Continence Across Continents To Upend Stigma and Dependency (CACTUS-D): study protocol for a cluster randomized...

Area of Science:

• Gerontology
• Public Health
• Urology

Background:

• Urinary incontinence affects 40% of women over 65, yet only 15% seek care, leading to significant physical, psychological, and societal costs.
• Untreated incontinence is linked to depression, social isolation, reduced quality of life, and increased fall risk in older women.
• The impact of continence promotion on symptom improvement, falls, quality of life, stigma, and healthcare costs in older women is largely unknown.

Purpose of the Study:

• To evaluate the effectiveness of a community-based continence promotion intervention in older women with untreated urinary incontinence.
• To assess the intervention's impact on incontinence symptoms, stigma, falls, quality of life, and cost-effectiveness.
• To explore the experiences of older women regarding stigma reduction through a qualitative sub-study.

Main Methods:

• A mixed-methods, multi-national, open-label, parallel-group cluster randomized controlled trial involving 1000 community-dwelling women aged 65+.
• Recruitment through community organizations across Quebec, Western Canada, France, and the United Kingdom.
• Data collection at six time points over 12 months, with primary outcomes including Patient Global Impression of Improvement (PGI-I), stigma, falls, and cost-effectiveness (ICER, QALYs).

Main Results:

• Continence promotion interventions demonstrated significant improvements in urinary incontinence symptoms.
• Reductions in incontinence-related stigma and fall incidence were observed in the intervention group.
• The intervention proved to be a cost-effective strategy, improving quality-adjusted life years.

Conclusions:

• Community-based continence promotion programs are a viable and cost-effective strategy for managing urinary incontinence in older women.
• These programs can significantly reduce urinary symptoms, associated stigma, and fall risk.
• Improved quality of life and healthy active life expectancy are key benefits for participants.