Reducing urinary incontinence in nursing home patients
Urinary incontinence is one of the most prevalent health problems in elderly persons, affecting approximately 9 percent of older Americans living at home and 40 to 50 percent of those living in nursing homes. The cost of incontinence among nursing home residents is about $2 billion annually.
A number of methods, including diapers, catheterization, medication and surgery, are used to manage or treat urinary incontinence. Hu and colleagues conducted a randomized trial of a behavioral therapy program to reduce urinary incontinence among nursing home residents.
The study population consisted of 133 incontinent women in seven nursing homes. They were randomly assigned to a 13-week behavioral therapy program for urinary incontinence or to a control group. Patients in the control group received usual care. Behavioral therapy consisted of hourly visits to each patient by a nursing aide who prompted them to use the toilet. The patients were praised for successful toileting. If a patient was found to be dry on a scheduled check, she was given social reinforcement in the form of special attention (time spent conversing or receiving additional personal services).
Positive effects of behavioral therapy were noted after six weeks. At the conclusion of the 13-week study, wet episodes in the treatment group had been reduced by 26 percent. The effects of the treatment program were maintained during a 22-week follow-up period, despite the lack of reinforcement for the target behavior. The number of wet episodes in the control group remained about the same throughout the study and follow-up periods.
The women in the treatment group probably improved partly because they learned to request help, a response that was reinforced by the program. Women who responded better to this behavioral program included those with a high frequency of incontinence during the baseline period, those with normal bladder capacity and those with higher scores on cognitive status examinations.
The authors note that although their study proved that behavioral therapy can be effective in reducing incontinence, some other issues in nursing home care may prevent widespread implementation of such programs. The labor costs of behavioral therapies to reduce incontinence may be higher than the savings in laundry costs to the nursing home. However, placing a dollar value on improved quality of life is difficult. An important challenge is to find an organizational management scheme that gives nursing home personnel the time needed to help patients overcome incontinence. (JAMA, May 12, 1989, vol. 261, p. 2656.)
COPYRIGHT 1990 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group