Prompted Voiding for Management of Urinary Incontinence Among Older Adults
Prompted voiding has been shown in research to be an effective means of control and management of urinary incontinence (UI) in older patients. This therapeutic model involves prompts by the caregiver to consistently timed visits to the restroom (for instance, once every 2 hours). As opposed to timed voiding, in which the patient regulates his or her own schedule, prompted voiding is most often applied in settings such as long-term care, where patients have impaired mobility or cognition due to dementia or Alzheimer’s disease that increases the likelihood of incontinence; limits on mobility can make it difficult, while dementia can reduce the motivation, to reach the toilet.1 Through prompted voiding (PV), a caregiver reminds individuals to go to the washroom on a regular schedule, which reduces the number of incontinence episodes and keeps them aware of their bladder control.
Typical intervention in a PV program has been described as comprising 3 elements: residents are asked at regular intervals (eg, every 1 or 2 hours) whether they are wet or dry; residents receive up to 3 prompts at scheduled intervals to ask for help if they need it; requests for assistance receive positive social reinforcement and the resident is assisted to the toilet.1 This method can help to differentiate mobility and cognitive impairments from other causes of incontinence and has proven to be effective, with more than 60% reduction in UI seen in one study after completion of a PV program.2
A more recent experimental study from Hong Kong reinforced the effectiveness of PV as a behavioral strategy for management of UI in older adults. In a 31-month study of residents from 5 different assisted-care facilities, Lai and colleagues randomly assigned 52 residents to receive either PV therapy or typical incontinence care (eg, adult diapers). The researchers saw a reduction in the rate of UI episodes among patients in the PV group, from 72.6% to 58.7%, whereas the rate increased in the control group, from 66% to 77.6%. In a subsequent press release, Dr. Lai said that, “When prompted by staff to regularly go to the washroom, the elderly went a long way towards managing their urinary incontinence problem and were able to enhance the quality of their life.”
It is estimated that at least 50% of US nursing home residents have some form of UI.3 The results of this study reemphasize the benefits of prompted voiding for behavioral management of incontinence in older adults living in long-term care facilities.
References
1. Leung FW, Schnelle JF. Urinary and fecal incontinence in nursing home residents. Gastroenterol Clin North Am. 2008;37(3):697-707.
2. Ouslander JG, Schnelle JF, Uman G, et al. Predictors of successful prompted voiding among incontinent nursing home residents. JAMA. 1995;273:1366–137.
3. Schnelle JF, Ouslander JG, Simmons SF. Predicting nursing home resident responsiveness to a urinary incontinence treatment protocol. Int Urogynecol J. 1993;4:89-94.
