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Yoneyama F, Okamoto T, Tamura Y, Ishii N, Togashi K, Soma O, Fujita N, Yamamoto H, Hatakeyama S, Kobayashi W, Ohyama C. Association between oral frailty and lower urinary tract symptoms among middle-aged and older adults in community-dwelling individuals: a cross-sectional study. Int Urol Nephrol 2024; 56:1803-1810. [PMID: 38216828 DOI: 10.1007/s11255-023-03878-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/04/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE We assessed the association between oral frailty risk and LUTS among middle-aged and older adults in a community-dwelling population. METHODS This cross-sectional study was conducted among 586 subjects aged ≥ 40 years who participated in the Iwaki Health Promotion Project in Hirosaki, Japan. We used the International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS) to assess LUTS. LUTS was defined as an IPSS score of 8 or higher or meeting diagnostic criteria for OAB. Oral frailty risk was defined as experiencing two or more of the following: decreased chewing ability, decreased biting force, and dry mouth sensation. Physical performance (10-m gait speed and grip strength) was used for analysis. The association between oral frailty risk and LUTS was examined using multivariate logistic regression analyses. RESULTS The study included 218 men and 370 women, of whom 140 had LUTS. The mean age of this cohort was 59 years. Significant differences were observed between the LUTS and non-LUTS groups, including age, hypertension, history of CVD, depressive status, sleep disturbance, and 10 m gait speed. The prevalence of oral frailty risk was significantly higher in the LUTS group than in the non-LUTS group (26% vs. 11%, P < 0.001). Multivariate analysis revealed that age, male gender, and oral frailty risk (odds ratio: 2.67, 95% confidence interval: 1.57-4.51, P < 0.001) were independent factors for LUTS. Moreover, oral frailty risk was an independent factor in both participants aged < 65 years and participants aged ≥ 65 years. CONCLUSIONS Oral frailty was independently associated with LUTS.
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Affiliation(s)
- Fumiya Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan.
| | - Yoshihiro Tamura
- Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Noritaka Ishii
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Kyo Togashi
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Osamu Soma
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Wataru Kobayashi
- Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Hellman-Bronstein AT, Luukkaala TH, Ala-Nissilä SS, Nuotio MS. Associated factors of stress, urgency, and mixed urinary incontinence in a geriatric outpatient assessment of older women with hip fracture. Eur Geriatr Med 2024:10.1007/s41999-024-00997-w. [PMID: 38802641 DOI: 10.1007/s41999-024-00997-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Urinary incontinence (UI) is known to be common among older female hip fracture patients. Little is known about different subtypes of UI among these patients. Our aim was to identify factors associated with subtypes of UI in a cross-sectional design. METHODS 1,675 female patients aged ≥ 65 and treated for their first hip fracture in Seinäjoki Central Hospital, Finland, during 2007-2019, were included in a prospective cohort study. Of these, 1,106 underwent comprehensive geriatric assessment (CGA), including questions on continence, at our geriatric outpatient clinic 6 month post-fracture. A multivariable-adjusted multinomial logistic regression model was used to examine factors associated with UI subtypes. RESULTS Of the 779 patients included, 360 (46%) were continent and 419 (54%) had UI 6-month post-fracture. Of the women with UI, 117 (28%) had stress UI, 183 (44%) had urgency UI and 119 (28%) had mixed UI, respectively. Mean age of the patients was 82 ± 6,91. In multivariable analysis, depressive mood and poor mobility and functional ability were independently associated with stress UI. Fecal incontinence (FI) and Body Mass Index (BMI) over 28 were independently associated with urgency UI. Mixed UI shared the aforementioned factors with stress and urgency UI and was independently associated with constipation. CONCLUSIONS Mixed UI was associated with most factors, of which depressive mood and impaired mobility and poor functional ability were shared with stress UI, and FI and higher BMI with urgency UI. CGA is key in assessing UI in older hip fracture patients, regardless of subtype.
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Affiliation(s)
- Aino T Hellman-Bronstein
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland.
| | - Tiina H Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Seija S Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Afyouni AS, Wu YX, Balis UGJ, DeLancey J, Sadeghi Z. An Overview of the Effect of Aging on the Female Urethra. Urol Clin North Am 2024; 51:239-251. [PMID: 38609196 DOI: 10.1016/j.ucl.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Urethral function declines by roughly 15% per decade and profoundly contributes to the pathogenesis of urinary incontinence. Individuals with poor urethral function are more likely to fail surgical management for stress incontinence that focus on improving urethral support. The reduced number of intramuscular nerves and the morphologic changes in muscle and connective tissue collectively impact urethral function as women age. Imaging technologies like MRI and ultrasound have advanced our understanding of these changes. However, substantial knowledge gaps remain. Addressing these gaps can be crucial for developing better prevention and treatment strategies, ultimately enhancing the quality of life for aging women.
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Affiliation(s)
- Andrew S Afyouni
- Division of Neurourology and Reconstructive Pelvic Surgery, Department of Urology, University of California Irvine, 3800 W. Chapman Avenue, Suite 7200, Orange, CA 92868, USA
| | - Yi Xi Wu
- Division of Neurourology and Reconstructive Pelvic Surgery, Department of Urology, University of California Irvine, 3800 W. Chapman Avenue, Suite 7200, Orange, CA 92868, USA
| | - Ulysses G J Balis
- Division of Pathology Informatics, Department of Pathology, University of Michigan Medical School, 2800 Plymouth Road, NCRC Building 35, Ann Arbor, MI 48109, USA
| | - John DeLancey
- Department of Obstetrics and Gynecology, University of Michigan Medical School, L4208 UH South, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Zhina Sadeghi
- Division of Neurourology and Reconstructive Pelvic Surgery, Department of Urology, University of California Irvine, 3800 W. Chapman Avenue, Suite 7200, Orange, CA 92868, USA.
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Gao D, Zhang C, Chen Q, Cao Z, Li P, Zhou G, Xu H, Xu B, Wang Z. Association between dietary fatty acids and urinary incontinence. Heliyon 2024; 10:e28595. [PMID: 38571581 PMCID: PMC10988052 DOI: 10.1016/j.heliyon.2024.e28595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
Background Dietary nutrient intake contributes to urination; however, the association between dietary nutrient intake, especially that of fat, and urinary incontinence (UI) is not well understood. The most common types of UI include stress UI (SUI) and urgency UI (UUI). Objective To investigate the potential effect(s) of dietary fat intake on UI and explore its mechanism of action in relation to body mass index (BMI). Methods A cross-sectional survey of data from 15,121 individuals (20-85 years of age) from the National Health and Nutrition Examination Survey (2001-2008), a random population-based sample, was performed. Data regarding dietary nutrient intake were collected through 24 h dietary recall interviews. UI and covariate data were collected through in-person interviews. UI was assessed according to the American Urological Association Symptom Index. The odds ratio (OR) for SUI and UUI were calculated using multivariate logistic regression analysis. The mediation effect was estimated using observational mediation analysis. Results Higher total fat intake was positively associated with increased odds for developing UI (OR 1.44 [95% confidence interval (CI) 1.08-1.93]). Females who consumed more saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA) were more likely to develop SUI. BMI partially explained the association between total fat, SFA, MUFA, and PUFA and SUI; the proportions of the mediation effect of BMI were 14.7%, 13.0%, 18.7%, and 16.3%, respectively. Conclusions Results of this study emphasize the key role of dietary fat intake in the prevalence of UI. Higher fat intake was positively associated with UI and BMI partially mediated the effect of fat intake on SUI.
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Affiliation(s)
- Dajun Gao
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai, 200011, China
| | - Caoxu Zhang
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostics and Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi Chen
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai, 200011, China
| | - Zhi Cao
- Shanghai Changhai Hospital, Shanghai, China
| | - Peizhang Li
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai, 200011, China
| | | | - Huan Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai, 200011, China
| | - Bin Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai, 200011, China
| | - Zhong Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai, 200011, China
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Bower WF, Da Silva A, Gibson W, Wagg A, Whishaw DM. NITES, a nocturnal bladder score to aid diagnosis during the transition to older age care. Neurourol Urodyn 2024. [PMID: 38606622 DOI: 10.1002/nau.25475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/04/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND As adults transition to older age, bothersome nocturnal lower urinary tract symptoms (LUTS) become common. There is need for a reliable assessment metric to detect and measure specific symptoms. OBJECTIVE To subject the nocturnal LUTS score for older individuals, Nocturia, Incontinence, Toileting and Enuresis Symptom Score (NITES), to psychometric analysis. MATERIAL AND METHODS Factor analysis of the metric was conducted with completed questionnaires from 151 older individuals who were either admitted to a tertiary hospital or attending an outpatient continence clinic. Test re-test reliability involved 18 older community dwelling individuals attending a Geriatrician clinic completing the metric at two timepoints separated by at least 1 week. Intra-class correlation coefficients were determined for reliability of each factor and item. RESULTS The NITES metric was completed by 98 hospitalized older individuals and 53 attending a continence clinic (mean age 83.2 years [SD 7.0]). Factor analysis demonstrated that one item had a floor effect and two items had poor endorsement. After test re-test reliability analysis, a further three items were removed: one due to poor correlation between timepoints and two demonstrating inadequate internal consistency. The final NITES metric is comprised of three factors: Sleep 4-items, Incontinence 4-items, and Personal Bother 2-items. A 4-item short form for symptom screening was extracted from the longer measure. CONCLUSION The final NITES metric is a 10-item questionnaire with an embedded 4-item short symptom screen. It has utility utilized to detect nocturnal bladder symptoms in both community dwelling and hospitalized older adults.
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Affiliation(s)
- Wendy F Bower
- Sub-Acute Continence Service, Home First, Ambulatory & Complex Care Services, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, Victoria, Australia
| | - Alisha Da Silva
- Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - D Michael Whishaw
- Sub-Acute Continence Service, Home First, Ambulatory & Complex Care Services, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Brown A, Ferguson L, Castillo J, Nguyen HXT, Ervin C, Whishaw DM, Bower W. Determinants of Bladder Care at Night in a Subacute Ward for Aged Patients: An Observational Study. J Wound Ostomy Continence Nurs 2024; 51:146-151. [PMID: 38215216 DOI: 10.1097/won.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE The purpose of this study was to evaluate how bladder care at night correlates to patients' mobility status. DESIGN This was an observational study. SUBJECTS AND SETTING The sample comprises 63 aged care subacute patients who were observed over 3 consecutive nights in an inpatient subacute aged care ward located in Melbourne, Australia. Half of the participants were female; their mean age was 82.0 (standard deviation 8.2) years. Data were collected from December 2020 to March 2021. METHODS Outcome variables included demographic and pertinent clinical characteristics, type and timing of toileting and/or bladder care provided, and mobility classification. Descriptive statistics were used to summarize the frequency of nocturnal bladder care provided each night and as a mean over the 3 nights. The relationship between the type of care units provided and other variables was explored using a 1-way analysis of variance; values ≤.05 were deemed statistically significant. RESULTS Findings indicate that 27% (n = 17), 41% (n = 26), and 48% (n = 30) of participants required assistance to move in bed, sit up in bed, and stand from sitting, respectively. Care episodes for both incontinence and assistance with voiding were significantly associated with functional mobility in bed ( F = 5.52, P < .001; F = 2.14, P = .02) and with ambulation independence ( F = 3.52, P = .001; F = 2.04, P = .03) but not with age or ambulation distance. CONCLUSIONS Care provided for urinary incontinence during the night was related to the need for physical support of ambulation and poor mobility in bed. Targeted input from a multidisciplinary team is warranted to facilitate change of practice at night.
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Affiliation(s)
- Adelle Brown
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Laura Ferguson
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Jasper Castillo
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Huong Xuan Thi Nguyen
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Claire Ervin
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - David Michael Whishaw
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Wendy Bower
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
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Hellman-Bronstein AT, Luukkaala TH, Ala-Nissilä SS, Nuotio MS. Do urinary and double incontinence predict changes in living arrangements and mobility in older women after hip fracture? - a 1-year prospective cohort study. BMC Geriatr 2024; 24:100. [PMID: 38273298 PMCID: PMC10811924 DOI: 10.1186/s12877-023-04637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/24/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Continence problems are known to be associated with disability in older adults. Costs of disability and resulting need for more supported living arrangements are high after a hip fracture. The aim was to examine pre-fracture urinary incontinence (UI) and double incontinence (DI, concurrent UI and fecal incontinence) as predictors of changes in mobility and living arrangements in older female hip fracture patients in a 1-year follow-up. METHODS Study population comprised 1,675 female patients aged ≥ 65 (mean age 82.7 ± 6.8) sustaining their first hip fracture between 2007-2019. Data on self-reported pre-fracture continence status was collected. The outcomes were declined vs. same or improved mobility level and need for more assisted vs same or less assisted living arrangements 1-year post-fracture. Separate cohorts of 1,226 and 1,055 women were generated for the mobility and living arrangements outcomes, respectively. Age- and multivariable-adjusted logistic regression models were used to determine the associations of UI, DI, and other baseline characteristics with the outcomes. RESULTS Of the patients, 39% had declined mobility or more assisted living arrangements at 1-year follow-up. Adjusting for age, both pre-fracture UI and DI were associated with changes in mobility and living arrangements. In the multivariable analysis, UI (OR 1.88, 95% CI 1.41-2.51) and DI (1.99, 95% CI 1.21-3.27) were associated with decline in mobility level while only DI (OR 2.40, 95% CI 1.22-4.75) remained associated with the need for more assisted living arrangements. CONCLUSIONS Both pre-fracture UI and DI in older women are risk factors for declining mobility level, but only DI for more supported living arrangements 1-year post-hip fracture. UI likely develops earlier in life and might not necessarily be strongly associated with the onset or increasing disability in later years. DI may indicate more marked vulnerability and burden to patients as well as to formal and informal caregivers.
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Affiliation(s)
- Aino T Hellman-Bronstein
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland.
| | - Tiina H Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Seija S Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Reaves S, Arya LA, Newman DK, Wyman J, Klusaritz H, Walsh W, Brown RT, Andy UU. Reducing Falls in Older Women with Urinary Incontinence. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2024; 5:e230011. [PMID: 38454916 PMCID: PMC10919213 DOI: 10.20900/agmr20230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Urinary incontinence is common in older women and doubles the risk of falls in this population. The association between urinary incontinence, especially urgency urinary incontinence, and falls is multifactorial and likely the result of a complex interaction between physical, mental, social, and environmental factors. As a result of this multifactorial etiology and based on existing evidence, the integration of different fall prevention strategies including strength and resistance exercises, bladder training, and home hazard reduction have the potential to decrease the risk of falls in older women with urinary incontinence. Given the prevalence of urinary incontinence and the significant morbidity associated with falls, effective interventions to reduce fall risk in older women with urinary incontinence is of high public health significance.
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Affiliation(s)
- Simone Reaves
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Lily A. Arya
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Diane K. Newman
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jean Wyman
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Heather Klusaritz
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Wendy Walsh
- Department of Occupational Therapy, Saint Joseph’s University, Philadelphia, PA, USA
| | - Rebecca T. Brown
- Division of Geriatric Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Uduak U. Andy
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
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9
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Fisher SR, Villasante-Tezanos A, Allen LM, Pappadis MR, Kilic G. Comparative effectiveness of pelvic floor muscle training, mirabegron, and trospium among older women with urgency urinary incontinence and high fall risk: a feasibility randomized clinical study. Pilot Feasibility Stud 2024; 10:1. [PMID: 38178267 PMCID: PMC10765875 DOI: 10.1186/s40814-023-01440-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Untreated, urgency urinary incontinence (UUI) and overactive bladder (OAB) can precipitate a vicious cycle of decreasing physical activity, social isolation, fear of falling, and falls. Structured behavioral interventions and medications are common initial treatment options, but they elicit their effects through very different mechanisms of action that may influence fall-related outcomes differently. This study will determine the feasibility of conducting a comparative effectiveness, three-arm, mixed methods, randomized clinical trial of a behaviorally based pelvic floor muscle training (PFMT) intervention versus two recent drug options in older women with UUI or OAB who are also at increased risk of falling. METHODS Forty-eight women 60 years and older with UUI or OAB who screen positive for increased fall risk will be recruited through the urogynacology and pelvic health clinics of our university health system. Participants will be randomly assigned to one of three 12-week treatment arms: (1) a course of behavioral and pelvic floor muscle training (PFMT) provided by physical therapists; (2) the beta-3 agonist, mirabegron; and (3) the antimuscarinic, trospium chloride. Study feasibility will be established through objective metrics of evaluability, adherence to the interventions, and attrition. We will also assess relevant measures of OAB symptom severity, quality of life, physical activity, incident falls, and concern about falling. DISCUSSION The proposed research seeks to ultimately determine if linkages between reduction in UI symptoms through treatment also reduce the risk of falling in this patient population. TRIAL REGISTRATION NCT05880862. Registered on 30 May 2023.
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Affiliation(s)
- Steve R Fisher
- Department of Physical Therapy, University of Texas Medical Branch at Galveston, Galveston, USA.
| | | | - Lindsay M Allen
- Department of Physical Therapy, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Monique R Pappadis
- Department of Population Health and Health Disparities, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Gokhan Kilic
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, USA
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10
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Yang JM, Huang WC. Ultrasound in Female Urinary Incontinence. J Med Ultrasound 2024; 32:14-20. [PMID: 38665347 PMCID: PMC11040483 DOI: 10.4103/jmu.jmu_25_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 04/28/2024] Open
Abstract
Urinary incontinence (UI) is a common health condition that may interfere with the quality of life. A comprehensive evaluation of female UI helps with effective and safe treatments. Ultrasound has gained popularity to explore UI recently because it can collect crucial information for treatment planning and counseling. Translabial and introital approaches are commonly and reliably applied to ultrasound. The images can be obtained using two-dimensional and three-dimensional ultrasounds. Ultrasound is the only modality capable of confirming the presence or absence of a mid-urethral sling (MUS) and is able to demonstrate bulking agents as well. Although some of the ultrasound findings may only be incidental or supplementary to the patient's symptoms, ultrasound benefits for investigating the pathophysiology of UI and surgical outcomes of MUS procedures. It is anticipated that standardization in terminology, measurement techniques, and reporting can be established in the near future.
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Affiliation(s)
- Jenn-Ming Yang
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chen Huang
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
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11
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Fisher SR, Halder GE, Lee MJ, Allen L, Kilic GS. Cumulative Effects of Comorbid Burden and Overactive Bladder Symptoms on Fall Risk Among Older Women Seeking Treatment for Urogynecologic Conditions. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:763-769. [PMID: 36946883 DOI: 10.1097/spv.0000000000001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
IMPORTANCE Overactive bladder (OAB) syndrome and urinary incontinence, age, and comorbid burden are strong risk factors for falls in women. Less is known about their cumulative effects on fall risk in a urogynecologic population. OBJECTIVE The purpose of this study was to investigate the effects of coexisting OAB, older age, and comorbidities on risk of falling among treatment seeking women with pelvic floor disorders. STUDY DESIGN We conducted a retrospective medical records review of 348 consecutive women presenting to a urogynecology clinic over 6 months. Fall risk was determined by the Centers for Disease Control and Prevention's, Stopping Elderly Accidents, Deaths, and Injuries screening tool. Clinical and sociodemographic measures were abstracted from the electronic medical record. Odds of screening positive for high fall risk based on different patient profiles were calculated. We then used a classification and regression tree analysis to determine the relative importance of the different variables on fall risk within the homogeneous subgroups. RESULTS Of the 348 women (mean age, 58.7 ± 15.8 years) who completed the fall risk screen, 124 (36%) screened positive for increased fall risk. Overactive bladder symptoms increased the likelihood of a positive fall risk screen across all combinations of age and comorbid burden. The patient profile of ≥3 OAB symptoms, ≥4 comorbid conditions, and age 65 years or older increased the odds of screening positive for high fall risk more than 6-fold (odds ratio, 6.4; 95% confidence interval, 3.1-12.9). In the following order of importance, the combination of high comorbid burden, OAB, and older age identified approximately 3 in 4 patients (73.3%) at high risk of falling. CONCLUSION The presence of 3 easily identifiable patient characteristics is strongly associated with a risk of falls in women seeking care for pelvic floor disorders.
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Affiliation(s)
- Steve R Fisher
- From the Department of Physical Therapy, School of Health Professions
| | - Gabriela E Halder
- Female Pelvic Medicine and Reconstructive Surgery, Urogynecology, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX
| | - Mi Jung Lee
- From the Department of Physical Therapy, School of Health Professions
| | - Lindsay Allen
- From the Department of Physical Therapy, School of Health Professions
| | - Gokhan S Kilic
- Female Pelvic Medicine and Reconstructive Surgery, Urogynecology, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX
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12
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Fu Y, Jackson C, Nelson A, Iles-Smith H, McGowan L. Exploring support, experiences and needs of older women and health professionals to inform a self-management package for urinary incontinence: a qualitative study. BMJ Open 2023; 13:e071831. [PMID: 37400236 DOI: 10.1136/bmjopen-2023-071831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES Many women attempt to manage urinary incontinence (UI) independently with variable success while health professionals may be unaware of their needs. This study aimed to (1) understand older women's experiences of UI, their self-management strategies and support needs; (2) explore health professionals' experiences of supporting women and providing relevant services and (3) combine their experiences contribute to development of a theory-based and evidence-based self-management package for UI. DESIGN Qualitative semi-structured interviews were conducted with 11 older women with UI and 11 specialist health professionals. Data were analysed independently using the framework approach, then synthesised in a triangulation matrix to identify implications for content and delivery of the self-management package. SETTING Community centres, community continence clinic and urogynaecology centre of a local teaching hospital in northern England. PARTICIPANTS Women aged 55 years and over who self-reported symptoms of UI and health professionals delivering UI services. RESULTS Three overarching themes emerged. Older women see UI as a 'fact of life' but many struggle with it: women typically considered UI as part of ageing yet expressed annoyance, distress, embarrassment and had made significant lifestyle changes. Access to information and limited high-quality professional support: health professionals provided specialist UI care and information. Yet less than half of women accessed specialist services, those who had, highly valued these services. 'Trial and error' with different self-management strategies: women had tried or were using different strategies (continence pads, pelvic floor exercises, bladder management and training, fluid management and medication), with mixed success. Health professionals provided evidence-based, personalised support and motivation. CONCLUSIONS Findings informed the content of the self-management package that focused on providing facts, acknowledging challenges of living with/self-managing UI, sharing others' experiences, using motivational strategies and self-management tools. Delivery preferences were independent use by women or working through the package with a health professional.
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Affiliation(s)
- Yu Fu
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Andrea Nelson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Heather Iles-Smith
- School of Health and Society, University of Salford, Salford, UK
- Corporate Nursing, Northern Care Alliance NHS Group, Salford, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
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Bailey ES, Hooshmand SJ, Badihian N, Sandroni P, Benarroch EE, Bower JH, Low PA, Singer W, Coon EA. Sex and Gender Influence Urinary Symptoms and Management in Multiple System Atrophy. J Mov Disord 2023; 16:196-201. [PMID: 37258281 DOI: 10.14802/jmd.23016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/24/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE Multiple system atrophy (MSA) is characterized by urinary dysfunction, yet the influence of sex and gender on urinary symptoms and treatment is unclear. We sought to characterize sex and gender differences in the symptomatology, evaluation, and management of urinary dysfunction in patients with MSA. METHODS Patients with MSA evaluated at our institution were reviewed and stratified by sex. RESULTS While the prevalence of urinary symptoms was similar in male and female patients, incontinence was more common in females. Despite this, males and females underwent postvoid residual (PVR) measurement at similar rates. While catheterization rates were similar when PVR was measured, males were more than twice as likely to be catheterized than females in the absence of PVR measurement. CONCLUSION Urinary symptoms are common in MSA, but their presentation differs between males and females. The difference in catheterization rates may be driven by a gender disparity in referrals for PVR, which can guide treatment.
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Affiliation(s)
| | | | - Negin Badihian
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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14
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Bektas Akpinar N, Unal N, Akpinar C. Urinary Incontinence in Older Adults: Impact on Caregiver Burden. J Gerontol Nurs 2023; 49:39-46. [PMID: 36989470 DOI: 10.3928/00989134-20230310-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
The objective of the current descriptive, cross-sectional, and relationship-seeking study was to evaluate the severity of urinary incontinence (UI) in older adults and its impact on care burden of their family caregivers. This study was performed prospectively with 80 older adults (aged ≥65 years) with UI and their family caregivers who attended a urology clinic between June and December 2021. UI was assessed using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF), and caregiver burden using the Zarit Burden Interview (ZBI). Increase in care time was associated with higher burden of care (p = 0.018). Post-hoc analyses suggested that caregivers' burden of care gradually increased up to the first 9 months. Daily care time >9 hours had a higher burden compared to care times <9 hours (p < 0.001). Mean ZBI score of caregivers was 41.47 (SD = 10.18) and mean ICIQ-UI-SF score of older adults was 15.02 (SD = 3.9). A significant correlation was observed between increased ICIQ-UI-SF scores of older adults and ZBI scores of caregivers (r = 0.354, p = 0.001). Caring for older adults with UI is associated with a significant burden of care and an increase in severity of UI is associated with increased burden of care. Female sex, lower educational level, presence of comorbidities, increased care time, and daily care hours were factors associated with increased burden of care among caregivers. [Journal of Gerontological Nursing, 49(4), 39-46.].
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15
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Urinary and double incontinence in older women with hip fracture - risk of death and predictors of incident symptoms among survivors in a 1-year prospective cohort study. Arch Gerontol Geriatr 2023; 107:104901. [PMID: 36521394 DOI: 10.1016/j.archger.2022.104901] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/24/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the association of urinary incontinence (UI) and double incontinence (DI, concurrent UI and fecal incontinence) with one-year mortality among older female hip fracture patients and to identify predictors of incident UI and DI. DESIGN A prospective cohort study SETTING AND SUBJECTS: 1,468 female patients aged ≥ 65 treated for their first hip fracture during the period 2007-2019 METHODS: Continence status was elicited at baseline and one-year post-fracture. Age- and multivariable-adjusted Cox proportional hazards and multinomial logistic regression models were used to determine the associations of incontinence with one-year mortality and to examine the associations of baseline predictors with incident UI and DI respectively. RESULTS Of the women with no incontinence, UI and DI, 78 (13%), 159 (23%) and 60 (34%), died during follow-up. UI (HR 1.72, 95% CI 1.31-2.26) and DI (HR 2.61, 95% CI 1.86-3.66) were associated with mortality after adjusting for age. These associations lost their predictive power in multivariable analysis while age over 90, living in an institution, impaired mobility, poor nutrition, polypharmacy, and late removal of urinary catheter remained associated with mortality. Of continent women, 128 (21%) developed UI and 23 (4%) DI during follow-up. In multivariable analysis, impaired mobility was associated with incident UI (OR 2.56, 95% CI 1.48-4.44) and DI (OR 4.82, 95% CI 1.70-13.7), as well as living in an institution (OR 3.44, 95% CI 1.56-7.61 and OR 3.90, 95% CI 1.17-13.0). CONCLUSIONS AND IMPLICATIONS Underlying vulnerability likely explains differences in mortality between continence groups and development of incident UI and DI.
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16
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Overactive Bladder and Cognitive Impairment: The American Urogynecologic Society and Pelvic Floor Disorders Research Foundation State-of-the-Science Conference Summary Report. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:S1-S19. [PMID: 36548636 DOI: 10.1097/spv.0000000000001272] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Overactive bladder (OAB) is prevalent in older adults in whom management is complicated by comorbidities and greater vulnerability to the cognitive effects of antimuscarinic medications. OBJECTIVES The aim of this study is to provide a comprehensive evidence-based summary of the 2021 State-of-the-Science (SOS) conference and a multidisciplinary expert literature review on OAB and cognitive impairment. STUDY DESIGN The American Urogynecologic Society and the Pelvic Floor Disorders Research Foundation convened a 3-day collaborative conference. Experts from multidisciplinary fields examined cognitive function, higher neural control of the OAB patient, risk factors for cognitive impairment in older patients, cognitive effects of antimuscarinic medications for OAB treatment, OAB phenotyping, conservative and advanced OAB therapies, and the need for a multidisciplinary approach to person-centered treatment. Translational topics included the blood-brain barrier, purine metabolome, mechanotransduction, and gene therapy for OAB targets. RESULTS Research surrounding OAB treatment efficacy in cognitively impaired individuals is limited. Short- and long-term outcomes regarding antimuscarinic effects on cognition are mixed; however, greater anticholinergic burden and duration of use influence risk. Oxybutynin is most consistently associated with negative cognitive effects in short-term, prospective studies. Although data are limited, beta-adrenergic agonists do not appear to confer the same cognitive risk. CONCLUSIONS The 2021 SOS summary report provides a comprehensive review of the fundamental, translational, and clinical research on OAB with emphasis on cognitive impairment risks to antimuscarinic medications. Duration of use and antimuscarinic type, specifically oxybutynin when examining OAB treatments, appears to have the most cognitive impact; however, conclusions are limited by the primarily cognitively intact population studied. Given current evidence, it appears prudent to minimize anticholinergic burden by emphasizing nonantimuscarinic therapeutic regimens in the older population and/or those with cognitive impairment.
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17
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Evidence-Informed, Interdisciplinary, Multidimensional Action Plan to Advance Overactive Bladder Research and Treatment Initiatives: Directives From State-of-the-Science Conference on Overactive Bladder and Cognitive Impairment. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:S20-S39. [PMID: 36548637 DOI: 10.1097/spv.0000000000001274] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT This article outlines an evidence-informed, interdisciplinary, multidimensional, comprehensive action plan for the American Urogynecologic Society to improve care of women with overactive bladder (OAB) while minimizing treatment-related adverse events, including cognitive impairment. It is a "call to action" to advance basic, translational, and clinical research and summarizes initiatives developed at the State-of-the-Science Conference on OAB and Cognitive Impairment to (1) develop framework for a new OAB treatment approach in women, (2) define research gaps and future research priorities, (3) champion health equity and diversity considerations in OAB treatment, (4) foster community and promote education to remove stigma surrounding OAB and urinary incontinence, and (5) elevate visibility and impact of OAB, by creating partnerships through education and engagement with health care professionals, industry, private and public payers, funding agencies, and policymakers.
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18
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Bundogji N, Toma G, Khan A. Identification of preferred reminder systems and patient factors to promote adherence in the management of urinary incontinence. PEC INNOVATION 2022; 1:100067. [PMID: 37213766 PMCID: PMC10194242 DOI: 10.1016/j.pecinn.2022.100067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 05/23/2023]
Abstract
Objective To investigate comfort level and preferences of automated reminder systems (mail, email, text message, phone call, patient-portal message, and/or smartphone application) to promote adherence to recommended therapies for patients seeking care for urinary incontinence (UI) at our urology clinic in Phoenix, Arizona. Methods Anonymous surveys were distributed in English to adult patients with UI from 4/2019-5/2019. Patient demographics, UI type, and access to and use of the Internet, smartphone and patient-portal were assessed. Using a Likert scale, patients indicated level of comfort with each reminder system and numerically ranked each system. Statistical analyses were performed to identify patient characteristics associated with reminder modality and determine significance in ranking of systems. Results Fifty-seven patients (67.3 ± 16.3 years) completed the survey with an 87% response rate. Text-message and phone call reminder modalities were ranked the highest compared to other modalities (p < 0.05). A Chi-squared test showed no correlation between preferred reminder system modality and type of incontinence, age, gender, race/ethnicity, or language spoken (p > 0.05). Internet usage and access significantly correlated with preference for smartphone application and patient-portal message reminder systems (p < 0.05). Conclusion Patients reported they were extremely comfortable with all communication modalities, except for smartphone applications in which patients were the least comfortable. The modalities most preferred by patients were phone call and text message and least preferred were patient portal and smart phone application. In conclusion, phone calls and text messages were the most preferred communication modality, with smart phone applications as the least comfortable. Innovation This study demonstrates the potential utility of specific reminder modalities for patients seeking help with treatment adherence.
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Affiliation(s)
- Nour Bundogji
- College of Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
- Corresponding author at: 475 N 5 St., Phoenix, AZ 85004, USA.
| | - Gina Toma
- Department of Urology, The Mayo Clinic in Scottsdale, Scottsdale, AZ, USA
| | - Aqsa Khan
- Department of Urology, The Mayo Clinic in Scottsdale, Scottsdale, AZ, USA
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19
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Egashira R, Sato T, Miyake A, Takeuchi M, Nakano M, Saito H, Moriguchi M, Tonari S, Hagihara K. The Japan Frailty Scale is a promising screening test for frailty and pre-frailty in Japanese elderly people. Gene X 2022; 844:146775. [PMID: 36007804 DOI: 10.1016/j.gene.2022.146775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 12/23/2022] Open
Abstract
Frailty is one of the most important problems in a super-aged society. It is necessary to identify frailty quickly and easily at the bedside. We developed a simple patient-reported frailty screening scale, the Japan Frailty Scale (JFS), based on the aging concept of Kampo medicine. Eight candidate questions were prepared by Kampo medicine experts, and a simple prediction model was created in the development cohort (n=434) and externally validated in an independent validation cohort (n=276). The physical indicators and questionnaires associated with frailty were also comprehensively evaluated. The reference standard for frailty or pre-frailty was determined based on the Kihon checklist. In the development cohort, four questions, nocturia (0-2), lumbago (0-2), cold sensitivity (0-2), exhaustion (0-4), and age (0-1) were selected by multivariable logistic regression analysis. The total JFS score is 0-11. Receiver-operating characteristic curve analysis of the JFS for identifying frailty status showed moderately good discrimination (area under the curve (AUC) =0.78, 95% confidence interval (CI): 0.73-0.82). At the JFS cutoff value of 3/4 for frailty or pre-frailty, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 86.9%, 53.3%, 62.8%, and 81.7%, respectively. External validation of the JFS showed moderately good discrimination (AUC=0.76, 95% CI: 0.70-0.81). The sensitivity, specificity, PPV, and NPV were 79.9%, 61.4%, 69.3%, and 73.7%, respectively. These results indicate that the JFS is a promising patient-reported clinical scale for early identification of pre-frail/frail patients at the bedside in primary care.
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Affiliation(s)
- Ryuichiro Egashira
- Department of Advanced Hybrid Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Tomoharu Sato
- Department of Biostatistics and Data Science, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Akimitsu Miyake
- Department of Medical Innovation, Osaka University Hospital, Suita, Osaka 565-0871, Japan; Tohoku University School of Medicine, Sendai 980-8575, Japan
| | - Mariko Takeuchi
- Department of Advanced Hybrid Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Mai Nakano
- Department of Advanced Hybrid Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Hitomi Saito
- Department of Advanced Hybrid Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Misaki Moriguchi
- Department of Advanced Hybrid Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Satoko Tonari
- Department of Advanced Hybrid Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Keisuke Hagihara
- Department of Advanced Hybrid Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.
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20
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Brady SS, Bavendam TG, Bradway CK, Conroy B, Dowling-Castronovo A, Epperson CN, Hijaz AK, Hsi RS, Huss K, Kim M, Lazar J, Lee RK, Liu CK, Loizou CN, Miran S, Mody L, Norton JM, Reynolds WS, Sutcliffe S, Zhang N, Hokanson JA. Noncancerous Genitourinary Conditions as a Public Health Priority: Conceptualizing the Hidden Burden. Urology 2022; 166:39-49. [PMID: 34536410 PMCID: PMC8924010 DOI: 10.1016/j.urology.2021.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/07/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide a conceptual framework to guide investigations into burdens of noncancerous genitourinary conditions (NCGUCs), which are extensive and poorly understood. METHODS The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop of diverse, interdisciplinary researchers and health professionals to identify known and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden. Following the meeting, a subgroup of attendees (authors of this article) continued to meet to conceptualize burden. RESULTS The Hidden Burden of Noncancerous Genitourinary Conditions Framework includes impacts across multiple levels of well-being and social ecology, including individual (ie, biologic factors, lived experience, behaviors), interpersonal (eg, romantic partners, family members), organizational/institutional (eg, schools, workplaces), community (eg, public restroom infrastructure), societal (eg, health care and insurance systems, national workforce/economic output), and ecosystem (eg, landfill waste) effects. The framework acknowledges that NCGUCs can be a manifestation of underlying biological dysfunction, while also leading to biological impacts (generation and exacerbation of health conditions, treatment side effects). CONCLUSION NCGUCs confer a large, poorly understood burden to individuals and society. An evidence-base to describe the comprehensive burden is needed. Measurement of NCGUC burdens should incorporate multiple levels of well-being and social ecology, a life course perspective, and potential interactions between NCGUCs and genetics, sex, race, and gender. This approach would elucidate accumulated impacts and potential health inequities in experienced burdens. Uncovering the hidden burden of NCGUCs may draw attention and resources (eg, new research and improved treatments) to this important domain of health.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
| | - Tamara G Bavendam
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Christine K Bradway
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Britt Conroy
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Cynthia Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - Adonis K Hijaz
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Karen Huss
- Division of Extramural Science Programs, Symptom Science and Genetics, Self-Management Office, National Institute of Nursing Research, Bethesda, MD
| | - Michelle Kim
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Jason Lazar
- Department of Medicine, SUNY Downstate Health Sciences University, New York, NY
| | - Richard K Lee
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Christine K Liu
- Section of Geriatrics, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA; Geriatric Research and Education Clinical Center, Palo Alto VA Health Care System, Palo Alto, CA; Section of Geriatrics, Department of Medicine, Boston University, Boston, MA
| | | | - Saadia Miran
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Nicole Zhang
- The Valley Foundation School of Nursing, College of Health and Human Sciences, San Jose State University, San Jose, CA
| | - James A Hokanson
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI
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21
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Factors associated with urinary and double incontinence in a geriatric post-hip fracture assessment in older women. Aging Clin Exp Res 2022; 34:1407-1418. [PMID: 34984652 PMCID: PMC9151507 DOI: 10.1007/s40520-021-02046-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/02/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Incontinence and hip fractures are common in older people, especially women, and associated with multiple adverse effects. Incontinence is a risk factor for falls. AIMS We aimed to investigate the prevalence of urinary (UI) and double incontinence (DI, concurrent UI and faecal incontinence), and to identify factors associated with UI and DI 6 months post-fracture. METHODS A prospective real-life cohort study was conducted consisting of 910 women aged ≥ 65 who were treated for their first hip fracture in Seinäjoki Central Hospital, Finland, between May 2008 and April 2018. Continence status was elicited at baseline and 6 months postoperatively at our geriatric outpatient clinic where all participants underwent a multidisciplinary comprehensive geriatric assessment (CGA) consisting of an evaluation of cognition, nutrition, mood, mobility, and functional ability. RESULTS At baseline, 47% of the patients were continent, 45% had UI and 8% had DI, and at follow up, 38%, 52%, and 11%, respectively. The mean age of the patients was 82.7 ± 6.8. Both UI and DI were associated with functional disability and other factors related to frailty. The associations were particularly prominent for patients with DI who also had the worst performance in the domains of CGA. We identified several modifiable risk factors: depressive mood (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.16-2.84) and constipation (OR 1.48, 95% CI 1.02-2.13) associated with UI and, late removal of urinary catheter (OR 2.33, 95% CI 1.31-4.14), impaired mobility (OR 2.08, 95% CI 1.05-4.15), and poor nutrition (OR 2.31, 95% CI 1.11-4.79) associated with DI. CONCLUSIONS This study demonstrates a high prevalence of UI and DI in older women with hip fracture and modifiable risk factors, which should be targeted in orthogeriatric management and secondary falls prevention. Patients with DI were found to be an especially vulnerable group.
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22
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Challenges and New Insights in the Management of Urinary Incontinence in Older Women. CURRENT GERIATRICS REPORTS 2022. [DOI: 10.1007/s13670-022-00375-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Martines GA, Tamanini JTN, Mota GMDS, Barreto ET, Santos JLF, Sartori MGF, Girão MJBC, Castro RDA. Urinary incontinence, overactive bladder, and quality of life in women submitted to total hip replacement. Neurourol Urodyn 2022; 41:830-840. [PMID: 35114028 DOI: 10.1002/nau.24888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Hip osteoarthritis (OA) compromises functioning. Total hip replacement (THR) is the indicated treatment and may improve urinary incontinence (UI) and symptoms of overactive bladder (OAB). OBJECTIVES Assess UI, OAB symptoms, and quality of life (QoL) impact in preoperative and postoperative periods of women submitted to THR and investigate associated factors. METHODS A prospective cohort was conducted with 183 women submitted to THR. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), International Consultation on Incontinence Questionnaire-Overactive Bladder (ICIQ-OAB) and SF-12 questionnaires were administered pre- and 3 and 6 months after surgery. RESULTS Significant improvements were found in UI and QoL 3- and 6-month postoperatively in the overall sample and in the subgroup with preoperative UI. The multivariate regression revealed that the preoperative ICIQ-SF and ICIQ-OAB final scores were the best predictors of UI 6-month postoperatively. The factors the best predicted the occurrence of UI 6-month following THR were the preoperative ICIQ-OAB scores and preoperative UI. Each unit of increase in the ICIQ-OAB increases the chances of UI by 26.9% and preoperative UI increases the chances of postoperative UI by 18.7-fold. A weak but significant negative correlation was found between the ICIQ-SF score and the SF-12 score. CONCLUSION Significant improvements in UI, OAB and QoL were found at 3- and 6-month postoperatively. Preoperative ICIQ-SF and ICIQ-OAB final scores were the best predictors of UI at 6 months after surgery. We found significant association between urinary symptoms and THR, but this association is partially explained by current literature.
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Affiliation(s)
- Guilherme Augusto Martines
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, SP, Brazil
| | | | | | - Eduardo Tavares Barreto
- Department of Orthopedics, Evangelical Hospital of Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Jair Lício Ferreira Santos
- Department of Social Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Rodrigo de Aquino Castro
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, SP, Brazil
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24
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Heart rate variability dynamics in women with urinary incontinence: a systematic review. Int Urogynecol J 2022; 33:1145-1155. [PMID: 34985534 DOI: 10.1007/s00192-021-05060-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Sympathetic and parasympathetic pathways of the autonomic nervous system (ANS) regulate the lower urinary tract. The aim of the present study was to synthesize the evidence regarding ANS regulation in women with urinary incontinence (UI) evaluated through heart rate variability (HRV). METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Five databases were researched in April 2021 (PubMed, CINHAL, Scopus, Web of Science and Cochrane Library) and included cross-sectional studies in full-length publications in the English language. Studies assessed the HRV during bladder filling (group A) and after voiding (group B). The Joanna Briggs Institute (JBI) checklist was applied for methodological quality assessment purposes. RESULTS A total of 920 articles were identified and 5 studies were included. Most studies analyzed the HRV by linear indexes. Studies from group A (n = 2) presented fair methodological quality; one study from group B (n = 3) showed fair methodological quality (Im et al. Korean J Urol. 51:183, 2010) whereas the others presented high methodological quality. One study from group A found an increase in both modulations between women with overactive bladder (OAB) versus women with stress UI, whereas a decrease was reported between incontinent and continent women. Studies from group B showed a decreased sympathetic and parasympathetic modulation in AOB with detrusor overactivity (DO), whereas one study found an increase in both modulations in women with OAB compared with stress UI. CONCLUSION Parasympathetic and sympathetic modulation increased during bladder filling and rest in UI with OAB associated or not with DO. Both modulations decreased during bladder filling in incontinent women and during rest in OAB.
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25
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Van Besien W, Shire S, Decalf V, Ervin CE, King S, Baldrey C, Da Silva A, Wagg A, Everaert KE, Bower WF. The Bladder at Night during Hospitalisation: Towards optimal care for elderly patients with nocturia. Int J Clin Pract 2021; 75:e14876. [PMID: 34525254 DOI: 10.1111/ijcp.14876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/20/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study aimed to describe the characteristics of nocturia in older hospitalised patients and to explore knowledge, beliefs and experiences associated with night toileting while in hospital in order to identify unmet care needs. METHODS A multisite mixed methods cross-sectional study of older hospitalised adults who were admitted for ≥2 days was conducted using a standardised researcher-administered questionnaire. An additional cohort 16 older hospitalised adults with nocturia >twice per night were interviewed to understand the experience and impact of nocturia during hospitalisation. RESULTS Nocturia was experienced by 260 out of 308 participants. In-hospital nocturia was significantly correlated with nocturia in the month preceding admission, high diurnal voiding frequency and nocturnal urinary urgency. Bother was attributed to multiple nocturia episodes. Participants had poor knowledge and understanding of nocturia and believed the symptom to be a normal occurrence; only 20% had discussed management with staff. Disrupted sleep and fear of falling were common in older immobile participants with nocturia. CONCLUSION Nocturia is highly prevalent in hospitalised older people. Toileting multiple times at night bothers patients, disrupts sleep, heightens a fear of falling yet is rarely addressed in ward management plans. A screening process to identify, assess, provide education and intervene for nocturia has the potential to improve wellbeing, safety at night and to address risk factors.
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Affiliation(s)
- Wouter Van Besien
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Samia Shire
- Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Veerle Decalf
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Claire E Ervin
- Continence Service, Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Sharyn King
- Continence Service, Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Christine Baldrey
- Continence Service, Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Alisha Da Silva
- Department of Allied Health, Discipline of Physiotherapy, Royal Melbourne Hospital, Parkville, Australia
| | - Adrian Wagg
- Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Karel E Everaert
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Wendy F Bower
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Continence Service, Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- Department of Allied Health, Discipline of Physiotherapy, Royal Melbourne Hospital, Parkville, Australia
- Department of Aged Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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Prevalence and Predictors of Increased Fall Risk Among Women Presenting to an Outpatient Urogynecology and Pelvic Health Center. Female Pelvic Med Reconstr Surg 2021; 28:e7-e10. [PMID: 34628446 DOI: 10.1097/spv.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to determine the prevalence of increased fall risk among women presenting to a large pelvic health center using a screening method compatible with the busy clinic environment and to identify factors associated with increased risk. METHODS A retrospective medical records review was conducted on consecutive treatment-seeking women presenting to a Urogynecology & Pelvic Health Center over 6 months. The Centers for Disease Control and Prevention, Stopping Elderly Accidents, Deaths, and Injuries fall risk screening tool was included among the intake questionnaires all patients completed before their scheduled appointments. Relevant sociodemographic and clinical measures were abstracted from the electronic medical record. RESULTS Three hundred and forty-eight women completed the fall screen. One hundred and twenty-four (36%) screened positive for increased fall risk. Mean age was 58.7 ± 15.8 years. An age threshold of 68 years best discriminated between those who were and were not identified as at risk. There was a gradient of association between number of urinary symptoms and prevalence of increased fall risk. Patients with 3 or more urinary symptoms were most likely to screen positive (1: odds ratio [OR], 1.51 [0.86-2.66]; 2: OR, 1.62 [0.99-2.64]; 3 or more: OR, 1.84 [1.07-3.17]) after adjusting for other know fall risk factors. CONCLUSIONS The prevalence of increased fall risk in this patient population is high and highest in women with multiple urinary symptoms. The Stopping Elderly Accidents, Deaths, and Injuries screening tool was a feasible and nonintrusive screening method for identifying increased fall risk during routine patient care. Fall risk and concern about falling should be taken into consideration when deciding management strategies for urinary problems.
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27
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Gibson W, Jones A, Hunter K, Wagg A. Urinary urgency acts as a source of divided attention leading to changes in gait in older adults with overactive bladder. PLoS One 2021; 16:e0257506. [PMID: 34606514 PMCID: PMC8489708 DOI: 10.1371/journal.pone.0257506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/02/2021] [Indexed: 11/19/2022] Open
Abstract
AIMS There is a well-recognised but unexplained association between lower urinary tract symptoms including urgency and urgency incontinence and falls in older people. It has been hypothesised that urinary urgency acts as a source of divided attention, leading to gait changes which increase falls risk. This study aimed to assess whether urinary urgency acts as a source of divided attention in older adults with overactive bladder (OAB). METHODS 27 community-dwelling adults aged 65 years and over with a clinical diagnosis of OAB underwent 3-Dimensional Instrumented Gait Analysis under three conditions; bladder empty, when experiencing urgency, and when being distracted by the n-back test. Temporal-spatial gait and kinematic gait data were compared between each condition using repeated measures ANOVA. RESULTS Gait velocity decreased from 1.1ms-1 in the bladder empty condition to 1.0ms-1 with urgency and 0.9ms-1 with distraction (p = 0.008 and p<0.001 respectively). Stride length also decreased, from 1.2m to 1.1m with urgency and 1.0m with distraction (p<0.001 for both). The presence of detrusor overactivity did not influence these results (p = 0.77). CONCLUSIONS In older adults with OAB, urinary urgency induced similar changes in gait to those caused by a distracting task. These gait changes are associated with increased fall risk. This may be part of the explanation for the association between falls and lower urinary tract symptoms in older people. Future research should examine the effect of pharmacological treatment of OAB on gait and on the effect of dual-task training on gait when experiencing urgency.
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Affiliation(s)
- William Gibson
- Division of Geriatric Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Dahlke S, Hunter KF, Pietrosanu M, Kalogirou MR. Testing and e-learning activity designed to enhance student nurses understanding of continence and mobility. Int J Nurs Educ Scholarsh 2021; 18:ijnes-2021-0033. [PMID: 34289268 DOI: 10.1515/ijnes-2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/06/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to test if the e-learning activity that we developed could improve student nurses' knowledge of continence and mobility and whether or not students would find the style of learning beneficial. METHODS A quasi-experimental pre-post-test design was used to test if the continence and mobility e-learning activity could improve student nurses' knowledge about assessing and managing the needs of continence and mobility. An 18-item true/false knowledge of continence quiz was completed by 116 student nurses and a Likert style feedback learning survey was completed by 135 nursing students. RESULTS There was a statistically significant increase in students' knowledge about continence and its relationship to mobility following the e-learning activity. The e-learning activity also enhanced students' knowledge, confidence and perceptions about older people. CONCLUSIONS The e-learning activity we developed has the potential to improve nursing students' knowledge about continence and mobility in an enjoyable manner.
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Affiliation(s)
- Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Pietrosanu
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Maya R Kalogirou
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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29
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Rogers C. Perspectives: Evaluation of Older Adult Cochlear Implant Candidates for Fall Risk in a Developing Country Setting. Front Neurol 2021; 12:678773. [PMID: 34122319 PMCID: PMC8187949 DOI: 10.3389/fneur.2021.678773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Dizziness, vertigo, and falls are common in older adults. Data suggest that cochlear implant candidates are no different and could be argued to be at elevated risk due to the presence of hearing loss and likely vestibular involvement. Perspectives contextualizes current testing and screening paradigms for vestibular deficits and fall risk and suggests a protocol suitable for use in developing country settings.
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Affiliation(s)
- Christine Rogers
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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30
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Moon S, Chung HS, Kim YJ, Kim SJ, Kwon O, Lee YG, Yu JM, Cho ST. The impact of urinary incontinence on falls: A systematic review and meta-analysis. PLoS One 2021; 16:e0251711. [PMID: 34010311 PMCID: PMC8133449 DOI: 10.1371/journal.pone.0251711] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 04/30/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Previous studies on the association between urinary incontinence (UI) and falls have reported conflicting results. We, therefore, aimed to evaluate and clarify this association through a systematic review and meta-analysis of relevant studies. METHODS We performed a literature search for relevant studies in databases including PubMed and EMBASE from inception up to December 13, 2020, using several search terms related to UI and falls. Based on the data reported in these studies, we calculated the pooled odds ratios (ORs) for falls and the corresponding 95% confidence intervals (CIs) using the Mantel-Haenszel method. RESULTS This meta-analysis included 38 articles and a total of 230,129 participants. UI was significantly associated with falls (OR, 1.62; 95% CI, 1.45-1.83). Subgroup analyses based on the age and sex of the participants revealed a significant association between UI and falls in older (≥65 years) participants (OR, 1.59; 95% CI, 1.31-1.93), and in both men (OR, 1.88; 95% CI, 1.57-2.25) and women (OR, 1.41; 95% CI, 1.29-1.54). Subgroup analysis based on the definition of falls revealed a significant association between UI and falls (≥1 fall event) (OR, 1.61; 95% CI, 1.42-1.82) and recurrent falls (≥2 fall events) (OR, 1.63; 95% CI, 1.49-1.78). According to the UI type, a significant association between UI and falls was observed in patients with urgency UI (OR, 1.76; 95% CI, 1.15-1.70) and those with stress UI (OR, 1.73; 95% CI, 1.39-2.15). CONCLUSIONS This meta-analysis, which was based on evidence from a review of the published literature, clearly demonstrated that UI is an important risk factor for falls in both general and older populations.
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Affiliation(s)
- Shinje Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hye Soo Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yoon Jung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Sung Jin Kim
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Ohseong Kwon
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Young Goo Lee
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jae Myung Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Sung Tae Cho
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
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Azevedo C, Moura CDC, Corrêa HP, Assis BBD, Mata LRFD, Chianca TCM. Auriculotherapy in adults and elderly people with lower urinary tract symptoms: an integrative review. Rev Esc Enferm USP 2021; 55:e03707. [PMID: 33978143 DOI: 10.1590/s1980-220x2020000503707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 09/03/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the evidence available in the literature on the use of auriculotherapy in adults and elderly people with lower urinary tract symptoms. METHOD An integrative literature review. Primary study search was carried out in nine relevant health databases. The characterization of studies regarding the method of application of auriculotherapy was based on the Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture recommendations. RESULTS 296 studies were found, 17 pre-selected and eight included in the review. Favorable results from auriculotherapy were evidenced in specific populations, such as elderly men with prostatic disorders and individuals undergoing surgical procedures. The main urinary symptoms addressed were frequency, urgency, nocturia, incomplete voiding, intermittency, weak flow, effort to start urination, incontinence, and urinary retention. CONCLUSION Despite the limited number of studies and weaknesses with regard to sample size and different intervention protocols, it is suggested that auriculotherapy, associated or not with other complementary therapies, may contribute to lower urinary tract symptom control in adults and elderly people.
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Affiliation(s)
- Cissa Azevedo
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil
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32
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Million E, Vexlard E, Lognos B, Cayrac M. Urinary incontinence as a marker of temporality in women: a qualitative study. Climacteric 2021; 24:605-611. [PMID: 33942698 DOI: 10.1080/13697137.2021.1915272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Urinary incontinence (UI) is prevalent in postmenopausal women. To manage UI, it necessary to improve UI screening. We aimed to analyze and understand the experience of women with UI. METHODS We conducted a qualitative study using semi-structured interviews with postmenopausal women (age >50 years), who were recruited from an urban general practice office. The data of the patients were analyzed using the grounded theory method to allow the conceptualization of categories to emerge. RESULTS Data saturation was reached after eight interviews and was confirmed by two additional interviews. There were four conceptualizing categories: UI is a marker of temporality in women and of societal temporality; women's information about UI is a prerequisite for screening, and the media and information providers have an impact on women's UI experience; UI has a strong societal taboo for women (women consider UI a minor but pejorative disease and fear stigmatization); and faced with the complexity of implementing personalized screening, women recommend systematic screening by their general practitioner or gynecologist to trivialize UI and optimize its management. CONCLUSIONS Women were uninformed about UI. They requested that the provision of information on the female anatomy should be started in childhood.
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Affiliation(s)
- E Million
- Department of General Practice, School of Medicine, University of Montpellier, Montpellier, France.,General Practice, University Multiprofessional Health Center Pauline Lautaud, France.,IDESP (Institut Desbrest d'Epidémiologie et de Santé Publique), RMU INSERM, Montpellier University, Montpellier, France
| | - E Vexlard
- Department of General Practice, School of Medicine, University of Montpellier, Montpellier, France
| | - B Lognos
- Department of General Practice, School of Medicine, University of Montpellier, Montpellier, France.,General Practice, University Multiprofessional Health Center Pauline Lautaud, France.,IDESP (Institut Desbrest d'Epidémiologie et de Santé Publique), RMU INSERM, Montpellier University, Montpellier, France
| | - M Cayrac
- Department of Obstetrics and Gynecology, Saint-Roch Polyclinic, Montpellier, France
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Decalf V, Bower W, Rose G, Petrovic M, Pieters R, Eeckloo K, Everaert K. Prevalence and characteristics of incident falls related to nocturnal toileting in hospitalized patients. Acta Clin Belg 2021; 76:85-90. [PMID: 31478467 DOI: 10.1080/17843286.2019.1660022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: Although nocturia is a risk factor for incident falls in the community, studies are required to gain an understanding of incident falls related to nocturnal toileting in hospitals. The aim of this study is to describe the prevalence and characteristics of incident falls in adult hospitalized patients related to nocturnal toileting.Methods: A retrospective review of the electronic incident reporting and learning system and medical records of inpatients that had an incident fall.Results: The prevalence of toileting-related incident falls was 53% (73/137) and 28% of all incident falls were related to nocturnal toileting.Intravenous fluid infusion was associated with falls related to toileting, whereby median perfusion volume during night-time was 375 ml [IQR: 225-578 ml].Conclusions: The prevalence of nocturnal toileting-related incident falls in hospitals is high. Nocturia could be a leading cause of these incident falls. Intravenous fluid infusion might be part of the aetiology of (iatrogenic) nocturia.
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Affiliation(s)
- Veerle Decalf
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Wendy Bower
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne, Melbourne, Australia
| | - Georgie Rose
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Ronny Pieters
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Kristof Eeckloo
- Department of Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Karel Everaert
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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34
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Batmani S, Jalali R, Mohammadi M, Bokaee S. Prevalence and factors related to urinary incontinence in older adults women worldwide: a comprehensive systematic review and meta-analysis of observational studies. BMC Geriatr 2021; 21:212. [PMID: 33781236 PMCID: PMC8008630 DOI: 10.1186/s12877-021-02135-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/07/2021] [Indexed: 12/14/2022] Open
Abstract
Background Urinary incontinence is a common condition in the general population and, in particular, the older adults population, which reduces the quality of life of these people, so this study aims to systematically examine and meta-analyse the overall prevalence of urinary incontinence in older women around the world and the related and influential factors. Methods This report is a comprehensive systematic review and meta-analysis of the findings of research on urinary incontinence in older adults people across the world through looking for MEDLINE, Cochrane Library Sciencedirect, Embase, Scopus, ProQuest and Persian databases, namely iranmedex, magiran, and SID from January 2000 to April 2020, the heterogeneity of the experiments was measured using the I2 index and the data processing was done in the Systematic Meta-Analysis programme. Results In 29 studies and the sample size of 518,465 people in the age range of 55–106 years, urinary incontinence in older adults’ women in the world based on a meta-analysis of 37.1% (95% CI: 29.6–45.4%) was obtained. The highest prevalence of urinary incontinence was reported in older adults’ women in Asia with 45.1% (95% CI: 36.9–53.5%). Meta-regression also showed that with increasing the sample size and year of the study, the overall prevalence of urinary incontinence in the older adults women of the world decreased and increased, respectively, which were statistically significant differences (P < 0.05). According to studies, the most important factors influencing the incidence of urinary incontinence in older women are women’s age (p < 0.001), obesity (p < 0.001), diabetes (p < 0.001), women’s education (p < 0.001), delivery rank (p < 0.001), hypertension (p < 0.001), smoking (p < 0.001). They also have urinary tract infections (p < 0.001). Conclusion Given the high prevalence of urinary incontinence in older women around the world, health policy makers must consider control and diagnostic measures in older women and prioritize treatment and rehabilitation activities.
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Affiliation(s)
- Sedighe Batmani
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Shadi Bokaee
- Faculty of Health and Life Sciences, School of Life Sciences, Coventry University, Coventry, UK
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Geary RS, Gurol-Urganci I, Mamza JB, Lynch R, El-Hamamsy D, Wilson A, Cohn S, Tincello D, van der Meulen J. Variation in availability and use of surgical care for female urinary incontinence: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Urinary incontinence affects between 25% and 45% of women. The availability and quality of services is variable and inequitable, but our understanding of the drivers is incomplete.
Objectives
The objectives of the study were to model patient, specialist clinician, primary and secondary care, and geographical factors associated with referral and surgery for urinary incontinence, and to explore women’s experiences of urinary incontinence and expectations of treatments.
Design
This was a mixed-methods study.
Setting
The setting was NHS England.
Participants
Data were collected from all women with a urinary incontinence diagnosis in primary care data, and all women undergoing mid-urethral mesh tape surgery for stress urinary incontinence were included. Interviews were also carried out with 28 women from four urogynaecology clinics who were deciding whether or not to have surgery, and surveys were completed by 245 members of the Royal College of Obstetricians and Gynaecologists with a specialist interest in urinary incontinence.
Data sources
The sources were patient-level data from Hospital Episode Statistics, the Clinical Practice Research Datalink and the Office for National Statistics mortality data linked to Hospital Episode Statistics. Interviews were conducted with women. An online vignette survey was conducted with members of the Royal College of Obstetricians and Gynaecologists.
Main outcome measures
The main outcome measures were the rates of referral from primary to secondary care and surgery after referral, the rates of stress urinary incontinence surgery by geographical area, the risk of mid-urethral mesh tape removal and reoperation after mid-urethral mesh tape insertion.
Results
Almost half (45.8%) of women with a new urinary incontinence diagnosis in primary care were referred to a urinary incontinence specialist: 59.5% of these referrals were within 30 days of diagnosis. In total, 14.2% of women referred to a specialist underwent a urinary incontinence procedure (94.5% of women underwent a stress urinary incontinence procedure and 5.5% underwent an urgency urinary incontinence procedure) during a follow-up period of up to 10 years. Not all women were equally likely to be referred or receive surgery. Both referral and surgery were less likely for older women, those who were obese and those from minority ethnic backgrounds. The stress urinary incontinence surgery rate was 40 procedures per 100,000 women per year, with substantial geographical variation. Among women undergoing mid-urethral mesh tape insertion for stress urinary incontinence, the 9-year mesh tape removal rate was 3.3%. Women’s decision-making about urinary incontinence surgery centred on perceptions of their urinary incontinence severity and the seriousness/risk of surgery. Women judged urinary incontinence severity in relation to their daily lives and other women’s experiences, rather than frequency or quantity of leakage, as is often recorded and used by clinicians. Five groups of UK gynaecologists could be distinguished who differed mainly in their average inclination to recommend surgery to hypothetical urinary incontinence patients. The gynaecologists’ recommendations were also influenced by urinary incontinence subtype and the patient’s history of previous surgery.
Limitations
The primary and secondary care data lacked information on the severity of urinary incontinence.
Conclusions
There was substantial variation in rates of referrals, surgery, and mesh tape removals, both geographically and between women of different ages and women from different ethnic backgrounds. The variation persisted after adjustment for factors that were likely to affect women’s preferences. Growing safety concerns over mid-urethral mesh tape surgery for stress urinary incontinence during the period from which the data are drawn are likely to have introduced more uncertainty to women’s and clinicians’ treatment decision-making.
Future work
Future work should capture outcomes relevant to women, including ongoing urinary incontinence and pain that is reported by women themselves, both before and after mesh and non-mesh procedures, as well as following conservative treatments. Future research should examine long-term patient-reported outcomes of treatment, including for women who do not seek further health care or surgery, and the extent to which urinary incontinence severity explains observed variation in referrals and surgery.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rebecca S Geary
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Royal College of Obstetricians and Gynaecologists Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Ipek Gurol-Urganci
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Royal College of Obstetricians and Gynaecologists Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Jil B Mamza
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Royal College of Obstetricians and Gynaecologists Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Rebecca Lynch
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Dina El-Hamamsy
- Department of Obstetrics and Gynaecology, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andrew Wilson
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Simon Cohn
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Douglas Tincello
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Royal College of Obstetricians and Gynaecologists Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK
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Gibson W, Makhani A, Hunter KF, Wagg A. Do Older Adults with Overactive Bladder Demonstrate Impaired Executive Function Compared to Their Peers Without OAB? Can Geriatr J 2020; 23:329-334. [PMID: 33282051 PMCID: PMC7704076 DOI: 10.5770/cgj.23.423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Maintaining urinary continence is not an automatic process, but relies on continuous processing of sensory signals from the bladder and suppression of the desire to void. Urinary incontinence (UI) and lower urinary tract symptoms (LUTS), including urinary urgency, frequency, and nocturia are highly prevalent among the general population. This prevalence rises in association with increasing age, and this may be in part due to changes in the central nervous system rather than the urinary tract. The aim of this study was to assess if older adults with overactive bladder (OAB) had demonstrable impairment in executive function. Methods This was a cross-sectional study comparing the performance of adults aged 65 and over with and without OAB on two cognitive tests, the Trail Making Test B (TMT-B) and simple reaction time (SRT). OAB was defined as urgency, with at least weekly urgency incontinence and a daytime urinary frequency of 8 or more. The control group were defined as a Bladder control Self-Assessment Questionnaire (B-SAQ) score of ≤4. Results 56 participants were recruited, of whom 35 met criteria for OAB. The OAB group took significantly longer to complete the TMT-B than the control group (103s vs. 77s, p = .003). There was no difference in the SRT. Conclusions In this sample of older adults, OAB was associated with measurable slower performance on the TMT-B, suggesting that impaired executive function is associated with OAB.
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Affiliation(s)
- William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB
| | - Asad Makhani
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB
| | | | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB
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37
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Bauer SR, Scherzer R, Suskind AM, Cawthon P, Ensrud KE, Ricke WA, Covinsky K, Marshall LM. Co-Occurrence of Lower Urinary Tract Symptoms and Frailty among Community-Dwelling Older Men. J Am Geriatr Soc 2020; 68:2805-2813. [PMID: 32822081 PMCID: PMC7744321 DOI: 10.1111/jgs.16766] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND/OBJECTIVES To estimate associations between lower urinary tract symptoms (LUTS) and phenotypic frailty in older men. DESIGN Cross-sectional study. SETTING Community-dwelling men recruited from 2000 to 2002 from six U.S. academic centers for the Osteoporotic Fractures in Men Study. PARTICIPANTS A total of 5,979 men aged 65 and older. MEASUREMENTS The independent variable was LUTS severity (none/mild, moderate, or severe) assessed with the American Urologic Association Symptom Index. Participants were categorized as frail, intermediate stage, or robust using an adapted Cardiovascular Health Study index (components: low lean mass, weakness, exhaustion, slowness, and low physical activity). Associations were estimated with odds ratios and 95% confidence intervals (CIs) from multivariable multinomial logistic regression models adjusted for potential confounders of age, other demographics, health-related behaviors, and comorbidities. RESULTS The prevalence of frailty was 7%, 11%, and 18% among men with none/mild, moderate, and severe LUTS, respectively. Moderate and severe LUTS, overall and by storage and voiding subscores, were associated with higher odds of both intermediate stage and frailty in all models. After adjustment for confounders, the odds of frailty was 1.41 times higher among men with moderate LUTS (95% CI = 1.14-1.74) and 2.51 times higher among men with severe LUTS (95% CI = 1.76-3.55), compared with none/mild LUTS. Severe LUTS was associated with a greater odds of individual frailty components exhaustion and low physical activity. CONCLUSION The prevalence of phenotypic frailty is higher among older community-dwelling men with moderate or severe LUTS compared with those with mild or no LUTS. The positive association between LUTS severity and frailty among older men appears independent of age and known frailty risk factors. Although the temporal direction of this association and the utility of LUTS or frailty interventions in this population remain unclear, the high co-occurrence of these conditions could lead to earlier identification of frailty when clinically appropriate.
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Affiliation(s)
- Scott R. Bauer
- Department of Medicine, University of California, San Francisco, CA
- Department of Urology, University of California, San Francisco, CA
- Veterans Affairs Medical Center, San Francisco, CA
| | | | - Anne M. Suskind
- Department of Urology, University of California, San Francisco, CA
| | - Peggy Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Kristine E. Ensrud
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
- Center for Care Delivery and Outcomes Research, Veterans Affairs Health Care System, Minneapolis, MN
| | - William A. Ricke
- George M. O’Brien Center of Research Excellence, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kenneth Covinsky
- Department of Medicine, University of California, San Francisco, CA
- Veterans Affairs Medical Center, San Francisco, CA
| | - Lynn M. Marshall
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR
- Oregon Health and Science University-Portland State University School of Public Health, Portland OR
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38
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Gurol-Urganci I, Geary RS, Mamza JB, Iwagami M, El-Hamamsy D, Duckett J, Wilson A, Tincello D, van der Meulen J. Determinants of referral of women with urinary incontinence to specialist services: a national cohort study using primary care data from the UK. BMC FAMILY PRACTICE 2020; 21:211. [PMID: 33066730 PMCID: PMC7568393 DOI: 10.1186/s12875-020-01282-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Female urinary incontinence is underdiagnosed and undertreated in primary care. There is little evidence on factors that determine whether women with urinary incontinence are referred to specialist services. This study aimed to investigate characteristics associated with referrals from primary to specialist secondary care for urinary incontinence. METHODS We carried out a cohort study, using primary care data from over 600 general practices contributing to the Clinical Practice Research Datalink (CPRD) in the United Kingdom. We used multi-level logistic regression to estimate adjusted odds ratios (aOR) that reflect the impact of patient and GP practice-level characteristics on referrals to specialist services in secondary care within 30 days of a urinary incontinence diagnosis. All women aged ≥18 years newly diagnosed with urinary incontinence between 1 April 2004 and 31 March 2013 were included. One-year referral was estimated with death as competing event. RESULTS Of the 104,466 included women (median age: 58 years), 28,476 (27.3%) were referred within 30 days. Referral rates decreased with age (aOR 0.34, 95% CI 0.31-0.37, comparing women aged ≥80 with those aged 40-49 years) and was lower among women who were severely obese (aOR 0.84, 95% CI 0.78-0.90), smokers (aOR 0.94, 95% CI 0.90-0.98), women from a minority-ethnic backgrounds (aOR 0.76, 95% CI 0.65-0.89 comparing Asian with white women), women with pelvic organ prolapse (aOR 0.77, 95% CI 0.68-0.87), and women in Scotland (aOR 0.60, 95% CI 0.46-0.78, comparing women in Scotland and England). One-year referral rate was 34.0% and the pattern of associations with patient characteristics was almost the same as for 30-day referrals. CONCLUSIONS About one in four women with urinary incontinence were referred to specialist secondary care services within one month after a UI diagnosis and one in three within one year. Referral rates decreased with age which confirms concerns that older women with UI are less likely to receive care according to existing clinical guidelines. Referral rates were also lower in women from minority-ethnic backgrounds. These finding may reflect clinicians' beliefs about the appropriateness of referral, differences in women's preferences for treatment, or other factors leading to inequities in referral for urinary incontinence.
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Affiliation(s)
- Ipek Gurol-Urganci
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Rebecca S Geary
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Jil B Mamza
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Masao Iwagami
- Department of Health Services Research, University of Tsukuba, Tsukuba, Japan.,Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Dina El-Hamamsy
- Leicester General Hospital, Women's and Children's Clinical Business Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Andrew Wilson
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Douglas Tincello
- Leicester General Hospital, Women's and Children's Clinical Business Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.,Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. .,Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK.
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39
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Moon S, Chung HS, Yu JM, Na HR, Kim SJ, Ko KJ, Choi DK, Kwon O, Lee YG, Cho ST. Impact of urinary incontinence on falls in the older population: 2017 national survey of older Koreans. Arch Gerontol Geriatr 2020; 90:104158. [DOI: 10.1016/j.archger.2020.104158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 12/27/2022]
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40
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Manuelyan Z, Siomara Muñiz K, Stein E. Common Urinary and Bowel Disorders in the Geriatric Population. Med Clin North Am 2020; 104:827-842. [PMID: 32773048 DOI: 10.1016/j.mcna.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The prevalence of urinary incontinence and other lower urinary tract symptoms increases with older age. These symptoms are more noticeable in men after the seventh decade of life and in women after menopause. Constipation and fecal incontinence are major causes of symptoms in elderly patients and can significantly impair quality of life. This article summarizes the current literature regarding the occurrence and implications of lower urinary tract and bowel symptoms in the geriatric population.
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Affiliation(s)
- Zara Manuelyan
- Department of Gastroenterology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, 3rd Floor, A Building Johns Hopkins Bayview, Baltimore, MD 21224, USA
| | - Keila Siomara Muñiz
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, 301 Building, Suite 3100, Baltimore, MD 21224, USA
| | - Ellen Stein
- Department of Gastroenterology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, 3rd Floor, A Building Johns Hopkins Bayview, Baltimore, MD 21224, USA.
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Makhani A, Thake M, Gibson W. Mirabegron in the Treatment of Overactive Bladder: Safety and Efficacy in the Very Elderly Patient. Clin Interv Aging 2020; 15:575-581. [PMID: 32368024 PMCID: PMC7185319 DOI: 10.2147/cia.s174402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/27/2020] [Indexed: 01/29/2023] Open
Abstract
Lower urinary tract symptoms, including urgency, urgency incontinence, frequency, and nocturia, are highly prevalent in older adults and are associated with significant morbidity and impairment in quality of life. When conservative measures such as bladder training fail to improve symptoms, pharmacological management is recommended by national and international guidelines. Mirabegron, an agonist of the β3 adrenergic receptor, demonstrates similar efficacy to the anticholinergic drugs without the risk of anticholinergic effects, but experience and evidence in the very elderly population are limited. This narrative review examines the current evidence base for mirabegron in very elderly adults.
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Affiliation(s)
- Asad Makhani
- University of Alberta, Division of Geriatric Medicine, Edmonton, Alberta, Canada
| | - Miriam Thake
- Great Western Hospitals NHS Foundation Trust, Swindon SN3 6BB, UK
| | - William Gibson
- University of Alberta, Division of Geriatric Medicine, Edmonton, Alberta, Canada
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Roggeman S, Weiss JP, Van Laecke E, Vande Walle J, Everaert K, Bower WF. The role of lower urinary tract symptoms in fall risk assessment tools in hospitals: a review. F1000Res 2020; 9. [PMID: 32269762 PMCID: PMC7135676 DOI: 10.12688/f1000research.21581.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 11/20/2022] Open
Abstract
A large number of falls in hospitals occur on the way to the toilet. Accordingly, a literature search was conducted in Web of Science, PubMed, Embase, and the Cochrane Library to identify fall risk screening and assessment metrics published between 1980 and 2019 and to study the inclusion of lower urinary tract symptoms (LUTS) and their related parameters in these screening tools. In addition, the literature was searched to explore the relationship between toilet-related falls and LUTS. In total, 23 fall risk scales were selected, from which 11 were applicable for in-hospital patients. In nine of the 11 scales for in-hospital patients, a LUTS or LUTS-related parameter was included. In the 12 risk assessment tools for community-dwelling older people, there were no LUTS included. Frequency, urinary incontinence, and nocturia were mostly reported in the literature as a potential fall risk parameter. It is recommended to create greater awareness of nocturia and other LUTS among caregivers of hospitalized patients to prevent falls.
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Affiliation(s)
- Saskia Roggeman
- NOPIA research group, Urology Department, Ghent Universtity Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Jeffrey P Weiss
- NOPIA research group, Urology Department, Ghent Universtity Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Erik Van Laecke
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Urology Department, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- 5. Faculty of Medicine and Health Sciences, Department of internal Medicine and Pediatrics, Ghent University, Ghent, 9000, Belgium.,Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- NOPIA research group, Urology Department, Ghent Universtity Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Urology Department, Ghent University Hospital, Ghent, Belgium
| | - Wendy F Bower
- NOPIA research group, Urology Department, Ghent Universtity Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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43
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Booth J, Aucott L, Cotton S, Goodman C, Hagen S, Harari D, Lawrence M, Lowndes A, Macaulay L, MacLennan G, Mason H, McClurg D, Norrie J, Norton C, O’Dolan C, Skelton DA, Surr C, Treweek S. ELECtric Tibial nerve stimulation to Reduce Incontinence in Care homes: protocol for the ELECTRIC randomised trial. Trials 2019; 20:723. [PMID: 31843002 PMCID: PMC6915984 DOI: 10.1186/s13063-019-3723-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/13/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is highly prevalent in nursing and residential care homes (CHs) and profoundly impacts on residents' dignity and quality of life. CHs predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous posterior tibial nerve stimulation (TPTNS) is a non-invasive, safe and low-cost intervention with demonstrated effectiveness for reducing UI in adults. However, the effectiveness of TPTNS to treat UI in older adults living in CHs is not known. The ELECTRIC trial aims to establish if a programme of TPTNS is a clinically effective treatment for UI in CH residents and investigate the associated costs and consequences. METHODS This is a pragmatic, multicentre, placebo-controlled, randomised parallel-group trial comparing the effectiveness of TPTNS (target n = 250) with sham stimulation (target n = 250) in reducing volume of UI in CH residents. CH residents (men and women) with self- or staff-reported UI of more than once per week are eligible to take part, including those with cognitive impairment. Outcomes will be measured at 6, 12 and 18 weeks post randomisation using the following measures: 24-h Pad Weight Tests, post void residual urine (bladder scans), Patient Perception of Bladder Condition, Minnesota Toileting Skills Questionnaire and Dementia Quality of Life. Economic evaluation based on a bespoke Resource Use Questionnaire will assess the costs of providing a programme of TPTNS. A concurrent process evaluation will investigate fidelity to the intervention and influencing factors, and qualitative interviews will explore the experiences of TPTNS from the perspective of CH residents, family members, CH staff and managers. DISCUSSION TPTNS is a non-invasive intervention that has demonstrated effectiveness in reducing UI in adults. The ELECTRIC trial will involve CH staff delivering TPTNS to residents and establish whether TPTNS is more effective than sham stimulation for reducing the volume of UI in CH residents. Should TPTNS be shown to be an effective and acceptable treatment for UI in older adults in CHs, it will provide a safe, low-cost and dignified alternative to the current standard approach of containment and medication. TRIAL REGISTRATION ClinicalTrials.gov, NCT03248362. Registered on 14 August 2017. ISRCTN, ISRCTN98415244. Registered on 25 April 2018. https://www.isrctn.com/.
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Affiliation(s)
- J. Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - L. Aucott
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - S. Cotton
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - C. Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - S. Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Glasgow, UK
| | - D. Harari
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - M. Lawrence
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - A. Lowndes
- Playlist for Life, Unit 1/14, Govanhill Workspace, Glasgow,, UK
| | - L. Macaulay
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - G. MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - H. Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - D. McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Glasgow, UK
| | - J. Norrie
- Usher Institute, Edinburgh University, Edinburgh, UK
| | | | - C. O’Dolan
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - D. A. Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - C. Surr
- School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - S. Treweek
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
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Hervé F, Abrams P, Bower W, Wachter S, Epstein M, Lombardo R, Robinson D, Tubaro A, Wein A, Weiss JP, Everaert K. Is our current understanding and management of nocturia allowing improved care? International Consultation on Incontinence‐Research Society 2018. Neurourol Urodyn 2019; 38 Suppl 5:S127-S133. [DOI: 10.1002/nau.23961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/11/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Francois Hervé
- Department of UrologyGhent University HospitalGhent Belgium
| | - Paul Abrams
- Bristol Urological Institute, Southmead HospitalBristol UK
| | - Wendy Bower
- Department of Medicine and Community CareFaculty of Medicine, Dentistry and Health Science, Melbourne Health, University of MelbourneMelbourne Australia
| | - Stefan Wachter
- Department of UrologyAntwerp University HospitalEdegem Belgium
- Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerp Belgium
| | - Matthew Epstein
- Department of UrologySUNY Downstate College of MedicineBrooklyn Newyork
| | - Riccardo Lombardo
- Department of UrologySant'Andrea Hospital, School of Health Sciences, Sapienza University of RomeRome Italy
| | | | - Andrea Tubaro
- Department of UrologySant'Andrea Hospital, School of Health Sciences, Sapienza University of RomeRome Italy
| | - Alan Wein
- Department of UrologyPerelman School of Medicine, University of PennsylvaniaPhiladelphia Pennsylvania
| | - Jeffrey P. Weiss
- Department of UrologySUNY Downstate College of MedicineBrooklyn Newyork
| | - Karel Everaert
- Department of UrologyGhent University HospitalGhent Belgium
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Gibson W, Morrison R, Wagg A, Hunter KF. Is the strong desire to void a source of diverted attention in healthy adult volunteers? Neurourol Urodyn 2019; 39:324-330. [PMID: 31782977 DOI: 10.1002/nau.24201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/20/2019] [Indexed: 01/23/2023]
Abstract
AIMS The strong desire to void (SDV) induces changes in both cognition and gait. This may be due to the sensation of urinary urge acting as a source of diverted attention. This exploratory study examined the influence of SDV and a standardized distracting task on the performance of two measures of cognition, a simple reaction time (SRT) test and the trail making B test (TMT-B). METHODS 18 volunteers, 8 male and 10 female, without lower urinary tract symptoms (LUTS) (mean age: 20.5, range: 20-47), performed a test of SRT and the TMT-B under three conditions; undistracted with an empty bladder, while experiencing SDV, and when performing a simultaneous distracting task, the auditory n back test. RESULTS A statistically significant increase in SRT was found when experiencing SDV and when distracted compared with the undistracted, bladder empty condition. The time taken to compete the TMT-B significantly increased with distraction but was not affected by SDV. CONCLUSION SDV induced a similar but smaller change in reaction time when compared with a distracting task, suggesting that SDV may act as a source of diverted attention in continent, healthy volunteers.
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Affiliation(s)
- William Gibson
- Division of Geriatric Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rachael Morrison
- Division of Geriatric Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Rose G, Decalf V, Everaert K, Bower WF. Toileting-related falls at night in hospitalised patients: The role of nocturia. Australas J Ageing 2019; 39:e70-e76. [PMID: 31321899 DOI: 10.1111/ajag.12696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/21/2019] [Accepted: 06/11/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the prevalence and characteristics of toileting-related falls in hospitalised older people. METHODS Retrospective analysis of falls related to night-time toileting in patients 60 years or over in a tertiary hospital during a one-year period. RESULTS Overall 34% of falls were related to toileting with at least 44% of these falls occurring during the night. Toilet-related falls peaked between 11 pm and 1 am, a period that coincides with maximum supine-induced diuresis. Almost half of night falls occurred at the bedside. In 80% of night toileting-related falls, patients were mobilising without the recommended level of assistance. Half of all patients had no strategies for toileting documented in their care plan. CONCLUSION Findings support screening for nocturia in older inpatients and implementation of strategies to reduce both the need for toileting at night and risk factors for falling.
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Affiliation(s)
- Georgie Rose
- Department of Medicine & Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Veerle Decalf
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Wendy F Bower
- Department of Medicine & Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
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Ashe MC, Edwards NY, Taylor A, Burnett L, Giangregorio L, Milne K, Clemson L, Fleig L. Return to Everyday Activity in the Community and Home: a feasibility study for a lifestyle intervention to sit less, move more, and be strong. Pilot Feasibility Stud 2019; 5:84. [PMID: 31297236 PMCID: PMC6599351 DOI: 10.1186/s40814-019-0467-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 06/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Many interventions designed to meet physical activity guideline recommendations focus on a single component (e.g., walking), to the detriment of other elements of a healthy lifestyle, such as reducing prolonged sitting and doing balance and strength exercises (i.e., bundled multiple behaviors). Adopting these multiple health behaviors within daily life routines may facilitate uptake and support longer-term behavior change. We tested feasibility for a three-part lifestyle intervention to support older women to sit less, move more, and complete balance and strength exercises. METHODS We used a convergent parallel mixed-methods, single-arm study design to test feasibility for a 6-week lifestyle intervention: Return to Everyday Activities in the Community and Home (REACH). We collected information at baseline, 3 and 6 weeks (final), and 6 months (follow-up) using questionnaires, semi-structured interviews, and performance-based measures. We describe three key elements: (1) implementation factors such as recruitment, retention, program delivery, and adherence; (2) participants' acceptability and experience with the program; and (3) health outcomes, including participants' global mobility, activity, and perceptions of their physical activity identity, and habit strength for (i) physical activity, (ii) breaking up sitting time, and (iii) balance and strength exercises. RESULTS We were able to recruit enough participants in the allotted time to conduct one cycle of the REACH group-based program. There were 10 community-dwelling women, median (p25, p75) age 61 (57.5, 71) years, who completed the study. The program was feasible to deliver, with high attendance (mean 5/6 sessions) and positive overall ratings (8/10). Participants rated session content and length high, and educational materials as highly acceptable and understandable. Although participants were active walkers at baseline, few were breaking up prolonged sitting or participating in any balance and strength exercises. At final and follow-up assessments, participants reported developing habits for all three health behaviors, without diminishing physical activity. CONCLUSION These results show acceptability of the program and its materials, and feasibility for bundling multiple health behaviors within the REACH program. It also provides confirmation to advance to testing feasibility of this three-part lifestyle intervention with older, less active, adults. TRIAL REGISTRATION ClinicalTrials.gov Identifier, NCT02786394; May 18, 2016.
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Affiliation(s)
- Maureen C. Ashe
- Department of Family Practice, Centre for Hip Health and Mobility, 7F–2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
- The University of British Columbia, Vancouver, Canada
- The University of Adelaide, Adelaide, Australia
| | - Nicola Y. Edwards
- Department of Family Practice, Centre for Hip Health and Mobility, 7F–2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | | | - Laura Burnett
- Department of Family Practice, Centre for Hip Health and Mobility, 7F–2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Lora Giangregorio
- University of Waterloo, Waterloo, Canada
- Schlegel Research Institute for Aging, Waterloo, Ontario Canada
| | - Kate Milne
- Cardea Health Consulting, Vancouver, Canada
| | | | - Lena Fleig
- MSB Medical School Berlin, Berlin, Germany
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48
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Choi CK, Kim SA, Jeong JA, Kweon SS, Shin MH. Non-linear Relationship Between Body Mass Index and Lower Urinary Tract Symptoms in Korean Males. J Prev Med Public Health 2019; 52:147-153. [PMID: 31163949 PMCID: PMC6549014 DOI: 10.3961/jpmph.18.259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/14/2019] [Indexed: 11/28/2022] Open
Abstract
Objectives: The purpose of this study was to evaluate the association between body mass index (BMI) and severe lower urinary tract symptoms (LUTS) in Korean males. Methods: This study was conducted on males aged ≥50 years who participated in the 2011 Korean Community Health Survey. LUTS severity was assessed using the Korean version of the International Prostate Symptom Score (IPSS) questionnaire, and was dichotomized as severe (IPSS >19) and non-severe (IPSS ≤19). BMI was divided into 6 categories: <18.5, 18.5-22.9, 23.0-24.9, 25.0-27.4, 27.5-29.9, and ≥30.0 kg/m2. To evaluate the relationship between BMI and LUTS, a survey-weighted multivariate Poisson regression analysis was performed to estimate prevalence rate ratios (PRRs). Age, smoking status, alcohol intake, physical activity, educational level, household income, and comorbidities were adjusted for in the multivariate model. Results: A U-shaped relationship was detected between BMI and severe LUTS. Compared with a BMI of 23.0-24.9 kg/m2, the PRR for a BMI <18.5 kg/m2 was 1.65 (95% confidence interval [CI], 1.35 to 2.02), that for a BMI of 18.5-22.9 kg/m2 was 1.25 (95% CI, 1.09 to 1.44), that for a BMI of 25.0-27.4 kg/m2 was 1.20 (95% CI, 1.00 to 1.45), that for a BMI of 27.5-29.9 kg/m2 was 1.11 (95% CI, 0.83 to 1.47), and that for a BMI ≥30.0 kg/m2 was 1.85 (95% CI, 1.18 to 2.88). Conclusions: This study showed that both high and low BMI were associated with severe LUTS.
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Affiliation(s)
- Chang Kyun Choi
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Sun A Kim
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Ji-An Jeong
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
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Dunne E, Santorelli A, McGinley B, Leader G, O'Halloran M, Porter E. Image-based classification of bladder state using electrical impedance tomography. Physiol Meas 2018; 39:124001. [PMID: 30507554 DOI: 10.1088/1361-6579/aae6ed] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In this study, we examine the potential of using machine learning classification to determine the bladder state ('not full', 'full') with electrical impedance tomography (EIT) images of the pelvic region. Accurate classification of these states would enable urinary incontinence (UI) monitoring to alert the patient, before involuntary voiding occurs, in a low-cost and discrete manner. APPROACH Using both numerical and experimental data, we form datasets that contain diverse observations with varying clinical parameters such as bladder volume, urine conductivity, and the reference used for time-difference imaging. We then classify the bladder state using both pixel-wise and feature extraction-based classification techniques. We employ principal component analysis, wavelets, and image segmentation to help create features. MAIN RESULTS The performance was compared across several classifier algorithms. The minimum accuracy was 77.50%. The highest accuracy observed was 100%, and was found by combining principal component analysis and the Gaussian radial based function kernel support vector machine. This combination also offered the best trade-off between classification performance and the costs of training time and memory space. The biggest challenge in bladder state classification is classifying volumes near the separation volume of not full and full, in which choosing the most suitable classifier combination can minimize this error. SIGNIFICANCE We performed the first machine learning classification of bladder EIT images, achieving high classification accuracies with both numerical and experimental data. This work highlights the potential of using image-based machine learning with an EIT device to support bladder monitoring for those suffering from UI.
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Affiliation(s)
- Eoghan Dunne
- Translational Medical Device Lab, National University of Ireland Galway, Galway City, Ireland. Department of Electrical and Electronic Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway City, Ireland
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50
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Chmielewska D, Sobota GS, Stania M, Błaszczak E, Słomka K, Juras G. A comparison of a step-initiation task in women with and without urinary incontinence. A case-control study. Neurourol Urodyn 2018; 37:2571-2577. [PMID: 30152526 DOI: 10.1002/nau.23580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/13/2018] [Indexed: 11/10/2022]
Abstract
AIMS The aim of the study was to objectively determine differences in postural response by women with and without urinary incontinence during a step-initiation task depending on the degree of bladder filling. METHODS The study comprised 22 women with stress urinary incontinence and 20 women without urinary incontinence. All women participated in four trials: unperturbed and perturbed (obstacle crossing) transition between platforms, step-up and step-down trials. Velocities of center of pressure displacement, double-support period, time from exit from steady standing until the lead foot resting on the other platform and time from raising the foot from the first platform until gaining quiet standing on the other platform were measured and compared. RESULTS No significant differences were noted between the performance of a step-initiation task by incontinent women with full/empty bladder whereas continent women performed differently during unperturbed transition with full/empty bladder. The step-up trial revealed significant intergroup differences. The antero-posterior mean velocity of center of pressure during the empty bladder test was significantly higher in women with stress urinary incontinence (effect size = 1.02). During the same bladder condition the women with stress urinary incontinence performed significantly more slowly in unperturbed (effect size = 1.09) and perturbed (effect size = 0.84) transition compared to control group. CONCLUSIONS Our results indicate that women with incontinence performed the step initiation task slowly on the empty bladder tests compare to continent women.
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Affiliation(s)
- Daria Chmielewska
- Faculty of Physiotherapy, Department of Physiotherapy Basics, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Grzegorz Sobota Sobota
- Department of Human Motor Behaviour, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Magdalena Stania
- Faculty of Physiotherapy, Department of Physiotherapy Basics, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Edward Błaszczak
- Faculty of Medical Biophysics, Department of Medical Biophysics, Medical University of Silesia, Katowice, Poland
| | - Kajetan Słomka
- Department of Human Motor Behaviour, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Grzegorz Juras
- Department of Human Motor Behaviour, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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