Many older adults are not candidates for medications because of interactions with drugs they take for other conditions. For those who can take medications, the results can be troubling.

PTNM for senior living facilities data: approximately 60 percent of long-term care residents struggle with urinary incontinence.

One class of drugs (anticholinergics) is associated with an increased risk of dementia.1,2 In fact, the American Geriatrics Society lists a number of anticholinergics as potentially inappropriate for older adults due to side effects and uncertain effectiveness.4

In addition, F315 guidelines from the Centers for Medicare & Medicaid Services (CMS) state, "When using medications, potentially problematic anticholinergic and other side effects must be recognized. The use of medication therapy to treat urinary incontinence may not be appropriate for some residents because of potential adverse interactions with their other medications or other co-morbid conditions."5

American Medical Directors Association Guidelines

According to the American Medical Directors Association (AMDA) guidelines, urinary incontinence is one of the most common conditions among patients residing in long-term care facilities, and it is a condition with various causes. It can often be managed and modified, and in some cases, reversed, even in frail older adults and individuals with dementia who reside in long-term care facilities. Correction of underlying factors such as medical illnesses, functional limitations, and medication side effects can also improve urinary incontinence.6

The Challenge: Effective Overactive Bladder Treatment

Effectively managing overactive bladder (OAB) in your facility can help you meet important objectives:

  • Minimize the risks associated with incontinence, including falls, wounds, and infections7
  • Address regulatory requirements of the Centers for Medicare & Medicaid Services (CMS) F690 to maintain reimbursement rates5
  • Demonstrate to state surveyors that additional focus is being placed on improving care planning with regard to F690 and to meet QAPI plan measures
  • Reduce time spent on toileting, laundry and housekeeping, freeing up time to focus on quality of care
  • Reduce the implication of incontinence with regard to your CMS star rating

The intent of the F315 requirement is to ensure that “each resident who is incontinent of urine is identified, assessed, and provided appropriate treatment and services to achieve or maintain as much normal urinary function as possible.”5

Managing OAB is challenging, and finding treatments for the elderly is difficult, but not impossible.

Expand Options for Residents Who Have Overactive Bladder

Nuro device in use on foot

Percutaneous tibial neuromodulation (PTNM) delivered by the NURO™ system is a safe and effective overactive bladder (OAB) treatment.8-10* It's proven to restore bladder function without the side effects of medication11*‡. and may help your residents who:

  • Have OAB with symptoms of urinary urgency, urinary frequency, or urge incontinence
  • Are seeking an alternative to oral medications due to the concerns associated with interactions with other medications and side effects
  • Prefer an on-site treatment in a long-term care or assisted living facility

Bring Therapy Directly to Residents

PTNM can easily be performed in long-term care and assisted living facilities. Providers trained in PTNM come to your facility, perform the treatment, and bill for the service. For each session, the clinician inserts a 34-gauge needle slightly above the ankle and uses an external neurostimulator to deliver an adjustable electrical pulse to the sacral nerve plexus via the tibial nerve. Treatment protocol involves:

  • 30-minute sessions once a week for 12 weeks
  • Monthly maintenance therapy thereafter
  • Residents can rest, read, or listen to music while the therapy is administered

Patients have been treated with PTNS (also known as PTNM) therapy for nearly a decade. The Medtronic NURO device was launched in the US in 2016.


Percutaneous Tibial Neuromodulation (PTNM) with the NURO System

This course provides a brief overview of advanced treatment options for OAB and a comprehensive introduction to the NURO system.


While the NURO device was not used in the Peters study cited here, since it delivers equivalent stimulation therapy as the device used in the study, a user can expect similar performance.

Restored bladder function is defined as a measurable reduction in urinary frequency and/or urinary incontinence episodes following treatment.

Most common side effects are temporary and include mild pain or skin inflammation at or near the stimulation site.


Lechevallier-Michel N, Molimard M, Dartigues JF, et al. Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID Study. Br J Clin Pharmacol 2004;59(2):143-151.


Gray SL, Anderson ML, Dublin S, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015;175(3):401-407.


Jones AL, Dwyer LL, Bercovitz AR, et al. The National Nursing Home Survey: 2004 overview. Vital Health Stat 13. 2009 Jun;(167):1-155.


Campanelli CM. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults: The American Geriatrics Society 2012 Beers Criteria update expert panel. J Am Geriatr Soc. 2012 April ; 60(4): 616–631.


CMS Manual System. Department of Health & Human Services. Dec 2016. Pgs 291-326.


Urinary Incontinence in the Long-Term Care Setting. Clinical Practice Guideline. AMDA. 2012. Pgs 1-48.


Soliman Y, Meyer R, Baum N. Falls in the Elderly Secondary to Urinary Symptoms. Reviews in Urology. 2016;18(1):28-32.


Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized trial of percutaneous tibial nerve stimulation versus sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. 2010;183(4):1438-1443.


Finazzi-Agrò E, Campagna A, Sciobica F, et al. Posterior tibial nerve stimulation: is the once-a-week protocol the best option? Minerva Urol Nefrol. 2005;57(2):119-123.


Govier FE, Litwiller S, Nitti V, et al. Percutaneous afferent neuromodulation for the refractory overactive bladder: results of a multicenter study. J Urol. 2001;165(4):1193-1198.


Peters, K. M., S. A. Macdiarmid, et al. Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. J Urol 2009; 182(3): 1055-1061.