Effectiveness of behavioral therapy to treat incontinence in homebound older adults

OBJECTIVES: To examine the (1) short-term effectiveness of behavioral thera pies in homebound older adults and (2) characteristics of responders and no nresponders to the therapies. DESIGN: Prospective, controlled clinical trial with crossover design. SETTING: Adults aged 60 and older with urinary incontinence and who met Hea lth Care Financing Administration criteria for being homebound were referre d to the study by homecare nurses from two large Medicare-approved home hea lth agencies in a large metropolitan county in southwestern Pennsylvania. MEASURES: Structured continence and medical history, OARS Physical and Inst rumental Activities of Daily Living scales, Folstein Mini-Mental State Exam ination Score, Clock Drawing Test, Geriatric Depression Scale, Performance- Based Toileting Assessment, bladder diaries, and physical examination. RESULTS: One hundred five subjects were randomized to biofeedback-assisted pelvic floor muscle training (53 to the treatment group and 52 to the contr ol groups). Control subjects with complete pre- and post-control data (n = 45) experienced a median 6.4% reduction in urinary accidents in contrast to a median 75.0% reduction in subjects with complete pre- and post-treatment data (n = 48, P < .001). Following the control phase, subjects crossed ove r to the treatment protocol. Eighty-five subjects completed treatment, achi eving a median 73.9% reduction in UI. Exercise adherence was the most consi stent predictor of responsiveness to the behavioral therapy. CONCLUSIONS: Clinically significant reductions in urinary incontinence are achievable with behavioral therapies in many cognitively intact homebound o lder adults despite high levels of co-morbidity and functional impairment.