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Zou M, Lu R, Jiang Y, Liu P, Tian B, Liang Y, Wang X, Jiang L. Association between toileting and falls in older adults admitted to the emergency department and hospitalised: a cross-sectional study. BMJ Open 2023; 13:e065544. [PMID: 37263694 DOI: 10.1136/bmjopen-2022-065544] [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: 06/03/2023] Open
Abstract
OBJECTIVES This study aimed to explore the potential risk factors associated with toileting-related falls in community-dwelling older adults who presented to the emergency department and were subsequently hospitalised. DESIGN This was a cross-sectional study. SETTING AND PARTICIPANTS This study was conducted in two teaching hospitals in Shanghai, China between October 2019 and December 2021 among community-dwelling adults aged ≥60 years. METHODS In-person interviews, physical assessment and medical record review were performed to collect data on the characteristics and risk factors of falls. Associations of toileting-related falls with demographic characteristics and geriatric syndromes were examined using logistic regression models. MAIN OUTCOME MEASURES Potential risk factors for toileting-related falls. RESULTS This study included 419 older patients with a mean age of 73.8±9.7 years. Among 60 (14.3%) patients with toileting-related falls (mean age: 78.8±9.2 years), 63.3% of toileting-related falls, mainly occurred between 00:00 and 05:59 hours, compared with 17.3% of non-toileting-related falls, which primarily occurred during the daytime. The rate of recurrent falls (35%) was significantly higher in the toileting-related falls group than in the non-toileting-related falls group (21.2%) (p=0.02). Logistic regression showed that visual impairment (OR 2.7, 95% CI 1.1 to 7.1), cognitive impairment (OR 3.3, 95% CI 1.3 to 8.4), gait instability (OR 3.1, 95% CI 1.1 to 8.8) and urinary incontinence (OR 3.4, 95% CI 1.2 to 9.9) were strongly associated with toileting-related falls. Twenty-three (38.3%) patients in the toileting-related falls group had moderate and severe injuries, compared with 71.7% in the non-toileting-related falls group (p<0.05). CONCLUSIONS This study revealed that patients who reported toileting-related falls were more likely to have cognitive impairment, urinary incontinence, gait instability, visual impairment than patients who fell during other activities. Social and healthcare professionals should prioritise the management of toileting activities in older patients and provide targeted interventions to those in the high-risk group.
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Affiliation(s)
- Min Zou
- School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Emergency Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Lu
- Emergency Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijun Jiang
- Department of Pharmaceutics, Shanghai Pharmaceutical School, Shanghai, China
| | - Ping Liu
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bingjie Tian
- School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqi Liang
- School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - XiaoLing Wang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liping Jiang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Tyagi S, Chancellor MB. Nocturnal polyuria and nocturia. Int Urol Nephrol 2023; 55:1395-1401. [PMID: 37000379 DOI: 10.1007/s11255-023-03582-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/25/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Nocturia is a common complaint that can have a significant impact on quality of life. The pathophysiology is usually multifactorial and can be due to poor sleep, nocturnal polyuria, or low bladder capacity alone or in combination. OBJECTIVE Nocturnal polyuria (NP) is the most common cause of nocturia in older adults. We hereby review the role of nocturnal polyuria in nocturia. PATIENTS AND METHODS To manage nocturia, a multipronged approach personalized to the patient's multifactorial etiology is warranted, with a focus on lifestyle modifications and behavioral approaches as first-line therapies. Pharmacologic treatment should be considered based on underlying disease processes, and healthcare providers should be mindful of potential drug interactions and polypharmacy in older adults. RESULT Referral to specialists in sleep or bladder-related disorders may be necessary for some patients. With comprehensive and individualized management, patients with nocturia can achieve improved quality of life and overall health outcomes.
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Affiliation(s)
- Shachi Tyagi
- Department: Medicine, Division: Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Michael B Chancellor
- Department: Urology, Oakland University William Beaumont School of Medicine, Auburn Hills, USA.
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Lv K, Wu Y, Huang S, Luo Z, Lai W, Meng Q, Xia X, Lv C, Hao X, Song T, Yuan Q. Age and metabolic syndrome are associated with unsatisfactory improvement in nocturia after holmium laser enucleation of the prostate. Front Surg 2023; 9:1063649. [PMID: 36704512 PMCID: PMC9871621 DOI: 10.3389/fsurg.2022.1063649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To investigate the association between age, metabolic syndrome (MetS) and improvement in nocturia in patients with benign prostate hyperplasia (BPH) receiving holmium laser enucleation of the prostate (HoLEP). Methods The retrospective study was conducted on patients treated for BPH using HoLEP between January 2021 and May 2022. Lower urinary tract symptoms (LUTS) were measured before surgery and at 3 months postoperatively using the International Prostate Symptom Score (IPSS). The criteria of the Adult Treatment Panel III (ATP III) were adopted to diagnose the MetS. Unsatisfactory improvement in nocturia was defined as <50% reduction in nocturia from baseline on the IPSS. Results One hundred and seventy-five patients were eventually enrolled, with a median age of 69 years (IQR: 63/73). Unsatisfactory improvement in nocturia was reported in 95 patients (54%) after HoLEP. These patients were older (73; IQR: 67/79 vs. 66; IQR: 60/71, P < 0.001) and more likely to present with higher postoperative total (6; IQR: 4/9 vs. 3; IQR:2/5, P < 0.001), voiding (1; IQR: 0/3 vs. 1; IQR: 0/2, P = 0.017), and storage (4; IQR: 3/6 vs. 2; IQR: 1/4, P < 0.001) IPSS when compared to patients with satisfactory improvement in nocturia. Overall, 63 of 175 (36%) patients were diagnosed with MetS and of these, 44 (70%) reported unsatisfactory improvement in nocturia (P = 0.002) after HoLEP. Multivariate analysis revealed that age (OR = 1.117, 95% CI: 1.068-1.169, P < 0.001) and MetS (OR = 3.613, 95% CI: 1.727-7.562, P = 0.001) were independent risk factors for unsatisfactory improvement in nocturia after HoLEP. Conclusion Our findings suggest that increased age and MetS were associated with unsatisfactory improvement in nocturia in patients with BPH after HoLEP. Lifestyle management, including weight loss, may be of great importance in the improvement of nocturia.
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Affiliation(s)
- Kaikai Lv
- Department of Urology, the Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People's Liberation Army (PLA), Beijing, China
| | - Yangyang Wu
- Department of Urology, the Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People's Liberation Army (PLA), Beijing, China
| | - Shuai Huang
- Department of Postgraduate, Hebei North University, Zhangjiakou, Hebei, China
| | - Zhenjun Luo
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Wenhui Lai
- Department of Postgraduate, Hebei North University, Zhangjiakou, Hebei, China
| | - Qingyang Meng
- Department of Urology, the Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xinze Xia
- Department of Urology, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chao Lv
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China
| | - Xiaowei Hao
- Department of Urology, the Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People's Liberation Army (PLA), Beijing, China
| | - Tao Song
- Department of Urology, the Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People's Liberation Army (PLA), Beijing, China,Correspondence: Qing Yuan Tao Song
| | - Qing Yuan
- Department of Urology, the Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People's Liberation Army (PLA), Beijing, China,Correspondence: Qing Yuan Tao Song
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