Conservative Treatment of Fecal Incontinence in the Elderly: Effectiveness T

大便失禁（FI）影响9%的美国成年人，每周或更频繁地发生在2.7%。患病率 随着年龄的增长，到70岁时达到15%。FI对生活质量具有破坏性影响， 当患者患有需要护理人员的共病时， 援助.我们提出了一个有效性试验，其总体目标是确定是否保守 在单中心研究中已证明有效的干预措施将维持其疗效， 由家庭保健护士向居家人群传播。治疗包括患者 关于如何维持骨盆底运动的生理学教育，骨盆底运动，行为 预防FI的策略，以及使用纤维或非处方药治疗腹泻或 便秘为了最大限度地减少治疗传播给一大群提供者时的漂移，患者 教育和治疗的其他基本组成部分包括在DVD中;然而，护士的监督 个体化治疗仍然很重要。这项研究将在北中部的8个县进行， 北卡罗来纳州家庭保健大学和雷克斯家庭保健大学为卡罗莱纳提供服务 护理机构（本研究的合作伙伴）。这些县将被随机分为两组 在城市和农村居住的情况大致相同。在最初的两年里，一组患者中的所有患者， 县将接受积极干预，而其他县的居民接受常规护理， DVD和症状监测，以控制预期。两年后，所有8个县的患者将 积极干预。在排除严重认知障碍患者和 我们估计，252 - 340名年龄超过50岁的FI患者将接受治疗（至少189 治疗组和对照组各63例。具体目标是：（1）表明积极治疗比 在改善FI严重程度、患者生活质量和护理人员负担方面，比对照治疗有效， 并保持至少6个月的改善;（2）确定治疗的调节剂 有效性（候选变量为认知状态、行动障碍、家庭意愿 照顾者协助治疗，焦虑，抑郁，年龄和种族）;和（3）探索是否 FI的成功治疗降低了疗养院转诊的风险。这是一份修改后的申请。

Fecal incontinence (FI) affects 9% of U.S. adults and occurs weekly or more often in 2.7%. Prevalence increases with age reaching 15% by 70 years. FI has a devastating impact on quality of life and substantially increases caregiver burden when patients have comorbid conditions requiring caregiver assistance. We propose an effectiveness trial whose overall goal is to determine whether a conservative intervention which has been shown to be effective in single-site studies will sustain its efficacy when disseminated to a home bound population by home health care nurses. The treatment includes patient education about the physiology of how continence is maintained, pelvic floor exercises, behavioral strategies for preventing FI, and use of fiber or nonprescription medication to treat diarrhea or constipation. To minimize drift when the treatment is disseminated to a large group of providers, patient education and other basic components of treatment are included in a DVD; however, nurse supervision to individualize treatment remains important. The study will be carried out in 8 counties in central North Carolina which are served by the University of North Carolina Home Health Care and Rex Home Health Care agencies (partners in this study). These counties will be randomly assigned to two groups approximately matched on urban vs. rural residence. For the first two years all patients in one group of counties will receive the active intervention while residents of the other counties receive usual care plus a DVD and symptom monitoring to control for expectancy. After two years, patients in all 8 counties will receive the active intervention. After excluding patients with severe cognitive impairment and those with stomas, we estimate 252 - 340 patients with FI who are over age 50 will receive treatment (at least 189 in active treatment and 63 controls). Specific aims are (1) to show that the active treatment is more effective than the control treatment for improving FI severity, patient quality of life, and caregiver burden, and that improvements are maintained for at least 6 months; (2) to identify moderators of treatment effectiveness (candidate variables are cognitive status, mobility impairment, willingness of family caregiver to assist with treatment, anxiety, depression, age, and race); and (3) to explore whether successful treatment of FI reduces the risk of nursing home referral. This is a revised application.