Behavioral Therapy for Urinary Incontinence

To the Editor.—  The careful study by Hu et al¹ is an important addition to the data regarding urinary incontinence in the nursing home. I write to request clarification of three points.First, I am astonished by the durability of the response in a group of patients as debilitated as the ones included in this study (mean Mini-Mental State Examination score, 12.7; Katz score, 5.3). While some patients may have been motivated and able to continue to ask for toileting assistance, as shown in Fig 2 of the article, this "treatment effect" decayed by more than 50%, while the reduction in incontinent episodes declined by only 16%. Moreover, it is difficult to envision nonresearch nurse assistants voluntarily continuing a toileting regimen that requires hourly checks of all incontinent residents. Could the durability be an artifact due to the return of the nurse research assistants every 2 months to reassess