Prompted voiding for nighttime incontinence in nursing homes: is it effective?
OBJECTIVE
To determine whether prompted voiding (PV) is effective for nighttime urinary incontinence in nursing home (NH) residents and whether residents who respond well to daytime PV also respond well at night.


METHODS
Prospective case series.


METHODS
Four community NHs.


METHODS
Sixty-one long-stay incontinent NH residents of mean age 88 years, 75% female.


METHODS
The percentage of hourly checks for wetness and the appropriate toileting rate (continent voids divided by total voids) were measured during 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 disruptive to sleep, was carried out.


RESULTS
Fourteen residents (23%) responded well to daytime PV, with average wetness and appropriate toileting rates of 5% and 73%, respectively. In the group as a whole, nighttime PV was not effective, with wetness and appropriate toileting rates of 49% and 18%, respectively. Among those who responded well to daytime PV, wetness rates during nighttime PV remained significantly higher than during the day (24% vs. 5%; P = .000), and nighttime appropriate 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 daytime PV, their wetness rates remained relatively high and their appropriate toileting rates were low. These data suggest that routine nighttime toileting programs should not be carried out for the majority of incontinent NH residents. Instead, individualized care based on resident's preferences, willingness to toilet at night, and sleep patterns should be emphasized.
Ouslander
J G
JG
Wesley Woods Center of Emory University and the Atlanta VA Rehabilitation Research and Development Center, Atlanta, Georgia, USA.
Ai-Samarrai
N
N
Schnelle
J F
JF
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008609:Mental Status Schedule; D009551:Night Care / Q000379:methods* / Q000592:standards; D009730:Nursing Assessment / Q000379:methods / Q000592:standards; D009735:Nursing Homes; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014039:Toilet Training; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000517:prevention & control*