Urinary incontinencce (UI) is a problem for a significant portion of the community-living elderly. Two of the most striking and consistent findings of my earlier research on UI in the relatively healthy elderly have been (a) that management strategies for UI depend on the presence of coexistent illnesses or disabilities and (b) that UI, despite being recognized as troublesome, is cognitively seen to be a normal part of old age and therefore irremediable. This study extends the investigation of behavioral and cognitive contexts of UI to a very different population, the frail, homebound elderly, and asks: How to multiple and/or severe coexistent illnesses influence the management of UI? What types of cognitive organizational strategies are used by this group of elderly who are heavily embedded in a health service network? It consists of careful description of: (1) the patterns of UI in this population; (2) the illness or disability contexts, the physical environment contexts and the social contexts in which UI occurs; and (3) the congnitive organizational strategies used by the incontinent elderly and their caretakers. Further, several analytic quetions are posed concerning hierarchies of disorder and cognitive organizational strategies. A stratified, random sample of 200 homebound elderly clients will be drawn from the client list of the Visiting Nurse Association. A case study of each client will be constructed through interviews with the client, the client's family and/or caretakers, the VNA staff responsible for the client's care, and the client's referring physician. Each case study will start when the client begins receiving services and monthly followup will be conducted for a six-month period. The findings of this study will provide information about the behavioral contexts of urinary incontinence in the frail elderly. This knowledge will be useful for theory development concerning hierarchies of disorder and cognitive organizational strategies about age-related disorders as well as for interventions focusing on reducing the medical, social and personal burden of urinary incontinence.
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