Efficacy of Prompted Voiding Therapy in Elderly Hospitalized.

Study Overview
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Brief Summary
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This study evaluates effectiveness to apply prompted voiding in urinary incontinence and dependence patients admitted at functional recovery ward in a mid-stay hospital. This behavioural therapy is recommended in Best Practice Guidelines, and it has good results in elderly living in the community or in nursing home but yet it has not shown his benefits in hospitalized elderly patients for a long time.

Detailed Description
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The increased level of chronic diseases, greater chances of survival and older people hospitalized, place the Urinary Incontinence (UI) problem in a priority position both in hospital and community care. Guadarrama (Public Madrid Health Service) is a medium-stay Hospital. It makes treatment to recover from acute disease and UI has 80% prevalence at admitted patients. Main objective:To assess the efficacy of Prompted Voiding (PV) therapy for reverse of UI status in elderly patients hospitalized in a Functional Recovery Ward. (FRW) Methods: Experimental research pre/post-Intervention, with 5 repeated measures data: baseline (preintervention); at discharge, at one, three and six months after discharge (post-intervention). Sample size is 212 admitted patients in the FRW with UI. Prompted voiding intervention will be applied by nursing team following the procedure hospital approved and it will be individualized to each patient. Main Outcome: urinary continence (YES/NO), others outcomes: amount and frequency of urine loss, type of incontinence pads; follow-up: urinary continence at one, three, and six months after discharge. Applicability: Incorporating Prompted Voiding Therapy in UI patients care, encouraging global care, relevant implications for reduce the morbidity, improvement the quality of life, decrease health costs.

Official Title
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Efficacy of Prompted Voiding Therapy for Reverse the Urinary Incontinence Status in Elderly Patients Hospitalized in a Functional Recovery Ward.

Conditions
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Urinary Incontinence

Intervention / Treatment
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* Behavioral: Prompted voiding


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: onset of Urinary Incontinence less than 1 year (information extracted from the Patient's Medical History, or provided by the patient or family caregiver) sign the informed consent. Exclusion Criteria: patient with indwelling urinary catheters at admission irreversible urinary incontinence by disease itself moderate-severe cognitive impairment (Pfeiffer's questionnaire > 4) patients with indication of water restriction. patients who do not collaborate in Prompted Voiding therapy.

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: urinary incontinence<br>Recruitment, 3-day voiding record, initiate a individualized prompted voiding schedule based on the client's toileting needs until discharge, 1, 3 and 6 month follow-up post-discharge. | Behavioral: Prompted voiding<br>* Monitoring: This involves asking the incontinent individual, at regular intervals, if he or she needs to use the toilet. The care provider may look for behaviours that the client needs to be toileted (e.g., restlessness, agitation, disrobing), and take the client to the toilet at regular intervals specific to their schedule, rather than routinely every two hours. Prompting: This process includes prompting the person to use the toilet at regular intervals, and encourages the maintenance of bladder control between prompted voiding sessions. Praising: This important step is the positive reinforcement of dryness and appropriate toileting, and is the response from the care provider to the individual's success with maintaining bladder control.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of Urinary Incontinence status after prompted voiding program (PVP) | To value the efficacy of prompted voiding therapy to recovery urinary continence in elderly hospitalized at functional recovery ward. Data wil be collected from nursing assessment at admission, at discharge and telephone call. | at admission, at discharge (about 30 to 60 days), 1 , 3 and 6 month post discharge | 
| Improve urinary incontinence episodes/symptoms after prompted voiding program. | To value the efficacy of prompted voiding therapy to improve urinary incontinence episodes/symptoms (episodes frequency, volume loss, type pad used) in elderly hospitalized at functional recovery ward. It Will be measure with assistance nurse record. | at admission, each 15 days along admission, at discharge (about 30 to 60 days). | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of Urinary Incontinence status after PVP in admitted patients with Stress Urinary Incontinence | Assessment will be with IU4 questionnaire and NANDA diagnosis. Data will be collected from nursing assessment at admission and nursing assesment at discharge records. | at admission, at discharge.(about 30 to 60 days) | 
| Change of Urinary Incontinence status after PVP in admitted patients with Emergency Urinary Incontinence | Assessment will be with IU4 questionnaire and NANDA diagnosis. Data will be collected from nursing assessment at admission and nursing assesment at discharge records. | at admission, at discharge.(about 30 to 60 days) | 
| Change of Urinary Incontinence status after PVP in admitted patients with Mixed Urinary Incontinence | Assessment will be with IU4 questionnaire and NANDA diagnosis. Data will be collected from nursing assessment at admission and nursing assesment at discharge records. | at admission, at discharge.(about 30 to 60 days) | 
| Change of Urinary Incontinence status after PVP in admitted patients with Functional Urinary Incontinence | Assessment will be with IU4 questionnaire and NANDA diagnosis. Data will be collected from nursing assessment at admission and nursing assesment at discharge records. | at admission, at discharge.(about 30 to 60 days) | 
| Change from Urinary Incontinence status after PVP in admitted patients with Reflects Urinary Incontinence | Assessment will be with IU4 questionnaire and NANDA diagnosis. Data will be collected from nursing assessment at admission and nursing assesment at discharge records. | at admission, at discharge.(about 30 to 60 days) | 
| Change of Urinary Incontinence status after PVP in admitted patients with Total Urinary Incontinence | Assessment will be with IU4 questionnaire and NANDA diagnosis. Data will be collected from nursing assessment at admission and nursing assesment at discharge records. | at admission, at discharge.(about 30 to 60 days) | 
| Urinary Incontinence (UI) status reached related with aged. | To Identify promoting/difficulty continence factors. Data will be collected from clinical history records. | at admission, at discharge (about 30 to 60 days) | 
| Urinary Incontinence (UI) status reached related with cognitive ability. | To Identify promoting/difficulty continence factors. Data will be collected from clinical history records. Cognitive impairments will be measure with Pfeiffer test. | at admission, at discharge (about 30 to 60 days) | 
| Urinary Incontinence (UI) status reached related with Functional ability. | To Identify promoting/difficulty continence factors. Data will be collected from clinical history records. Functional ability will be measure with Barthel Scale. | at admission, at discharge (about 30 to 60 days) | 
| Urinary Incontinence (UI) status reached related with risk diseases presence. | To Identify promoting/difficulty continence factors. Data will be collected from clinical history records. Risk diseases: Diabetes Mellitus, Parkinson Disease, Heart Failure, Obesity, Urinary Tract infection, Nervous System Diseases, Stroke, Abdomen and pelvis surgery. | at admission, at discharge (about 30 to 60 days) | 
| Urinary Incontinence (UI) status reached related with risk drugs. | To Identify promoting/difficulty continence factors. Data will be collected from clinical history records and drug prescriptions. Risk drugs: Diuretics; sedatives; hypnotics; anticholinergics; amitriptyline; opioid analgesics, cholinesterase inhibitors. | at admission, at discharge (about 30 to 60 days) | 
| Urinary Incontinence (UI) status reached related with overweigth. | To Identify promoting/difficulty continence factors. Data will be collected from clinical history records. Body Mass Index greater than or equal to 25 | at admission, at discharge (about 30 to 60 days) | 
| Urinary Incontinence (UI) status reached related with caregiver presence. | To Identify promoting/difficulty continence factors. Data will be collected from clinical history records. | at admission, at discharge (about 30 to 60 days) | 
| Urinary Incontinence (UI) status reached related to diagnosis of admission | To Identify promoting/difficulty continence factors. Data will be collected from clinical history records. 3 groups will be assigned: Femoral Fractures, stroke, functional disability. | at admission, at discharge (about 30 to 60 days) | 
| Urinary Incontinence (UI) status reached related to risk of Skin Ulcer | Data will be collected from clinical history records. It will be valuated with Norton Scale. | at admission, at discharge (about 30 to 60 days) | 
| Urinary Incontinence (UI) status reached related to fall risk. | Data will be collected from clinical history records. It will be valuated with Sytratify Scale. | at admission, at discharge (about 30 to 60 days) | 
| Urinary Incontinence (UI) status reached related to days of hospitalization. | To Identify promoting/difficulty continence factors. Data will be collected from clinical history records. | at admission, at discharge (about 30 to 60 days) | 
| Urinary Incontinence (UI) status reached related with time of UI. | To Identify promoting/difficulty continence factors. Data will be collected from clinical history records. | at admission, at discharge (about 30 to 60 days) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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aged, Therapeutics, hospitalization, nursing care, rehabilitation, prompted voiding