(Poster 149) Telephone Coaching Improved Incontinence in Frail Adults: Results of Incon@Home

Objectives: Frail older adults living at home experience the highest rates of urinary incontinence (UI). We enhanced a telephone coaching program delivered by an incontinence product supplier to create Incon@Home, an accessible, convenient, discreet, and affordable intervention. This study evaluated the effectiveness of Incon@Home in reducing UI severity, preventing falls, urinary tract infections (UTIs), incontinence-associated dermatitis, and pressure ulcers, while improving health-related quality of life and participant satisfaction.

Methods: We used a single-group pretest-posttest design based on the NIH Framework for Dissemination and Implementation Science [1] to plan, implement, and evaluate the intervention. Incon@Home, a 9-month telephone coaching program, was delivered by incontinence product service representatives to help frail, community-dwelling Medicaid enrollees aged 55 and older self-manage UI using conservative treatment strategies.
Self-reported outcomes were collected throughout the program. UI severity was measured using the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF). Falls, UTIs, dermatitis, and pressure ulcers were assessed using investigator-developed questions. Quality of life was measured using the Incontinence Impact Questionnaire – Short Form (IIQ-7) and EQ-5D-5L. Program satisfaction was evaluated using a global improvement rating scale.
Descriptive statistics were used to characterize the sample, and paired t-tests or proportion tests were used to compare baseline and 9-month outcomes. The study was exempt from IRB oversight under 45 CFR 46.104, category 3(2). All participants provided oral consent in accordance with Medicaid regulations for implementation studies.

Results: Of 354 individuals contacted, 94 were eligible, and 82 enrolled. Attrition was 34% at 3 months, 49% at 6 months, and 50% at 9 months (see Figure 1). Participants ranged in age from 55–89 years (mean = 66.5, SD = 7.85) with a mean BMI of 35.4 (SD = 9.28). Over 90% were female, 67% identified as White, 28% as Black, and 5% as other races. Most participants (72%) were classified as frail, 61% used a mobility aid, and 9% used a wheelchair. Only 28% received home health services. Among those living with others (51%), 17% required assistance with toileting.
Statistically significant improvements were observed in ICIQ-SF, IIQ-7, and EQ-5D-5L scores. Small, statistically insignificant changes were noted in falls, UTIs, dermatitis, and pressure ulcers (see Table 1). At program completion, 98% of participants reported being completely satisfied. Participants reported their condition as much better (22%), better (44%), the same (29%), or worse (5%).

Conclusions: The Incon@Home program led to reported improvements in UI symptoms, quality of life, and participant satisfaction. While changes in pressure ulcers, dermatitis, and UTIs were minimal, the program demonstrated value for frail older adults who completed the intervention. Limitations include the single-group design, which precludes causal inference, and a high attrition rate. Nonetheless, these findings support the effectiveness of a practical, scalable model for delivering conservative UI management to vulnerable populations.