The purpose of this study is to test the efficacy of a non-invasive, behavioral treatment called Patterned Urge-Response Toileting (PURT) on urge/functional urinary incontinence (UI), among nursing home patients. Specifically, the study will test the effect of PURT on the: volume and rate of incontinence; 2) incidence of UI complications; 3) psychosocial well-being of the subjects; 4) nursing staffs' knowledge and attitudes in caring for incontinent patients; and 5) cost of implementing PURT versus the usual incontinence care costs. Urinary incontinence management is said to account for .5 to 1.5 billion dollars per year of the over 20 billion spent on nursing home care. It is also a major precipitating factor in the family's decision to institutionalize and it contributes to costly complications such as skin breakdown and urinary tract infections. Several types of urinary incontinence exist. Urge and functional UI are the most common accounting for from 50-70 percent of the patients with UI in nursing homes. The study will be conducted in 4 of the Robert Wood Johnson Teaching Nursing Homes after carefully screening patients. A unique feature of this study is the use of an electronic device to determine the individual subject's 24-hour pattern of voiding which will then be used to individually prescribe a toileting schedule for nursing assistants who care for the subjects to follow. Subjects will be randomly divided into experimental and control groups (50 in each group). Dependent measures include frequency and volume of incontinence, incidence of urinary tract infections, skin breakdown, and psychosocial well-being. Nursing staff will be subjected to a 3-hour incontinence management training program. Their knowledge and attitudes will be measured before the training and after the training, the 3-month intervention period and the 3-month post intervention period. Patient data will be collected at baseline and at 3-week intervals during the 3-month control period, the 3-month intervention period, and during 3-month post intervention period. Data will be analyzed using multivariate repeated measures ANOVA, and analysis of covariance (ANCOVA). The ultimate goal of this study is to provide nursing homes with practical, cost effective strategy for managing UI and for identifying patients who would be most likely to benefit from this intervention.
