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Table 2 Characteristics of the included studies

From: Conservative interventions for incontinence in people with dementia or cognitive impairment, living at home: a systematic review

Authors, date & location Research question Study design Participants: recruitment method, eligibility, characteristics and attrition Intervention and control Outcome measure
Gitlin and Corcoran [26] 1993 USA Community To test the effectiveness of a home based intervention to expand caregiver problem solving and use of environmental solutions for problems with bathing and incontinence for elderly people with dementia Randomised two group experimental pilot study Time period 3 months Recruited spouse carers from a network of social service agencies ; Inclusion criteria: 1) reside with a spouse diagnosed with moderate Alzheimer’s Disease 2) provide assistance with 2 or more activities of daily living 3) serve as a primary source of care and 4) not receive any home care services. 37 spouse carers recruited and 17 randomly assigned (unspecified) to the treatment group. Carers: 15 Caucasian, 9 male, mean age 71. Co-resident. People with dementia: no details given Attrition: none Intervention 5 visits by an occupational therapist (OT) using a framework from the competence –environmental literature. Visit 1 problem identification and review of current strategies, Visit 2 identification of environmental influences, education and development of plan. Visit 3 implementation of plan, Visit 4 expansion of plan, Visit 5 review and closure. Control An attention control group receiving home-making services. Number of effective solutions offered by OT and used by spouse carer and evaluated as effective by OT for intervention group only.
Jirovec & Templin [27] 2001 USA Community To determine if functional incontinence (FUI) could be reduced in memory impaired incontinent elders who had a individualised toileting programme (IST) 2 X 2 mixed design analysis by variance (group by time). Time period 6 months. Recruited by advertisement for carers of ‘Memory impaired’ elders. Eligibility criteria not specified. 118 dyads recruited. 77 randomly assigned (by random number tables) to intervention (38 to bi-monthly follow up and 38 to 6 month follow up) and 41 to control. Memory impaired elders with FUI 82 females (69%) and 36 males (31%). Age: 79.89 (SD=7.93) yrs. c30% were African American. Interventions group mean SPMSQ [29] =6.64 (SD=2.2) and control group mean SPMSQ= 6.73 SD=2.44). FUI confirmed by assessment by nurse practitioner in patients home in consultation with an urologist. Carers: 79 females (67%), 39 males (33%). c30% were African American. 41% spouse, 39% adult child; remainder sibling, other relative or friend. Co-residence not specified. Attrition at 6 months 37%. 14 carers found the intervention ‘was too much for them’, 2 carers became ill or could not be reached. 19 elders moved to a nursing home. 9 people died. Intervention 1. Individualised scheduled toileting (IST) agreed with carer. (unspecified if day and night) 2. Carers taught about age related bladder changes and 3) the importance of insuring adequate fluid intake 4. Home environments assessed for obstacles to urine control and advice given. 5. Pamphlet of teaching protocol , written at 6th grade level left with carer 6. Monthly phone calls to review toileting schedule and difficulties, keep carers alert to intervention strategies, ensure carers offered elders 6–8 glasses of fluid a day and retain in study. 7. Bi-monthly visit (IST reviewed) or six month follow up visit. Control Control group paid $25 a visit. Monthly phone calls to maintain commitment to study and provide ‘friendly visits’ Percentage of time the patient was incontinent derived by dividing incontinence episodes by the total number of voiding episodes, both continent and incontinent. Baseline compared with follow up at 6 months All voiding episodes recorded by carer in continence diary kept for up to one week baseline and 6 months. Majority of carers only able to keep diary 3–4 days. During the same week, carers asked how often they were able to implement the IST protocol.
Enberg et al. [28] (2002) USA Community To examine the short-term effectiveness of prompted voiding (PV) in cognitively impaired homebound older adults. Exploratory study Prospective, controlled cross-over design where the usual care controls crossed over to the intervention following an 8 week observation period. Time period 10 weeks. Participants recruited via Home Health Nursing Services Inclusion: > 60yrs, housebound, speak English, be incontinent at least 2x per week for at least 3 months and have a full time carer, MMSE [30] =<24. Exclusion: terminal illness; post void residual volume greater than 100 mL; their caregiver was unable or unwilling to participate or fewer than 2 incontinent episodes per week. 19 patient recruited and randomised by computerized minimization algorithm to the intervention (n=9) or control (n=10) Person with impairment. 68% female (n=13), mean age 83 yrs Mean MMSE[30]=17.24 (range 4–24) 95% needed help with bathing, 35% with eating and 79% needed assistance toileting. Carers (n=16, 8 for control and 8 for intervention) 69% female Mean age 65.2 (SD=12) yrs. All co-resident. Attrition: 3 of 9 intervention group before 8 weeks. 2 died and 1 carer became ill. Intervention PV instruction to carers in 8 weekly sessions in patient’ homes by nurse practitioners (NPs). PV described as a behavioural therapy where carers approached patients every 2 hrs to ask if wet or dry, to check and to praise if dry and ask or encouraged to use the toilet. . PV every 2 hrs (daytime 12–16 hrs) but was individually modified. Carers also encouraged to stop caffeine drinks. If they had enuresis carers were advised to limit fluids in the evening. . Control The NPs visited every 1 to 2 weeks group to provide ‘socialization (attention control) of an average of 35 minutes without discussing incontinence. . Percentage reduction in the average daily frequency of incontinent episodes Percentages of time subjects were wet by proportion of incontinence voids. Comparison of continence for the 2 weeks following the last control or treatment visit to the 2 week baseline period as recorded by the carers in bladder diaries. In addition for the carers a study designed questionnaire to assess perceptions of the intervention at the end.