Jo Booth, Dawn Skelton, Carolyn MacInnes, Claire Ballinger, Tracey Howe

1. Jo Booth, Dawn Skelton, Carolyn MacInnes, Claire Ballinger, Tracey Howe The effects of lifestyle and behavioural interventions for urinary incontinence on mobility, physical activity and falls in older people

2. Urinary symptoms • Urinary incontinence (UI) and other lower urinary tract symptoms (LUTS) are common in older people and prevalence increases with age • Storage symptoms Voiding symptoms Frequency 68% Weak stream 43% Urgency 53% Intermittency 39% Nocturia 85% Incomplete emptying 43% Urinary Straining 16% incontinence 42% • UI/LUTS respond to conservative approaches including behavioural and lifestyle interventions

3. Mobility • Reductions in mobility and physical activity common with ageing in all care contexts – results in deconditioning, impaired quality of life and increased risk of falls • One third community living older people fall each year • Rate of fall related injuries increases with age • Fall associated fractures are significant source morbidity and mortality

4. Morris V, Wagg A 2007 Int J Clin Pract 61,2,320-3232

5. Urinary incontinence & mobility issues • Studies indicate reduced activity with UI • Studies in different care contexts identified association between UI /LUTS and falls • Emerging theory highlights role of urinary incontinence in disablement process • Literature review highlights paucity of clinical trials on effective interventions for these overlapping areas to guide practice with older people

6. Will treating urinary incontinence impact on mobility, physical activity and falls rates in older people?

7. Review Title The effects of lifestyle and behavioural interventions for urinary incontinence on mobility, physical activity and falls in older people: A systematic review

8. Aims • To investigate the effectiveness of lifestyle interventions for urinary incontinence on physical activity, mobility and falls in older people • To investigate the effectiveness of behavioural interventions to treat urinary incontinence on physical activity, mobility and falls in older people • To identify the meaning of urinary incontinence to older people and their experiences of lifestyle and behavioural interventions for their mobility, physical activity and falls.

9. Types of study • Randomised controlled trials, quasi-randomised controlled trials that compare lifestyle and/or behavioural interventions for urinary incontinence versus control (no intervention, usual care or placebo control). • Narrative review will include quasi-experimental studies, cohort, observational studies, case control studies and qualitative studies using all methodologies and approaches.

10. Participants Older people aged 60 years and over, males and females, with any type of urinary incontinence, diagnosed by symptom classification or urodynamic study. They may be community-living, hospitalised or a care home resident.

11. Interventions • Lifestyle and/or behavioural interventions for LUTS including, but not limited to: • pelvic floor muscle training, • bladder training, • scheduled voiding programmes • fluid and caffeine management • treatment of constipation • weight loss • tobacco and alcohol reduction.

12. Outcomes Primary outcomes will focus on subjective and objective measures of : • mobility • physical activity • falls

13. Contribution to practice • Identify specific conservative treatment approaches for UI/LUTS that may impact on older peoples mobility and physical activity and prevent falls • Contribute new insights to understanding of falls prevention • Highlight need for research to explore relationship between UI/LUTS and mobility, physical activity and falls in older people