title: Can an individualized and comprehensive care strategy improve urinary incontinence (UI) among nursing home residents?
abstract: Urinary incontinence (UI) is one of the most common and distressing conditions among nursing home residents. Although scheduled care is usually provided for them, incontinence care should be individualized regarding going to the toilet, changing diapers, and taking food and water. We have developed an individualized and comprehensive care strategy to address the problem. We conducted an intervention study that involved training chiefs of staffs, who in turn trained other staffs, and encouraging residents. A total of 153 elderly subjects selected from 1290 residents in 17 nursing homes were eligible to receive our individualized and comprehensive care. The goals of the care strategy were (i) to complete meal intake; (ii) to take fluids up to 1500 ml/day; (iii) to urinate in a toilet; (iv) to spend over 6h out of bed; and (v) to reduce time spent in wet diapers. We explained the aims of our strategy to the chiefs of staff of each nursing home and instructed them to encourage residents to take an active part in our individualized and comprehensive care strategy for 12 weeks. For 3 days before and after that period, we assessed the changes in fluid volume intake, time spent in wet diapers, size of diaper pads, and urination habits. The result was that fluid volume intake significantly increased (p<0.001) while time spent in wet diapers decreased (p<0.001). The number of residents wearing diapers decreased as did the size of pads during the day (p=0.0017). The proportion of residents using diapers at night was reduced and those using toilets at night increased (p=0.007). This study suggests that such an individualized and comprehensive care strategy can offer a measurable improvement in UI care.
authors.affiliation: Department of Public Health, Gunma University Graduate School of Medicine, 3-39-15 Showa, Maebashi 371-8511, Japan; Department of Internal Medicine, Uchida Hospital, 345-1 Kuyahara, Numata 378-0005, Japan; Nonprofit Organization Silver Age Institute, 1-12-5 Hamamatsucho, Minato 105-0013, Japan. Electronic address: y-tanaka@kyujinkai.com.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Research Division, Tokyo Dementia Care Research and Training Center, 1-12-1 Takaidonishi, Suginami 168-0071, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Nagata
authors.affiliation: Nonprofit Organization Silver Age Institute, 1-12-5 Hamamatsucho, Minato 105-0013, Japan.
authors.forename: Tomoe
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Nonprofit Organization Silver Age Institute, 1-12-5 Hamamatsucho, Minato 105-0013, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kuwano
authors.affiliation: Department of Comprehensive Geriatric Medicine, National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology, 36-3 Morioka, Obu 474-8511, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Endo
authors.affiliation: Department of Public Health, Gunma University Graduate School of Medicine, 3-39-15 Showa, Maebashi 371-8511, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Otani
authors.affiliation: Department of Public Health, Gunma University Graduate School of Medicine, 3-39-15 Showa, Maebashi 371-8511, Japan.
authors.forename: Minato
authors.initials: M
authors.lastname: Nakazawa
authors.affiliation: Department of Public Health, Gunma University Graduate School of Medicine, 3-39-15 Showa, Maebashi 371-8511, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Koyama
mesh_terms: D041382:Diapers, Adult / Q000706:statistics & numerical data; D005260:Female; D005440:Fluid Therapy; D006707:Homes for the Aged; D006801:Humans; D007318:Inservice Training; D008297:Male; D009735:Nursing Homes; D019982:Organizational Case Studies; D010347:Patient Care Planning; D014039:Toilet Training; D014549:Urinary Incontinence / Q000628:therapy*