Prevalence and Conditions of Urinary Incontinence among the Elderly

Analysis of the Results Obtained with a new Phytotherapeutic Association for Benign Prostatic Hyperplasia versus Controls

Introduction

Benign prostatic hypertrophy (BPH) is a common disease whose frequency has risen throughout the world in concomitance with the increase in life expectancy. BPH causes voiding distur-bances known by the acronym LUTS (lower urinary tract symptoms), which heavily influence the quality of life in the elderly. The treatment for LUTS is mainly divided into medical and surgical, the latter usually represented by prostate ablation. Medical therapy includes synthetic molecules that interfere with the hormonal control of BPH or act on the bladder neck tonus, as well as natural remedies based on plant extracts from Serenoa Repens and/or Urtica Dioica.

Material and Methods

TWO groups of patients who were candidates for surgery for BPH-induced LUTS, were randomly recruited in a six-month trial aimed at comparing outcome of treatment with a new combination of plants extracts (Pluvio®), which differs from the previous ones in that it also contains avocado and soya oil, as well as a high dose of Urtica Dioica, with no therapy. Age, IPSS score, maximal uroflow, prostate volume, PSA, free-to-total PSA ratio, post voiding residual urine and number of nocturia episodes were recorded and statistically evaluated using a NCSS 60® program.

Result

A marked benefit in terms of quality of life, measured by IPSS score, uroflow, residual urine and nocturia, was observed in the treated group compared to controls. PSA and prostate volume were not significantly affected. No noteworthy adverse events were observed.

Conclusions

The new phytotherapeutic combination evaluated in the present study would seem to be highly effective for the treatment of LUTS in BPH patients and does not have negative side effects. Its use could therefore be strongly advocated in this setting.

[Risk factors associated with urinary incontinence in community-dwelling elderly women]

AIM

To evaluate whether the frequency, volume, and type of urinary incontinence (UI) correlated with physical fitness and self-rated health, and to assess the risk factors associated with frequency and volume of UI, and self-rated health in elderly community-dwelling women with UI.

METHODS

The subjects were 957 women aged 70 or older who participated in a comprehensive health examination which included a face-to-face interview and physical fitness tests. In order to evaluate the differences in the physical fitness and the interview data with the frequency, volume, and type of UI we used student t-test for continuous variables and the chi-square test for categorical variables. Multivariate logistic regression models were used to assess the factors associated with frequency and volume of UI, and self-rated health.

RESULTS

The prevalence of UI was 43.5% in elderly women. The high frequency and large amount of UI, and the urge and mixed UI were significantly associated with a lower level of balance, muscular strength, walking ability, and higher BMI. According to the logistic model, self-rated health (odds ratio (OR)=0.49, 95%confidence intervals (CI)=0.26-0.92), urge (OR=2.04, 95%CI=1.04-4.06) and mixed UI (OR=4.07, 95%CI=1.94-8.70), BMI (OR=1.10, 95%CI=1.01-1.21), urination frequency during the daytime(OR=1.25, 95%CI=1.10-1.44), maximum walking speed (OR=0.25, 95%CI=0.08-0.71) were independent variables significantly associated with frequency of UI, the volume of UI was significantly associated with urge (OR=2.27, 95%CI=1.08-4.91) and mixed UI (OR=3.02, 95%CI=1.33-6.98), and the self-rated health was significantly associated with frequency of UI (OR=2.18, 95%CI=1.28-3.68) and urge UI (OR=2.28, 95%CI=1.30-4.06).

CONCLUSIONS

The high frequency and urge UI was significantly associated with a lower level of physical fitness and self-rated health. Our findings suggest that active lifestyle, which was focused on a decreased BMI and increased walking ability, may contribute to the prevention of UI.

[Health status of community-dwelling elderly with geriatric syndrome]

OBJECTIVES

This study was conducted in order to examine the prevalence of geriatric syndrome (falls, incontinence, depression, and under-nutrition) in community-dwelling elderly people, and to analyze the health status of the elderly with geriatric syndrome risk compared to those of a group not at risk.

METHODS

The subjects comprised 1,784 residents (769 men and 1,015 women) aged 70 years or more living in Itabashi-ku, Tokyo, who took part in the study. For this study, we divided the subjects into two groups: those with geriatric syndrome (n=688) and those without (n=1,096).

RESULTS

It was found that 33.6% of men and 42.4% of women had geriatric syndrome. Elderly with geriatric syndrome in both men and women had a significantly lower the proportion of subjects who perceived as 'healthy' in terms of the self-rated health, the higher-level functional capacity, higher prevalence of fear of falling, and decreased physical performance including handgrip strength and usual.maximal walking speed than those in the group who did not have geriatric syndrome. Logistic regression analysis showed that geriatric syndrome was associated with poor perceived self-rated health, a lower hemoglobin level and a slower usual walking speed in men, whereas in women it was associated with poor perceived self-rated health and fear of falling.

CONCLUSION

Elderly individuals with geriatric syndrome have significantly decreased health status and physical performance compared to those without geriatric syndrome.

Frequency of going outdoors as a good predictors for incident disability of physical function as well as disability recovery in community-dwelling older adults in rural Japan

BACKGROUND

The clinico-epidemiologic relevance of the reduction in the frequency of going outdoors in older adults has not been well characterized. This study examined whether the frequency of going outdoors has predictive values for incident physical disability and recovery among community-dwelling elderly.

METHODS

One thousand, two hundred and sixty-seven persons aged 65+ years who lived in a rural community in Niigata, Japan, and participated in the baseline survey were assessed again 2 years later in terms of mobility, and instrumental and basic activities of daily living (IADL and BADL). We compared the incident disability and recovery at follow-up among three subgroups classified by the baseline frequency of going outdoors: once a day or more often, once per 2-3 days, and once a week or less often. Multivariate analyses tested associations between the frequency of going outdoors and functional transition, independent of potential confounders.

RESULTS

A lower frequency of going outdoors at baseline was associated with a greater incident disability, and a lower recovery at the two-year follow-up. Even after adjustment, the effects of going outdoors remained significant. Adjusted risks of incident mobility and IADL disabilities were significantly higher (odds ratio[OR]=4.02, 95% confidence interval [CI]: 1.77-9.14 and OR=2.65, 95% CI: 1.06-6.58), respectively, and recovery from mobility disability was significantly lower (OR=0.29, 95% CI: 0.08-0.99) for “once a week or less often” subgroup compared with “once a day or more often” subgroup.

CONCLUSION

The frequency of going outdoors is a good predictor for incident physical disability and recovery among community-living elderly. Public health nurses and clinicians should pay more attention how often their senior clients usually go outdoors.

Incontinence Induces Stratum Corneum Vulnerability and Impairs the Skin Barrier Function in the Perianal Region

BACKGROUND

Incontinence leads to a reduced skin barrier function, while also increasing the risk of skin breakdown.

AIM

To investigate the perianal skin barrier function of elderly patients with or without incontinence.

METHODS

We compared the skin barrier function by investigating the skin hydration, the skin pH, the amount of ceramide and by making a dermatological skin inspection of the perianal region in patients with and without incontinence.

RESULTS

Twenty-one incontinent patients (70.0%) showed a glossy skin, which indicates impairment of the skin barrier while none of the patients in the continence group did so. In the incontinence group, those who had a glossy skin showed a significantly greater skin pH and total amount of ceramide than those with a normal skin (p = 0.0099, p = 0.0179, respectively).

CONCLUSIONS

These results demonstrate that a glossy skin may be a useful indicator of a reduced perianal skin barrier function.

Urinary incontinence and pelvic floor dysfunction in Asian-American women

OBJECTIVE

The objective of the study was to describe the prevalence, risk factors, and impact of urinary incontinence and other pelvic floor disorders among Asian-American women.

STUDY DESIGN

This was a population-based cohort study of older women randomly selected from age and race strata.

RESULTS

Weekly urinary incontinence was reported by 65 of 345 Asian women (18%), with stress and urge incontinence being approximately equally common. In multivariate analysis, higher body mass index (greater than 25 kg/m2) was associated with both stress incontinence (odds ratio 4.90, 95% confidence interval 1.76 to 13.68) and urge incontinence (odds ratio 2.49, 95% confidence interval 1.01 to 6.16) in Asians. Hysterectomy was a significant risk factor for stress incontinence (odds ratio 2.79, 95% confidence interval 1.03 to 7.54). Only 34% of Asian women with weekly urinary incontinence reported ever having sought treatment. Pelvic floor exercises were the most common form of treatment, being used by 29% of Asian women with weekly incontinence. Asians were less likely then white women to report anal incontinence (21% versus 29%, P = .007), although this difference became nonsignificant after adjusting for differences in risk factors.

CONCLUSION

Asian women share some risk factors for stress and urge urinary incontinence with white women. Urinary incontinence is associated with anal incontinence among Asian women.

Magnetic resonance imaging to evaluate NASHA/Dx gel (Zuidex) for stress urinary incontinence

The Zuidex system for the treatment of stress urinary incontinence consists of non-animal stabilised hyaluronic acid/dextranomer (NASHA/Dx) gel and a precision guide, the Implacer. Whether the Implacer accurately deposits NASHA/Dx gel in the desired location within the urethral wall was investigated by magnetic resonance imaging (MRI), performed at a mean of 35 days post-treatment. Three or more deposits were observed in 11 of 16 patients (68.8%), with 39 of the 50 deposits clearly located within the urethral wall, as intended. Fourteen of 16 patients (87.5%) demonstrated improvement in their incontinence at 3 months, sustained at 12 months in 13 patients. No significant correlations between total implant volume and improvements in incontinence were observed at 3 months (p > or = 0.16) and 12 months (p > or = 0.30). In conclusion, accurate placement of NASHA/Dx gel into the desired location within the urethral wall was achieved in the majority of cases using the Implacer device, without endoscopic guidance.

Incontinence-specific quality of life measures used in trials of treatments for female urinary incontinence: a systematic review

This systematic review examined the use of incontinence-specific quality of life (QOL) measures in clinical trials of female incontinence treatments, and systematically evaluated their quality using a standard checklist. Of 61 trials included in the review, 58 (95.1%) used an incontinence-specific QOL measure. The most commonly used were IIQ (19 papers), I-QoL (12 papers) and UDI (9 papers). Eleven papers (18.0%) used measures which were not referenced or were developed specifically for the study. The eight QOL measures identified had good clinical face validity and measurement properties. We advise researchers to evaluate carefully the needs of their specific study, and select the QOL measure that is most appropriate in terms of validity, utility and relevance, and discourage the development of new measures. Until better evidence is available on the validity and comparability of measures, we recommend that researchers consider using IIQ or I-QOL with or without UDI in trials of incontinence treatments.

Development, Implementation, and Evaluation of a Continence Education Package in Acute and Subacute Care Settings

OBJECTIVE

The objective of the study was to trial and evaluate the effect that a discharge Continence Education Package (CEP) had on patients' continence awareness and management preferences.

DESIGN

An exploratory descriptive design was used.

SETTINGS AND SUBJECTS

A total of 631 participants were included in the study: 352 females (55.8%) and 279 males (44.2%) from 4 rural and regional settings in Victoria, Australia.

INSTRUMENTS AND METHODS

A specifically designed questionnaire was used to assess participants' knowledge of incontinence and its management and also to investigate their treatment preferences and intentions if they experienced this type of problem. Data were collected at 2 time periods. Specifically, patients were interviewed before discharge from acute and subacute settings identified as Time 1 (T1). Then the participants were given the CEP and asked to complete a similar questionnaire.

RESULTS

The findings revealed that fewer than 25% of participants had received information on continence before the study being conducted, yet the majority had indicated that they had experienced continence symptoms. The majority of participants found the CEP easy to understand (98.2%) and helpful (95.3%). Most participants said it provided them with information about types of actions to take and/or treatment options for incontinence problems. It also raised their awareness of the signs and symptoms associated with incontinence and provided them with a useful self-administered gauge with which to assess their continence status.

CONCLUSIONS

These findings suggest that the CEP may be a useful educational tool for use in the general population.

Prevalence rate of urinary incontinence in community-dwelling elderly individuals: the Veneto study

BACKGROUND

Urinary incontinence (UI) is a common problem in elderly people, due mainly to functional impairments and concurrent medical diseases. Few studies, however, have assessed the prevalence of UI in noninstitutionalized individuals. The objectives of the present work were to estimate the prevalence of UI in a community-based population of elderly Italians and to determine the associated physical, social, and psychological factors.

METHODS

A random sample of noninstitutionalized men (n = 867) and women (n = 1531), aged 65 years and older, from the Veneto region of northeastern Italy, were interviewed at home, using an extensive multidisciplinary questionnaire, to assess their quality of life and social, biological, and psychological correlates.

RESULTS

The prevalence rate of UI was of 11.2% among men and of 21.6% among women. Among those reporting the condition, approximately 53% of women and 59% of men reported experiencing incontinence daily or weekly. Association of UI was found for participants older than 70 years in both men (odds ratio [OR] 2.49, 95% confidence interval [CI] 1.45-4.28) and women (OR 1.49, 95% CI 1.11-2.02). Three of the medical conditions investigated were associated with increases in the odds in women, namely chronic obstructive pulmonary disease (OR 1.53, 95% CI 1.11-2.12), Parkinsonism (OR 2.27, 95% CI 1.14-4.54), and hip fracture (OR 1.38,95% CI 1.02-1.88), whereas chronic diarrhea was the only condition associated with UI in men (OR 6.92, 95% CI 2.22-21.5). Participants with a physical disability were two times more likely to report incontinence, and the odds were increased by 50% in women who had sleep disturbances.

CONCLUSIONS

Incontinence is highly prevalent in the Italian elderly population, and several common chronic conditions are significantly associated with it. Moreover, very few people with incontinence seek health care or are aware of potential treatments.