Predicting response to a community-based educational workshop on incontinence among community-dwelling older women: Post hoc analysis of the CACTUS-D trial

Abstract

Aims: Our goal was to identify which women participating in an educational workshop on incontinence were most likely to benefit from it.

Methods: We included women aged 65 or older, living in the community, and not treated for incontinence despite reporting urinary leakage at least twice a week. The workshop's aims were to change beliefs about accepting incontinence as a normal part of ageing, explain that incontinence is not irreversible, and that solutions exist. We performed structured interviews at 6 and 12 months to assess impressions of improvement (PGI-I) and changes in both continence (ICIQ-FLUTS) and quality of life (I-QOL).

Results: The analysis included 392 women, 39% aged 80 or older and 57% with daily urinary incontinence. Twelve months after the workshop, 16% of women were "much better" (PGI-I); factors associated with impression of improvement were refusal to believe that incontinence is part of normal ageing at baseline and improvement of urinary symptoms. The median improvement was 4 points on the ICIQ-FLUTS and 8 on the I-QOL. Factors associated with a clinically significant improvement in urinary symptoms were more severe baseline urinary incontinence, obesity, and starting Kegel exercises. Factors associated with a clinically significant improvement in quality of life were a poor urinary quality of life at baseline and an age younger than 81 years.

Conclusions: A short, inexpensive and nonmedical intervention can change the mind-set and behavior of older women with incontinence who are not seeking care. A clinically significant improvement is possible even in women with severe symptoms.

Keywords: ageing; educational workshop; urinary incontinence.

Figure 1

Changes in ICIQ‐FLUTS scores between baseline and follow‐up (dotted line for the minimal clinically important difference, MCID, −3.19). Negative change reflects improvement in continence. ICIQ‐FLUTS, International Consultation on Incontinence Questionnaire‐Female Lower Urinary Tract Symptoms; MCID, minimum clinical difference

Figure 2

Changes in I‐QOL scores between baseline and follow‐up (dotted line for the minimal clinically important difference, MCID, +4.74). Positive change reflects improvement in Quality of Life (QoL)