title: The effect of conservative treatment of urinary incontinence among older and frail older people: a systematic review.
abstract: BACKGROUND
  urinary incontinence (UI) is a common symptom among older people, with a higher prevalence among frail older persons living in nursing homes. Despite consequences such as reduced health and quality of life, many older people do not seek help for their symptoms, resulting in missed opportunity for treatment.
  
  
  OBJECTIVE
  the aim of this study was to investigate the evidence and the effect of conservative treatment of UI and the quality of life among older and frail older persons.
  
  
  METHODS
  a systematic review of randomised controlled studies and prospective, non-randomised studies was conducted, evaluating interventions of conservative treatment of UI in an older population (65 years or older). A total of 23 studies fulfilled the inclusion criteria and 9 were of high or moderate quality. Fourteen studies were of low quality and were therefore excluded from the analysis.
  
  
  RESULTS
  documented and effective conservative treatments are available even for older persons with UI. Pelvic muscle exercise, physical training in combination with ADL, prompted voiding and attention training, and help to toilet are important treatments. In some studies, however, the evidence of effectiveness is limited.
  
  
  CONCLUSIONS
  this systematic review concludes that there are conservative treatments for UI for older and frail older persons that reduce leakage and increase quality of life. There is however a need for further high-quality studies.
authors.affiliation: Faculty of Health and Society, Malmö University and Skåne University Hospital, 205 02 Malmö, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Stenzelius
authors.affiliation: Sahlgrenska University Hospital, Gothenburg 400 43, Sweden.
authors.forename: Ulla
authors.initials: U
authors.lastname: Molander
authors.affiliation: SBU-The Swedish Council on Health Technology Assessment, Stockholm 103 59, Sweden.
authors.forename: Jenny
authors.initials: J
authors.lastname: Odeberg
authors.affiliation: Department of Gynecology and Obstetrics and Childrens and Youth Hospital of Queen Silvia, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Hammarström
authors.affiliation: Department of Gynecology and Obstetrics, Örebro University Hospital, Örebro 701 85, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Franzen
authors.affiliation: Clinical Research Centre (CRC), Skåne University Hospital, 205 02 Malmö, Sweden.
authors.forename: Patrik
authors.initials: P
authors.lastname: Midlöv
authors.affiliation: Family Medicine, Department of Public Health and Clinical medicine, Umeå University, Umeå 901 85, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Samuelsson
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro 701 85, Sweden.
authors.forename: Gunnel
authors.initials: G
authors.lastname: Andersson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D016330:Frail Elderly / Q000523:psychology; D015577:Geriatric Assessment; D006801:Humans; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*
keywords: bladder training; conservative treatment; older and frail older; older people; pelvic floor exercise; prompted voiding; systematic review; toilet assistance; urinary incontinence