Frail community-dwelling older people with incontinence are at high risk for falls, urinary tract infections (UTIs), incontinence associated dermatitis, pressure ulcers, and poor quality of life creating costly sequelae for patients and health care systems. Contributors to these poor outcomes include a hesitancy to seek treatment for incontinence due to stigma, functional limitations hindering travel to appointments, and being unaware of conservative treatments for incontinence and the impact of poorly fitting body-worn incontinence products (1). When patients can no longer manage incontinence at home, their risk for admission to the hospital, acute rehabilitation, and nursing home escalates, irrespective of age and gender (2). Additionally, in the USA 45 states require health insurers to provide body-worn incontinence products to Medicaid enrollees and have been encouraged to reduce costs associated with these products. These sequelae can be minimized if incontinence is optimally managed at home, but patients need support implementing conservative treatments and guidance on selecting proper incontinence products. Novel approaches are needed to create incontinence treatments that remove barriers such as, distance, stigma, and access. Therefore, we created a telephone counseling intervention provided by the suppliers of incontinence products as a novel, accessible, convenient, discreet, and affordable solution to provide appropriate incontinence products and conservative treatments to frail community-dwelling older adults. We present the study design and baseline characteristics of participants enrolled in our ongoing study.
This study will evaluate the effectiveness of the Incon@Home intervention in community-dwelling Medicaid enrollees aged 55-90 with incontinence. Apriori power analysis indicated a sample size of 160 would have 90% power to detect a moderate cost reduction of 5% with a type 1 error rate of 0.05 with a conservative dropout rate of 30%. The specific aims include:
Aim 1: Evaluate Incon@Home’s effectiveness at reducing older adults’ incontinence severity, development of falls, UTIs, incontinence-associated dermatitis, pressure ulcers, health related quality of life, and satisfaction with the intervention.
Aim 2: Evaluate the cost-effectiveness of Incon@Home at reducing incontinence-related product costs and health care utilization of incontinence-associated (i.e., UTI, pressure ulcers, dermatitis, falls) and all-cause emergency department, clinic, and home health visits, as well as, hospital, rehabilitation, and nursing home admissions.