© 2014 Wiley Periodicals, Inc. Background: Evidence based guidelines for the management of frail older persons with urinary incontinence are rare. Those produced by the International Consultation on Incontinence represent an authoritative set of recommendations spanning all aspects of management. Aims: To update the recommendations of the 4th ICI. Materials and Methods: A series of systematic reviews and evidence updates were performed by members of the working group in order to update the 2009 recommendations. The resulting guidelines were presented at the 2012 meeting of the European Associatioon of Urology. Results: Along with the revision of the treatment algorithm and accompanying text. There have been significant advances in several areas including pharmacological treatment of overactive bladder. Discussion: The committee continue to notes the relative paucity of data concerning frail older persons and draw attention to knowledge gaps in this area.