Efficacy of Behavioral Interventions for Urinary Incontinence Among Women Residing in Nursing Homes

Abstract

PURPOSE:The purpose of this systematic review was to summarize recent evidence on the efficacy of behavioral interventions for the management of urinary incontinence (UI) among women in nursing homes. METHODS: Systematic review of the literature. For this review, behavioral interventions were defined as those that included some form of physical exercise or behavior modification such as scheduled toileting. SEARCH STRATEGY: A search of MEDLINE/PubMed, CINAHL, Scopus, and Cochrane Library electronic databases was conducted seeking randomized controlled trials published since 2010 in female participants residing in long-term care facilities (nursing homes, skilled nursing facilities) and diagnosed with UI. Inclusion criteria were studies that addressed the effects of voiding regimens, lower extremity strengthening, functional training, food and fluid management, and pelvic floor muscle training. Independent reviewers extracted relevant data and assessed methodological quality using the PEDro scale. FINDINGS: Five studies (pooled sample, N = 399) met inclusion criteria; mean age of participants was 81.1 ± 6.8 years; 85% were female. The PEDro scores ranged from 6 to 9; only 2 studies included residents with cognitive impairment. Interventions included voiding strategies, increasing physical activity, functional mobility training, pelvic floor muscle training, fluid management, and multicomponent combinations of approaches. Three of the 5 studies were multicomponent interventions and 2 focused on a single intervention. Outcomes included objective measures of incontinent episodes and subjective assessments of UI severity. CONCLUSIONS: Behaviorally based interventions can be successful in improving UI among nursing residents with and with no cognitive impairment. IMPLICATIONS: Future studies should examine logistic and labor costs associated with sustaining behavioral interventions using nursing home staff and investigate the effects of these therapies using appropriate quality-of-life metrics for this population.

Determinants of Bladder Care at Night in a Subacute Ward for Aged Patients

“…Nursing care could move beyond containment strategies and nightly rounding. Simple nondrug lifestyle modifications consisting of restriction of evening fluid intake, decreased excess time in bed, moderate exercise, and keeping warm have efficacy in decreasing the number of nocturia episodes 22,23. Ward-level changes that support sleep maintenance, such as noise and light reduction, later timing of sleep, and reduction in duration of “night” hours should be implemented.…”

“…Simple nondrug lifestyle modifications consisting of restriction of evening fluid intake, decreased excess time in bed, moderate exercise, and keeping warm have efficacy in decreasing the number of nocturia episodes. 22,23 Ward-level changes that support sleep maintenance, such as noise and light reduction, later timing of sleep, and reduction in duration of "night" hours should be implemented. An expectation that patients will progress with their toileting independence and improve continence would encourage patients to be less passive with their interactions around bladder care.…”

A Multisite Study on the Effect of a Urinary Incontinence Self-Management Program on Community-Dwelling Older Women in Korea

“…7 Self-management programs for UI typically employ one or more behavioral or lifestyle strategies designed to alleviate UI and related lower urinary tract symptoms. [8][9][10] Possible interventions include pelvic floor muscle exercises, fluid and dietary interventions, and weight loss, along with prevention and management of constipation. According to Lorig and Holman, 10 chronic disease self-management skills include problem-solving, decision-making, resource utilization, the formation of a patient-provider partnership, action planning, and self-tailoring.…”

“…Self-management programs for UI typically employ one or more behavioral or lifestyle strategies designed to alleviate UI and related lower urinary tract symptoms 8–10. Possible interventions include pelvic floor muscle exercises, fluid and dietary interventions, and weight loss, along with prevention and management of constipation.…”