Conservative Treatment of Fecal Incontinence in the Elderly: Effectiveness T

大便失禁(FI)影响着9%的美国成年人，每周或更频繁发生的比例为2.7%。流行率 随着年龄的增长，到70岁时达到15%。FI对生活质量有毁灭性的影响， 当病人有需要照顾者的合并症时，大幅增加照顾者的负担 援助。我们提出了一项有效性试验，其总体目标是确定一名保守派 已被证明在单部位研究中有效的干预措施将在以下情况下保持其有效性 由家庭保健护士向居家人口传播。治疗包括病人 关于如何保持可控性的生理学教育，盆底锻炼，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。当治疗传播给一大群提供者、患者时，将漂移降至最低 教育和治疗的其他基本组成部分都包含在DVD中；然而，护士监督 个体化治疗仍然很重要。这项研究将在中北部的8个县进行 由北卡罗来纳大学家庭保健和雷克斯家庭健康提供服务的卡罗莱纳 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 与城市和农村的住宅大致匹配。在前两年，同一组中的所有患者 各县将接受积极干预，而其他县的居民将接受常规护理和 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。在排除了严重认知障碍患者和有 造口，我们估计50岁以上的FI患者将接受治疗(至少189人 积极治疗组和63名对照组)。具体目标是(1)表明积极治疗更多 在改善FI严重程度、患者生活质量和照顾者负担方面比对照治疗有效， 并保持改善至少6个月；(2)确定治疗的缓解剂 有效性(候选变量为认知状态、行动能力障碍、家庭意愿 照顾者协助治疗、焦虑、抑郁、年龄和种族)；以及(3)探索 FI的成功治疗降低了养老院转诊的风险。这是一份修改后的申请表。

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.