The major long term goal of this grant is to develop an effective, nursing staff based, urinary incontinence, treatment program for nursing home patients. Urinary incontinence which is correlated with a variety of insidious medical/psychological side effects, has been identified as pervasive in nursing home populations. Preliminary research has suggested that this pervasive incontinence can be dramatically reduced with treatment programs implemented by nursing staff. This project will refine this staff based technology and address the following specific aims: (1) Predict what types of nursing patients are most responsive to incontinence rehabilitation. (2) Define and evaluate rehabilitative protocols that effectively reduce urinary incontinence in heterogeneous nursing home populations. (3) Develop a staff management and training system which facilitates the effective staff implementation of treatment protocols over a 12-month test period. (4) Replicate the total technology (assessment, treatment protocols, training/management system) to randomly selected nursing homes. Behavioral and urodynamic assessment will be conducted on 80 incontinent nursing home patients in the first year. Baseline observations of the frequency and severity of the urinary incontinence will be conducted on an hourly basis for two weeks. Groups of 20 patients will then be prompted each hour to request voiding assistance if needed. The groups will be sequentially treated thus permitting a multiple baseline evaluation of the treatment procedures. Patients who are responsive to the prompted voiding will be further taught to independently toilet within their physical limitations. The treatment protocols developed in the first year will be replicated in four different nursing homes who will receive different management systems designed to maximize the maintenance of the treatment protocols over a 12-month period. The most effective management strategy will be documented by: (1) direct observation of staff incontinence care performance; and (2) reduction in patient incontinence episodes. The most effective incontinence treatment and management package will be replicated in four additional nursing homes during the third grant year.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01AG005270-02
Application #
3546239
Study Section
(SSS)
Project Start
1984-09-28
Project End
1987-08-31
Budget Start
1985-09-01
Budget End
1986-08-31
Support Year
2
Fiscal Year
1985
Total Cost
Indirect Cost
Name
Middle Tennessee State University
Department
Type
Schools of Education
DUNS #
077648780
City
Murfreesboro
State
TN
Country
United States
Zip Code
37132
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Schnelle, J F; Newman, D R; Fogarty, T E et al. (1991) Assessment and quality control of incontinence care in long-term nursing facilities. J Am Geriatr Soc 39:165-71
Schnelle, J F (1990) Treatment of urinary incontinence in nursing home patients by prompted voiding. J Am Geriatr Soc 38:356-60
Schnelle, J F; Newman, D R; Fogarty, T (1990) Statistical quality control in nursing homes: assessment and management of chronic urinary incontinence. Health Serv Res 25:627-37
Schnelle, J F; Newman, D R; Fogarty, T (1990) Management of patient continence in long-term care nursing facilities. Gerontologist 30:373-6
Schnelle, J F; Traughber, B; Sowell, V A et al. (1989) Prompted voiding treatment of urinary incontinence in nursing home patients. A behavior management approach for nursing home staff. J Am Geriatr Soc 37:1051-7
Petrilli, C O; Traughber, B; Schnelle, J F (1988) Behavioral management in the inpatient geriatric population. Nurs Clin North Am 23:265-77
Schnelle, J F; Sowell, V A; Hu, T W et al. (1988) Reduction of urinary incontinence in nursing homes: does it reduce or increase costs? J Am Geriatr Soc 36:34-9
Sowell, V A; Schnelle, J F; Hu, T W et al. (1987) A cost comparison of five methods of managing urinary incontinence. QRB Qual Rev Bull 13:411-4