PREDICTORS OF SUCCESSFUL PROMPTED VOIDING AMONG INCONTINENT NURSING-HOME RESIDENTS

Objective.-To develop a simple, noninvasive assessment strategy that w ill enable nursing home staff to identify incontinent residents who re spond well to prompted voiding. Design.-Incontinent nursing home resid ents underwent an extensive clinical and functional assessment and the n 7 days of prompted voiding. Data from the assessment and the first 3 days of prompted voiding were used to predict responsiveness to the i ntervention. Setting.-Seven nursing homes. Patients.-A cohort of 191 i ncontinent, long-stay nursing home residents who passed a simple behav ioral screen (able to state their name or reliably point to one of two named objects). Intervention.-Prompted voiding was carried out by tra ined research nurse's aides from 7 AM to 7 PM for 7 days, The interven tion was maintained in responsive residents 5 days per week for an add itional 9 weeks. Main Outcome Measures.-Physical checks for wetness we re done by research staff hourly from 7 AM to 7 PM for 3 days in a bas eline condition, during days 5 through 7 of the 7-day prompted voiding intervention, and for 3 days at the end of 9 weeks of prompted voidin g in the responsive group. Outcome measures were percentage of checks wet and response to prompted voiding, with ''responders'' defined as r esidents with an average of one or fewer wet episode per day on days 5 through 7 of prompted voiding. Results.-Seventy-eight (41%) of the re sidents were responders. Their wet percentage went from 26.7% to 6.4% at the end of 1 week and was maintained at 9.6% after 9 weeks of promp ted voiding. The best predictors of responsiveness were the wet percen tage and the appropriate toileting percentage during the first 3 days of prompted voiding, the self-care subscale score of the Multidimensio nal Observational Scale for the Elderly, and the ability to ambulate w ithout human assistance. The best sensitivity and specificity in ident ifying responders was achieved when either the wet percentage was lowe r than 20% or the appropriate toileting percentage was higher than 66% during the first 3 days of prompted voiding (sensitivity, 87%; specif icity, 69%). Those residents falsely identified as responders by these criteria still had a 46% relative reduction in wetness. Conclusions.- A substantial proportion of nursing home residents respond well to pro mpted voiding, The most responsive residents can be easily identified using data collected during a 3-day trial of the intervention, The ass essment strategy is consistent with federal guidelines and could be us ed to facilitate quality control by assessing changes in percentage of wetness from the expected norm.