Author/s, year Country Aim | Setting Participants Demographic details for PLWD | Intervention | Data collection Outcome measures MMAT score |
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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% |