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Table 4 Characteristics of included quantitative experimental studies

From: Understanding how to facilitate continence for people with dementia in acute hospital settings: a mixed methods systematic review and thematic synthesis

Author/s, year

Country

Aim

Setting

Participants

Demographic details for PLWD

Intervention

Data collection

Outcome measures

MMAT score

Case series with non-concurrent multiple baseline design

Study 5: Lancioni et al. 2009a [70]

USA

The authors presented three pilot studies that assessed the effectiveness of verbal instructions, presented automatically through simple technology, in helping persons with mild-to-moderate AD recapture basic daily activities

Setting

Alzheimer rehabilitation centre

Participants

Residents with AD (n = 3)

Gender: Female (100%)

Age (years): 79, 81, 86

Mental status

AD

MMSE scores: 10, 19, 22

Intervention

Baseline: Pilot study 1: the participants were to perform the bathroom routine without the help of the technology and related verbal instructions

Intervention: pilot study 1: The participants performed all bathroom-routine steps with the help of the technology, which presented the instructions Step 1 was “sit on the toilet”. 17 steps in total and step 1 was “to sit on the toilet”

Data collection

The participants’ performance of a step was recorded as ‘correct’ if it matched the description of such step (and the instruction available for it during the intervention) and occurred independent of prompting by research assistants

Outcome measures

Percentage of correct steps performed

MMAT score: 100%

Study 6: Lancioni et al. 2009 [71]

USA

To assess the effectiveness of verbal instructions (presented automatically through simple technology) in helping persons with mild or moderate AD perform daily living activities

Setting

Alzheimer rehabilitation centre

Participants

Residents with AD (n = 4)

Gender: female (100%)

Age (years): 59, 76, 79, 85

Mental status

AD

MMSE scores: 11, 12, 16, 20

Intervention

Same as Lancioni et al. 2009a

Four studies with the first one aimed at replicating pilot study 1 from Lancioni et al. 2009a. efforts directed at re-establishing the performance of morning bathroom routine

Data collection

Same as Lancioni et al. 2009a

Outcome measures

Same as Lancioni et al. 2009a

MMAT score: 100%

Randomised control trials

Study 8: Jirovec and Templin 2001 [72]

USA

To evaluate the effectiveness of an individualised scheduled toileting program on incontinent, memory impaired elders being cared for at home

Setting: home

Participants

Caregivers (n = 118)

Memory impaired elders (n = 118)

Randomised to I (n = 77), C (n = 41)

Recruited through announcements in newsletters, flyers on bulletin boards, and newspaper advertisements asking for volunteers who were caring for a memory-impaired elder

Gender: female (69%)

Age (mean + SD) years

79.89 + 7.93

Mental status

SPMSQ: mean 6.69 + 2.28

Intervention

individualised scheduled toileting program

The intervention group was taught an IST procedure that compensated for cognitive impairment by providing memory-impaired patients toileting reminders

Initially, assignment was to one of two intervention groups: one group of participants was visited every 2 months, and the other group after a 6-month interval. There was also a control group

At the 6-month follow-up, the two intervention groups did not differ with respect to UI. The original two intervention groups were combined, leaving a single intervention group and a control group.

Data collection

Incontinence was calculated as the percentage of time the patient was incontinent by dividing the incontinent episodes by the total number of voiding episodes, both continent and incontinent

Voiding record

Outcome measures

Decrease in percentage of incontinent episodes versus staying the same or not showing improvement in incontinence

Incontinence frequency

Mobility

Consistency in implementing the IST protocol

MMAT score: 75%

Prospective cohort study

Study 15: Wijk et al. 2018 [73]

Sweden

To operationalise, assess, and evaluate the feasibility and preliminary effects of implementing a person-centres approach to incontinence care for older adults with cognitive decline in residential care facilities in Sweden

Setting

Residential care facilities (n = 3)

Participants

Health care workers (n = 20)

Residents with cognitive decline (n = 54)

Gender

Female (59.9%)

Age (mean + SD) years

83.9 + 8.72

Range 68 to 99

Mental status

Cognitive decline

MMSE score of 9.28 + 7.94

Intervention

Person centred approach focused on assessment and care planning to incontinence care over a 10-month period

Training was provided over 5 session s to teach participants how to tailor a person-centred incontinence plan

At the end of the 10-month period the participants created guidelines to make change towards person-centred incontinence care sustainable

Data collection

Health care records assessed by research team at baseline, immediately after and at 6 months

Process outcome measures of the person-centred approach

Impact outcome measures of participants quality of life

Impact outcome measures of participants quality of care

Outcome measures

Quality of life in late stage dementia

Continence status (totally independent—using the toilet with no need of any containment product; partly continent—continent if assisted when needing to go to the toilet with or without use of a containment product; totally incontinent—being dependent on containment products 24/7 and not managing by oneself

Has baseline assessment of incontinence been conducted?

Have person centred actions been taken regarding incontinence?

Has the resident been given adapted continence aids?

MMAT score

75%

Pre-test/post-test

Study 9: Tanaka et al. 2009 [74]

Japan

To investigate whether a system of individualised and comprehensive care was able to increase the intake of fluids and food, and to reduce the proportion of diaper users and the size of their diaper pads, thus leading to an enhanced quality of life

Setting

Nursing homes (n = 17)

Participants

Nursing home residents (n = 122)

Gender

Female (85.2%)

Age (mean) years

85.2

Mental status

Dementia

Intervention

Individualised and comprehensive care that focused on providing adequate fluids and meals, encouraging patients to use toilets and reducing the size of their diaper pads. This approach would differ significantly from the usual UI care in which diapers would be changed only at scheduled times

Data collection methods

Water intake volume, condition of diapers (dry or wet), when residents wet their diapers were recorded in residents check sheets by staff

Hours spent in wet diapers were calculated by subtracting the total time spent in dry diapers from 24 h

Types of pants or diapers (cloth pants, training pants, diaper, cloth diapers), and the size of pads (S, M, L, XL, 2XL)

Method of daytime urination (toilet, commode chair, urinary chamber pot, diaper

Outcome measures

Mean water intake volume

Time spent in wet diapers (hours/day)

Changing types of pants or diapers and the size of pads during daytime

Change in method of daytime night-time urination

MMAT score: 100%

Post-intervention descriptive surveys

Study 10: Gitlin and Corcoran 1993 [75]

USA

To describe the use of the home environment by 17 spouse caregivers to manage problems associated with bathing and incontinence

Setting: Home

Participants

Spouse caregivers of elderly with dementia (n = 17)

Recruited from a network of local social services agencies

Demographic characteristics of elderly PLWD not provided

Mental status

Physician’s diagnosis of dementia

Intervention

Individual treatment strategies delivered by an OT and designed to enhance the caregiver’s ability to problem solve about their environment and to develop effective solutions to situations they considered problematic

Data collection

Data recording form completed by OT

Outcome measures

Number of solutions which were implemented by a caregiver

Number of solutions deemed ineffective and which were eliminated by the caregiver

MMAT score: 75%

Study 11: Corcoran and Gitlin 2001 [75]

USA

To describe the specific aspects of treatment that were accepted and utilised by 100 family caregivers

Setting: home

Participants

Family caregivers in the treatment arm of a RCT (n = 100)

Recruited using media announcements and social service referrals

Demographic characteristics of elderly PLWD not provided

Mental status

Physician’s diagnosis of dementia

Intervention

Environmental Skill-Building Program

Home environment intervention delivered by OTs and included toileting and incontinence same as Gitlin and Corcoran 1993

Data collection

Interviews to ascertain:

The specific problems areas that were addressed in the intervention

The specific strategies that the caregiver indicated a willingness to try (attempted)

The strategies the caregiver actually used

Outcome measures

Number and type of problem area

Strategies for specific problems

Strategies by environmental layers

Acceptance and use of environmental strategies

MMAT score: 75%

  1. Key: AD Alzheimer’s disease, CI confidence intervals, C control, I intervention, IST individualised scheduled toileting, MMAT Mixed Methods Evaluation Tool, MSE Mental State Examination, OT occupational therapist, PLWD people living with dementia, RCT randomised controlled trial, RR response rate, SPMSQ Short Portable Mental Status Questionnaire, UI urinary incontinence