Urinary incontinence treatment preferences in long-term care

OBJECTIVE: To elicit preferences for different urinary incontinence (UI) tr eatments in long-term care (LTC) from groups likely to serve as proxy decis ion makers for LTC residents. DESIGN: A descriptive, comparative study of preference for UI treatments of frail older adults, family members of nursing home (NH) residents, and LTC nursing staff. Surveys were mailed to families and self-administered by st aff. Older adults were interviewed. SETTING: Four LTC facilities and two residential-care facilities in Los Ang eles. PARTICIPANTS: Four hundred and three family members of incontinent NH resid ents were mailed surveys. Sixty-six nursing staff caring for these incontin ent residents and 79 older adult residents of care facilities (nine cogniti vely intact NH respondents and 70 residential care residents) answered surv eys, MEASUREMENTS: Preference rankings between seven paired combinations of five different UI treatments were measured on an 11-point visual analog scale, with the verbal anchors "definitely prefer" this treatment, "probably prefe r" this treatment, and "uncertain." Respondents gave open-ended comments as well. RESULTS: Forty-two percent of family members (171/ 403) returned the mailed survey. Of all respondents, 85% "definitely" or "probably" preferred diape rs, and 77% "definitely" or "probably" preferred prompted voiding (PV) to i ndwelling catheterization. Respondent groups occasionally differed signific antly in their preferences. In choosing between treatment pairs using a vis ual analogue scale, nurses preferred PV to diapers significantly more than did older adults or families (both of whom preferred diapers) (F (2,295) = 13.11, P < .0001). Older adults, compared with family and nurse respondents , showed a significantly stronger preference for medications over diapers ( F (2,296) = 41.54, P < .0001). In open-ended re sponses, older adults state d that they would choose a UI treatment based in part upon criteria of feel ing dry, being natural, not causing embarrassment, being easy, and not resu lting in dependence. Nurses said that they would base their choice of UI tr eatment upon increasing self-esteem and avoiding infection. CONCLUSIONS: Although there was wide variation within and between groups ab out preferred UI treatment, most respondents preferred noninvasive strategi es (diapers and PV) to invasive strategies (indwelling catheters and electr ical stimulation). Older adults preferred to a greater degree medications a nd electrical stimulation, therapies directed at the underlying cause of UI . Despite data documenting that diapering is a less time intensive way to m anage UI and that toileting programs are difficult to maintain in LTC, nurs es viewed PV as "natural" and strongly preferred it to diapering. Several f amily members and older adults viewed PV as "embarrassing" and "fostering d ependence." These data highlight the need to elicit preferences for UI trea tment among LTC residents and their families.