Overcoming the barriers to optimum continence care: the need for an expanded approach to implementation

In spite of a growing body of evidence to show that urinary incontinence is treatable or symptoms can be significantly improved in the majority of older people significant shortfalls in the quality of continence care are highlighted consistently in the international literature. The key barriers to providing optimal continence care for older people points to a need to address change not only from an individual practitioner perspective but also at the levels of the multidisciplinary team and organization. Examples of some emerging implementation frameworks that incorporate the broader context in which change occurs in 'real world' practice are introduced which may serve as useful guides. It is argued that if national and international standards of good practice for continence care are to be achieved, implementation methods have to take account of the complex interplay of patient, practitioner, social and organizational factors that mediate change.