`Resigned agency' in older adults: a meta-ethnography of the lived experience of urinary incontinence

Abstract

Background Urinary incontinence (UI) is highly prevalent among older adults and often leads to significant physical, social and psychological consequences. Understanding these lived experiences is essential for developing effective, person-centred interventions that address not only the physiological but also the emotional and social dimensions of UI. Methods A qualitative systematic review following the PRISMA guidelines was conducted to identify original studies that explored older adults’ experiences with UI. Databases including PubMed, EMBASE, Scopus and PsycINFO were searched up to 30 November 2024. Eligible studies employed qualitative methods or mixed-methods designs with a clear qualitative component, examined participants aged 60 or older with any type of UI and focused on their perceptions, coping mechanisms or lived experiences. Meta-ethnography guided the synthesis of first-, second- and third-order constructs. Results Thirty-two studies were included. Five interlinked themes emerged: (i) normalisation of UI as a part of ageing, (ii) stigma and concealment, (iii) adaptive self-management strategies, (iv) barriers and critical triggers for help-seeking and (v) identity disruptions and relational strain. A central concept of ‘resigned agency’ was identified, where individuals acknowledged the burden of UI yet deferred help-seeking, navigating the condition through self-regulation and quiet endurance. Conclusions Older adults with UI often enact a form of resigned agency, balancing silent acceptance with personal coping strategies while delaying or avoiding formal care. For future work, interventions (such as destigmatising conversations and support) should be developed to address both individual illness representations and the social contexts that shape them, including stigma, cultural norms and healthcare responsiveness. Registration The study protocol was registered in PROSPERO (registration number CRD42024614673).