To determine whether women exposed to the continence promotion intervention will report improved urinary symptoms and quality of life, and lower incontinence-related stigma and falls than women who receive a control intervention at one-year post-intervention.

Primary Outcome Measures

Self-reported improvement in urinary incontinence [ Time Frame: 1 year ] [ Designated as safety issue: No ]
Patient global impression of improvement questionnaire Sandvik severity index ICIQ-FLUTS

Secondary Outcome Measures

Falls [ Time Frame: 1 year ] [ Designated as safety issue: No ]
Reduction in incontinence-related falls measured by fall diary

Reduction in incontinence related stigma and quality of life [ Time Frame: 1 year ] [ Designated as safety issue: No ]
Measured with the Incontinence Quality of Life questionnaire (IQOL)

Other Outcome Measures

Cost-utility of the continence promotion intervention [ Time Frame: 1-year ] [ Designated as safety issue: No ]

Cost/QALY. Direct costs will include costs related to the intervention as well as health care resource use due to incontinence-associated falls and health care seeking for incontinence will be measured. Indirect costs will be measured such as the time lost from work for a child or spouse to accompany the participant to receive medical treatment for incontinence or falls. The change in utility from the baseline incontinent condition to improved incontinence with increased social participation and decreased stigma on quality of life will be calculated from SF6D utilities derived from the SF-12 questionnaire at baseline and 1-year follow-up. A disease-specific measure, the IQOL is currently undergoing mapping onto the SF-6D to see if it will provide a more responsive indication of improved quality of life than the generic SF-12 measure.

Les calmants de type benzodiazépines ( BZD ) sont des médicaments prescrits pour traiter les problèmes d'anxiété et d'insomnie. Il est préférable de ne pas en consommer sur de longues périodes ( pas plus de trois mois selon le Collège des médecins du Québec ) étant donné qu'ils provoquent une accoutumance et une dépendance. Il est alors plus difficile d'arrêter le médicament à cause des effets de sevrage. Une consommation prolongée de BZD, surtout si elle excède un an, peut aussi occasionner des problèmes cognitifs et de concentration. En étant moins concentré ou plus distrait, le consommateur âgé de BZD est alors plus à risque de se blesser en chutant ou d'être responsable d'accidents de la route lorsqu'il conduit. Outre l'option d'arrêter complètement son médicament, le consommateur âgé qui désire améliorer ses fonctions cognitives et sa concentration peut se tourner vers l'activité physique. Des études ont effectivement démontré que l'entraînement physique pouvait améliorer les capacités d'attention de patients âgés. Or, pour plusieurs personnes âgées, le simple fait de penser qu'ils devront investir temps et argent dans un programme d'entraînement physique, les découragent et les empêchent de passer à l'action. La psychoéducation, c'est-à-dire le fait d'informer les gens sur les bienfaits de l'activité physique, serait un motivateur à considérer.

Aussi, la présente étude vise à savoir si l'entraînement en gymnase pourrait améliorer les fonctions cognitives et la concentration de consommateurs âgés. Réalisée auprès de consommateurs âgés de BZD, faisant peu d'activités physiques au départ, la présente étude a comme objectif de vérifier si des séances d'informations sur les effets positifs de l'activité physique pourraient les encourager à passer à l'action et à demeurer actifs.

Cette recherche est hautement pertinente puisqu'elle permettra d'améliorer la qualité de vie des consommateurs âgés de BZD exposés, bien malgré eux, aux effets indésirables du médicament.

As more and more people consume medications, there is increasing concern about side effects and drug-drug interactions. Individuals taking two medications face a 13 % risk of adverse drug interactions, a 38 % risk if four medications are prescribed, and an 82 % risk if seven or more drugs are consumed. Inappropriate prescribing is largely preventable and easily avoidable with equally effective but lower-risk therapies. Interventions targeting physicians and pharmacists to reduce the risk of medication interactions and change prescriptions have not succeeded in substantially improving patient safety. We will test whether this knowledge transfer tool helps people decide to wean themselves off benzodiazepines with the help of their physician. If our effort is successful, then we will adapt our intervention for other inappropriate prescriptions.

Our project seeks to develop and test a new knowledge transfer tool aimed at activating and empowering the patient to be the primary driver of reducing inappropriate prescriptions.

Using computerized health technology systems, audiovisual materials, and written self-assessment and confidence building strategies, we will provide chronic benzodiazepine consumers with knowledge about their risks of adverse health events related to consumption of these medications, and simultaneously equip them with information on lower-risk therapeutic options.

Urinary incontinence is a common and devastating geriatric condition with important physical, psychological and economic consequences. Among individuals older than 50 years living in the community, incontinence affects almost 20 percent of men and 50 percent of women. Drug therapy, consisting of a growing number of acetylcholine-blocking agents, is currently prescribed to approximately one third of incontinent individuals to help relax their bladder. However, the same acetylcholine-blocking mechanism that controls unwanted contractions in the bladder forms the basis of many of the theories underlying memory loss in Alzheimer's disease patients. A number of patients on incontinence medication have experienced sudden memory problems. Surprisingly, few large studies have investigated whether bladder relaxant medications indeed affect memory and function in older individuals.

The goal of this project is to systematically evaluate whether medications used to treat incontinence affect memory and function in older adults, by asking them to undergo detailed neuropsychological testing before and after they begin their therapy. We also intend to discover the most sensitive screening test for physicians to use to detect if any of their patients are at risk for having memory side effects from their incontinence treatment.

In this way proper screening and prevention can be done in the future to allow patients to continue reaping the benefits of treatment for their incontinence without suffering undue harm.

This proposal offers a Canadian contribution to The Tackling Ageing Continence through Theory, Tools and Technology (TACT3) programme in the area of improving continence interventions and services for older person. The proposed UK-Canada synergy has 3 objectives: 1) To contribute evidence-based strategies for optimizing healthcare seeking for older adults with incontinence. 2): To augment primary care interventions for urinary incontinence in older adults. 3) To contribute to the efficacy outcome evaluation of various key elements of continence care desired by older adults. The objectives are aligned to maximize the potential benefit to older patients by addressing key areas of need in health care delivery by systematic dissemination of best practice, and dialogue between primary and secondary care.

Specifically, the Canadian contribution will provide Continence Promotion Workshops for Older Adults, a new Self-Management Tool for Urinary Incontinence, an Instructional Toolkit for Clinicians to diagnose and treat incontinence in the primary care setting, and the Geriatric Self-Efficacy Index for Urinary Incontinence for measuring outcomes in the TACT3 programme. The contributions will undergo rigorous validation and cultural adaptation in association with the International Consultation on Incontinence Questionnaire (ICI-Q) working group at the University of Bristol and the TACT3 Health Services Outcomes Group in Sheffield. Testing and dissemination of the UK- adapted Canadian products will be conducted through key UK and European Union primary care professional bodies. This extensive interaction with primary care will maximize the dissemination of the Canadian initiatives and offer new insights into rapid and wide uptake. Networking opportunities within Canada via the Canadian Continence Foundation, the Canadian Association of Family Practitioners and the Canadian Nurse Continence Advisor association will also be provided to UK collaborators.

When we are young we are able to defer the need to void. Though we may sense the urge to urinate, if the phone rings or a child begs our attention, we promptly forget that we have to go to the bathroom. As people age, they lose the ability to put off their desire to void. A pressing need to urinate all too frequently results in « accidents » on the way to the bathroom. What is it about aging that prevents us from retaining our urine? Is it a problem with the aging bladder or the aging brain? Current theories suggest that with age, some people's brains develop an exaggerated emotional response to bladder fullness, possibly out of fear of leaking. The brain then triggers an urgent message to the bladder to void, whether or not it is socially appropriate. Our study will investigate the aging brain's response to bladder fullness by imaging the brain with Magnetic Resonance Imaging ( MRI ) while the bladder is being filled to the point of fullness.

Thirty older men and women, 15 who experience involuntary urine loss associated with severe urinary urgency, and 15 who do not, will participate in this study. The participants will be scanned 2 times, 3 months apart. The participants with urge incontinence will undergo treatment with behavioural techniques for their urinary urgency. We wish to see how the brain responds to treatment, when the feeling of urinary urgency has resolved.

This will help us understand how brain-bladder relationships change with age and will allow preventive strategies to be put in place to avoid urine leakage.