Prioritising modifiable risk factors for self-management of urinary incontinence in older men: integrating expert consensus with patient readiness.

BACKGROUND

Urinary incontinence (UI) affects up to one-third of men aged ≥65 years, yet evidence to guide the selection of targets for self-management interventions remains limited. Although many contributing risk factors are potentially modifiable, little is known about which are considered clinically important by experts and are also viewed by older men as feasible and worthwhile to address. This study combined expert consensus with older men's perspectives to identify candidate priorities for future self-management intervention development.

METHODS

We conducted a sequential multi-methods study: an international Delphi survey with continence care experts followed by a cross-sectional survey of community-dwelling men aged ≥65 years with UI in Alberta, Canada. Experts rated the clinical importance and modifiability of evidence-informed risk factors, with consensus defined as ≥75% agreement. Older men reported willingness and perceived capability to modify expert-identified factors and completed the Geriatric Self-Efficacy Index for Urinary Incontinence (GSE-UI).

RESULTS

Experts (n = 32 in Round 1; n = 20 in the final round) reached consensus on 19 clinically important and modifiable risk factors, spanning medical (obesity, constipation, diabetes) and behavioural (smoking, alcohol, caffeine) domains. Older men (n = 212, mean age 77.6 years) reported moderate self-efficacy (overall GSE-UI-51.0 ± 35.9), with lower confidence in socially or physically challenging situations.

CONCLUSION

Integrating expert consensus with patient-reported willingness and perceived capability identified nocturia/nocturnal polyuria, insomnia/sleep disorder, increased body mass index (BMI)/obesity and anxiety as candidate priorities for future self-management intervention development. Increased BMI/obesity and anxiety exceeded the thresholds for prevalence, willingness and perceived capability, whereas nocturia/nocturnal polyuria and insomnia/sleep disorder exceeded the thresholds for prevalence and willingness but not perceived capability. Integrating expert consensus with older men's willingness and perceived capability provides an empirical approach to prioritising candidate intervention targets rather than relying on clinical importance alone. These findings provide a rationale for designing and evaluating future self-management interventions that better align with both clinical priorities and patient readiness.