BACKGROUND Urinary incontinence is especially common in older age. Non-pharmacological therapies are particularly desirable in this group. OBJECTIVE To define optimal evidence-based non-pharmacological, non-surgical therapies for urinary incontinence in older persons. METHODS A Delphi process determined critical outcome measures of interest. Studies of any non-pharmacological intervention reporting critical outcomes were identified through database searches for relevant systematic reviews in Medline, Embase, CINAHL, PsycInfo and Cochrane up to June 2018. Primary trials with a population mean age ≥65years were identified, from which data were extracted and risk of bias was assessed. Qualitative analysis and meta-analysis, when possible, were undertaken, followed by grading of the evidence using GradePro software. Finally, bullet-point recommendations were formulated for the indications and contraindications for non-pharmacological interventions for urinary incontinence in older persons. RESULTS Frequency of incontinence was identified as a critically important outcome. In total, 33 systematic reviews were identified with 27 primary trials meeting inclusion criteria. Evaluated therapies included exercise therapy, habit retraining, behavioural therapy, electrical stimulation, transcutaneous tibial nerve stimulation, magnetic stimulation, caffeine reduction and acupuncture. From meta-analysis, group exercise therapy and behavioural therapy in women were beneficial in reducing episodes of incontinence (mean reduction of 1.07 (95 %CI 0.69-1.45) and 0.74 (95 %CI 0.42-1.06) episodes per day respectively, evidence grade 'moderate'). Evidence for other interventions was limited and of insufficient quality. CONCLUSIONS There is sufficient evidence to warrant recommendation of group exercise therapy for stress incontinence and behavioural therapy for urgency, stress or mixed urinary incontinence in older women. Evidence was insufficient to recommend any other non-drug therapy.

中文翻译：

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老年人尿失禁的非药物、非手术干预：系统评价的系统评价。SENATOR 项目 ONTOP 系列

背景尿失禁在老年人中尤其常见。非药物疗法在这一群体中尤其受欢迎。目的 确定老年人尿失禁的最佳循证非药物、非手术疗法。方法 Delphi 过程确定了感兴趣的关键结果指标。截止 2018 年 6 月，通过对 Medline、Embase、CINAHL、PsycInfo 和 Cochrane 中的相关系统评价的数据库搜索，确定了任何报告关键结果的非药物干预研究。确定了人群平均年龄≥65 岁的主要试验，其中数据来自提取并评估偏倚风险。在可能的情况下进行定性分析和荟萃分析，然后使用 GradePro 软件对证据进行分级。最后，针对老年人尿失禁的非药物干预的适应症和禁忌症制定了要点建议。结果 失禁频率被确定为一个至关重要的结果。总共确定了 33 项系统评价，其中 27 项主要试验符合纳入标准。评估的疗法包括运动疗法、习惯再训练、行为疗法、电刺激、经皮胫神经刺激、磁刺激、减少咖啡因和针灸。根据荟萃分析，女性的团体运动疗法和行为疗法有助于减少尿失禁发作（每天平均减少 1.07 (95 %CI 0.69-1.45) 和 0.74 (95 %CI 0.42-1.06) 发作，证据等级'缓和'）。其他干预措施的证据有限且质量不足。结论 有足够的证据支持对老年女性的压力性尿失禁进行集体运动疗法和针对紧迫性、压力性或混合性尿失禁的行为疗法的推荐。证据不足以推荐任何其他非药物治疗。