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Ge S, Wu KC, Chien SY, Jin X, Park S, Belza B. Urinary concerns among older adults: a qualitative analysis in the context of healthy aging. BMC Geriatr 2024; 24:605. [PMID: 39009962 PMCID: PMC11251362 DOI: 10.1186/s12877-024-05191-y] [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: 11/16/2023] [Accepted: 07/01/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Urinary concerns increase with age impacting health and quality of life. The aims of this study were to describe: (1) urinary concerns as an age-related change (ARC); (2) the challenges of urinary concerns; (3) adaptation strategies used to manage urinary concerns; and (4) the value of engaging with aging (EWA) as a framework to promote self-management of urinary concerns. METHODS Data was used from semi-structured interviews with 29 older adults (mean age 77 years). An iterative coding process was used. A codebook was developed based on a-priori themes derived from the EWA framework, our previous publication, and a line-by-line coding of one of the transcripts. As the analysis progressed, additional codes emerged, enriching the codebook. RESULTS Six themes emerged: (1) the participants' experiences; (2) responses to urinary concerns, (3) adaptation and management strategies; (4) knowledge and understanding of urinary concerns; (5) available capacities and resources; and (6) the impact of the COVID-19 pandemic on urinary concerns. Participants tended to address their urinary concerns by adjusting routines, medication schedules, or diet patterns. They tried to secure restroom locations or use tools or reminders to resolve their urinary concerns. COVID-19 led to increased inconvenience for older adults to engage in outdoor activities due to the closure of public restrooms. CONCLUSIONS Our in-depth qualitative analysis found that participants developed personalized adjustments to address their needs and abilities to their urinary concerns. These findings offer insights into the individual aging experience, which will further enhance our understanding and advancement of person-centered care.
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Affiliation(s)
- Shaoqing Ge
- School of Nursing, University of Texas at Austin, Austin, TX, USA.
| | - Kuan-Ching Wu
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Shao-Yun Chien
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Xianglan Jin
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Suah Park
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Basia Belza
- School of Nursing, University of Washington, Seattle, WA, USA
- de Tornyay Center for Healthy Aging, University of Washington School of Nursing, Seattle, WA, USA
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Wang M, Liao Y, Liu Y, Zhou W, Yu H. Development and future prospects of the artificial urinary sphincter. Artif Organs 2023; 47:1688-1699. [PMID: 37424277 DOI: 10.1111/aor.14606] [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: 04/23/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Urinary incontinence is a urinary disorder in which urine leaks out involuntarily. This disorder seriously affects the quality of life of patients. For patients with mild incontinence, conservative treatment and medication may be the ideal treatment modality, but for patients with severe incontinence, an artificial urinary sphincter is currently a better treatment option. METHODS In order to design an ideal artificial urinary sphincter, this article first searched and collected literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses searched strategy by selecting specific subject terms and reviewed the artificial urinary sphincters that are currently in the research stage based on different activation methods. RESULTS In response to the deficiencies of the existing artificial urinary sphincter, this article discusses the future optimization of the artificial urinary sphincter from three aspects: individual improvement of the artificial urinary sphincter, engineering design elements, and optimization of the artificial urinary sphincter manufacturing process. CONCLUSIONS The manufacture of an idealized artificial urinary sphincter capable of meeting clinical needs is of great importance to improve the quality of life of patients. However, this approach is a reasonable option to explore and should not be overestimated until further evidence is available.
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Affiliation(s)
- Minghui Wang
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yucheng Liao
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yunlong Liu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Wei Zhou
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Tavares J, Santinha G, Rocha NP. Implementation of the World Health Organization Age-Friendly Principles: A Case Study from Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6532. [PMID: 37569072 PMCID: PMC10419270 DOI: 10.3390/ijerph20156532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
Demographic ageing has emphasized the need to adapt current healthcare systems to the comorbidity profile of older adults. In 2004, the World Health Organization (WHO) developed the Age-Friendly Principles, but the approach to their implementation in the health systems still remains uncertain. This article intends to address this gap by assessing how the Principles are perceived and implemented in the Portuguese National Health Service (NHS), where this topic has recently been placed on the political agenda. A questionnaire survey was administered to primary care directors and hospital administrators, covering a total of 173 health units. Findings show that most respondents are unaware of the WHO Principles (71%) and do not identify the current organizational structure of care as a problem for the provision of care (80%). However, the implementation of the WHO Principles is lower than desired, especially regarding professional training and the management system (50% and 28% of the criteria are implemented, respectively). These criteria defined by the WHO are implemented in a reduced number of health units, as opposed to the physical environment where implementation is more widespread (64%). Accordingly, further dissemination and implementation support in the national territory are needed in order to improve the health outcomes of older adults and increase the performance of health units.
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Affiliation(s)
- Jéssica Tavares
- Research Unit on Governance, Competitiveness and Public Policies (GOVCOPP), Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Gonçalo Santinha
- Research Unit on Governance, Competitiveness and Public Policies (GOVCOPP), Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Nelson Pacheco Rocha
- Institute of Electronics and Informatics Engineering of Aveiro (IEETA), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
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Nanna MG, Sutton NR, Kochar A, Rymer JA, Lowenstern AM, Gackenbach G, Hummel SL, Goyal P, Rich MW, Kirkpatrick JN, Krishnaswami A, Alexander KP, Forman DE, Bortnick AE, Batchelor W, Damluji AA. Assessment and Management of Older Adults Undergoing PCI, Part 1: A JACC: Advances Expert Panel. JACC. ADVANCES 2023; 2:100389. [PMID: 37584013 PMCID: PMC10426754 DOI: 10.1016/j.jacadv.2023.100389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
As the population ages, older adults represent an increasing proportion of patients referred to the cardiac catheterization laboratory. Older adults are the highest-risk group for morbidity and mortality, particularly after complex, high-risk percutaneous coronary interventions. Structured risk assessment plays a key role in differentiating patients who are likely to derive net benefit vs those who have disproportionate risks for harm. Conventional risk assessment tools from national cardiovascular societies typically rely on 3 pillars: 1) cardiovascular risk; 2) physiologic and hemodynamic risk; and 3) anatomic and procedural risks. We propose adding a fourth pillar: geriatric syndromes, as geriatric domains can supersede all other aspects of risk.
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Affiliation(s)
| | - Nadia R. Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, and Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Ajar Kochar
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Grace Gackenbach
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Scott L. Hummel
- University of Michigan School of Medicine and VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Michael W. Rich
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - James N. Kirkpatrick
- Division of Cardiology, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ashok Krishnaswami
- Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
| | | | - Daniel E. Forman
- Divisions of Geriatrics and Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- VA Pittsburgh GRECC, Pittsburgh, Pennsylvania, USA
| | - Anna E. Bortnick
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Abdulla A. Damluji
- Inova Center of Outcomes Research, Fairfax, Virginia, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Di J, Nelson RS, Jicha GA, Moga DC, Barber JM, Cykowski MD, Fardo DW, Abner EL, Nelson PT. Urinary Incontinence in a Community-Based Autopsy Cohort Is Associated with Limbic Predominant Age-Related TDP-43 Encephalopathy Neuropathologic Changes. J Alzheimers Dis 2023; 94:333-346. [PMID: 37248909 PMCID: PMC10618953 DOI: 10.3233/jad-230425] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Dementia and urinary incontinence (UI) are etiologically complex clinical syndromes. Dementia and UI often occur in the same individuals, but underlying factors connecting them are incompletely understood. OBJECTIVE Query data from a community-based autopsy series to assess pathologies that underlie UI. METHODS Included research subjects came to autopsy from the University of Kentucky Alzheimer's Disease Research Center longitudinal cohort. A total of 368 research volunteers met inclusion criteria for this cross-sectional study. The average age at death was 85.3 years and the average number of annual clinic visits was 5.2 visits. Statistical models were run to evaluate which pathologies were associated with UI. Data included pathologies scored according to conventional stage-based systems, and these studies were complemented by quantitative digital neuropathology. RESULTS Dementia was diagnosed at the final clinical visit in 208 (56.7% of the sample) and UI was documented in 156 (42.7%). UI was associated with depression and dementia (both p < 0.001). More women than men had a history of UI (p < 0.04), and women with UI had had more biological children than those without UI (p < 0.005). Participants with limbic predominant age-related TDP-43 encephalopathy neuropathologic changes (LATE-NC) were more likely to have UI than those without LATE-NC (p < 0.001). The presence of LATE-NC (Stage > 1) was associated with UI with or without severe Alzheimer's disease neuropathologic changes and/or Lewy body pathology. CONCLUSION In this community-based autopsy cohort, multiple factors were associated with UI, but the neuropathologic change most robustly associated with UI was LATE-NC.
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Affiliation(s)
- Jing Di
- University of Kentucky Department of Pathology and Laboratory Medicine, Lexington, KY
| | | | - Gregory A. Jicha
- Sanders-Brown Center on Aging Lexington, KY
- Department of Neurology, Lexington, KY
| | - Daniela C. Moga
- Sanders-Brown Center on Aging Lexington, KY
- Department of Pharmacology, Lexington, KY
| | | | | | - David W. Fardo
- Sanders-Brown Center on Aging Lexington, KY
- Department of Biostatistics, Lexington, KY
| | - Erin L. Abner
- Sanders-Brown Center on Aging Lexington, KY
- College of Public Health, Lexington, KY
| | - Peter T. Nelson
- University of Kentucky Department of Pathology and Laboratory Medicine, Lexington, KY
- Sanders-Brown Center on Aging Lexington, KY
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Javanmardifard S, Gheibizadeh M, Shirazi F, Zarea K, Ghodsbin F. Psychosocial Experiences of Older Women in the Management of Urinary Incontinence: A Qualitative Study. Front Psychol 2022; 13:785446. [PMID: 35350738 PMCID: PMC8957818 DOI: 10.3389/fpsyg.2022.785446] [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: 09/29/2021] [Accepted: 02/14/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Urinary incontinence is a prevalent disorder amongst older women. Identifying the psychosocial experiences of older women in disease management can improve the patient care process. Hence, the present study aimed to determine the psychosocial experiences of older women in the management of urinary incontinence. Methods This qualitative study was conducted using conventional content analysis. The study data were collected via unstructured in-depth face-to-face interviews with 22 older women suffering from urinary incontinence selected via purposive sampling. Sampling and data analysis were done simultaneously and were continued until data saturation. The interviews were recorded, transcribed, and analyzed using the method proposed by Graneheim and Lundman. Results The results indicated that the older people with urinary incontinence had various psychosocial experiences while living with and managing this disease. Accordingly, four main themes were extracted from the data as follows: “problem incompatibility with the disease,” “mental impasse,” “facing social restrictions,” and “concealment and social escapism.” Conclusion The findings demonstrated that older people with urinary incontinence experienced significant psychosocial pressures while living with this disorder, which affected their psychosocial well-being. Thus, paying attention to these psychosocial experiences while supporting and taking care of these patients can positively impact their psychosocial health and quality of life.
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Affiliation(s)
- Sorur Javanmardifard
- Student Research Committee, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahin Gheibizadeh
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Shirazi
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kourosh Zarea
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fariba Ghodsbin
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Yan F, Xiao LD, Zhou K, Li Z, Tang S. Perceptions and help-seeking behaviours among community-dwelling older people with urinary incontinence: A systematic integrative review. J Adv Nurs 2022; 78:1574-1587. [PMID: 35150161 DOI: 10.1111/jan.15183] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/05/2021] [Accepted: 01/04/2022] [Indexed: 12/30/2022]
Abstract
AIM To synthesize research evidence on perceptions and help-seeking behaviours in community-dwelling older people with urinary incontinence based on the Capability-Opportunity-Motivation-Behaviours model. BACKGROUND Urinary incontinence is highly prevalent in community-dwelling older people, yet only a small proportion seek help from health professionals. Untreated urinary incontinence has a detrimental impact on older people's quality of life and distresses their caregivers. DESIGN Systematic integrative review. DATA SOURCES Ten databases were searched systematically between 9 November 2020 and 17 December 2020 including Medline (PubMed), CINAHL, Ageline, Web of Science, Scopus, ProQuest, Psyclnfo, CNKI, Wanfang and Vip. REVIEW METHODS Quality appraisal was applied to assess the quality of selected articles. Data relevant to the review aim were extracted from included articles for analysis. Convergent qualitative synthesis was used to synthesize findings. RESULTS Twenty articles were included and two main themes with six sub-themes were identified. Theme one described three common perceptions including urinary incontinence as a part of normal ageing, a stigma and a health problem. Each perception had a profound impact on older people's motivation to self-report the problem to health professionals. Theme two revealed three main help-seeking approaches comprising self-help, help from friends and help from health professionals. Of these, self-help was the dominant approach used to conceal urinary incontinence and contributed to social isolation. CONCLUSION Improving urinary incontinence management in community-dwelling older people requires the development of their capability and motivation, and increased opportunities to access and gain help from skilled health professionals. IMPACT Findings can facilitate resource development to improve health literacy for the general public pertinent to urinary incontinence and associated stigma. Moreover, findings can inform a user-friendly reporting and referral system for the problem. In addition, findings can inform education and skill training for health professionals, older people and their caregivers to effectively manage the problem.
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Affiliation(s)
- Fang Yan
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Lily D Xiao
- College of Nursing and Health Science, Adelaide, South Australia, Australia
| | - Keyi Zhou
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Zeen Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Bartolone SN, Sharma P, Chancellor MB, Lamb LE. Urinary Incontinence and Alzheimer's Disease: Insights From Patients and Preclinical Models. Front Aging Neurosci 2022; 13:777819. [PMID: 34975457 PMCID: PMC8718555 DOI: 10.3389/fnagi.2021.777819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Alzheimer's disease effects a large percentage of elderly dementia patients and is diagnosed on the basis of amyloid plaques and neurofibrillary tangles (NFTs) present in the brain. Urinary incontinence (UI) is often found in the elderly populations and multiple studies have shown that it is more common in Alzheimer's disease patients than those with normal cognitive function. However, the link between increased UI and Alzheimer's disease is still unclear. Amyloid plaques and NFTs present in micturition centers of the brain could cause a loss of signal to the bladder, resulting in the inability to properly void. Additionally, as Alzheimer's disease progresses, patients become less likely to recognize the need or understand the appropriate time and place to void. There are several treatments for UI targeting the muscarinic and β3 adrenergic receptors, which are present in the bladder and the brain. While these treatments may aid in UI, they often have effects on the brain with cognitive impairment side-effects. Acetylcholine esterase inhibitors are often used in treatment of Alzheimer's disease and directly oppose effects of anti-muscarinics used for UI, making UI management in Alzheimer's disease patients difficult. There are currently over 200 pre-clinical models of Alzheimer's disease, however, little research has been done on voiding disfunction in these models. There is preliminary data suggesting these models have similar voiding behavior to Alzheimer's disease patients but much more research is needed to understand the link between UI and Alzheimer's disease and discover better treatment options for managing both simultaneously.
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Affiliation(s)
- Sarah N Bartolone
- Department of Urology, Beaumont Health, Royal Oak, MI, United States
| | - Prasun Sharma
- Oakland University William Beaumont School of Medicine, Rochester Hills, MI, United States
| | - Michael B Chancellor
- Department of Urology, Beaumont Health, Royal Oak, MI, United States.,Oakland University William Beaumont School of Medicine, Rochester Hills, MI, United States
| | - Laura E Lamb
- Department of Urology, Beaumont Health, Royal Oak, MI, United States.,Oakland University William Beaumont School of Medicine, Rochester Hills, MI, United States
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