Prompted voiding for nighttime incontinence in nursing homes: Is it effective?

OBJECTIVES: To determine whether prompted voiding (PV) is effective for nig httime urinary incontinence in nursing home (NH) residents and whether resi dents who respond well to daytime PV also respond well at night. DESIGN: Prospective case series. SETTING: Four community NHs. PARTICIPANTS: Sixty-one long-stay incontinent NH residents of mean age 88 y ears, 75% female. MEASUREMENTS: The percentage of hourly checks for wetness and the appropria te toileting rate (continent voids divided by total voids) were measured du ring 3 days (7 a.m.-7 p.m.) of PV, and for an average of 5 nights (7 p.m.-7 a.m., during which a modified PV protocol, designed to be minimally disrup tive to sleep, was carried out. RESULTS: Fourteen residents (23%) responded well to daytime PV, with averag e wetness and appropriate toileting rates of 5% and 73%, respectively. In t he group as a whole, nighttime PV was not effective, with wetness and appro priate toileting rates of 49% and 18%, respectively. Among those who respon ded well to daytime PV, wetness rates during nighttime PV remained signific antly higher than during the day (24% vs 5%; P =.000), and nighttime approp riate toileting rates were significantly lower (39% vs 73%; P = .002). The poor response rate at night was primarily observed between 10 p.m. and 6 a. m. CONCLUSIONS: In this sample of incontinent NH residents, nighttime PV, even when carried out so as to minimize sleep disruption, was not an effective intervention. Although residents who responded well to daytime PV responded better to nighttime PV than those who did not respond to da) time PV, thei r wetness rates remained relatively high and their appropriate toileting ra tes were low. These data suggest that routine nighttime toileting pro- gram s should not be carried out for the majority of incontinent NH residents. I nstead, individualized care based on resident's preferences, willingness to toilet at night, and sleep patterns should be emphasized.