Urinary incontinence prevalence and management in nursing homes in Austria, the Netherlands, Turkey and the United Kingdom: A multi-site, cross-sectional study

Pelvic floor muscle training for urinary incontinence in older adults: a best practice implementation project

OBJECTIVES

This project aimed to implement best practices for pelvic floor muscle training to manage urinary incontinence among older women in long-term care in Kerala, India.

INTRODUCTION

Urinary incontinence is a prevalent and distressing condition that affects a significant proportion of older adults and is characterized by involuntary loss of urine, leading to social embarrassment, decreased quality of life, and increased health care costs. It is more prevalent in women and is associated with dementia, limited mobility, and other comorbidities in long-term care. Pelvic floor muscle training is a first-line treatment option for urinary incontinence in older adults, given its potential to improve quality of life and reduce health care costs.

METHODS

This project was based on the JBI Evidence Implementation Framework. A baseline audit was conducted to evaluate current practice against best practices. After identifying barriers and implementing strategies, follow-up audits were conducted after 3 and 6 months.

RESULTS

The baseline audit showed 0% compliance with all best practices. Barriers such as lack of knowledge and practice of pelvic floor exercises for urinary incontinence among participants and nurses; unknown cognitive status; and health emergencies were identified. Strategies including video-assisted training of pelvic floor muscle exercises, training calendars, and flip charts with instructions. The follow-up audits showed significant improvements in compliance.

CONCLUSIONS

This project reduced urinary incontinence in the participants. Although two of the audit criteria did not reach 100% compliance by the end of 6 months, the stakeholders of the long-term care facility understood the importance of pelvic floor muscle training, which will be beneficial for future residents with urinary incontinence.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A211.

Prevalence of urinary incontinence and associated factors in nursing homes: a multicentre cross-sectional study

BACKGROUND

Urinary incontinence (UI) is a common geriatric syndrome with high health and socio-economic impacts in nursing home (NH) residents.

OBJECTIVES

To estimate the prevalence and types of UI and its associated factors in older people living in NHs in Central Catalonia (Spain). We also determined the proportion of residents who were receiving behavioural strategies to prevent/manage UI.

DESIGN AND SETTING

Cross-sectional study in 5 NHs conducted from January to March 2020.

METHODS

We included consenting residents aged 65 + permanently living in the NHs. Residents who were hospitalized, in a coma or palliative care were excluded. UI was assessed using Section H of the Minimum Data Set. Sociodemographic and health-related variables were examined. Descriptive, bivariate, and multivariate (logistic regression) analyses were performed.

RESULTS

We included 132 subjects (82.6% women), mean age of 85.2 (SD = 7.4) years. The prevalence of UI was 76.5% (95% CI: 68.60-82.93). The most common type was functional UI (45.5%), followed by urgency UI (11.4%). Only 46.2% of residents received at least one behavioural strategy to manage UI. Most sedentary behaviour (SB) variables presented a p-value lower than 0.001 in the bivariate analyses, but none remained in the final model. Moderate-severe cognitive impairment (OR = 4.44, p =.003), anticholinergic activity (OR = 3.50, p =.004) and risk of sarcopenia using SARC-F (OR = 2.75, p =.041) were associated with UI.

CONCLUSIONS

The prevalence of UI was high in this sample of NH residents compared to the literature, yet less than half received prompted voiding as a strategy to prevent/reduce UI.UI was associated with cognitive impairment, anticholinergic activity, and risk of sarcopenia.

Comparative Study of Continuous Wavelet Transform and Multivariate Calibration for the Simultaneous Spectrophotometric Determination of Tamsulosin and Solifenacin in Pharmaceutical Formulation and Biological Sample

BACKGROUND

Spectrophotometry alone is not applicable for the simultaneous determination of drugs in a multicomponent pharmaceutical formulation owing to their overlap.

OBJECTIVE

In this study, the combination of UV-Vis spectrophotometry and chemometric methods, including continuous wavelet transform (CWT) and partial least-squares (PLS) was presented for the simultaneous estimation of tamsulosin (TAM) and solifenacin (SOL) in synthetic mixtures, commercial formulations, and a biological sample.

METHODS

The simultaneous spectrophotometric determination of TAM and SOL in binary mixtures, a real sample, and a biological sample was performed by applying CWT and PLS approaches.

RESULTS

In the CWT method, two various wavelet families named Daubechies (db2) at wavelength 223 nm and Biorthogonal (bior1.3) at wavelength 227 nm based on the appropriate zero-crossing point were selected for TAM and SOL, respectively. The linear ranges of TAM and SOL were 0.25-4 μg/mL and 10-30 μg/mL, respectively. The LODs were 0.0459 μg/mL and 0.2085 μg/mL, while the LOQs were 0.3208 μg/mL and 0.6495 μg/mL for TAM and SOL, respectively. The average recovery values of 18 mixtures were 98.28% and 97.79% for TAM and SOL, respectively. Also, the root mean square error (RMSE) of both components was lower than 2.3. Based on the k-fold cross-validation in the PLS approach, the optimum number of components related to TAM and SOL were 9 and 5 with a mean square error prediction (MSEP) of 0.0153 and 0.0370, respectively. The mean recovery values of the test set were found to be 100.09% for TAM and 99.95% for SOL where RMSE values were 0.0064 and 0.0169 for TAM and SOL, respectively.

CONCLUSION

Analysis of variance (ANOVA) was applied to the results of the real sample and there was no significant difference between the proposed methods and HPLC as a reference technique. The result obtained revealed that the proposed methods were found to be fast, facile, economical, and precise, and provide a suitable alternative to the HPLC technique for the concurrent determination of TAM and SOL in QC laboratories.

HIGHLIGHTS

UV-Vis spectrophotometry combined with CWT and PLS was developed. Simultaneous analysis of TAM and SOL was performed using the proposed approaches. These methods were implemented on synthetic mixtures, commercial formulations, and a biological sample. ANOVA test was used to compare the suggested methods and the HPLC technique.

Predictors and profiles of non-invasive management of urinary incontinence in residents living in nursing homes: A decision tree analysis

PURPOSE

The purpose of this study is to explore the characteristics and capabilities of nursing home residents with urinary incontinence in relation to urinary incontinence interventions.

MATERIALS AND METHODS

A secondary data-analysis on the data from 1417 residents (65 years and above), suffering from urinary incontinence and living in nursing homes and collected by a cross-sectional multi-center point prevalence measurement, the Dutch annual independent (Inter)national Prevalence Measurement of Quality of Care of Maastricht University, was performed. In order to explore the relationship between an urinary incontinence intervention and the predictors diagnosis dementia, body posture, mobility, (un)dressing, hygiene and communication; onset urinary incontinence; frequency, time of loss and quantity urinary incontinence and fecal incontinence, a Chi-squared Automatic Interaction Detector (CHAID) analysis was performed.

RESULTS

The level of care dependency for hygiene is the key variable in predicting the use of an urinary incontinence intervention. The ability to adopt an appropriate body posture, being urinary incontinence prior to admission into a nursing home and being diagnosed with dementia are identified as significant predictors. Residents care independent for hygiene and for adopting an appropriate body posture and urinary incontinence before admission into a nursing home are more likely to use absorbing material. In residents being care dependent for hygiene and for adopting an appropriate body posture and diagnosed with dementia, a combination of absorbing material with toileting or other interventions are mostly applied.

CONCLUSIONS

Results reveal that residents' characteristics and capabilities determine the implementation of an urinary incontinence intervention.

PROPOSAL FOR A CLINICAL PROTOCOL FOR THE CONSERVATIVE TREATMENT OF URGE URINARY INCONTINENCE

Objective: To present a proposal for a clinical protocol for the conservative treatment of urge urinary incontinence. Method: Experience report based on existing scientific evidence and clinical experience of authors who perform nursing consultations for people with urge urinary incontinence, outlined in accordance with the Brazilian Ministry of Health’s proposal for the elaboration of clinical protocols. Results: A clinical protocol was proposed with nursing diagnosis and interventions based on the North American Nursing Diagnosis Association (NANDA) and Nursing Interventions Classifications (NIC), with systematized steps to verify the presence of related factors or conditions associated with the diagnosis, namely: hyperactive pelvic floor, anxiety, constipation, urinary tract infection, low fluid intake, inadequate sanitary behavior, diabetes mellitus, pelvic organ prolapse, high consumption of potential bladder irritants and persistence of symptoms. Soon after, the actions that should be implemented by the nurse were described in detail. Conclusion: It is considered that the flow and detailing of the actions presented can be adopted by nurses in order to identify and treat people with urge urinary incontinence, thus minimizing the prevalence of the problem and promoting the quality of life of these people.

PROPOSTA DE PROTOCOLO CLÍNICO PARA TRATAMENTO CONSERVADOR DA INCONTINÊNCIA URINÁRIA DE URGÊNCIA

Objetivo:Apresentar proposta de protocolo clínico para tratamento conservador da incontinência urinária de urgência (IUU). Método: Relato de experiência fundamentado nas evidências científicas existentes e na experiência clínica dos autores que realizam consultas de enfermagem a pessoas com IUU, delineada conforme proposição do Ministério da Saúde para elaboração de protocolos clínicos. Resultados: Foi proposto um protocolo clínico com diagnóstico e intervenções de enfermagem baseados na North American Nursing Diagnosis Association (NANDA) e na Nursing Interventions Classifications, com etapas sistematizadas em verificar presença de fatores relacionados ou condições associadas ao diagnóstico, sendo eles: assoalho pélvico hiperativo, ansiedade, constipação, infecção urinária, baixa ingestão hídrica, comportamento sanitário inadequado, diabetes mellitus, prolapso de órgão pélvico, alto consumo de potenciais irritantes vesicais e persistência de sintomas. Logo após, as ações que devem ser implementadas pelo enfermeiro são descritas de forma detalhada. Conclusão: Considera-se que o fluxo e o detalhamento das ações apresentadas possam ser adotados pelos enfermeiros de forma a identificarem e tratarem pessoas com IUU, minimizando assim a prevalência do problema e fomentando a qualidade de vida dessas pessoas.