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.
