The purpose of this proposal is to extend a prompted voiding incontinence management system that has been validated during daytime hours into the nighttime period. the nighttime incontinence management intervention is designed in consideration of a resident's sleep pattern, incontinence severity, and risk for pressure sore development. Extensive preliminary data collected by the investigative team and recent practice guidelines established by government expert panels for the management of incontinence and pressure sore prevention influenced the design of the intervention program. The intervention will be tested in 8 nursing homes over a period of four years using the multiple baseline delayed intervention design employed in our previous studies. Outcomes will be compared among residents in the immediate and delayed intervention nursing homes during three major phases: (1) both homes in baseline, (2) immediate home during intervention and delayed home still in baseline, and (3) both homes during intervention. Differences between the immediate and delayed intervention homes are hypothesized on measures of nighttime incontinence frequency and measures of sleep. In addition, daytime behavioral observations will be completed following nighttime monitoring of sleep to assess if improvements in nighttime incontinence and sleep are associated with improved resident daytime functioning.
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