Introduction to TACT3
Who are the NDA and the ESRC?
The New Dynamics of Ageing Programme is a seven year multidisciplinary research initiative with the ultimate aim of improving quality of life of older people. The programme is a unique collaboration between five UK Research Councils - ESRC, EPSRC, BBSRC, MRC and AHRC - and is the largest and most ambitious research programme on ageing ever mounted in the UK. TACT3 is administered by the ESRC.
What is TACT3?
TACT3 is one of the collaborative research projects on the New Dynamics of Ageing Programme.
What does TACT3 stand for?
Tackling Ageing Continence through Theory, Tools and Technology.
What is the relationship between continence and ageing?
Problems with continence are not directly related to the ageing process but a number of factors means that incontinence becomes more common as people age. The bladder and urinary system can become less efficient with age but many other age related conditions can affect the bladder or bowels. For example medication for high blood pressure can increase both frequency and urgency of urination. In addition, mobility problems are increasingly common in older people. Any limitation in mobility is likely to cause difficulties with continence simply because the older person finds it difficult to get to the toilet in time and they may have trouble getting on or off the toilet.
What is incontinence?
The National Institute for Clinical Excellence (NICE) uses International Continence Society definition where UI is defined as ‘the complaint of any involuntary leakage of urine’. The Continence Foundation (UI) definition of Urinary Incontinence 'is a condition in which involuntary urine loss is a social or hygienic problem and is objectively demonstrable'. These two different definitions are part of the reason why the prevalence of Urinary incontinence is difficult to determine accurately.
Faecal Incontinence (FI) is also subject to widely different definitions the most exacting being “Any leakage of gas, liquid or stool” (dictionary definition also used for some prevalence studies). Many studies include loss of control of gas as FI many other use solid or liquid stool leakage as the defining symptom of FI. Some studies state any loss of bowel control including “skid marks” some state faecal soiling three times within the last month.
FI is a symptom not a diagnosis and often arises from a number on different underlying conditions working together. For older people with gastro intestinal problems (chronic or acute) sphincter problems due to muscle weakness or nervous system problems, those with limited mobility or any combination of the above, the issue is not whether they are labelled incontinent. The most important issues (both of which our research program addresses) are getting appropriate treatment that promotes continence and being provided with sufficient good quality toilet facilities so that it is possible to remain active and continent.
For links to further sources of information on incontinence, please visit the continence resources page.
Who is carrying out this study?
Brunel Institute for Bioengineering (BIB) is leading the consortium together with the Brunel Institute for Ageing Studies (BIAS). For further details of who is conducting the research, please see Investigators and Researchers.
Meet the team
The team at our first project meeting, held in November 2008 at Brunel University.
How long will the project run?
TACT3 is a three and a half year project and work began on the 1st November 2008.
Why research Continence?
Incontinence is probably one of the last social taboos. Even in relatively open societies like the UK continence difficulties are rarely discussed. As people grow older, bladder and bowel problems become more common. Urinary systems become less efficient as we age and medications increase the frequency of urination and disturb gastro-intestinal functions. Mobility problems make it hard for older people to maintain continence because of difficulties in reaching a toilet in time and transferring onto it.
Continence problems can cause
embarrassment and distress to the sufferer and are a burden (emotionally, physically and financially) on family carers. Enabling older people to have a good quality of life and defer the fear of transition of 'fit old' to 'frail old', could be greatly aided by the reassurance of appropriate toilet provisions, effective treatment for continence problems and well designed assistive devices.
What subject areas are covered?
TACT3 is an interdisciplinary project with no lead discipline. The subject areas included are:
Environmental Planning
Psychology
Science and Technology Studies
Medical Sciences*
Assistive Technology
What are the aims of TACT3?
This collaborative research project consists of three applied research work packages and an overarching Knowledge
Transfer and Project Management work package. The aims of the research work packages are to-:
(1) Improve toilet provision for older people - by investigating the problems older people have locating and using toilets
when they are away from home and exploring why older people do not like or use the new automatic conveniences. For example finding it difficult to locate a public toilet or finding their public toilets are not open when they need them. We
shall also explore the demands of toilet provision from the perspective and experiences of public toilet providers. The
findings will facilitate the redesign and provision of public toilets to facilitate an age-friendly society.
(2) Improve understanding of continence treatment services - by exploring patient, family and professional viewpoints
when people seek help for continence difficulties from the health services. We shall look at the advantages of specialist
continence care and try to find out why people do not seek treatment. We shall investigate whether specialist geriatric continence care is
significantly better than standard continence care. Our results will be used to ensure more older people obtain greater benefit from continence services.
(3) Provide assistive devices to help people with continence disability - by developing two products that have been
requested by continence pad users to help older people to feel more confident and manage their condition better. The first
product is a urine odour detector that will warn the continence pad user that their pad needs changing before any odour is
detected by the human nose. This simple colour change device will be in the form of a small card or a piece of jewellery or other items requested by users.
The other product is smart underwear that will detect a pad leak immediately and warn the wearer or carer before the leak
spreads to outer clothes or furniture.
Together the findings from the three research work packages will empower older adults to resist frailty and defer the
transition from the third age to the fourth age. The transition from continent to incontinent is a physical and psychological transition from being one of the 'fit old' to one of the 'frail old'. Incontinence damages older people physically in terms of its unpleasant effects.
Incontinence also damages psychosocially because of what it signifies to the older person - loss of control, social stigma and encroaching dependency, all of which threaten self-esteem and self-identity. This project will add to and is
underpinned by, the growing body of theoretical work on 'possible selves' and identity maintenance in old age.
At the core of this project is a Knowledge Transfer and Management work package that will ensure the involvement of
older people at all stages, from the start of the project to dissemination of the findings and assistive device marketing. The
views of other stakeholders affected by, and concerned with, continence issues - families, charities, local government,
health services, public service providers - are to be integrated via project partnership. Stakeholder involvement will (a)
raise public awareness of continence issues, (b) ensure that the project produces useful findings which are disseminated
widely and (c) help ensure that the urine odour detector and the leakage detecting underwear developed through this
research get to market.
Did you know?
The impact of continence difficulties is far more than the physical effort and expense of coping with the day to day management of incontinence. Incontinence can be a precursor to social isolation, loss of self esteem and depression. Inability to cope with continence needs is a major factor in why people move into residential care.
About 50% of this percentage of women over 40 will suffer some symptoms of urinary incontinence, with the number increasing with age; about half as many men are affected. Faecal incontinence is present in about 1% in the general population, rising to 17% in the very old and as high as 25% in nursing homes. The decline in urinary system function and mobility problems, both contribute to loss of continence as we age.
Although there are treatments that can offer some level of symptom relief, many do not provide a complete "cure" and many are not appropriate for older people. Thus, many older people have to cope with the constant requirement to manage their continence needs. Finding the most effective treatment for their symptoms, the best management, (especially outside the home) for their needs, and the most well designed management products, is essential for the maintenance of a good quality of life.
Maintenance of image and positive self concept is essential for successful ageing. Given the large number of older people affected by continence difficulties and the detrimental effects that it has on them, it is essential that the best practice for maintaining continence with regard to health service provisions, the design of the environment and assistive technology is applied.
What are the other NDA Collaborative Research Projects?
These projects are also funded by the NDA and are independent to TACT3. Please direct any questions to the relevant Principal Investigator.
Working late: strategies to enhance productive and healthy environments for the Older Workforce
SUS-IT: Sustaining IT use by older people to promote autonomy and independence
SomnIA - Optimising quality of sleep among Older People
NANA: Novel assessment of Nutrition and Ageing
MAP2030 - Modelling ageing populations to 2030
A life course approach to healthy ageing: capitalising on the value of UK life course cohorts