• Eleanor van den Heuvel, Brunel University

  • Professor Mary Gilhooly, Brunel University

  • Professor Ian Sutherland, Brunel University

  • Felicity Jowitt, Brunel University

  • Dr Kevin McKee, Dalarna Research Institute and Dalarna University, Sweden

  • Dr Lena Dahlberg, Dalarna Research Institute and Dalarna University, Sweden

  • Professor Stuart Parker, the University of Sheffield

  • Professor Patrick Gaydecki, The University of Manchester

  • Professor Norman Ratcliffe, University of the West of England

  • Jo-Anne Bichard, Royal College of Art

  • Adele Long, BioMed HTC, Bristol Urological Institute

  • Dr Nikki Cotterill, BioMed HTC, Bristol Urological Institute

  • Dr Susie Orme, Clinical Consultant, Barnsley Hospital


Advisory committee members

  • Professor Alan Cottenden

  • Dr Kenneth Collins

  • Professor Paul Knight

Canadian link

  • Professor Jeffrey Jutai, University of Ottawa

  • Dr Kenneth Southall, University of Ottawa

  • Dr Cara Tannenbaum, University of Montreal

  • Rona Agnew, Brunel University

Project team

  • Dr Alison Orrell, the University of Sheffield

  • Dr Bosco Fernandes, The University of Manchester

  • Gail Knight, Royal College of Art

  • Mary Caspillo-Brewer, Brunel University

PhD student

  • Rose Kahwa, the University of Sheffield


  • The Centre for Accessible Environments

  • Devices for Dignity

  • Age UK

  • Technology Sourcing

  • The British Toilet Association

  • The IBS Network

  • The National Trust

  • The Simon Foundation

  • The Relatives and Residents Association


Principal investigator

Eleanor van den Heuvel
Email: eleanor.van.den.heuvel@brunel.ac.uk

Project administrator

Mary Caspillo-Brewer
Email: mary.caspillo-brewer@brunel.ac.uk


Continence difficulties are very common; some studies show 30 to 60% of women over 40 will suffer some symptoms of urinary incontinence; 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. Older people may become less mobile, their urinary system function may decline and they are more likely to suffer other diseases and conditions which affect continence.

There are treatments that can offer some level of symptom relief, but many do not provide a complete “cure” and some are less suitable for older people. Thus many older people have to cope with the constant requirement to manage their continence needs.

Thus, 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.

The impact of continence difficulties is far more than the physical effort and expense of coping with the day to day management. Incontinence is a precursor to social isolation, loss of self esteem and depression. Inability to cope with continence needs is a major reason why people move into residential care.

Maintenance of image and positive self-esteem is important for successful ageing. Large numbers of older people lives are negatively affected by continence difficulties. Therefore, it is essential that the best practice for continence health service provisions, the design of the environment and assistive technology development is applied.

Aims and objectives

Knowledge transfer and project management

We aimed to

  • ensure that stakeholders play a direct role in the project, gathering information from all stakeholders (older people with continence difficulties, family carers, healthcare professionals and policy makers)

  • ensure timely production of project deliverables

  • ensure that project results are brought to the attention of all stakeholders and the general public

Challenging environmental barriers to continence

We investigated environmental barriers to continence and continence management and identified how they can be removed.

Improving continence interventions and services

We aimed to promote more effective continence treatment and support better service outcomes by enhancing perceptions of control and efficacy in the older person.

Developing assistive devices

Our aim was to design, develop and evaluate two assistive devices (an odour sensor and wetness sensing smart underwear) that were requested by continence pad users themselves.


Challenging environmental barriers to continence

Two sets of stakeholders were involved, older people with continence difficulties and toilet providers. Focus groups, workshops, interviews and photographic diaries were used to identify key issues for the stakeholders.

From the information gathered, a design tool and pictorial reference cards were produced which have been made freely available to users, providers and designers. These were reviewed by stakeholders before release.

Improving continence interventions and services

140 patients and their carers were interviewed twice, with a 12 month interval, from a specialist continence clinic for older people and generic continence clinic.

20 health and social care managers and 200 practitioners were also interviewed. Care outcomes were analysed from each clinic and a cost benefit analysis was carried out.

Developing assistive devices

An inexpensive colour change odour indicating formula was developed to indicate the presence of the odour of urine at a just imperceptible level. A washable fabric underwear wetness sensor and alert mechanism was developed.

Potential user opinions were sought by focus groups to identify desired forms for the sensor and underwear. Users tested the developed prototypes for acceptability.

Policy implications

  • A consolidated report for policy makers on the toileting needs of an active ageing population with continence concerns, to ensure social inclusion and access to the built environment.

  • Design templates of facilities, and pictorial reference cards of current provision, based on the budget requirements and social considerations of providers and the needs and aspirations of older users.

  • A user led image data bank of continence barriers in the built environment.

  • Information and a ‘points by points’ check list for providers of toilet facilities into how such provision can be made more age friendly. Such information was delivered through a series of workshops that target leaders in toilet provision (local and national businesses, local authorities).

  • A cost-benefit analysis of specialist vs standard clinical continence care.

  • New health promotion guidelines for overcoming barriers to help-seeking in older people with continence problems.

  • New guidelines for health and social care professionals to support service provision delivery that is tailored to the needs of older people and their carers.

  • Information and a ‘points by points’ check list for providers of toilet facilities into how such provision can be made more age friendly. Such information was delivered through a series of workshops that target leaders in toilet provision (local and national businesses, local authorities).

  • New guidelines for clinical continence care to maximise continence management and quality of life and optimise levels of service use in older people with incontinence

Product development impacts

  • A design tool was developed for planners, architects and anyone wanting to provide toilets that was suitable for older people particularly those with continence management difficulties.

  • A range of inexpensive colour change urine odour indicators were developed. The colour change odour detectors could be in the form of credit card sized cards, rings with colour change stones or other items depending on user preferences. The indicators give users reassurance that no urine odour is detectable to other people.

  • A Smart underwear range with wetness sensor was developed. This product alerts the user to a pad leak before wetness wicks through to outer clothing and furnishings. The underwear is washable and informs the user by mobile phone text or pager.