From the April Issue of JAMDA

Abstract

Transcutaneous nerve stimulation is safe and noninvasive and may benefit nursing home residents with bladder and bowel dysfunction, according to a pilot study. Some 30%-60% of nursing home residents experience urinary incontinence, and one-third experience fecal incontinence, the researchers said. Although noninvasive peripheral electrical neuromodulation shows promise as a therapy, the authors said, studies have yet to establish it as a first-line treatment. Joanne Booth, PhD, of the Institute for Applied Health Research at Glasgow Caledonian University in Scotland and her colleagues recruited 30 long-term care residents with bladder or bowel dysfunction or both. Participants were randomized to receive 12 half-hour sessions of transcutaneous posterior tibial nerve stimulation (TPTNS) for 6 weeks or a sham treatment. Urinary symptoms, as measured by American Urological Association Symptom Index scores, improved significantly more in residents who received TPTNS. Thirteen of those 15 patients (87%) reported improved urinary symptoms, whereas only 4 of the 15 patients (27%) who received sham treatment said they improved. Two patients (13%) in the treatment group and 7 patients (54%) in the sham group reported worsening symptoms. Symptoms were unchanged in 2 patients in the sham group. Urinary incontinence, measured by International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-SF), improved by 1 or more points in 67% of people in the TPTNS group vs. 46% in the sham group, and it remained unchanged in 20% of each group. Scores worsened in 13% of patients in the treatment group vs. 26% of the sham group. Bowel urgency and fecal leakage improved in both groups. “The study is exciting because it offers the potential to actively treat bothersome bladder and bowel symptoms and leakage in an unobtrusive way that preserves the older person's dignity,” Dr. Booth said in an interview. “Current treatment options for bladder and bowel dysfunction involve participation in behavioral programs that many older people are unable to achieve or sustain. Or it involves medication that is often effective but associated with limiting side effects.” Dr. Booth cautioned that larger trials are needed to investigate TPTNS as a potential alternative to percutaneous posterior tibial nerve stimulation and pharmacological interventions for lower urinary tract symptoms. Although none of the patients in this study was cognitively impaired, Dr. Booth said that TPTNS may be suitable for demented patients with bladder and bowel dysfunction, something that she and her colleagues plan to investigate. “This large and growing population is usually unable to participate in behavioral programs for bladder and bowel symptoms,” she said. ▸ Source: A Feasibility Study of Transcutaneous Posterior Tibial Nerve Stimulation for Bladder and Bowel Dysfunction in Elderly Adults in Residential Care – Booth et al. Visual acuity is measurable even in nursing home residents who have severe dementia, according to findings from the School of Optometry at the University of Montreal. Dr. Estefania Chriqui and her colleagues evaluated 30 young individuals (mean age, 25 years), 30 nursing home residents (mean age, 86 years) who had cognitive impairment up to severe dementia and 30 elderly people (mean age, 70 years) not living in nursing homes and with no history of a cognitive or communication disorder. All individuals underwent the following tests, with refraction: Snellen chart, tumbling E, Patty Pics, Early Treatment Diabetic Retinopathy Study (ETDRS) letters, numbers, and preferential looking visual acuity (Teller cards). All individuals in the first two groups and 11 (63%) in the third group responded to all the charts. Broken down further, 24 cognitively impaired nursing home residents (80%) responded to the Snellen chart, 29 (97%) to the Teller cards, 26 (87%) to the numbers, 27 (90%) to the ETDRS letters, 21 (70%) to the tumbling E, and 23 (77%) to the Patty Pics. One individual could not respond to any chart. Patients with severe dementia (a score less than 13 on a Mini-Mental State Examination [MMSE]) responded to significantly fewer visual acuity charts than those with higher MMSE scores. Among those with severe dementia, more responded to the Teller cards, but their level of visual acuity was 20/73, the lowest level among all charts tested. Tests yielding the lowest visual acuity scores were the Teller cards (20/65) and the Patty Pics (20/62). Highest acuity scores were obtained with the Snellen and ETDRS letter charts (20/35 and 20/36, respectively). The results of this study suggest that nursing homes should at least attempt to measure visual acuity, even in those patients with severe dementia, although the effort with them will require extra time and encouragement. Source: Visual Acuity in Institutionalized Seniors With Moderate to Severe Dementia – Chriqui et al.