Background/Aims Continence conditions are a widespread and prevalent issue within the UK. However, provision of continence products are not distributed on an equitable basis across the country and often do not take into account patient-centric factors, such as quality of life and physical needs. The aim of this study was to establish the level of agreement held by UK healthcare professionals around the provision and selection of continence products and identify any areas where recommendations could be proposed to reduce harm to patients in relation to quality of life, mental health, skin health and patient wellbeing through the right choice of continence product. Methods A steering group of incontinence experts identified 50 statements impacting continence care. From this, an online survey was developed and respondents from across the UK were invited to rate their agreement with each statement. A modified Delphi methodology was used to review responses, with a threshold for consensus agreement set at 66%. Results A total of 181 responses were received. Overall, 39 out of 50 statements achieved very high consensus agreement (≥90%), nine statements achieved high consensus agreement (between 66% and 90%) and two statements did not achieve the consensus threshold but were over 60%. Conclusions The results demonstrated clear support among respondents for making improvements that focus on meeting the individual needs of the patient, which includes accurate, comprehensive continence assessment and product provision and mental health aspects, rather than budgetary concerns.

Background Evidence-based guidelines for the management of frail older persons with urinary incontinence are rare. Those produced by the International Consultation on Incontinence represent an authoritative set of recommendations spanning all aspects of management. Aims To summarize the available evidence relating to the management of urinary incontinence in frail older people published since the 5th International Consultation on Incontinence. Materials and Methods A series of systematic reviews and evidence updates were performed by members of the working group to update the 2012 recommendations. Results Along with the revision of the treatment algorithm and accompanying text, there have been significant advances in several areas of the management of lower urinary tract symptoms in frail older people. Discussion The committee continues to note the relative paucity of data concerning frail older persons and draw attention to knowledge gaps and research opportunities. Clinicians treating older people with lower urinary tract symptoms should use the available evidence from studies of older people combined with careful extrapolation of those data from younger subjects. Due consideration to an individual's frailty and wishes is crucial.

Abstract Urinary incontinence is not an inevitable consequence of ageing and its impact on social, psychological, and physical well-being is comparable to that of other chronic conditions such as diabetes and dementia. Meanwhile, constipation, including symptoms of evacuation difficulty and/or fewer bowel movements, is a common problem as people age. Risk factors include problems in cognition, mobility, gastrointestinal motility, dysautonomia, anorectal dysfunction, and disabling neurologic disorders. Faecal incontinence is more common in frail individuals but is often assessed inadequately. The cause is often multifactorial. Treatment depends on the cause: a combination of approaches may be necessary, including avoidance of faecal impaction, instigation of a structured bowel care plan including regular prompted toileting, dietary modification, and (in some cases) use of loperamide or similar medications.

Urinary incontinence and lower urinary tract symptoms are highly prevalent in late life and are strongly associated with dementia and frailty. Incontinence is extremely common among those living in long-term care and is most commonly due to urgency incontinence. Although national and international guidelines for continence care exist, they often fail to consider the complex comorbidity found in patients with dementia and are often not followed; continence practices in long-term care may promote rather than prevent incontinence. The majority of those with dementia living in the community can be managed successfully with standard treatments, both pharmacological and non-pharmacological; the expectations and aims of treatment of both the patient and their caregivers should be considered. A dementia diagnosis does not preclude management of incontinence, but treatment options may be more limited in those with advanced dementia who are unable to retain information and modify behaviors. High-quality data to guide the choice of pharmacological agent in those with dementia are lacking. Oxybutynin has been shown to have significant adverse cognitive effects, but data to support the use of trospium, solifenacin, darifenacin, and fesoterodine are limited. No data are available for mirabegron. Neither age, frailty, nor dementia should be considered a barrier to pharmacological management, but consideration should be given to the total anticholinergic load. Evidence to guide the treatment of incontinence in this vulnerable patient group is scarce, and available guidelines adapted for each individual's situation should be applied.