With a donation of HK$1.26 million from The Hong Kong Jockey Club Charities Trust under CADENZA: A Jockey Club Initiative for Seniors, Prof. Claudia Lai of School of Nursing, who is also Jockey Club CADENZA Fellow, recently completed an experimental study on the effectiveness of "Prompted Voiding" (PV) as a behavioural strategy for urinary incontinence among elderly people. The results showed that PV is effective for managing the problem of urinary incontinence. In this issue, Prof. Lai will give more details about the study and its implications for elderly people.

What is “prompted voiding” (PV)?

PV is a non-invasive behavioural strategy. Caregivers will provide positive reinforcement and prompt the elderly to go to the washroom regularly, so as to reduce the occurrence of incontinence and increase their awareness of bladder control.

This is the first local study about the effectiveness of PV as a behavioural strategy to manage urinary incontinence. Why did you conduct this study?

Urinary incontinence is a common health problem among the elderly. It not only affects their everyday life, but also has a negative impact on their physical and psychological well-being. According to a survey conducted by a local university in 2003, 10-15% of those aged 65 and above in Hong Kong suffer from urinary incontinence. Among elderly residents of nursing homes, the occurrence of urinary incontinence has significantly increased over the past 20 years. The most common way of managing urinary incontinence among elderly people is to use adult diapers, which however could affect their dignity and self-confidence. It also irritates their skin and leads to a greater chance of developing urinary tract infections. There are several cognitive behavioural strategies that can be used to deal with the problem, but according to research conducted in other countries, PV is one of the most effective strategies and it can reduce the reliance of elderly people on diapers. However, no similar study has been conducted in Hong Kong and that was why we conducted the study.

How was the study conducted and what were the findings?

We conducted an experimental study on the effectiveness and sustainability of PV in managing urinary incontinence in the elderly between January 2011 and July 2013, involving residents from five local nursing homes. A total of 52 elderly people who met the criteria were selected for inclusion from 486 voluntary participants. The 52 participants were randomly assigned to an experimental group (PV therapy) and a control group (normal incontinence care). The results showed that the urinary incontinence rate among those with PV therapy dropped from 72.6% to 58.7%, while the rate for the control group rose from 66% to 77.6%. This indicates that PV is effective in reducing urinary incontinence in local nursing homes and that the effects are sustainable over time.

The study has proved the effectiveness of PV programme. But how should we ensure the success of the programme?

When prompted by staff to regularly go to the washroom and with positive reinforcement, over time, the elderly went a long way towards managing their urinary incontinence problem and were able to enhance the quality of their life. Staff training and quality assurance are the keys to the success of the PV programme. To ensure its continued success, nursing homes should appoint an officer-in-charge to develop a quality assurance, continuous surveillance and feedback system. The results and data collected in this study will definitely help to increase the public's concern about urinary incontinence. To further promote the therapeutic value of PV as a cognitive behavioural strategy, we have consolidated the findings and the key points into a practical report and manual under the sponsorship of The Hong Kong Jockey Club Charities Trust. Any interested parties are welcome to request a copy for reference.

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