determined critical outcome measures of interest. Studies of any non-pharmacological intervention reporting critical outcomes were identified through database searches for relevant systematic reviews in Medline, Embase, CINAHL, Psyclnfo and Cochrane up to June 2018. Primary trials with a population mean age >= 65years were identified, from which data were extracted and risk of bias was assessed. Qualitative analysis and meta-analysis, when possible, were undertaken, followed by grading of the evidence using GradePro software. Finally, bullet-point recommendations were formulated for the indications and contraindications for non-pharmacological interventions for urinary incontinence in older persons. Results: Frequency of incontinence was identified as a critically important outcome. In total, 33 systematic reviews were identified with 27 primary trials meeting inclusion criteria. Evaluated therapies included exercise therapy, habit retraining, behavioural therapy, electrical stimulation, transcutaneous tibial nerve stimulation, magnetic stimulation, caffeine reduction and acupuncture. From meta-analysis, group exercise therapy and behavioural therapy in women were beneficial in reducing episodes of incontinence (mean reduction of 1.07 (95 %CI 0.69-1.45) and 0.74 (95 %CI 0.42-1.06) episodes per day respectively, evidence grade 'moderate'). Evidence for other interventions was limited and of insufficient quality. Conclusions: There is sufficient evidence to warrant recommendation of group exercise therapy for stress incontinence and behavioural therapy for urgency, stress or mixed urinary incontinence in older women. Evidence was insufficient to recommend any other non-drug therapy.