O' Callaghan Maureen, Robinson Katie, Whiston Aoife, Senter Morgan, Clifford Amanda M
School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
PLoS One. 2025 May 14;20(5):e0322742. doi: 10.1371/journal.pone.0322742. eCollection 2025.
Urinary incontinence (UI) is highly prevalent among older adults with frailty, impacting function, quality of life and risk of long-term care admission.
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.
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.
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.
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.
This review was prospectively registered on the International Prospective Register of Systematic Reviews, PROSPERO (CRD42022316287; https://www.crd.york.ac.uk/prospero/).
尿失禁（UI）在体弱的老年人中非常普遍，会影响功能、生活质量以及长期护理入院风险。
系统评价和综合随机对照试验（RCT）的结果，这些试验研究了保守的非药物干预措施对≥65岁体弱老年人尿失禁管理的效果。
检索了五个数据库（Cochrane图书馆、Medline（EBSCO）、CINAHL（EBSCO）、Embase（OVID）、PsycINFO（EBSCO）），从创建到2024年4月，查找评估针对体弱老年人尿失禁的保守非药物干预措施的RCT。两名独立评审员筛选记录，使用Cochrane偏倚风险（RoB 2.0）工具评估方法学质量，并使用GRADE指南总结证据水平。根据情况进行随机效应模型的荟萃分析或叙述性综合分析。
纳入了12项RCT，包括1580名参与者，偏倚风险为中到高。保守的非药物干预措施（分为单组分或多组分干预）使尿失禁客观指标有非统计学意义的降低（6项RCT，g = -0.39，p = 0.090；合并效应量，置信区间为-0.39 [-0.832, 0.060]，I² = 85.26%，证据确定性非常低）。未发现功能能力有统计学意义的改善（5项RCT，g = 0.20，p = 0.39，合并效应量，置信区间为0.20 [-0.251, 0.642]，I² = 85.87%，证据确定性非常低）。这些干预措施未导致不良事件。研究未评估照顾者的生活质量。
极低质量的证据表明，保守的非药物干预措施对尿失禁客观指标和功能能力有有益但无统计学意义的影响。由于体弱老年人中干预性疾病和死亡率较高，建议未来的研究采用更合适的研究设计和结局指标，评估实施针对可改变风险因素的量身定制干预措施的效果。
本综述已在国际前瞻性系统评价注册库PROSPERO上进行前瞻性注册（CRD42022316287；https://www.crd.york.ac.uk/prospero/）。
