The major research goal is to maintain continence in nursing home patients for a minimum six month period. It has been demonstrated that patient continence can be developed and maintained by research staff for thirty days with the use of a two hour prompted voiding treatment schedule. Follow-up measures taken when patients were returned to nursing staff for care revealed that patient continence returned to pretreatment levels within fourteen days. This project will develop and evaluate continence maintenance strategies and address the following specific goals: (1) Can a system be developed to efficiently assess the degree of patient continence over long time periods. (2) Can a staff feedback system based on continence measures be developed that will lead to continence maintenance over a six month period. 180 patients in fifteen nursing homes will be identified as potentially responsive to prompted voiding treatment according to validated prognostic criteria. Following a four day baseline period, the patients will be treated by research staff with prompted voiding procedures for six days. Patients who become continent 90% of the time will be randomly divided into experimental and control groups. The continence of both groups of patients will be monitored by research staff for a six month period. Experimental patient continence will also be monitored by supervisory nurses who will provide feedback to nursing aides. The degree such feedback assists in maintaining patient continence will be evaluated. The time costs of the supervisory feedback system will be measured and contrasted to the savings that may result from improved continence.
