Toileting-related falls at night in hospitalised patients: The role of nocturia

Using the TrueLoo Smart Device to Record Toileting Sessions in Older Adults: Retrospective Validation and Acceptance Study

BACKGROUND

Because of the relationship between independent living and activities of daily living, care teams spend significant time managing assisted living residents' toileting problems. Recently, the TrueLoo was developed as a connected toilet seat to automatically log and monitor toileting sessions.

OBJECTIVE

This study aimed to demonstrate the validity of the TrueLoo to (1) record and identify toileting sessions with regard to stool and urine events; (2) compare the results with the person-reported, standard-of-care methods; and (3) establish metrics of user acceptability and ease of use in a assisted living facility population.

METHODS

We used two phases: (1) initial development of the TrueLoo algorithms to accurately identify urine and stool events and (2) evaluation of the algorithms against person-reported, standard-of-care methods commonly used in assisted living facilities. Phase 2 analyzed data over a 3-day period from 52 devices. Participants' age ranged from 63 to 101 (mean 84, SD 9.35) years. Acceptability and ease-of-use data were also collected.

RESULTS

Regarding the development of the TrueLoo algorithm for urine assessment, sensitivity and specificity of 96% and 85% were observed when evaluating a gold-standard labeled data set, respectively (F1-score=0.95). For stool, sensitivity and specificity of 90% and 79% were observed, respectively (F1-score=0.85). Regarding the TrueLoo algorithm in assisted living settings, classification performance statistics for urine assessment revealed sensitivity and specificity of 84% and 94%, respectively (F1-score=0.90), and for stool, 92% and 98%, respectively (F1-score=0.91). Throughout the study, 46 person-reported instances of urine were documented, compared with 630 recorded by the TrueLoo. For stool events, 116 person-reported events were reported, compared with 153 by the TrueLoo. This indicates that person-reported events were captured 7% (46/630) of the time for urine and 76% (116/153) of the time for stool. Overall, 45% (32/71) of participants said that the new toilet seat was better than their previous one, 84% (60/71) reported that using the TrueLoo was easy, and 99% (69/71) said that they believed the system could help aging adults. Over 98% (69/71) of participants reported that they would find alerts related to their health valuable and would be willing to share this information with their doctor. When asked about sharing information with caregivers, 66% (46/71) reported that they would prefer the TrueLoo to send information and alerts to their caregiver, as opposed to the participant having to personally communicate those details.

CONCLUSIONS

The TrueLoo accurately recorded toileting sessions compared with standard-of-care methods, successfully establishing metrics of user acceptability and ease of use in assisted living populations. While additional validation studies are warranted, data presented in this paper support the use of the TrueLoo in assisted living settings as a model of event monitoring during toileting.

Determinants of Bladder Care at Night in a Subacute Ward for Aged Patients: An Observational Study

PURPOSE

The purpose of this study was to evaluate how bladder care at night correlates to patients' mobility status.

DESIGN

This was an observational study.

SUBJECTS AND SETTING

The sample comprises 63 aged care subacute patients who were observed over 3 consecutive nights in an inpatient subacute aged care ward located in Melbourne, Australia. Half of the participants were female; their mean age was 82.0 (standard deviation 8.2) years. Data were collected from December 2020 to March 2021.

METHODS

Outcome variables included demographic and pertinent clinical characteristics, type and timing of toileting and/or bladder care provided, and mobility classification. Descriptive statistics were used to summarize the frequency of nocturnal bladder care provided each night and as a mean over the 3 nights. The relationship between the type of care units provided and other variables was explored using a 1-way analysis of variance; values ≤.05 were deemed statistically significant.

RESULTS

Findings indicate that 27% (n = 17), 41% (n = 26), and 48% (n = 30) of participants required assistance to move in bed, sit up in bed, and stand from sitting, respectively. Care episodes for both incontinence and assistance with voiding were significantly associated with functional mobility in bed ( F = 5.52, P < .001; F = 2.14, P = .02) and with ambulation independence ( F = 3.52, P = .001; F = 2.04, P = .03) but not with age or ambulation distance.

CONCLUSIONS

Care provided for urinary incontinence during the night was related to the need for physical support of ambulation and poor mobility in bed. Targeted input from a multidisciplinary team is warranted to facilitate change of practice at night.

Implementation of the UMove Mobility Program to Promote Safe Patient Mobility and Reduce Falls in the Hospital Setting

The purpose of the current quality improvement (QI) project was to implement the UMove Early Mobility Program to engage patients in safe out of bed (OOB) activities and reduce falls, specifically focusing on toileting-related falls, during the hospital stay. Eight nursing units implemented the UMove program, including the UMove Mobility Screen (UMove MS), to select strategies to reduce toileting-related falls while increasing mobility. De-identified, unit-based data were collected from hospital reports. Nursing had a 95% documentation compliance rate for the UMove MS, and OOB activities and ambulation were documented at 50% and 57%, respectively. There was no statistical difference found in reducing toileting-related falls or sustaining increased OOB activities across the 15-month QI project. Toileting-related falls approached significance with a rate reduction from 1.77 pre-implementation to 0.23 at 6 months and no toileting-related falls at 12 months. Despite no significant findings, there is evidence that clinical changes occurred with nurses assessing and promoting mobility, while implementing strategies to reduce toileting-related falls. [Research in Gerontological Nursing, 17(1), 19-29.].

Association between toileting and falls in older adults admitted to the emergency department and hospitalised: a cross-sectional study

OBJECTIVES

This study aimed to explore the potential risk factors associated with toileting-related falls in community-dwelling older adults who presented to the emergency department and were subsequently hospitalised.

DESIGN

This was a cross-sectional study.

SETTING AND PARTICIPANTS

This study was conducted in two teaching hospitals in Shanghai, China between October 2019 and December 2021 among community-dwelling adults aged ≥60 years.

METHODS

In-person interviews, physical assessment and medical record review were performed to collect data on the characteristics and risk factors of falls. Associations of toileting-related falls with demographic characteristics and geriatric syndromes were examined using logistic regression models.

MAIN OUTCOME MEASURES

Potential risk factors for toileting-related falls.

RESULTS

This study included 419 older patients with a mean age of 73.8±9.7 years. Among 60 (14.3%) patients with toileting-related falls (mean age: 78.8±9.2 years), 63.3% of toileting-related falls, mainly occurred between 00:00 and 05:59 hours, compared with 17.3% of non-toileting-related falls, which primarily occurred during the daytime. The rate of recurrent falls (35%) was significantly higher in the toileting-related falls group than in the non-toileting-related falls group (21.2%) (p=0.02). Logistic regression showed that visual impairment (OR 2.7, 95% CI 1.1 to 7.1), cognitive impairment (OR 3.3, 95% CI 1.3 to 8.4), gait instability (OR 3.1, 95% CI 1.1 to 8.8) and urinary incontinence (OR 3.4, 95% CI 1.2 to 9.9) were strongly associated with toileting-related falls. Twenty-three (38.3%) patients in the toileting-related falls group had moderate and severe injuries, compared with 71.7% in the non-toileting-related falls group (p<0.05).

CONCLUSIONS

This study revealed that patients who reported toileting-related falls were more likely to have cognitive impairment, urinary incontinence, gait instability, visual impairment than patients who fell during other activities. Social and healthcare professionals should prioritise the management of toileting activities in older patients and provide targeted interventions to those in the high-risk group.

Effects of consultation for voiding behavior on nocturnal urination status of older adults living alone: A preliminary study

Nocturia and its related arousal may impair the quality of life and increase the risk of falls in older adults. This study aimed to clarify the change in urination status during the main sleeping period within 1 year. We also aimed to examine the effects of a consultation for voiding behavior in addition to the traditional behavioral therapy on urination status during sleep in a group of independent community-dwelling older adults. A single-arm intervention study was conducted in 10 older adults, with a mean age of 80.1 years and nocturia frequency of 1-4 times/day. Natural changes in urination status were observed between 2016 and 2017. Participants received traditional behavioral therapy and a consultation related to voiding behavior four times from summer 2017 to spring 2018. Urination status was monitored using sensing devices placed in the participant's home. The average time staying in the toilet significantly increased after 1 year. Although this parameter significantly decreased after the first consultation in 2017, this change was not observed with the subsequent consultation. A combination of traditional behavioral therapy and consultation for voiding behavior may be effective in improving urination status during the main sleeping period.

The Bladder at Night during Hospitalisation: Towards optimal care for elderly patients with nocturia

OBJECTIVE

This study aimed to describe the characteristics of nocturia in older hospitalised patients and to explore knowledge, beliefs and experiences associated with night toileting while in hospital in order to identify unmet care needs.

METHODS

A multisite mixed methods cross-sectional study of older hospitalised adults who were admitted for ≥2 days was conducted using a standardised researcher-administered questionnaire. An additional cohort 16 older hospitalised adults with nocturia >twice per night were interviewed to understand the experience and impact of nocturia during hospitalisation.

RESULTS

Nocturia was experienced by 260 out of 308 participants. In-hospital nocturia was significantly correlated with nocturia in the month preceding admission, high diurnal voiding frequency and nocturnal urinary urgency. Bother was attributed to multiple nocturia episodes. Participants had poor knowledge and understanding of nocturia and believed the symptom to be a normal occurrence; only 20% had discussed management with staff. Disrupted sleep and fear of falling were common in older immobile participants with nocturia.

CONCLUSION

Nocturia is highly prevalent in hospitalised older people. Toileting multiple times at night bothers patients, disrupts sleep, heightens a fear of falling yet is rarely addressed in ward management plans. A screening process to identify, assess, provide education and intervene for nocturia has the potential to improve wellbeing, safety at night and to address risk factors.

Clinical prediction models for hospital falls: a scoping review protocol

INTRODUCTION

Falls remain one of the most prevalent adverse events in hospitals and are associated with substantial negative health impacts and costs. Approaches to assess patients' fall risk have been implemented in hospitals internationally, ranging from brief screening questions to multifactorial risk assessments and complex prediction models, despite a lack of clear evidence of effect in reducing falls in acute hospital environments. The increasing digitisation of hospital systems provides new opportunities to understand and predict falls using routinely recorded data, with potential to integrate fall prediction models into real-time or near-real-time computerised decision support for clinical teams seeking to mitigate fall risk. However, the use of non-traditional approaches to fall risk prediction, including machine learning using integrated electronic medical records, has not yet been reviewed relative to more traditional fall prediction models. This scoping review will summarise methodologies used to develop existing hospital fall prediction models, including reporting quality assessment.

METHODS AND ANALYSIS

This scoping review will follow the Arksey and O'Malley framework and its recent advances, and will be reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews recommendations. Four electronic databases (CINAHL via EBSCOhost, PubMed, IEEE Xplore and Embase) will be initially searched for studies up to 12 November 2020, and searches may be updated prior to final reporting. Additional studies will be identified by reference list review and citation analysis of included studies. No restriction will be placed on the date or language of identified studies. Screening of search results and extraction of data will be performed by two independent reviewers. Reporting quality will be assessed by the adherence to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis.

ETHICS AND DISSEMINATION

Ethical approval is not required for this study. Findings will be disseminated through peer-reviewed publication and scientific conferences.

The role of lower urinary tract symptoms in fall risk assessment tools in hospitals: a review

A large number of falls in hospitals occur on the way to the toilet. Accordingly, a literature search was conducted in Web of Science, PubMed, Embase, and the Cochrane Library to identify fall risk screening and assessment metrics published between 1980 and 2019 and to study the inclusion of lower urinary tract symptoms (LUTS) and their related parameters in these screening tools. In addition, the literature was searched to explore the relationship between toilet-related falls and LUTS. In total, 23 fall risk scales were selected, from which 11 were applicable for in-hospital patients. In nine of the 11 scales for in-hospital patients, a LUTS or LUTS-related parameter was included. In the 12 risk assessment tools for community-dwelling older people, there were no LUTS included. Frequency, urinary incontinence, and nocturia were mostly reported in the literature as a potential fall risk parameter. It is recommended to create greater awareness of nocturia and other LUTS among caregivers of hospitalized patients to prevent falls.