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Fluck A, Fry CH, Affley B, Kakar P, Sharma P, Fluck D, Han TS. Sex-specific independent risk factors of urinary incontinence in acute stroke patients: A multicentre registry-based cohort study. Neurourol Urodyn 2024; 43:818-825. [PMID: 38451041 DOI: 10.1002/nau.25440] [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: 12/07/2023] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND The presence of urinary incontinence (UI) in acute stroke patients indicates poor outcomes in men and women. However, there is a paucity and inconsistency of data on UI risk factors in this group and hence we conducted a sex-specific analysis to identify risk factors. METHODS Data were collected prospectively (2014-2016) from the Sentinel Stroke National Audit Program for patients admitted to four UK hyperacute stroke units. Relevant risk factors for UI were determined by stepwise multivariable logistic regression, presented as odds ratios (OR) and 95% confidence intervals (CI). RESULTS The mean (±SD) age of UI onset in men (73.9 year ± 13.1; n = 1593) was significantly earlier than for women (79.8 year ± 12.9; n = 1591: p < 0.001). Older age between 70 and 79 year in men (OR = 1.61: CI = 1.24-2.10) and women (OR = 1.55: CI = 1.12-2.15), or ≥80 year in men (OR = 2.19: CI = 1.71-2.81), and women (OR = 2.07: CI = 1.57-2.74)-reference: <70 year-both predicted UI. In addition, intracranial hemorrhage (reference: acute ischemic stroke) in men (OR = 1.64: CI = 1.22-2.20) and women (OR = 1.75: CI = 1.30-2.34); and prestroke disability (mRS scores ≥ 4) in men (OR = 1.90: CI = 1.02-3.5) and women (OR = 1.62: CI = 1.05-2.49) (reference: mRS scores < 4); and stroke severity at admission: NIHSS scores = 5-15 in men (OR = 1.50: CI = 1.20-1.88) and women (OR = 1.72: CI = 1.37-2.16), and NIHSS scores = 16-42 in men (OR = 4.68: CI = 3.20-6.85) and women (OR = 3.89: CI = 2.82-5.37) (reference: NIHSS scores = 0-4) were also significant. Factors not selected were: a history of congestive heart failure, hypertension, atrial fibrillation, diabetes and previous stroke. CONCLUSIONS We have identified similar risk factors for UI after stroke in men and women including age >70 year, intracranial hemorrhage, prestroke disability and stroke severity.
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Affiliation(s)
- Adam Fluck
- Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK
| | - David Fluck
- Department of Cardiology, Ashford & St Peter's NHS Foundation Trust, Chertsey, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
- Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
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Shogenji M, Yoshida M, Kakuchi T, Hirako K. Factors associated with caregiver burden of toileting assistance at home versus in a nursing home: A cross-sectional study. PLoS One 2024; 19:e0299721. [PMID: 38452135 PMCID: PMC10919849 DOI: 10.1371/journal.pone.0299721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024] Open
Abstract
This study aimed to identify differences in caregiver burden related to toileting assistance, and examine the factors associated with the most burdensome aspects of providing toileting assistance. In 2019, a self-administered postal survey was conducted with 743 caregivers of older adults who received subsidies for continence products in Komatsu City, Japan. Both family caregivers and nursing home staff answered questions regarding older adults' urinary/fecal symptoms, toileting assistance, and perceived caregiver burden. Older adults living at home had less need for toileting assistance than those in nursing homes. However, family caregivers experienced more burden than nursing home staff. The most frequent physical burden associated with toileting assistance for family caregivers was urinary/fecal leakage from absorbent incontinence products. This burden was linked to family caregivers providing care at home, using a combination of urinary pads and diapers, and symptoms that caused burdens on caregivers including urinary/fecal incontinence, nocturia, and no desire to urinate. These results suggest that leakage caused by the inappropriate use of urinary pads combined with diapers is a source of caregiver burden. Continence care experts should provide guidance to family caregivers of older adults, particularly those who are underweight and frail, regarding the selection and fitting of absorbent incontinence products.
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Affiliation(s)
- Miho Shogenji
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa City, Ishikawa, Japan
| | - Mikako Yoshida
- Department of Women’s Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai City, Miyagi, Japan
| | - Takahiro Kakuchi
- Graceful Aging Division, Health & Welfare Department, Komatsu City Hall, Komatsu City, Ishikawa, Japan
| | - Kohei Hirako
- The Establishment Preparation Office for The Faculty of Interdisciplinary Economics, Kinjo University, Hakusan City, Ishikawa, Japan
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Gobbens RJJ, Kuiper S, Dijkshoorn H, van Assen MALM. Associations of individual chronic diseases and multimorbidity with multidimensional frailty. Arch Gerontol Geriatr 2024; 117:105259. [PMID: 37952423 DOI: 10.1016/j.archger.2023.105259] [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: 09/08/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To examine the associations between individual chronic diseases and multidimensional frailty comprising physical, psychological, and social frailty. METHODS Dutch individuals (N = 47,768) age ≥ 65 years completed a general health questionnaire sent by the Public Health Services (response rate of 58.5 %), including data concerning self-reported chronic diseases, multidimensional frailty, and sociodemographic characteristics. Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). Total frailty and each frailty domain were regressed onto background characteristics and the six most prevalent chronic diseases: diabetes mellitus, cancer, hypertension, arthrosis, urinary incontinence, and severe back disorder. Multimorbidity was defined as the presence of combinations of these six diseases. RESULTS The six chronic diseases had medium and strong associations with total ((f2 = 0.122) and physical frailty (f2 = 0.170), respectively, and weak associations with psychological (f2 = 0.023) and social frailty (f2 = 0.008). The effects of the six diseases on the frailty variables differed strongly across diseases, with urinary incontinence and severe back disorder impairing frailty most. No synergetic effects were found; the effects of a disease on frailty did not get noteworthy stronger in the presence of another disease. CONCLUSIONS Chronic diseases, in particular urinary incontinence and severe back disorder, were associated with frailty. We thus recommend assigning different weights to individual chronic diseases in a measure of multimorbidity that aims to examine effects of multimorbidity on multidimensional frailty. Because there were no synergetic effects of chronic diseases, the measure does not need to include interactions between diseases.
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Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Tranzo, Tilburg University, Tilburg, the Netherlands.
| | - Sandra Kuiper
- Tranzo, Tilburg University, Tilburg, the Netherlands; Department of Research, Public Health Service of West-Brabant, Breda, the Netherlands
| | - Henriëtte Dijkshoorn
- Department of Healthy Living, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Marcel A L M van Assen
- Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
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Elsaqa M, Papaconstantinou H, El Tayeb MM. Preoperative Frailty Scores Predict the Early Postoperative Complications of Holmium Laser Enucleation of Prostate. J Endourol 2023; 37:1270-1275. [PMID: 37776182 DOI: 10.1089/end.2023.0196] [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: 10/01/2023] Open
Abstract
Background: Frailty is a recent multidimensional concept of a contemporary growing interest for understanding the complex health status of elderly population. We aimed to assess the impact of frailty scores on the outcome and complication rate of holmium laser enucleation of prostate (HoLEP). Methods: A 7-year data of HoLEP patients in a single tertiary referral center were reviewed. The preoperative, operative, early, and late postoperative outcome data were collected and compared according to the preoperative frailty scores. Frailty was assessed preoperatively using the Modified Hopkins frailty score. Results: The study included 837 patients categorized into two groups: group I included 533 nonfrail patients (frailty score = 0), whereas group II included 304 frail patients (frailty score ≥1). The median (interquartile range) age was 70 (11) and 75 (11) years for groups I and II, respectively (<0.001). The 30-day perioperative complication rate (p = 0.005), blood transfusion (p = 0.013), failed voiding trial (p = 0.0015), and 30-day postoperative readmission (p = 0.0363) rates were significantly higher in frail patients of group II. The two groups were statistically comparable regarding postoperative international prostate symptom score (p = 0.6886, 0.6308, 0.9781), incontinence rate (p = 0.475, 0.592, 0.1546), postvoid residual (p = 0.5801, 0.1819, 0.593) at 6 weeks and 3 months, and 1-year follow-up intervals, respectively. Conclusion: In elderly patients undergoing HoLEP, the preoperative frailty scores strongly correlate with the risk of perioperative complications. Frail patients should be counseled regarding their relative higher risk of early perioperative complications although they gain the same functional profit of HoLEP as nonfrail patients.
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Affiliation(s)
- Mohamed Elsaqa
- Division of Urology, Department of Surgery, Baylor Scott and White Health, CTX, Temple, Texas, USA
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Harry Papaconstantinou
- Division of Urology, Department of Surgery, Baylor Scott and White Health, CTX, Temple, Texas, USA
| | - Marawan M El Tayeb
- Division of Urology, Department of Surgery, Baylor Scott and White Health, CTX, Temple, Texas, USA
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Elsaqa M, Zhang Y, Papaconstantinou H, Tayeb MME. Incidence and predictors of urinary incontinence rates post-holmium laser enucleation of prostate. Low Urin Tract Symptoms 2023; 15:185-190. [PMID: 37376761 DOI: 10.1111/luts.12494] [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: 03/18/2023] [Revised: 05/05/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION One of the main adverse outcomes following Holmium laser enucleation of the prostate (HoLEP) is the development of transient de novo urinary incontinence (UI). We aimed to evaluate the correlation of multiple risk factors to UI rates post-HoLEP. METHODS A review of prospectively maintained 7 year database for HoLEP patients in a single center was performed. UI data at 6 week, 3 month, and 1 year follow-up intervals were assessed with bivariate and multivariate analysis of multiple potential risk factors. RESULTS The study included 666 patients with median (IQR) age of 72 (66-78) years old and median (IQR) preoperative prostate volume of 89 (68-126) gm. UI was seen in 287 (43%), 100 (15%) and 26 (5.8%) at 6 week, 3 month, and 1 year follow up occasions respectively. At 6 weeks follow up, UI type was stress, urge and mixed in 121 (18.16%), 118 (17.72) and 48 (7.21%) patients respectively. Using a multivariate regression analysis, obesity and pre-operative UI were associated with postoperative UI rate at both 6 week (p = .0065, .031) and 3 month (p = .0261, .044) follow up encounters respectively. Also, larger specimen weight was another predictor for 6 week UI (p = .0399) while higher frailty score was a predictor for UI at 3 month occasion (p = .041). CONCLUSION Patients with preoperative UI, obesity, frailty, and large prostate volume are at higher risk of short-term UI post-HoLEP up to 3 months. Patients with one or more of these risk factors should be counseled regarding the higher risk of UI.
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Affiliation(s)
- Mohamed Elsaqa
- Baylor Scott & White Health, CTX, Temple, Texas, USA
- Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Yu Zhang
- Baylor Scott & White Health, CTX, Temple, Texas, USA
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Kravchenko G, Korycka-Bloch R, Stephenson SS, Kostka T, Sołtysik BK. Cardiometabolic Disorders Are Important Correlates of Vulnerability in Hospitalized Older Adults. Nutrients 2023; 15:3716. [PMID: 37686746 PMCID: PMC10490417 DOI: 10.3390/nu15173716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
With an increasingly aging population worldwide, the concept of multimorbidity has attracted growing interest over recent years, especially in terms of frailty, which leads to progressive multisystem decline and increased adverse clinical outcomes. The relative contribution of multiple disorders to overall frailty index in older populations has not been established so far. This study aimed to assess the association between the vulnerable elders survey-13 (VES-13) score, which is acknowledged to be one of the most widely used measures of frailty, and the most common accompanying diseases amongst hospitalized adults aged 60 years old and more. A total of 2860 participants with an average age of 83 years were included in this study. Multiple logistic regression with adjustment for age and nutritional status was used to assess the independent impact of every particular disease on vulnerability. Diabetes mellitus type 2, coronary artery disease, atrial fibrillation, heart failure, chronic kidney disease, osteoarthritis, fractures, eyes disorders, depression, dementia, pressure ulcers, and urinary incontinence were associated with higher scores of VES-13. Hospital admission of older subjects with those conditions should primarily draw attention to the risk of functional decline, especially while qualifying older patients for further treatment in surgery and oncology. At the same time, lipid disorders, gastrointestinal diseases, higher body mass index, and albumins level were related to a lower risk of being vulnerable, which may be attributed to a younger age and better nutritional status of those patients.
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Affiliation(s)
| | | | | | - Tomasz Kostka
- Department of Geriatrics, Healthy Aging Research Centre (HARC), Medical University of Lodz, Haller Sqr. No. 1, 90-647 Lodz, Poland; (G.K.); (R.K.-B.); (S.S.S.); (B.K.S.)
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Schmidt S, Neumann A, Muller J, Schweitzer A, Gölly KI, Brandl J. Digital assistance systems in the field of incontinence care for individuals in need of long-term care (EASY): study protocol of a stratified randomised controlled trial. BMC Geriatr 2023; 23:409. [PMID: 37403028 DOI: 10.1186/s12877-023-04135-2] [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: 08/17/2022] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND In general, urinary and faecal incontinence is a multifaceted problem that is associated with increasing burdens for those affected, a massive impairment of quality of life and economic consequences. Incontinence is associated with a high level of shame, which in particular reduces the self-esteem of those being incontinent and leads to additional vulnerability. Those affected by incontinence often perceive incontinence and the care they receiveas humiliating, hence they can no longer control their own urination; nursing care and cleansing support then lead to additional dependency. People with incontinence in need of care not uncommonly experience a poor communication and many taboos surrounding the issue as well as the use of force when incontinence products are changed. AIMS AND METHODS This RCT aims to validate the benefits of using a digital assistance system to optimise incontinence care and to enable statements concerning the effect of the assistance technology on nursing and social structures and processes as well as on the quality of life from the perspective of the person in need of care. In a two-arm, stratified, randomised, controlled interventional study, primarily incontinence-affected residents of four inpatient nursing facilities will be examined (n = 80). One intervention group will be equipped with a sensor-based digital assistance system, which will transmit care-related information to the nursing staff (via smartphone). The collected data will be compared to the data of the control group. Primary endpoints are falls occurring; secondary endpoints are quality of life and sleep, sleep disturbances and material consumption. In addition, nursing staff (n = 15-20) will be interviewed regarding the effects, experience, acceptance and satisfaction. DISCUSSION The RCT aims at the applicability and effect of assistance technologies on nursing structures and processes. It is assumed that, amongst other things, this technology may lead to a reduction of unnecessary checks and material changes, an improvement of life quality, an avoidance of sleep disturbances and thus an improvement of sleep quality as well as to a reduced risk of falling for people with incontinence in need of care. The further development of incontinence care systems is of social interest as this offers the prospect of improving the quality of care for nursing home residents with incontinence. TRAIL REGISTRATION Approval of the RCT is granted by the Ethics Committee at the University of Applied Sciences Neubrandenburg (Reg.-Nr.: HSNB/190/22). This RCT is registered at the German Clinical Trials Register on July 8th, 2022, under the identification number DRKS00029635.
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Affiliation(s)
- Stefan Schmidt
- Faculty of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Brodaer Strasse 2, Neubrandenburg, 17033, Germany.
| | - Alexandra Neumann
- Faculty of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Brodaer Strasse 2, Neubrandenburg, 17033, Germany
| | - Julie Muller
- Faculty of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Brodaer Strasse 2, Neubrandenburg, 17033, Germany
| | | | | | - Julio Brandl
- AssistMe GmbH, Bachstrasse 12, Berlin, 10555, Germany
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Jones CP, Shaw NM, Mena J, Breyer BN, Walter LC, Baussan C, Quanstrom K, Allen IE, Dohan D, Hampson LA. The relationship between frailty, incontinence severity, and treatment decisions for men with post-prostatectomy stress urinary incontinence: a mixed methods analysis. Transl Androl Urol 2023; 12:840-848. [PMID: 37305619 PMCID: PMC10251103 DOI: 10.21037/tau-22-839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/28/2023] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Frailty is common among urology patients in general as well as among men seeking evaluation for stress urinary incontinence (SUI), with 6.1% of men undergoing artificial urinary sphincter placement considered frail. It is unclear if and how patient views on frailty and incontinence severity impact decision-making with regards to SUI treatment. METHODS We undertook a mixed methods analysis to evaluate the intersection of frailty, incontinence severity, and treatment decision-making is presented. To do so, we utilized a previously published cohort of men undergoing evaluation for SUI at the University of California, San Francisco between 2015 and 2020, selecting those who had evaluation with timed up and go test (TUGT), objective measures of incontinence, and patient-reported outcome measures (PROMs). A subset of these participants had additionally undergone semi-structured interviews, and these interviews were re-examined to thematically code them with a focus on the impact of frailty and incontinence severity on SUI treatment decision-making. RESULTS Among the original cohort of 130 patients, 72 had an objective measure of frailty and were included in our analysis; 18 of these individuals had corresponding qualitative interviews. Common themes identified included (I) impact of incontinence severity on decision-making; (II) the interaction between frailty and incontinence; (III) the impact of comorbidity on treatment decision-making; and (IV) age as a construct of frailty and impact on surgical choice and/or recovery. Direct quotations regarding each theme provides insight into patients' views and drivers of SUI treatment decision-making. CONCLUSIONS The impact of frailty on treatment decision-making for patients with SUI is complex. This mixed methods study highlights the variety of patient views on frailty with regards to surgical intervention for male SUI. Urologists should make a concerted effort to personalize patient counseling for SUI management and take time to understand each patient's perspective in order to individualize SUI treatment decision-making. More research is needed to help identify factors that influence decision-making for frail male patients with SUI.
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Affiliation(s)
- Charles P. Jones
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nathan M. Shaw
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jorge Mena
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin N. Breyer
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Louise C. Walter
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Caitlin Baussan
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn Quanstrom
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - I. Elaine Allen
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Daniel Dohan
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lindsay A. Hampson
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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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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Soysal P, Veronese N, Ippoliti S, Pizzol D, Carrie AM, Stefanescu S, López-Sánchez GF, Barnett Y, Butler L, Koyanagi A, Jacob L, Ghaydya RA, Sheyn D, Hijaz AK, Oliva-Lozano JM, Muyor JM, Trott M, Kronbichler A, Grabovac I, Tully MA, Yang L, Hwang J, Kim JY, Park S, Song J, Shin JI, Ilie PC, Smith L. The impact of urinary incontinence on multiple health outcomes: an umbrella review of meta-analysis of observational studies. Aging Clin Exp Res 2023; 35:479-495. [PMID: 36637774 DOI: 10.1007/s40520-022-02336-0] [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: 09/19/2022] [Accepted: 12/21/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM We aimed to capture the breadth of health outcomes that have been associated with the presence of Urinary Incontinence (UI) and systematically assess the quality, strength, and credibility of these associations through an umbrella review and integrated meta-analyses. METHODS We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p-values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV). RESULTS AND DISCUSSION From 3172 articles returned in search of the literature, 9 systematic reviews were included with a total of 41 outcomes. Overall, 37 out of the 41 outcomes reported nominally significant summary results (p < 0.05), with 22 associations surviving the application of a more stringent p-value (p < 10-6). UI was associated with worse scores than controls in female sexual function (Class II), while it was also associated with a higher prevalence of depression (odds ratio [OR] = 1.815; 95% confidence interval [CI]: 1.551-2.124), and anxiety (OR = 1.498; 95% CI: 1.273-1.762) (Class IV). UI was associated with poorer quality of life (QoL), higher rate of mortality (hazard ratio = 2.392; 95% CI: 2.053-2.787) an increase in falls, frailty, pressure ulcers, diabetes, arthritis, and fecal incontinence (Class IV). CONCLUSIONS UI is associated with female sexual dysfunction, with highly suggestive evidence. However, the evidence of other adverse outcomes including depression, anxiety, poorer QoL, higher mortality, falls, pressure ulcers, diabetes, arthritis, fecal incontinence, and frailty is only weak. A multidimensional approach should be taken in managing UI in the clinical setting.
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Affiliation(s)
- Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Street), Fatih, 34093, Istanbul, Turkey
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Simona Ippoliti
- Urology Department, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Damiano Pizzol
- Italian Agency for Development Cooperation, 33 Street, Amarat, 79371, Khartoum, Sudan
| | | | | | - Guillermo F López-Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Yvonne Barnett
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Laurie Butler
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, 08830, Barcelona, Spain.,ICREA, Pg. Lluis Companys 23, 08010, Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, 08830, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180, Montigny-le-Bretonneux, France
| | - Ramy Abou Ghaydya
- Department of Urology, University Hospitals Cleveland Medical Center, 11000 Euclid Avenue, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Sheyn
- Department of Urology, University Hospitals Cleveland Medical Center, 11000 Euclid Avenue, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Adonis K Hijaz
- Department of Urology, University Hospitals Cleveland Medical Center, 11000 Euclid Avenue, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Jose M Muyor
- Health Research Centre, University of Almeria, Almeria, Spain
| | - Mike Trott
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Andreas Kronbichler
- Department of Internal Medicine IV, Medical University Innsbruck, Innsbruck, Austria
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090, Vienna, Austria
| | - Mark A Tully
- School of Medicine, Ulster University, Londonderry, BT48 7JL, UK
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Canada.,Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Jimin Hwang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jong Yeob Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seoyeon Park
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junmin Song
- Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
| | - Petre-Cristian Ilie
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
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The impact of low back pain and disability on frailty levels in older women: longitudinal data from the BACE-Brazil cohort. Eur Geriatr Med 2023; 14:181-189. [PMID: 36622621 DOI: 10.1007/s41999-022-00733-2] [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: 07/06/2022] [Accepted: 12/14/2022] [Indexed: 01/10/2023]
Abstract
METHODS This is a longitudinal observational study with a convenience subsample from the international Back Complaints in the Elders (BACE)-Brazil. Frailty was assessed by researchers at baseline, 6 and 12 months according to the Frailty Phenotype. Pain was assessed using a Numerical Pain Scale (NPS). Disability was assessed using the Roland Morris Disability Questionnaire. RESULTS A total of 155 older women (70.4 ± 5.4 years) participated. Follow-up for 6 and 12 months in this study was associated with a change of older women to worse frailty levels (OR = 2.83, 95% CI 1.98-4.67; p < 0.01). A significant association was observed between greater pain intensity and the transition of the older women through the frailty levels (β = - 0.73; p < 0.01) when inserting the pain variable at baseline of the statistical model. Older women who reported greater pain intensity worsened their frailty level. The same happened when the disability variable was inserted in the model (β = - 0.74; p < 0.01). The criteria proposed by Fried et al. were able to identify frailty throughout the follow-up and no prevalence of any item. CONCLUSIONS In older women, relevant factors such as pain and disability are closely linked to the frailty phenomenon. Thus, the frailty syndrome must be assessed, monitored and treated in relation to the individualities of older adults, as those with back pain and greater disabilities are more susceptible to frailty.
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Yüceler Kaçmaz H, Döner A, Kahraman H, Akin S. Prevalence and factors associated with frailty in older hospitalized patients. Rev Clin Esp 2023; 223:67-76. [PMID: 36372380 DOI: 10.1016/j.rceng.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to determine the prevalence and factors associated with frailty in older hospitalized patients. METHODS The point-prevalence study was completed on 263 patients aged 65 and over hospitalized in internal medicine and surgical clinics at a tertiary hospital in Türkiye. Data were collected between July 19th and July 22nd, 2021. A comprehensive geriatric assessment was performed on the participants. The Edmonton Frailty Scale (EFS) and FRAIL scale were used for frailty assessment. RESULTS The mean age of the individuals was 72.40 ± 6.42, 51.7% were female, and 63.9% were hospitalized in internal medicine and surgical units. The prevalence of frailty was 57.4% according to the FRAIL scale and 46.8% according to EFS. Factors affecting frailty were gender (OR 3.36, 95% CI 1.48-7.64), comorbidity (OR 1.29, 95% CI 1.01-1.64), polypharmacy (OR 0.33, 95% CI 0.13-0.80), history of falling in the last year (OR 3.54, 95% CI 1.34-9.35), incontinence (OR 5.93, 95% CI 2.47-14.27), and functional dependency (ADL, OR 0.65, 95% CI 0.46-0.92; IADL, OR 0.59, 95% CI 0.46-0.76). This model correctly predicted the participants' frailty at 70.5%. CONCLUSIONS The importance of frailty, which affects one out of every two hospitalized older persons, to the health care system should not be overlooked. Considering the increasing trend of the aging person population, national and global plans should be made to prevent and manage frailty.
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Affiliation(s)
- Hatice Yüceler Kaçmaz
- Department of Nursing, Health Sciences Faculty, Erciyes University, Kayseri, Turkey.
| | - Ayser Döner
- Department of Nursing, Health Sciences Faculty, Erciyes University, Kayseri, Turkey
| | - Hilal Kahraman
- Department of Nursing, Health Sciences Faculty, Erciyes University, Kayseri, Turkey
| | - Sibel Akin
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Kayseri, Turkey
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13
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Prevalencia y factores asociados a la fragilidad en pacientes mayores hospitalizados. Rev Clin Esp 2023. [DOI: 10.1016/j.rce.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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14
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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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Urinary Incontinence and Its Association with Physical and Psycho-Cognitive Factors: A Cross-Sectional Study in Older People Living in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031500. [PMID: 35162524 PMCID: PMC8835480 DOI: 10.3390/ijerph19031500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023]
Abstract
Urinary incontinence (UI) is a common geriatric syndrome affecting bladder health and is especially prevalent in nursing homes (NHs). The aim of the study was to determine the prevalence of UI and its associated factors in five Spanish NHs. UI (measured with Minimum Data Set 3.0), sociodemographic, and health-related variables were collected. Chi-square (or Fisher's) or Student's t-test (or Mann Whitney U) for bivariate analysis were used, with Prevalence Ratio (PR) as an association measure. The prevalence of UI was 66.1% (CI:95%, 53.6-77.2) in incontinent (n = 45, mean age 84.04, SD = 7.7) and continent (n = 23, mean age 83.00, SD = 7.7) groups. UI was significantly associated with frailty (PR = 1.84; 95%CI 0.96-3.53), faecal incontinence (PR = 1.65; 95%CI 1.02-2.65), anxiety (PR = 1.64; 95%CI 1.01-2.66), physical performance (PR = 1.77; 95%CI 1.00-3.11), and cognitive state (PR = 1.95; 95%CI 1.05-3.60). Statistically significant differences were found between incontinent and continent NH residents for limitations in activities of daily living (ADL), mobility, quality of life, sedentary behaviour, and handgrip strength. It can be concluded that two out of three of the residents experienced UI, and significant associated factors were mainly physical (sedentary behaviour, frailty, physical performance, ADL limitations, mobility, faecal incontinence, and handgrip strength) followed by psycho-cognitive factors (cognition, anxiety, and quality of life).
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16
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A Review of Aging and the Lower Urinary Tract: The Future of Urology. Int Neurourol J 2022; 25:273-284. [PMID: 34991304 PMCID: PMC8748297 DOI: 10.5213/inj.2142042.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) are common among elderly people, with significant effects on individuals, caregivers, and the wider health care system. As the elderly population with multiple comorbidities is increasing, the burden of LUTS will increase. This review describes the demographic trends in the aging society, changes in lower urinary tract function with aging, and deterioration of physical and cognitive function in aging, as well as what has been done regarding geriatric urology and what urologists should do to meet the health care needs of the aging population. Frailty and dementia are unmissable factors in the evaluation of elderly patients. Numerous reports have described associations between LUTS and frailty and between LUTS and dementia. Urologists must be aware of the multiplex physical, cognitive, and social characteristics of elderly people. Maintaining a geriatric viewpoint in the diagnosis, treatment, and management of elderly individuals with LUTS will fulfill the unmet needs of elderly people. It is also essential to discuss the treatment and management goals of LUTS with patients and caregivers. Active case identification, appropriate evaluations of LUTS and comorbidities, and a multidisciplinary approach with other health-care professionals are recommended for better treatment and management.
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Veronese N, Smith L, Pizzol D, Soysal P, Maggi S, Ilie PC, Dominguez LJ, Barbagallo M. URINARY INCONTINENCE AND QUALITY OF LIFE: A LONGITUDINAL ANALYSIS FROM THE ENGLISH LONGITUDINAL STUDY OF AGEING. Maturitas 2022; 160:11-15. [PMID: 35550703 DOI: 10.1016/j.maturitas.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/28/2021] [Accepted: 01/19/2022] [Indexed: 12/12/2022]
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18
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Cintra MTG, Bento BMA, Branco BVC, Sousa ADDM, Moraes END, Bicalho MAC. Clinical predictors of frailty in users of Secondary Care in Geriatrics and Gerontology. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2022. [DOI: 10.1590/1981-22562022025.220150.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Abstract Objective To analyze the health predictors associated with frailty in the older population treated at a Secondary Care Service in Geriatrics and Gerontology, Belo Horizonte, Minas Gerais state, Brazil. Methods A cross-sectional observational study involving a sample of 4,323 individuals aged 60 years or older that underwent a clinical-functional evaluation was conducted. Sociodemographic and clinical-functional variables were analyzed and compared against the dependent variable of the study: clinical-functional stratum, as measured by the Visual Frailty Scale, dichotomized into frail and non-frail. Univariate logistic regressions were performed and the variables with p-value <0.2 were submitted to multivariate regression by stepwise and forward methods of selecting variables in the equation. Results The potential explanatory value of the model was 70.4%. Seven variables were associated with frailty: age (OR 1.016; 95%CI: 1.001–1.028; p<0.001), dementia (OR 5.179; 95%CI: 3.839–5.961; p<0.001), depressive symptoms (OR 1.268; 95%CI: 1.090–1.475; p=0.002), urinary incontinence (OR 1.330; 95%CI: 1.153–1.535; p<0.001), changes in gait speed (OR 1.483; 95%CI: 1.287–1.709; p<0.001), calf circumference (OR 0.956; 95%CI: 0.932–0.982; p=0.001), and BMI (OR 1.026; 95%CI: 1.008–1.044; p=0.005). Conclusion Advanced age, dementia, depressive symptoms, and continence and gait changes were associated with frailty. The study results reveal an association of reduced calf circumference and increased BMI values with frailty in older adults and that dementia diagnosis had the strongest association with the frailty syndrome.
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Cintra MTG, Bento BMA, Branco BVC, Sousa ADDM, Moraes END, Bicalho MAC. Preditores clínicos de fragilidade em usuários de serviço de Atenção Secundária em Geriatria e Gerontologia. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2022. [DOI: 10.1590/1981-22562022025.220150.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Resumo Objetivo Analisar os preditores de saúde associados à fragilidade na população idosa atendida em um serviço de Atenção Secundária em Geriatria e Gerontologia, Belo Horizonte, Minas Gerais, Brasil. Métodos Estudo observacional transversal, envolvendo amostra de 4.323 indivíduos com idade igual ou superior a 60 anos, submetidos a avaliação clínico-funcional. Selecionou-se variáveis sociodemográficas e clínico-funcionais que foram analisadas em comparação à variável dependente do estudo: estrato clínico-funcional por meio da Escala Visual de Fragilidade de forma dicotomizada em frágil e não frágil. Foram realizadas regressões logísticas univariadas. As variáveis com valor p<0,2 foram submetidas à regressão multivariada por meio dos métodos de stepwise e forward de seleção de variáveis na equação. Resultados O valor potencial de explicação do modelo foi de 70,4%. Sete variáveis relacionaram-se à fragilidade: idade (OR 1,016; IC 95%: 1,00–1,028; p<0,001), demência (OR 5,179; IC 95%: 3,839–5,961; p<0,001), sintomatologia depressiva (OR 1,268; IC 95: 1,090–1,475; p=0,002), incontinência urinária (OR 1,330; IC 95%: 1,153–1,535; p<0,001), alterações no padrão de marcha (OR 1,483; IC 95%: 1,287–1,709; p<0,001), circunferência de panturrilha (OR 0,956; IC 95%: 0,932–0,982; p=0,001), IMC (OR 1,026; IC 95%: 1,008–1,044; p=0,005). Conclusão A idade avançada, os quadros demenciais, sintomatologia depressiva, alterações esfincterianas e da marcha associaram-se com fragilidade. Destacam-se a associação entre fragilidade com mensurações reduzidas da circunferência de panturrilha e valores aumentados de IMC e o diagnóstico de demência como a maior força de associação com a síndrome de fragilidade.
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Tai H, Liu S, Wang H, Tan H. Determinants of Urinary Incontinence and Subtypes Among the Elderly in Nursing Homes. Front Public Health 2021; 9:788642. [PMID: 34938714 PMCID: PMC8685234 DOI: 10.3389/fpubh.2021.788642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Urinary incontinence (UI) is a common problem among older adults. This study investigated the prevalence of UI in nursing home residents aged ≥75 years in China and examined potential risk factors associated with UI and its subtypes. Data were collected during face-to-face interviews using a general questionnaire, the International Consultation Incontinence Questionnaire Short-Form, and the Barthel Index. A total of 551 participants aged ≥75 years residing in Changsha city were enrolled from June to December 2018. The UI prevalence rate among nursing home residents aged ≥75 years was 24.3%. The most frequent subtype was mixed (M) UI (38.1%), followed by urge (U) UI (35.1%), stress (S) UI (11.9%), and other types (14.9%). In terms of severity, 57.5% had moderate UI, while 35.1% had mild and 7.5% had severe UI. Constipation, immobility, wheelchair use, cardiovascular disease (CVD), and pelvic or spinal surgery were significant risk factors for UI. Participants with a history of surgery had higher risks of SUI (odds ratio [OR] = 4.87, 95% confidence interval [CI]: 1.55–15.30) and UUI (OR = 1.97, 95% CI: 1.05–3.71), those who were immobile or used a wheelchair had higher rates of MUI (OR = 11.07, 95% CI: 4.19–29.28; OR = 3.36, 95% CI: 1.16–9.78) and other UI types (OR = 7.89, 95% CI: 1.99–31.30; OR = 14.90, 95% CI: 4.88–45.50), those with CVD had a higher rate of UUI (OR = 2.25, 95% CI: 1.17–4.34), and those with diabetes had a higher risk of UUI (OR = 2.250, 95% CI: 1.14–4.44). Use of oral antithrombotic agents increased UUI risk (OR = 4.98, 95% CI: 2.10–11.85) whereas sedative hypnotic drug use was associated with a higher risk of MUI (OR = 3.62, 95% CI: 1.25–10.45). Each UI subtype has distinct risk factors, and elderly residents of nursing homes with a history of CVD and pelvic or spinal surgery who experience constipation should be closely monitored. Reducing time spent in bed and engaging in active rehabilitation including walking and muscle strengthening may aid in UI prevention and treatment.
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Affiliation(s)
- Hongyan Tai
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shunying Liu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Haiqin Wang
- Geriatric Department, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongzhuan Tan
- Xiangya School of Public Health, Central South University, Changsha, China
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Parker-Autry C, Kuchel GA. Urinary Incontinence in Older Women: A Syndrome-Based Approach to Addressing Late Life Heterogeneity. Obstet Gynecol Clin North Am 2021; 48:665-675. [PMID: 34416944 DOI: 10.1016/j.ogc.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Urinary incontinence is a prevalent pelvic floor disorder among women of all ages. However, in many older women, especially those who have multiple chronic conditions it may be a geriatric syndrome because of its shared characteristics of physical function impairments, cognitive decline, and mobility disability. The geriatric incontinence syndrome may represent a poorly characterized phenotype of UI among older women which in many ways reflects unhealthy aging. In this article, we explore the evidence behind these concepts together with potentiel impact on the diagnosis and management of UI in this group.
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Affiliation(s)
- Candace Parker-Autry
- Department of Urology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC 27103, USA.
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, USA
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22
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Siswoyo, Lestari C, Susanto T, Rasni H, Hakam M, Ridla AZ. The influences of prompted voiding for urinary incontinence among older people in nursing homes. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2021. [DOI: 10.1111/ijun.12260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Siswoyo
- Department of Medical Surgical Nursing Faculty of Nursing, Universitas Jember Jember Jawa Timur Indonesia
| | - Cicik Lestari
- Undergraduated Student of Internship Program Faculty of Nursing, Universitas Jember Jember Jawa Timur Indonesia
| | - Tantut Susanto
- Department of Community Family, and Geriatric Health Nursing, Faculty of Nursing, Universitas Jember Jember Jawa Timur Indonesia
| | - Hanny Rasni
- Department of Community Family, and Geriatric Health Nursing, Faculty of Nursing, Universitas Jember Jember Jawa Timur Indonesia
| | - Mulia Hakam
- Undergraduated Student of Internship Program Faculty of Nursing, Universitas Jember Jember Jawa Timur Indonesia
| | - Ahmad Zainur Ridla
- Undergraduated Student of Internship Program Faculty of Nursing, Universitas Jember Jember Jawa Timur Indonesia
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Fedecostante M, Onder G, Eusebi P, Dell'Aquila G, Zengarini E, Carrieri B, Manes Gravina E, Falsiroli C, Corsonello A, Luzi R, Lattanzio F, Bernabei R, Cherubini A. Predictors of Functional Decline in Nursing Home Residents: The Shelter Project. J Gerontol A Biol Sci Med Sci 2021; 75:1600-1605. [PMID: 31858108 DOI: 10.1093/gerona/glz296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of our study was to identify independent predictors of functional decline in older nursing home (NH) residents, taking into account both resident and facility characteristics. METHODS Longitudinal observational study involving 1,760 older (≥65 y) residents of NH participating in the SHELTER* study (57 NH in eight countries). All residents underwent a comprehensive geriatric assessment using the interRAI LTCF. Functional decline was defined as an increase of at least one point in the MDS Long Form ADL scale during a 1 year follow-up. Facility and country effects were taken into account. RESULTS During the study period 891 (50.6%), NH residents experienced ADL decline. Residents experiencing ADL decline were older, had lower disability at baseline, were more frequently affected by severe dementia and by urinary incontinence, and used more antipsychotics. In the mixed-effect logistic regression model, factors independently associated with a higher risk of functional decline were dementia and urinary incontinence, whereas the presence of a geriatrician was a protective factor. CONCLUSIONS Both resident and facility characteristics are associated with the risk of functional decline in NH residents. Increasing the quality of healthcare by involving a geriatrician in residents' care might be an important strategy to improve the outcome of this vulnerable population.
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Affiliation(s)
- Massimiliano Fedecostante
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy e Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Eusebi
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Giuseppina Dell'Aquila
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Elisa Zengarini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Barbara Carrieri
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy.,Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Ester Manes Gravina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy e Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cinzia Falsiroli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy e Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Clinical Laboratory, IRCCS INRCA, Cosenza, Italy
| | | | | | - Roberto Bernabei
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy e Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
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Pizzol D, Demurtas J, Celotto S, Maggi S, Smith L, Angiolelli G, Trott M, Yang L, Veronese N. Urinary incontinence and quality of life: a systematic review and meta-analysis. Aging Clin Exp Res 2021; 33:25-35. [PMID: 32964401 PMCID: PMC7897623 DOI: 10.1007/s40520-020-01712-y] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Urinary incontinence (UI) and low quality of life (QoL) are two common conditions. Some recent literature proposed that these two entities can be associated. However, no attempt was made to collate this literature. Therefore, the aim of this study was to conduct a systematic review and meta-analysis of existing data to estimate the strength of the association between UI and QoL. METHODS An electronic search of major databases up to 18th April 2020 was carried out. Meta-analysis of cross-sectional and case-control studies comparing mean values in QoL between patients with UI and controls was performed, reporting random-effects standardized mean differences (SMDs) ± 95% confidence intervals (CIs) as the effect size. Heterogeneity was assessed with the I2. RESULTS Out of 8279 articles initially screened, 23 were finally included for a total of 24,983 participants, mainly women. The mean age was ≥ 50 years in 12/23 studies. UI was significantly associated with poor QoL as assessed by the short-form 36 (SF-36) total score (n = 6 studies; UI: 473 vs. 2971 controls; SMD = - 0.89; 95% CI - 1.3 to - 0.42; I2 = 93.5) and by the sub-scales of SF-36 and 5/8 of the domains included in the SF-36. Similar results were found using other QoL tools. The risk of bias of the studies included was generally high. CONCLUSIONS UI is associated with a poor QoL, with a strong level of certainty. This work, however, mainly based on cross-sectional and case-control studies, highlights the necessity of future longitudinal studies for better understanding the importance of UI on QoL.
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Affiliation(s)
- Damiano Pizzol
- Italian Agency for Development Cooperation, Khartoum, Sudan
| | - Jacopo Demurtas
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Primary Care Department, USL Toscana Sud Est-Grosseto, Grosseto, Italy
| | - Stefano Celotto
- Primary Care Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - Lee Smith
- Faculty of Sport Sciences, University of Murcia, Murcia, Spain
| | - Gabriele Angiolelli
- Primary Care Department, Azienda Unità Locale Socio Sanitaria 3 "Serenissima", Venice, Italy
| | - Mike Trott
- Faculty of Sport Sciences, University of Murcia, Murcia, Spain
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Canada
- Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Nicola Veronese
- Primary Care Department, Azienda Unità Locale Socio Sanitaria 3 "Serenissima", Venice, Italy.
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.
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25
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Sullivan R, McNicholas T, Claffey P, Kenny RA, Briggs R. Unreported urinary incontinence: population-based prevalence and factors associated with non-reporting of symptoms in community-dwelling people ≥ 50 years. Eur Geriatr Med 2020; 12:405-412. [PMID: 33029753 DOI: 10.1007/s41999-020-00412-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Concerns exist around under-detection and under-treatment of urinary incontinence (UI) in specific patient groups, particularly older people. The aim of this study is to ascertain the prevalence of unreported UI in a large sample of older adults, to profile factors associated with under-reporting of UI and the association of unreported UI with quality of life (QOL). METHODS This study was embedded within the Irish Longitudinal Study on Ageing, involving a population-representative sample of almost 7,000 older adults (55% female, mean age 65 years). UI was defined as involuntary loss of urine from the bladder occurring on average at least twice per month. Unreported UI had not yet been reported to a healthcare professional. QOL was measured using the Control, Autonomy, Self-realisation and Pleasure-19 Scale (CASP-19). RESULTS Almost 40% (285/750) of participants with UI had not reported symptoms to a healthcare professional despite visiting their general practitioner (GP) on average over 4 times in the last year. Logistic regression modelling demonstrated that under-reporting of UI was associated with female sex, taking < 5 medications, less severe symptoms and lower number of GP visits. Linear regression models show that unreported UI was associated with significantly lower CASP-19 (β = - 1.20 (95% CI: - 2.19 to - 0.20)). CONCLUSION Only 40% of older people with UI report symptoms to a healthcare professional despite frequent symptoms, and a significant association with poorer QOL. This highlights the need to educate older people around seeking help for UI, as well as opportunistically addressing UI as part of comprehensive age-attuned care.
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Affiliation(s)
- Rachel Sullivan
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Triona McNicholas
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Paul Claffey
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Robert Briggs
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland.
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland.
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.
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Omae K, Yamamoto Y, Kurita N, Takeshima T, Naganuma T, Takahashi S, Ohnishi T, Ito F, Yoshioka T, Fukuhara S. Gait speed and overactive bladder in the healthy community‐dwelling super elderly: The Sukagawa Study. Neurourol Urodyn 2019; 38:2324-2332. [DOI: 10.1002/nau.24148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/04/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Kenji Omae
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT)Fukushima Medical University Hospital Fukushima City Fukushima Japan
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE)Fukushima Medical University Fukushima City Fukushima Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto University Kyoto Japan
- Department of UrologyTokyo Women's Medical University Tokyo Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto University Kyoto Japan
| | - Noriaki Kurita
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT)Fukushima Medical University Hospital Fukushima City Fukushima Japan
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE)Fukushima Medical University Fukushima City Fukushima Japan
- Department of Clinical Epidemiology, Graduate School of MedicineFukushima Medical University Fukushima Japan
| | - Taro Takeshima
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE)Fukushima Medical University Fukushima City Fukushima Japan
| | - Toru Naganuma
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE)Fukushima Medical University Fukushima City Fukushima Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto University Kyoto Japan
| | - Sei Takahashi
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE)Fukushima Medical University Fukushima City Fukushima Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto University Kyoto Japan
| | - Tsuyoshi Ohnishi
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE)Fukushima Medical University Fukushima City Fukushima Japan
| | - Fumihito Ito
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE)Fukushima Medical University Fukushima City Fukushima Japan
- Department of Clinical Epidemiology, Graduate School of MedicineFukushima Medical University Fukushima Japan
- Department of Emergency MedicineInternational University of Health and Welfare Narita City Chiba Japan
| | - Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE)Fukushima Medical University Fukushima City Fukushima Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto University Kyoto Japan
| | - Shunichi Fukuhara
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE)Fukushima Medical University Fukushima City Fukushima Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto University Kyoto Japan
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