Urinary incontinence is a common health problem among older adults. Previous research has shown that behavioral treatments are effective methods of reducing incontinence in mentally alert, ambulatory outpatients and in nursing home residents. However, their effectiveness has not been established in older patients who are homebound. The primary purpose of the proposed project is to study the effects of individualized programs of prompted voiding and biofeedback-assisted behavioral training implemented by nurse practitioners in the home care setting. The second purpose is to identify characteristics of individuals who are most responsive to such intervention in order to aid us later in developing selection criteria. This project will be a prospective, controlled trial of behavioral treatment with incontinent men and women, 60 years of age or older who receive home health care. Approximately 424 patients will be evaluated for participation with the expectation that 106 will complete the protocol (53 in each of two groups). Subjects will be classified according to three key characteristics and randomized to eight weekly sessions of behavioral treatment or to a control condition consisting of no intervention for eight weeks followed by entry into the delayed treatment protocol (also eight weekly sessions). Patients who are identified as having significant cognitive impairment (MMSE < 24) will be treated with a program of prompted voiding implemented by the caregiver. Patients without significant cognitive impairment (MMSE greater than or equal to 24) will be treated with a program of scheduled voiding and biofeedback-assisted pelvic floor muscle training, and assisted as needed by a caregiver. Bladder diaries completed by subjects or caregivers prior to randomization and following the eight-week protocols will be used to calculate reduction of incontinence.
