Skip to main content

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