The competing effects of disease states on quality of life of the elderly: the case of urinary symptoms in men

Patient centred care for the medical treatment of lower urinary tract symptoms in patients with benign prostatic obstruction: a key point to improve patients' care - a systematic review

Background

Even though evidence based medicine, guidelines and algorithms still represent the pillars of the management of chronic diseases (i.e: hypertension, diabetes mellitus), a patient centred approach has been recently proposed as a successful strategy, in particular to improve drug adherence. Aim of the present review is to evaluate the unmet needs in LUTS/BPH management and the possible impact of a patient centered approach in this setting.

Methods

A National Center for Biotechnology Information (NCBI) PubMed search for relevant articles published from January 2000 until December 2016 was performed by combining the following MESH terms: patients centred medicine, patient centered care, person centered care, patient centered outcomes, value based care, shared decision making, male, Lower Urinary Tract Symptoms, Benign Prostatic Hyperplasia, treatment. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). All studies reporting on patient centred approach, shared decision making and evidence-based medicine were included in the review. All original article, reviews, letters, congress abstracts, and editorials comments were included in the review. Studies reporting single case reports, experimental studies on animal models and studies not in English were not included in the review.

Results

Overall 751 abstracts were reviewed, out of them 87 full texts were analysed resulting in 36 papers included. The evidence summarised in this systematic review confirmed how a patient centred visit may improve patient’s adherence to medication. Although a patient centred model has been rarely used in urology, management of Low Urinary Tract Symptoms (LUTS) and Benign Prostatic Obstruction (BPO) may represent the perfect ground to experiment and improve this approach. Notwithstanding all the innovations in LUTS/BPO medical treatment, the real life picture is far from ideal.

Conclusions

Recent evidence shows a dramatical low drug adherence and satisfaction to medical treatment in LUTS/BPH patients. A patient centred approach may improve drug adherence and some unmet needs in this area, potentially reducing complications and costs. However further well designed studies are needed to confirm this data.

Impact of lower urinary tract symptoms and depression on health-related quality of life in older adults

Purpose

We aimed primarily to investigate the level of health-related quality of life (HRQoL), lower urinary tract symptoms (LUTS), and depression in older adults and secondly to identify the impact of LUTS and depression on HRQoL.

Methods

A community-based cross-sectional study was conducted from April to November 2010. Participants were recruited from five community senior centers serving community dwelling older adults in Jeju city. Data analysis was based on 171 respondents. A structured questionnaire was used to guide interviews; the data were collected including demographic characteristics, body mass index, adherence to regular exercise, comorbidities (hypertension, diabetes mellitus, and osteoarthritis), depression, urinary incontinence, LUTS (measured via the International Prostate Symptom Score [IPSS]), and HRQoL as assessed by use of the EQ-5D Index. Stepwise multiple regression analysis was used to test predictors of HRQoL.

Results

Eighteen percent (18.6%) of the respondents reported depressive symptoms. The mean LUTS score was 8.9 (IPSS range, 0 to 35). The severity of LUTS, was reported to be mild (score, 0 to 7) by 53% of the respondents, moderate (score, 8 to 19) by 34.5%, and severe (score, 20 to 35) by 12.5%. HRQoL was significantly predicted by depression (Partial R²=0.193, P<0.01) and LUTS (Partial R²=0.048, P=0.0047), and 24% of the variance in HRQoL was explained.

Conclusions

LUTS and depression were the principal predictors of HRQoL in older adults.

Lifestyle and health-related quality of life: a cross-sectional study among civil servants in China

Background

Health-related quality of life (HRQoL) has been increasingly acknowledged as a valid and appropriate indicator of public health and chronic morbidity. However, limited research was conducted among Chinese civil servants owing to the different lifestyle. The aim of the study was to evaluate the HRQoL among Chinese civil servants and to identify factors might be associated with their HRQoL.

Methods

A cross-sectional study was conducted to investigate HRQoL of 15,000 civil servants in China using stratified random sampling methods. Independent-Samples t-Test, one-way ANOVA, and multiple stepwise regression were used to analyse the influencing factors and the HRQoL of the civil servants.

Results

A univariate analysis showed that there were significant differences among physical component summary (PCS), mental component summary (MCS), and TS between lifestyle factors, such as smoking, drinking alcohol, having breakfast, sleep time, physical exercise, work time, operating computers, and sedentariness (P < 0.05). Multiple stepwise regressions showed that there were significant differences among TS between lifestyle factors, such as breakfast, sleep time, physical exercise, operating computers, sedentariness, work time, and drinking (P < 0.05).

Conclusion

In this study, using Short Form 36 items (SF-36), we assessed the association of HRQoL with lifestyle factors, including smoking, drinking alcohol, having breakfast, sleep time, physical exercise, work time, operating computers, and sedentariness in China. The performance of the questionnaire in the large-scale survey is satisfactory and provides a large picture of the HRQoL status in Chinese civil servants. Our results indicate that lifestyle factors such as smoking, drinking alcohol, having breakfast, sleep time, physical exercise, work time, operating computers, and sedentariness affect the HRQoL of civil servants in China.

Impacto da doença crônica na qualidade de vida de idosos da comunidade em São Paulo (SP, Brasil)

O objetivo deste artigo é avaliar o impacto da doença crônica na qualidade de vida de idosos da comunidade no município de São Paulo (SP). Trata-se de um estudo transversal de indivíduos acima de 60 anos, com aplicação de um questionário clínico-demográfico padronizado e do questionário genérico de qualidade de vida Short-Form 36 items (SF-36). Foram feitas análise estatística descritiva dos dados clínicos e demográficos e análise de variância (ANOVA) para correlação das médias dos domínios do SF-36 com a idade e o número de morbidades. Avaliaram-se 353 indivíduos. A média de idade foi de 71,6 anos, com 48,7% de homens e 51,3% de mulheres. O sexo feminino apresentou os piores níveis de qualidade de vida em todos os domínios avaliados. A análise de variância revelou uma variação significativa da qualidade de vida, em vários domínios, conforme o aumento do número de morbidades. O domínio mais comprometido foi limitação por aspectos físicos (p<0,05). A mesma análise, aplicada às médias dos domínios por faixa etária, mostrou uma relação inversa do domínio capacidade funcional (p<0,05) com a idade. O aumento do número de morbidades e o aumento da idade influenciam de modo significativo vários domínios da qualidade de vida dos idosos. O SF-36 apresenta-se como um instrumento válido para a avaliação de qualidade de vida da população idosa brasileira.

Prevalence, severity, and health correlates of lower urinary tract symptoms among older men: the MrOS study

OBJECTIVES

To describe the prevalence, severity, and health correlates of lower urinary tract symptoms (LUTS) in older community-dwelling U.S. men.

METHODS

We performed a cross-sectional analysis from a cohort study recruited from six U.S. clinical centers. This analysis included 5284 men without a history of prostate cancer who were at least 65 years of age. Participants completed questionnaires regarding the presence and severity of LUTS, including the American Urological Association Symptom and Bother indexes. Health status measures included the Medical Outcomes Survey SF-12 and self-rated health and instrumental activities of daily living.

RESULTS

LUTS were absent in 2.3%, mild in 51.6%, moderate in 39.6%, and severe in 6.6%. Dissatisfaction with the urinary symptoms increased with LUTS severity (P <0.001); 19.8% of moderate and 58.1% of men with severe LUTS reported feeling mostly unsatisfied to terrible with their present urinary symptoms. The prevalence, severity, and dissatisfaction with LUTS increased with age. Men reporting moderate or severe LUTS were 1.41-fold (95% confidence interval 1.23 to 1.61) and 1.51-fold (95% confidence interval 1.23 to 1.85) more likely to rate their overall health quality as fair to very poor for their age instead of good to excellent, even after controlling for age and comorbid conditions. Increased LUTS also was independently associated with increased impairment in instrumental activities of daily living and poorer SF-12 scores.

CONCLUSIONS

Moderate-to-severe LUTS is common in community-dwelling elderly U.S. men. In this study, LUTS severity was associated with poorer health quality and a greater prevalence of an inability to perform activities of daily living. The association of LUTS severity with poor health warrants increased clinical attention.

Charlson's Index was a poor predictor of quality of life outcomes in a study of patients following joint replacement surgery

OBJECTIVE

We examined the predictive validity of Charlson's Index as a tool to measure and adjust for comorbidity in studies of health-related quality of life(HRQOL) outcomes after joint replacement surgery.

STUDY DESIGN AND SETTING

SF-36 physical component summary scores were available for a cohort of patients who underwent primary hip or knee replacement surgery at one hospital over a 12-month period. Baseline comorbidity was assessed for the same group of patients using longitudinal hospital morbidity data from the Western Australia Department of Health. The presence or absence of individual conditions was determined, and Charlson's Index scores were calculated for each patient, using varying look-back periods.

RESULTS

In regression analysis, Charlson's Index was a poor predictor of the HRQOL outcome scores, explaining a maximum 1.79% of the variance. In contrast, the presence or absence of a small number of individual conditions together explained between 5% and 7% of the variance.

CONCLUSION

The findings suggest that Charlson's Index should not be used to adjust for HRQOL outcomes, particularly in this patient group with low levels of serious comorbidity. Alternative methods are needed for use in this context.

How important are mens lower urinary tract symptoms (LUTS) and their impact on the quality of life (QOL)?

PURPOSE

To investigate the extent to which symptom severity and related factors contribute to the explained variance of the quality of life (QOL) of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).

METHODS

Data from 480 men awaiting urological assessment were collected by questionnaires shortly after referral by their general practitioners in 1997-2000. The World Health Organization's QOL questionnaire (WHOQOL-bref), International Prostate Symptom Score (I-PSS), Symptom Problem Index (SPI), International Continence Society Benign Prostatic Hyperplasia questionnaire (ICS-BPH), the Sandvik Incontinence Severity Index, and BPH Specific Impact on Activity (BSIA) were used.

RESULTS

Regression analyses with WHOQOL-bref scores as dependent variables (physical, psychological, social relations, environmental domains, as well as overall QOL and general health) showed that symptom severity predicted only physical health. The severity of urinary incontinence was predictive of all domains except general health. Sexual function was predictive of all domains. Regression coefficients were close to zero. The explained variance of WHOQOL-bref scores was low (5-17%).

CONCLUSIONS

The WHOQOL-bref might be too comprehensive to identify associations between specific symptom-related factors. Alternatively, our results indicate that LUTS suggestive of BPH and LUTS-associated factors are not very important determinants of QOL.

Relevance and variability of the severity of incontinence, and increased daytime and night-time voiding frequency, associated with quality of life in men with lower urinary tract symptoms

OBJECTIVES

To estimate the distribution of the severity of urinary incontinence (UI) and daytime and night-time voiding in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH); to estimate the proportion of 'subjectively relevant' symptoms within each severity category; to identify differences in quality of life (QoL) by degree of subjectively relevant daytime and night-time symptoms; and to identify differences in QoL in men with subjectively relevant UI or no UI.

PATIENTS AND METHODS

Data from a group of 480 men awaiting urological assessment for LUTS suggestive of BPH were collected by questionnaire shortly after referral from their general practitioner in 1997-2000. The International Continence Society--Benign Prostatic Hyperplasia Index, Sandvik's Incontinence Severity Index, and the World Health Organization Quality of Life Survey--Abbreviated Version (WHOQoL-bref) were used to assess symptoms and QoL.

RESULTS

There was a large heterogeneity of self-reported symptom severity and related bother in the three symptoms of UI, increased daytime voiding frequency and night-time voiding in these referred patients. The WHOQoL-bref showed significant group differences of subjectively relevant symptoms.

CONCLUSION

The perception of increased night and daytime frequency, as measured by symptom severity and bother, varied greatly. The severity of UI and its effect on men waiting for a urological assessment of LUTS suggestive of BPH also varied widely. In general, the symptoms and their impact were slight to moderate. The WHOQoL-bref could be used to differentiate among groups of subjectively relevant symptoms, and in so doing supported information generated by the bother question.

Symptom severity and QOL scales for urinary incontinence

Symptoms of incontinence are common, particularly among older people, and incontinence can have a severe effect on the quality of life of some individuals at any age. A number of treatments are available, most of which aim to reduce the occurrence of incontinent episodes or to limit the effects of the disorder on everyday life. In research and clinical practice, it is essential that the symptoms and effects of incontinence be properly assessed and recorded. The only valid means of measuring patients' perspectives is through the use of psychometrically robust self-report questionnaires. Incontinence may be experienced as part of the symptom complex of a range of conditions (e.g., benign prostatic diseases or fistulas), and the effect of incontinence on quality of life varies depending on the severity of the condition and other psychosocial and medical factors. Questionnaires with acceptable levels of psychometric testing are identified and recommended for use in clinical practice and research investigations according to the following categories: (1) questionnaires to assess symptoms of incontinence, (2) generic health-related quality-of-life questionnaires to assess the effect of incontinence on quality of life, and (3) incontinence-specific measures to assess the effect and bothersomeness of incontinence on quality of life.

The relationship between lower urinary tract symptoms and health status: the UREPIK study

OBJECTIVES

To assess the hypothesis that as lower urinary tract symptoms (LUTS) increase in severity, the impact as measured by the BPH impact index (BII) would also increase.

SUBJECTS AND METHODS

The UREPIK survey collected information on this relationship from men and their partners in the Netherlands, Korea, France and the UK. Culturally and linguistically validated versions of three standard questionnaires, the SF-12, the BII and the International Prostate Symptom Score (IPSS) were used to assess the distribution of symptoms and the impact on health status. Stratified random samples of men aged 40-79 years in each community were recruited. Response rates were 72% in Boxmeer, 28% in Auxerre, 60% in Birmingham and 68% in Seoul. Regression analyses were undertaken on total SF-12, BII and IPSS.

RESULTS

In all, 4800 index men and 3674 women responded; the BII increased with increasing IPSS. The correlation coefficients were; Boxmeer 0.69, Auxerre 0.56, Birmingham 0.60 and Seoul 0.68. For women, the correlations were slightly lower except in Birmingham, at 0.65 (Boxmeer), 0.44 (Auxerre), 0.71 (Birmingham), 0.57 (Korea). BII scores were higher in women than in men with the same level of IPSS. Adjusting for IPSS there was no association between age and BII. There was an association between IPSS quality-of-life (QoL) score and BII; for men the correlation was 0.62 and for women 0.60. Men and women with the same score on the IPSS QoL reported the same bother. Among those with an IPSS of 20-35 women expressed significantly more bother (P < 0.001). The SF-12 scores decreased as the IPSS and the BII increased in both men and women. Furthermore, the SF-12 mental score decreased with increasing symptoms in the partner.

CONCLUSIONS

The relationship between the severity of LUTS and BII was similar in all centres. There is a clear association between the BII and the IPSS QoL question in men and women. The BII discriminates between people who are unhappy about their urinary condition compared with those who are pleased. Although designed for use in men with benign prostatic hyperplasia, the index also appears to be a useful among women. The severity of symptoms of LUTS has an adverse effect on the health status of the individual and his/her partner.

Health status and its correlates among Dutch community-dwelling older men with and without lower urogenital tract dysfunction

OBJECTIVE

To study health status and its correlates in older men with and without lower urogenital tract dysfunction.

METHODS

Cross-sectional population-based study on 1688 men aged 50-78 years without bladder or prostate cancer, radical prostatectomy, neurogenic bladder dysfunction or a negative advice from their general practitioner. Data were collected through self-administered questionnaires, including Sickness Impact Profile (SIP, three domains), Inventory of Subjective Health (ISH), International Prostate Symptom Score (IPSS) and International Continence Society (ICS) Male Sex questionnaire, medication use, socio-economic and lifestyle factors. Additional information was collected by measurement of blood pressure, transrectal ultrasonography of the prostate and uroflowmetry. Four health status domains were analyzed using the ISH and three domains of the SIP. Lower urinary tract symptoms (LUTS) were categorised using IPSS, erectile and ejaculatory dysfunction were defined using the ICS questionnaire.

RESULTS

All urogenital characteristics and parameters were related to at least two of the health status domains. Multivariate regression analyses yielded that LUTS and cardiac symptoms were associated with suboptimal scores of all four domains. Chronic obstructive pulmonary disease and drugs for abdominal symptoms were related to three domains; erectile and ejaculatory dysfunction, muskuloskeletal or psycho(ana)leptic drugs and marital status to two domains.

CONCLUSIONS

The impact of LUTS on health status was equally important as the impact of cardiac symptoms. The impact of sexual dysfunction was smaller than expected. Longitudinal studies are needed to determine how health status and illnesses interact.

Quality-of-life impact of lower urinary tract symptom severity: results from the Health Professionals Follow-up Study

OBJECTIVES

To estimate the magnitude of the quality-of-life impact of lower urinary tract symptom (LUTS) severity using a large (n = 8406) sample of U.S. men participating in the Health Professionals Follow-up Study.

METHODS

Multiple regression modeling was used to estimate the relative quality-of-life burden of different levels of LUTS severity (defined using the American Urological Association Symptom Index as none-mild symptoms, 0 to 7; low moderate, 8 to 14; high moderate, 15 to 19; and severe, 20 to 35) and to compare these with age-matched U.S. male norms. A standardized and validated measure of both LUTS severity (the American Urological Association Symptom Index) and a widely used, standardized, multidimensional measure of quality of life (Short Form 36) were used. In addition, the relative impact of severe LUTS on the quality of life was compared with that experienced for other chronic illness conditions (diabetes, angina, hypertension, gout).

RESULTS

The results showed that high-moderate LUTS was associated with small to moderate deficits in anxious and depressed mood and poorer role functioning related to emotional problems arising from illness. Severe LUTS was associated with additional quality-of-life deficits related to vitality and the ability to work and carry out daily tasks as a result of illness. Comparisons of the severe LUTS patient group with four other chronic illness groups showed vitality/energy, in particular, but also role functioning and depressed and anxious feelings, to be poorer in the severe LUTS group.

CONCLUSIONS

Men with high-moderate and severe LUTS identified in a large U.S. cohort have a poorer health status in several important quality-of-life dimensions. The detection and effective treatment of LUTS may substantially improve the health status for these men in these dimensions.

Functional status, health problems, age and comorbidity in primary care patients

OBJECTIVES

To determine the relationship between functional status and health problems, age and comorbidity in primary care patients.

METHODS

Patients from 60 general practitioners who visited their general practitioner were recruited and asked to complete a written questionnaire, including a list of 25 health problems and the SF-36 to measure functional status. The response rate was 67% (n = 4,112). Differences between subgroups were tested with p < 0.01.

RESULTS

Poorer functional status which was associated with increased age (except for vitality) and increased co-morbidity. Patients with asthma/ bronchitis/COPD, severe heart disease/infarction, chronic backpain, arthrosis of knees, hips or hands, or an 'other disease' had poorer scores on at least five dimensions of functional status. Patients with hypertension, diabetes mellitus or cancer did not differ from patients without these conditions on more than one dimension of functional status. In the multiple regression analysis age, had a negative effect on functional status (standardised beta-coefficients between -0.03 and -0.34) except for vitality. Co-morbidity had a negative effect on physical role constraints (-0.15) and bodily pain (-0.09). All health problems had effects on dimensions of functional status (coefficients between -0.04 and -0.13). General health and physical dimensions of functional status were better predicted by health problems, age and co-morbidity (between 6.4 and 16.5% of variation explained) than mental dimensions of functional status (between 1.1 and 3.2%).

CONCLUSION

Higher age was a predictor of poorer functional status, but there was little evidence for an independent effect of co-morbidity on functional status. Health problems had differential impact on functional status among primary care patients.

Symptom indexes to assess outcomes of treatment for early prostate cancer

BACKGROUND

Patients' perceptions of treatment outcomes are important in the management of early prostate cancer, but few studies have offered reliable and responsive measures to assess the likely side effects of the most common treatments.

OBJECTIVE

To develop indexes of urinary, bowel, and sexual function, and related distress.

RESEARCH DESIGN

Prospective cohort study of the outcomes of treatment for early prostate cancer, with self-administered questionnaires completed before treatment, and 3 and 12 months afterward. Hypothesized indexes, based on a clinical model of pathophysiological side effects of treatment, were defined and evaluated with respect to reliability and validity.

SUBJECTS

Patients (n = 184) undergoing radical prostatectomy or external beam radiotherapy for early prostate cancer.

MEASURES

Urinary and bowel items pertained to frequency or intensity of symptoms of dysfunction; parallel items assessed symptom-related distress. Sexual dysfunction items assessed the quality of erections, orgasm, and ejaculation; distress was assessed by 2 items adapted from the MOS Sexual Problems (MOS-SP) scale. HRQoL was assessed by the SF-36 and Profile of Mood States.

RESULTS

Symptom and symptom-related distress indexes for urinary incontinence, urinary obstruction/irritation, bowel dysfunction, and sexual dysfunction were defined. Symptom and distress indexes in each domain were highly correlated. Responsiveness was substantial and varied by treatment in ways consistent with clinical experience. The indexes accounted for significant proportions of the variance in HRQoL measures.

CONCLUSIONS

These indexes may be used in monitoring outcomes of treatment for early prostate cancer.