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 (Ul) among caregiver-dependent, incontinent community-dwelling elders. Specifically, the study will test the effect of PURT on the: (1) volume and frequency of UI; (2) incidence of Ul complications; (3) behavioral system balance; (4) family/friend caregiver strain and preparedness for caregiving; and (5) caregiver(s) economic burden of UI care. Urinary incontinence management in communitydwelling persons is reported to cost over $6 billion per year. It is also a major precipitating factor in the family's decision to institutionalize the person and contributes to costly complications such as skin breakdown and urinary tract infections (UTI). Urge and functional UI are most commonly found among older populations. Behavioral treatment has been demonstrated to be an appropriate strategy for urge and functional UI, is free of side effects, non-invasive and does not limit other future treatment options. This study is a departure from other behavioral programs because of its individualized approach and precise UI measurement technique. The study will be conducted in three large geographically disparate communities. All subjects will undergo extensive assessment of their Ul. An ambulatory electronic device to determine the individual subject's voiding pattern will provide the data from which to prescribe an individual toileting schedule for subjccts. Subjects will be randomly divided into treatment and control (delayed treatment) groups (60 in each group). Data will be gathered for three weeks prior to instituting PURT, every three weeks during the six-week PURT program, and for six weeks following the PURT program for dependent measures of volume and frequency of UI, UTI and skin breakdown incidence. The behavioral system measure will be obtained at baseline and then at six-week intervals; and caregiver strain and economic burden measures at baseline and at 12-week intervals. Data will be analyzed using multivariate repeated measures ANOVA and analysis of covariance (ANCOVA). The ultimate goal of this study is to provide caregivers of dependent incontinent elders with a practical, cost-effective strategy for managing Ul. A secondary goal is to identify which individuals would benefit most from this treatment program.
