Long-term effect of community-based continence promotion on urinary symptoms, falls and healthy active life expectancy among older women: cluster randomised trial.

Abstract

BackgroundThe long-term effectiveness of group continence promotion delivered via community organisations on female urinary incontinence, falls and healthy life expectancy remains unknown.MethodsA pragmatic cluster randomised trial was conducted among 909 women aged 65–98 years with urinary incontinence, recruited from 377 community organisations in the UK, Canada and France. A total of 184 organisations were randomised to an in-person 60-min incontinence self-management workshop (461 participants), and 193 to a control healthy ageing workshop (448 participants). The primary outcome was self-reported incontinence improvement at 1-year. Falls and gains in health utility were secondary outcomes.ResultsA total 751 women, mean age 78.0, age range 65–98 completed the trial (83%). At 1-year, 15% of the intervention group versus 6.9% of controls reported significant improvements in urinary symptoms, (difference 8.1%, 95% confidence intervals (CI) 4.0–12.1%, intracluster correlation 0.04, number-needed-to-treat 13) and 35% versus 19% reported any improvement (risk difference 16.0%, 95% CI 10.4–21.5, number-needed-to-treat 6). The proportion of fallers decreased from 42% to 36% in the intervention group (−8.0%, 95% CI −14.8 – −1.0) and from 44% to 34% in the control group (−10.3%, 95% CI −17.4 – −3.6), no difference between groups. Both intervention and control groups experienced a gain in health utility (0.022 points (95% CI 0.005–0.04) versus 0.035 (95% CI 0.017–0.052), respectively), with no significant difference between groups.ConclusionCommunity-based group continence promotion achieves long-term benefits on older women’s urinary symptoms, without improvement in falls or healthy life expectancy compared with participation in a healthy ageing workshop.