Conservative Treatment of Fecal Incontinence in the Elderly: Effectiveness T

老年人大便失禁的保守治疗：有效性 T

• 批准号: 8628752
• 负责人: WILLIAM E WHITEHEAD
• 金额: $ 45.85万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8628752
• 关键词: Conservative; Treatment; Fecal; Incontinence; Elderly

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.

大便失禁 (FI) 影响 9% 的美国成年人，每周或更频繁地发生一次，占 2.7%。患病率 随着年龄的增长而增加，到 70 岁达到 15%。 FI has a devastating impact on quality of life and 当患者患有需要护理人员的共病时，会大大增加护理人员的负担 协助。 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.治疗包括患者 关于如何保持节制、盆底运动、行为的生理学教育 strategies for preventing FI, and use of fiber or nonprescription medication to treat diarrhea or 便秘。当治疗传播给一大群提供者时，为了最大限度地减少漂移，患者 education and other basic components of treatment are included in a DVD;然而，护士监督 个体化治疗仍然很重要。该研究将在中北部8个县进行 Carolina which are served by the University of North Carolina Home Health Care and Rex Home Health 护理机构（本研究中的合作伙伴）。这些县将被随机分配到两组 城市与农村居住地大致匹配。在前两年，一组中的所有患者 县将接受积极干预，而其他县的居民则接受常规护理以及 DVD 和症状监测以控制预期。两年后，所有 8 个县的患者将 接受积极干预。排除严重认知障碍患者和患有以下疾病的患者后 造口，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 积极治疗和 63 名对照）。具体目标是（1）表明积极治疗更有效 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， 且改进至少维持 6 个月； (2) 确定治疗的调节因素 有效性（候选变量包括认知状态、行动障碍、家庭意愿 协助治疗、焦虑、抑郁、年龄和种族的护理人员）； (3) 探讨是否 FI 的成功治疗可降低转诊至疗养院的风险。这是修改后的应用程序。