Urinary incontinence (UI), a major problem in older adults with functional and cognitive decline, has been reported to affect a large number of people who live in community-based settings and in nursing homes. Moreover, it is one of the conditions that can lead to the decrease in quality of life and results in stigmatization for those affected. To reduce this problem, it is necessary to identify the best possible management options for UI. Therefore, the purpose of this study is to evaluate the effect of the interventions that have been developed for reducing UI in older adults with cognitive impairment.

A primary search of literature was conducted in PubMed, CINAHL, and MEDLINE databases with no limitation on publication date, language, or study design. The search strategy was developed using keywords and controlled vocabulary to describe older adults, UI, and cognitive impairment. Eligible studies focused on a clear implementation of an intervention aimed to reduce UI in older adults with cognitive impairment, were peer reviewed publications, and were written in English. Study participants had to be older adults ages 60 or older with UI and cognitive impairment. Search results were uploaded into Covidence, a web-based software program for managing and streamlining systematic review. Three independent reviewers screened each of the titles and abstracts from the initial literature search against the eligibility criteria. Full-text articles were then screened for the final approved articles. Disagreements during the process were settled by consensus. Final studies were extracted and synthesized by the three reviewers using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline.

Database searches led to the initial search results of 2817 references. After duplicates were removed, titles and abstracts of 1405 articles were screened; 267 full-text documents were reviewed and 9 articles met eligibility criteria. The studies were conducted in four countries (i.e., Canada, South Korea, the United Kingdom, and the United States). From the nine eligible studies, three studies employed randomized controlled study designs, two used quasi-experimental designs, two were pilot studies, and two were case studies. The majority of the studies were conducted in long term care facilities (n=5), while the rest were conducted in participants’ homes (n=3), and in a hospital (n=1). Among all studies, 375 persons were enrolled with 309 participants completing the intervention program, most of whom were women. The participants’ levels of cognitive impairment ranged from mild to severe. Most studies did not report the results based on specific types of UI (n=7), and only two studies reported the data regarding participant comorbidities, such as heart failure, diabetes mellitus, stroke, Parkinson’s disease, and major depression in their data analysis. Interventions included prompted voiding, urine alarm and prompted voiding, walking, walking/talking program, pelvic floor muscle exercise, and physiotherapy-led group exercise. The outcome measures included urine volume based upon undergarment weight, daily bladder diary, percentage of incontinence time, incidence of UI, frequencies of self-initiated toileting, urodynamic questionnaire, and the Frequency Volume Chart (FVC). Overall, studies showed statistically significant results in reducing UI in the intervention group participants. However, a walking/talking intervention in severe cognitive impaired participants did not show a reduction in UI at the end of the program.

Through this review, most studies were conducted in the late 1990s or the early 2000s. The majority of studies focused more on women and included relatively few men. The sample sizes in studies were relatively small, especially in the case study research designs, and more than half of the studies were conducted in long term care facilities. Among the interventions reviewed, studies that implemented exercise-based interventions and prompted voiding were effective in reducing UI in older adults with cognitive impairment. Although only one study in this review targeted mild cognitive impaired participants, effective early interventions for older adults with mild cognitive impairment are needed to prevent or delay the progression of UI before it becomes worse once cognitive impairment progresses. Similar to studies in other fields that involve behavioral interventions, reducing UI also requires motivation and commitment among participants to complete the programs. Ideally, implementing UI-reduction intervention programs should be done with the cooperation of health care professionals, patients, and their caregivers. Implementing a technology-based intervention, such as urine alarm, holds promise to successfully reduce UI in persons with cognitive impairments.

To provide effective and sustainable care to cognitive impaired older adults experiencing UI, addressing UI should be multi-component and tailored to meet the individual needs of care recipients. Future research should incorporate more strategies to offer early, practical interventions in participants with mild cognitive impairment and early-stage dementia for preventing or delaying the progression of UI, which may improve functional and cognitive status, and could reduce caregiver burden. Collaborations among health care professionals are needed to enhance the effectiveness of incontinence care. Maintaining continence improves quality of life for persons with cognitive impairment and supports caregivers in providing care in community and home-based settings.