Recent developments in technology for the assessment and management of incontinence

Technological Solutions for Urinary Continence Care Delivery for Older Adults: A Scoping Review

PURPOSE

The aim of this scoping review was to examine available evidence regarding use of technology-based continence care delivery for older adults and to identify gaps in knowledge.

METHODS

Scoping review.

SEARCH STRATEGY

With the help of a medical librarian, CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, Web of Science, and websites were searched. Search terms included technology, sensors, older adults, urinary incontinence, continence care, nursing homes, long-term care, and continence management. All literature elements except for opinion pieces and case reports written in English within the last 15 years were included. Articles not written in the English language were excluded; our search indicated that less than 6% of returned elements were written in other languages.

FINDINGS

After duplications were removed, 2146 potential sources were identified. After exclusions, 19 results were included in the review. Review findings suggest positive effects of technology-based continence care on older adults and those involved in their care such as enhanced delivery of a successful toileting program. Information on potential harms, from either the perspective of care provider or recipient, is limited. It is important that needs of older adults and collaborative efforts are considered in the implementation of technology-based continence care. A paucity of guidelines on the use and adoption of technology-based continence care was found; additional research into uptake and sustainability is needed.

CLINICAL IMPLICATIONS

Technological solutions, such as sensors, need to be accurate in the measurement of urine saturation levels and timely in notifying caregivers for effective delivery of continence care. Adverse consequences of incontinence, such as incontinence-associated dermatitis or urinary tract infection, may potentially be reduced or avoided with technology-based continence care delivery.

Current state of bladder diary: a survey and review of the literature

INTRODUCTION AND HYPOTHESIS

The objectives of this study are (1) to assess practice patterns among urogynecology/female pelvic medicine and reconstructive surgery (FPMRS) providers regarding the use of bladder diaries (BD) and (2) to review the literature regarding BD.

METHODS

For the first objective, a survey was emailed to United States-based urogynecology providers in 2019 querying frequency of use of bladder diaries (F_BD), indications, problems, patient education methods, and perception of utility. Chi-square tests and multiple logistic regression were performed. For the second objective, we reviewed literature published in English by searching the terms "voiding," "bladder," or "incontinence," in combination with "diary," "log," or "questionnaire."

RESULTS

A total of 371 of 851 (43.5%) contacted providers responded. Nearly 80% were attending physicians, 75.5% of whom completed the FPMRS fellowship; 20.8% of all respondents and nearly 25% of fellowship-trained attendings reported F_BD <20% in the last year. FPMRS providers were more likely to report F_BD >80%. A total of 97.5% of respondents cited difficulty in using BD. Most (71.6%) taught patients to use BD themselves or shared responsibility with a nonphysician staff member (53.4%). BD is a validated and valuable instrument; however, there are obstacles to its use. Despite recent innovations including electronic and automated BD, there is a paucity of data regarding the provider-viewed challenges in implementing BD.

CONCLUSIONS

The literature supports the use of BD; however, many survey respondents, including fellowship-trained attendings, never or rarely use BD. Most respondents reported difficulty in using BD. More research is needed to improve the ease, accuracy, and widespread adaptation of BD use in clinical practice.