Urinary incontinence (UI) is highly prevalent among frail, community-dwelling older adults and is associated with substantial personal and healthcare burdens. Many individuals do not seek treatment due to stigma, limited awareness of treatment options, and barriers to accessing care. While the use of appropriate, high-absorbency body-worn incontinence products in conjunction with proactive skin care can improve clinical outcomes, real-world data on product usage in this population remains limited.
The Incon@Home study aimed to (1) counseling on incontinence product selection could reduce UI severity and complications, while optimizing product usage and improving health-related quality of life (HRQoL) and (2) characterize the types and absorbency levels of incontinence products used by frail, community-dwelling older adults.

This single-group, pretest-posttest implementation study adhered to the NIH Framework for Dissemination and Implementation Science [1]. Eligible participants were frail Medicaid-enrolled, community-dwelling adults aged >55 years. Over a 9-month period, participants received telephone-based coaching from trained representatives of an incontinence product supplier.  
Coaches were educated in conservative UI management and assisted participants in selecting appropriate products. Self-reported data were collected at baseline, 3, 6, and 9 months.
Incontinence severity was measured with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). Investigator-developed questions assessed falls, urinary tract infections (UTIs), dermatitis, and pressure ulcers. Incontinence-related and HRQoL was measured with the Incontinence Impact Questionnaire (IIQ-7) and the EQ-5D-5L. The Global Rating of Improvement scale measured program satisfaction. 
Products were classified using International Continence Society terminology for absorbent body-worn incontinence products [3,4]; male pads (Guards), pads, bladder control pads, pull-on pads (protective underwear), all-in-ones (adult briefs).
Paired t-tests and tests of proportion were used to assess differences between baseline and 9-month outcomes. A priori power analysis indicated a sample size of 160 would yield 90% power to detect a moderate (5%) cost reduction (α = 0.05), assuming a 30% dropout rate.
The study was exempt from IRB review, and state insurance regulations for implementation studies were followed.

Of 354 individuals contacted, 82 enrolled and 41 completed the study (Figure 1). Participants were mostly white (67%) females (90%) with a mean(SD) age of 66.5(7.85) years and a mean(SD) BMI of 35.4(9.28). Over 72% were frail, 61% used walking assistive devices, and 9% used wheelchairs. Only 28% received home health services. Of the 51% that lived with a spouse or others, 17% of them required assistance with toileting. 
Significant improvements were observed in ICIQ-SF (UI severity), IIQ-7 (incontinence-related QoL), EQ-5D-5L (general HRQoL) scores. No significant changes were seen in falls, UTIs, dermatitis, or pressure ulcers (see Table 1). By 6 months, product use had shifted from heavy to moderate absorbency pads and pull-ons (Figure 2). Use of barrier creams increased, while underpad use decreased (Table 2). Program satisfaction was high as 98% of participants reported being completely satisfied. Participants said their condition was much better (22%), better (44%), about the same (29%) or worse (5%).

The Incon@Home program demonstrated feasibility and effectiveness in reducing UI severity and improving quality of life in a real-world setting. Product selection improved with a shift to more appropriate absorbency levels, and skin care practices became more consistent. Despite limitations including small sample size and high attrition, the study provides the first known real-world data on incontinence product use and individualized coaching among frail older adults living at home.

Telephone-based incontinence product counseling is a practical, scalable, and low-cost strategy that can reduce UI symptoms, promote appropriate product use, and improve quality of life among frail, community-dwelling older adults. The Incon@Home program offers a promising approach to enhancing conservative management and supporting dignity in home-based continence care.

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Bo K, Frawley H H, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and non-pharamacological management of female pelvic floor dysfunction. Neurourol Urodyn. 2017;36(2):221-244.