Now, about 80% residents in nursing homes in Japan have dementia. The residents with dementia may not be aware of their urge to urinate. As a result, the residents with dementia will receive excretory care using diapers. Currently, dementia is the number one reason for Japanese nursing home residents to use diapers. In the absence of urinary disorders, residents with functional urinary incontinence do not need to use diapers if their excretory rhythm are understood. Using bladder volume measurement device (Lilium-SPOT2, Lilium Otsuka Co., Ltd.) with a smartphone app (nocopo personal, Lilium Otsuka Co., Ltd.) as ultrasound-assisted prompted voiding for toilet guidance to understand rhythm in residents with functional urinary incontinence may eliminate the needs for diapers. The purpose of this study was to verify whether the use of ultrasound device with a smartphone app would be effective for excretory care of residents with functional urinary incontinence at nursing homes.

The study was single-arm, open-label, and conducted at a nursing home. A 22-item urination checklist developed by the Graduate School of Medicine, Nagoya University was used to select nursing home residents for inclusion. In the observation period, long-term care records, two days bladder diaries, QOL scale (EQ-5D-5E), LUTD questionnaire and Barthel index are recorded. In the intervention period, Lilium-SPOT○R2 with a smartphone app by care workers to understand each resident excretory rhythm and then guide to toilet. In the pre-intervention and post-intervention period, long-term care records, same questionnaires are recorded and the records are as pre-intervention and post-intervention are compared and analyzed. Ethical review was approved by the Japan Conference of Clinical Research (approval No.470).

Eight residents with functional urinary incontinence were selected. Frequency of urinary incontinence, Barthel index score and QOL scale did not change before and after the intervention. LUTD questionnaire (4.2 to 2.8, P<0.01) and residual urine volume score (1.0 to 0.29, P<0.01) showed significant improvement during the intervention period. The five of eight residents were grasped excretory rhythm and they are used the excretory pads, but no longer urinated in it after intervention. The long-term care records recorded that the behavior and psychological symptoms of dementia in five residents were improved. In three residents out of eight, care workers could connect using Lilium-SPOT2 with a smartphone app to support of care residents. One resident complained of the urge to urinate but was unable to urinate. However, using Lilium-SPOT2 with a smartphone app confirmed that residual urine was still visible. After that urethral catheterization was performed by a nurse. Two residents complained frequent urges to urinate. However, no residual urine was actually found in the bladder. The two residents were determined to need to be diagnosed by urologist.

There was no change in the Barthel index numbers, but there was a significant difference in the QOL scale. Ultrasound-assisted prompted voiding as a single measurement device and a smartphone application is effective to understand the rhythm of residents with functional incontinence in nursing homes. Data from ultrasound-assisted prompted voiding as a single measurement device and a smartphone application made it easier for care workers to seek support from medical professionals.

The effectiveness of excretory care using self-usable bladder volume measurement device with a smartphone app as ultrasound-assisted prompted voiding for the toilet guidance for the residents with functional urinary incontinence in nursing homes was suggested. It was also found to be useful in inter-professional work in nursing home setting.

Motofumi Suzuki, Hideyo Miyazaki, et,al. Ultrasound-assisted prompted voiding care for managing urinary incontinence in nursing home:  A randomized clinical trial. Neurourology and Urodynamics.2019;1-7.
Okamura K. et al., The Journal of Japanese Continence Society 13(2);301-311, 2002
Questionnaire for the assessment of lower urinary tract dysfunction developed by experts of the Japanese Society of Wound, Ostomy, and Continence Management, Japanese Society of Geriatric Urology and the Japanese Continence Society in 2018 and 2020.

Continence 7S1 (2023) 100738
DOI: 10.1016/j.cont.2023.100738