OBJECTIVES: Performing a basic evaluation of a resident's urinary incontinence (UI) condition is needed to determine the cause of the incontinence and guide appropriate treatment. The two objectives of this study were 1) to determine the prevalence of residents with UI that received one or more of the four parts of the Agency for Health Care Policy and Research (AHCPR) basic evaluation guidelines and 2) to compare the effectiveness of two types of oral antimuscarinic medications - tolterodine and oxybutynin. METHODS: Data were extracted from medical and Minimum Data Set records in 30 nursing homes in 5 regions of Texas. RESULTS: For Objective 1, medical charts of 255 residents were reviewed. There were 64 residents that met the study criteria for Objective 2. Regarding Objective 1, the majority (n=179, 70.2 percent) had no documentation of any part of the basic evaluation that is recommended for patients with urinary incontinence. Fifty-seven patients (22.3 percent) had documentation of one part of the evaluation, while less than 8% (n=19) had two or more parts of the basic evaluation documented. Female residents were more likely than male residents to have one or more parts of the basic evaluation performed. Residents residing in nursing homes located in urban areas were more likely to have one or more parts of the basic evaluation performed compared to residents residing in rural setting nursing homes. For Objective 2, results showed that residents receiving tolterodine had a greater decrease in urinary incontinence severity levels than residents receiving oxybutynin. Female residents had a greater improvement in UI levels than male residents. CONCLUSIONS: The sparse documentation of basic urinary incontinence evaluations indicates that health care providers and decision makers need to continue to focus on ways to improve the evaluation and management of urinary incontinence in elderly nursing home residents.