Urinary incontinence (UI) is highly prevalent among older men, with one in three men aged 65+ experiencing difficulty maintaining continence [1]. Understanding modifiable risk factors for UI can inform cost-effective prevention and treatment programs, such as self-management [2], which has proven to be a successful strategy for managing other chronic conditions. Through a scoping review, we identified 98 risk factors for UI in older men across six categories [3]. This study aimed to define and prioritize these factors by exploring the perspectives of continence experts on their importance and modifiability.

We conducted an electronic Delphi study among healthcare experts following the Guidance on Conducting and Reporting Delphi Studies (CREDES). To reduce cognitive load on Delphi panelists, the list of 98 identified risk factors was condensed to 47 factors/factor groups. This was done by organizing the factors into six categories using a taxonomical approach and grouping similar factors as subcategories within risk factor domains: behavioral, physiological and age-related physiological changes, demographic, medical factors/diseases, environmental, and genetic factors. A geographically dispersed, multidisciplinary panel of healthcare professionals (urologists, geriatricians, family physicians, and nurses) participated in anonymous rounds of the Delphi process, assessing the importance and modifiability of these 47 factors/factor groups. Consensus for each factor was set at a 75% threshold in each round, with the next round launched only after at least 70% of the previous round's respondents had completed the current round. The Delphi process was concluded after four rounds, as evidence suggests that consensus is unlikely to be achieved in additional rounds beyond this point. Delphi data were analyzed both quantitatively and qualitatively, and participants received the results after each round.

The first round of the Delphi study included 32 panelists, female: male – 1:2 (34% female, 66% male) from 14 countries across six continents. The majority (59%) were aged 51 years and older, with an average of 22.5 ± 8 years of professional experience. The panel composition consisted predominantly of urologists (n=24, 75%) [Figure 1]. The Delphi process lasted 5 months and concluded after four rounds, with 20 respondents remaining, yielding a response rate of 95% of the respondents from the previous round. Consensus was reached on 41 factors/factor groups (39 on both importance and modifiability criteria, and two for non-modifiability), while consensus could not be reached on six factors. These included the modifiability of heart disease, comorbid conditions, chronic cough, poor vision, and the importance of hypertension in UI development, as well as the modifiability and importance of self-perception of health.
Out of the 39 factors that reached consensus on both criteria, 19 (40%) were deemed both important and modifiable, 16 factors were considered important but not modifiable, while two were regarded as not important but modifiable, and two were considered neither important nor modifiable. Medical factors such as obesity, constipation, and diabetes mellitus accounted for 47% (n=9) of those considered both important and modifiable, while behavioral factors such as smoking, alcohol use, and caffeine intake accounted for 21% (n=4) [Table 1].

Although several risk factors for UI in older men are documented in the literature, they vary in importance, and most are not modifiable through self-management.

The factors identified as important and modifiable by experts were presented in a Likert scale to older men to assess their self-efficacy and willingness to modify these risk factors. Insights from this ongoing survey will inform the co-creation of a self-management intervention involving both continence experts and older men with incontinence.

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Grady PA, Gough LL. Self-management: a comprehensive approach to management of chronic conditions. Am J Public Health. 2014 Aug;104(8):e25-31.
Olagundoye O, Odusanya B, Kung JY, Gibson W, Wagg A. A scoping review of risk factors for urinary incontinence in older men. BMC Geriatr. 2023 Sep 2;23(1):534. pmid:37660036