Urinary incontinence in the elderly is a major problem with significant medical, psychological, and social consequences. Previous research on urge incontinence, a common form of incontinence, has demonstrated that behavioral interventions and drug treatments are effective for many individuals. However, it is clear that no one method has been 100% effective and all methods have disadvantages. This project will be a prospective, randomized trial comparing the effects of behavioral training, drug therapy (oxybutynin) and placebo on urge incontinence in ambulatory, community-dwelling women aged 55 years and older. Although the two treatments have been studied individually, their effects have never been compared. Approximately 390 women will be evaluated for participation with the expectation that 195 will complete the protocol. Stratified and blocked randomization procedures will be used to assign subjects to 4 sessions (8 weeks) of biofeedback-assisted behavioral training, 4 sessions (8 weeks) of treatment with oxybutynin, or 4 sessions (8 weeks) of placebo. The study will also evaluate the combined effects of the two interventions and characterize patients on clinical variables that may influence outcome. The candidate was a fellow at the Gerontology Research Center, N.I.A. or six years during which time she focused her research on the development and testing of behavioral methods for the treatment of urinary and fecal incontinence. In her new position as Director of Research at the Benedum Geriatric Center at the University of Pittsburgh, Department of Medicine, she plans to extend her research on incontinence. Her short term goals are to further evaluate and improve treatment methods for incontinence. Her long range career goals involve continued investigations of urinary incontinence in collaboration with faculty and fellows in geriatrics, nursing, neurology, urology, rehabilitation and gynecology. She hopes to establish herself as an expert in the field of incontinence, and to expand her research to other problem areas in behavioral geriatrics.
