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Shearon TL, Alexander JL. Urinary Incontinence and Quality of Life: A Cross-Sectional Study. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492241256869. [PMID: 38850048 DOI: 10.1177/15394492241256869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Over half of women in the United States report urinary incontinence (UI). This condition can be treated conservatively, but many people do not seek treatment. The current correlational study assessed women's knowledge of UI. Specifically, we investigated the relationships between knowledge level about UI and quality of life (QoL), and between severity level of UI and QoL. A convenience cross-sectional sample of 39 older women was obtained from two YMCA locations. Data were analyzed using the Spearman rank-order correlation coefficient. A significant relationship was found between severity of UI and QoL, rs = -.73, p < .001; no relationship was found between knowledge level of UI and QoL, rs = .24, p = .13. Results suggested women's knowledge about the causes of UI and conservative therapy is limited. Occupational therapists need to address UI with their patients and educate them about treatment options and availability.
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Escribà-Salvans A, Jerez-Roig J, Farrés-Godayol P, Bezerra de Souza DL, Skelton DA, Minobes-Molina E. Health and sociodemographic determinants of excess mortality in Spanish nursing homes during the COVID-19 pandemic: a 2-year prospective longitudinal study. Z Gerontol Geriatr 2024:10.1007/s00391-024-02294-4. [PMID: 38625391 DOI: 10.1007/s00391-024-02294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/06/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Age, multimorbidity, immunodeficiency and frailty of older people living in nursing homes make them vulnerable to COVID-19 and overall mortality. OBJECTIVE To estimate overall and COVID-19 mortality parameters and analyse their predictive factors in older people living in nursing homes over a 2-year period. METHOD Design: A 2-year prospective longitudinal multicentre study was conducted between 2020 and 2022. SETTING This study involved five nursing homes in Central Catalonia (Spain). PARTICIPANTS Residents aged 65 years or older who lived in the nursing homes on a permanent basis. MEASUREMENTS Date and causes of deaths were recorded. In addition, sociodemographic and health data were collected. For the effect on mortality, survival curves were performed using the Kaplan-Meier method and multivariate analysis using Cox regression. RESULTS The total sample of 125 subjects had a mean age of 85.10 years (standard deviation = 7.3 years). There were 59 (47.2%) deaths at 24 months (95% confidence interval, CI, 38.6-55.9) and 25 (20.0%) were due to COVID-19, mostly in the first 3 months. In multivariate analysis, functional impairment (hazard ratio, HR 2.40; 95% CI 1.33-4.32) was a significant risk factor for mortality independent of age (HR 1.17; 95% CI 0.69-2.00) and risk of sarcopenia (HR 1.40; 95% CI 0.63-3.12). CONCLUSION Almost half of this sample of nursing home residents died in the 2‑year period, and one fifth were attributed to COVID-19. Functional impairment was a risk factor for overall mortality and COVID-19 mortality, independent of age and risk of sarcopenia.
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Affiliation(s)
- Anna Escribà-Salvans
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família 7, 08500, Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Javier Jerez-Roig
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família 7, 08500, Vic, Spain.
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain.
- Department of Health Promotion and Rehabilitation, Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania.
| | - Pau Farrés-Godayol
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família 7, 08500, Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | | | - Dawn A Skelton
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Eduard Minobes-Molina
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família 7, 08500, Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
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Wang CY, Peng SJ, Zhao M, Wu C, Wang KF. A study to untangle the puzzle of urinary incontinence and frailty co-occurrence among older adults: The roles of depression and activity engagement. J Adv Nurs 2024. [PMID: 38523560 DOI: 10.1111/jan.16172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 09/11/2023] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
AIMS To explore the co-occurrence of urinary incontinence and frailty by testing the roles of depression and activity engagement guided by the mechanisms of common cause and interaction pathways. DESIGN A secondary analysis of a 1-year three-wave panel data collected from older nursing home residents in China. METHODS Changes in depression and activity engagement were regressed on urinary incontinence and frailty incidence underpinned by the common cause mechanism of chronic conditions co-occurrence, and these changes were also taken as mediators linking from frailty to urinary incontinence incidence supported by the interaction pathways' mechanism. RESULTS A total of 348 older adults were included in this study, and 55.7% were women. The co-occurrence of urinary incontinence and frailty was found in 16.7% of the participants at baseline. Older adults with sole frailty at baseline had almost twice the rate of incident urinary incontinence (32.7%) compared with those without (16.7%) over a 1-year period. The subsample analyses showed that changes in depression and activity engagement failed to significantly predict the incidence of urinary incontinence and frailty. The mediating roles of these changes linking frailty to urinary incontinence incidence were also not statistically significant. CONCLUSION The co-occurrence of urinary incontinence and frailty is prevalent in older nursing home residents. Older adults with frailty at baseline are more likely to develop urinary incontinence a year later. The common cause and interaction pathways mechanisms for the co-occurrence of urinary incontinence and frailty were not verified with changes in depression and activity engagement. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The phenomenon of urinary incontinence and frailty co-occurrence should be given extreme emphasis. Although statistically significant findings on the roles of depression and activity engagement were not inferred, this study provides multiple possibilities for future studies to test and depict a clear picture of this co-occurrence. IMPACT What problem did the study address? This study was designed to test the roles of depression and activity engagement in predicting the incidence of urinary incontinence and frailty, and the mediating roles in linking frailty to urinary incontinence incidence. What were the main findings? Despite the methodological pitfalls in literature have been addressed, neither depression nor activity engagement would significantly predict the incidence of urinary incontinence and frailty in older adults. Their mediating roles in linking frailty to urinary incontinence incidence were also not significant. Where and on whom will the research have an impact? Our findings add important pieces of evidence to promote researchers' understanding and provide an important basis for untangling the puzzle of urinary incontinence and frailty co-occurrence. REPORTING METHOD The report of this study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Chun-Yan Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Si-Jing Peng
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Meng Zhao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Chen Wu
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Ke-Fang Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
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Souza HDC, Pires LMT, Vieira GC, Castro EAB, Moura EA, Engelmann J, Fonseca DS. Prevalence of pelvic floor disorders and the associated quality of life among institutionalized and noninstitutionalized elderly women: A cross-sectional study. Curr Urol 2023; 17:184-187. [PMID: 37448617 PMCID: PMC10337817 DOI: 10.1097/cu9.0000000000000138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/17/2021] [Indexed: 11/27/2022] Open
Abstract
Background An increase in life expectancy has led to an increased elderly population. In turn, this aging population is more likely to develop health conditions, such as pelvic floor disorders (PFDs). This study aimed to assess the prevalence of these disorders and the associated quality of life in institutionalized and noninstitutionalized elderly women. Materials and methods A cross-sectional study was conducted with 80 female participants older than 60 years, divided into 2 groups: institutionalized and noninstitutionalized participants. The Pelvic Floor Distress Inventory Short-Form and a sociodemographic questionnaire were used. A chi-squared test was used to assess the differences in prevalence between groups. Results There was no statistically significant difference between the groups in the prevalence of PFDs or quality of life. In this study, the prevalence of PFDs was higher than that reported previously. In institutionalized women, a higher prevalence of PFDs and impaired quality of life were expected, although not observed. Conclusions There was a higher prevalence of pelvic disorders and impaired quality of life due to these disorders in elderly women.
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Affiliation(s)
- Heloisa da Costa Souza
- Programa de Graduação em Fisioterapia, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Lívia M. T. Pires
- Programa de Graduação em Fisioterapia, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Gláucia C. Vieira
- Programa de Pós-Graduação em Ciências da Reabilitação e Desempenho Físico Funcional, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Edna A. B. Castro
- Programa de Pós-Graduação em Enfermagem, Faculdade de Enfermagem, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Elaine A. Moura
- Programa de Pós-Graduação em Psicologia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Júlia Engelmann
- Programa de Graduação em Fisioterapia, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Diogo S. Fonseca
- Programa de Graduação em Fisioterapia, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
- Programa de Pós-Graduação em Ciências da Reabilitação e Desempenho Físico Funcional, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
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McDermott P, Smith J, Lorton L. The effectiveness of the Attends Product Selector Tool in continence management in a care home setting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S13-S17. [PMID: 37173089 DOI: 10.12968/bjon.2023.32.9.s13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Qualified nurses are accountable for selecting a suitable containment product for care home residents, which can be challenging for both the resident and health professional. Absorbent incontinence products are the most commonly used products for containing leakage. The purpose of this observational study was to review and understand how effective the Attends Product Selector Tool is when used to assess a resident for an appropriate disposable incontinence product and the in-use experience of products in relation to containment, product use and effectiveness. The study was undertaken in three care homes, with 92 residents who had an initial assessment undertaken either by an Attends Product Manager or a nurse trained in how to use the tool. A total of 316 products over a 48-hour period were individually assessed by the observer to check the time the pad was changed, the type of pad used, the voided volume in the pad and if the pad had leaked. The results showed that some residents had their products changed inappropriately. Not all residents were using the products that best suited their assessment; this mostly occurred at night. Overall, the tool was effective in enabling staff to select an appropriate style of containment product. However, when it came to selecting the absorbency, the assessor tended to choose a higher absorbency rather than starting at the lower absorbency in the product guide range. The observer found the assessed product was not always used and was sometimes changed inappropriately due to lack of communication and staff turnover.
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Affiliation(s)
- Patricia McDermott
- Consultant Clinical Nurse Specialist - Urology, Adult Community Services, States of Guernsey
| | | | - Lindsay Lorton
- Attends Brand Clinical Business Support Manager, Attends Ltd
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Hoedl M, Bauer S, Eglseer D, Everink I, Gordon AL, Lohrmann C, Saka B, Schols JMGA, Osmancevic S. Urinary incontinence prevalence and management in nursing homes in Austria, the Netherlands, Turkey and the United Kingdom: A multi-site, cross-sectional study. Arch Gerontol Geriatr 2022; 103:104779. [PMID: 35853273 DOI: 10.1016/j.archger.2022.104779] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study is to describe and compare the prevalence rates of urinary incontinence as well as the management of urinary incontinence in the nursing home setting in Austria, the Netherlands, Turkey and the UK. METHODS This study is a secondary analysis of the 2017 and 2018 data from a multi-site, cross-sectional study which is performed annually in the nursing home setting in Austria, the Netherlands, Turkey and the UK. RESULTS A total of 23,334 nursing home residents was included in this study, most of whom were female. The urinary incontinence prevalence rates ranged from 13.8% in Turkey to 35.1% in Austria. In all countries, the most frequently used intervention for urinary incontinence management was the use of absorbent products and/or catheters (ranging from 81% in Turkey to 94.5% in Austria). The countries differed with regard to the methods used to assess the type of urinary incontinence, scheduled individual bathroom visits and medication evaluation. In the UK (77.1%), scheduled individual bathroom visits were a more frequent measure than in Austria (51.3%), the Netherlands (24.4%) and Turkey (10.2%). CONCLUSION The most frequently used nursing intervention in all countries was the use of absorbent products and/or catheters. Future studies on the over- or misuse of these products are warranted. In order to avoid the over- or misuse of these products in the nursing home setting, the use of the evidence- and consensus-based algorithm provided by the Wound, Ostomy and Continence Nurses Society™ is recommended.
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Affiliation(s)
- Manuela Hoedl
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria
| | - Silvia Bauer
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria
| | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria
| | - Irma Everink
- Care and Public Health Research Institute, Department Health Services Research, Maastricht University, Minderbroedersberg 4-6, LK Maastricht 6211, the Netherlands
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Uttoxeter Road, Derby DE22 3DT, UK; East Midlands Academic Health Sciences Network Patient Safety Collaborative, Triumph Road, Nottingham NG7 2TU, UK; NIHR Applied Research Collaboration - East Midlands (ARC-EM), Triumph Road, Nottingham NG7 2TU, UK
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria
| | - Bülent Saka
- Istanbul Faculty of Medicine, Department Internal Medicine, Istanbul University, İstanbul Tıp Fakültesi Çapa - Fatih, LIstanbul, Turkey
| | - Jos M G A Schols
- Care and Public Health Research Institute, Department Health Services Research, Maastricht University, Minderbroedersberg 4-6, LK Maastricht 6211, the Netherlands
| | - Selvedina Osmancevic
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria.
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Meng Z, Cheng L, Hu X, Chen Q. Risk factors for in-hospital death in elderly patients over 65 years of age with dementia: A retrospective cross-sectional study. Medicine (Baltimore) 2022; 101:e29737. [PMID: 35777004 PMCID: PMC9239669 DOI: 10.1097/md.0000000000029737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
As the population continues to age, dementia is becoming a huge social, economic, and healthcare burden. However, the risk factors for in-hospital death in elderly patients over 65 years of age with dementia are not well understood. Identifying factors that affect their prognosis could help clinicians with scientific decision-making. To examine the risk factors for in-hospital death in elderly patients over 65 years of age with dementia in the Geriatric Department of West China Hospital. In this retrospective, cross-sectional study, we analyzed inpatients aged ≥65 years with dementia between 2010 and 2016 using electronic medical records from the Information Center of West China Hospital. The risk factors for death were assessed using multivariable logistic regression. Out of a total of 2986 inpatients with dementia, 3.4% died. Patient deaths were related to digestive diseases, respiratory diseases, circulatory diseases, urinary diseases, and chronic obstructive pulmonary disease, whereas patient survival was associated with osteoporosis and Parkinson disease. Patients with a mean length of hospital stay of ≥60 days had an increased risk of death (all P <.05). In the multiple logistic regression analysis, age ≥80 years, digestive diseases, respiratory diseases, urinary diseases, diabetes, chronic obstructive pulmonary disease, and ≥7 comorbidities were risk factors for death. Mortality in hospitalized older patients with dementia is low, but some risk factors may be easily ignored. These findings could raise awareness among clinicians and caregivers about risk factors in hospitalized older patients, particularly hospitalized elderly patients with multiple comorbidities. Therefore, to reduce mortality, early prevention and management of potential risks are necessary.
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Affiliation(s)
- Zhangmin Meng
- Department of Geriatrics, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Linan Cheng
- West China School of Nursing, Sichuan University/Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Chen
- Department of Geriatrics, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Qian Chen, Department of Geriatrics, West China Hospital/West China School of Nursing, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China (e-mail: )
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Tai H, Liu S, Wang H, Tan H. Determinants of Urinary Incontinence and Subtypes Among the Elderly in Nursing Homes. Front Public Health 2021; 9:788642. [PMID: 34938714 PMCID: PMC8685234 DOI: 10.3389/fpubh.2021.788642] [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: 10/03/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Urinary incontinence (UI) is a common problem among older adults. This study investigated the prevalence of UI in nursing home residents aged ≥75 years in China and examined potential risk factors associated with UI and its subtypes. Data were collected during face-to-face interviews using a general questionnaire, the International Consultation Incontinence Questionnaire Short-Form, and the Barthel Index. A total of 551 participants aged ≥75 years residing in Changsha city were enrolled from June to December 2018. The UI prevalence rate among nursing home residents aged ≥75 years was 24.3%. The most frequent subtype was mixed (M) UI (38.1%), followed by urge (U) UI (35.1%), stress (S) UI (11.9%), and other types (14.9%). In terms of severity, 57.5% had moderate UI, while 35.1% had mild and 7.5% had severe UI. Constipation, immobility, wheelchair use, cardiovascular disease (CVD), and pelvic or spinal surgery were significant risk factors for UI. Participants with a history of surgery had higher risks of SUI (odds ratio [OR] = 4.87, 95% confidence interval [CI]: 1.55–15.30) and UUI (OR = 1.97, 95% CI: 1.05–3.71), those who were immobile or used a wheelchair had higher rates of MUI (OR = 11.07, 95% CI: 4.19–29.28; OR = 3.36, 95% CI: 1.16–9.78) and other UI types (OR = 7.89, 95% CI: 1.99–31.30; OR = 14.90, 95% CI: 4.88–45.50), those with CVD had a higher rate of UUI (OR = 2.25, 95% CI: 1.17–4.34), and those with diabetes had a higher risk of UUI (OR = 2.250, 95% CI: 1.14–4.44). Use of oral antithrombotic agents increased UUI risk (OR = 4.98, 95% CI: 2.10–11.85) whereas sedative hypnotic drug use was associated with a higher risk of MUI (OR = 3.62, 95% CI: 1.25–10.45). Each UI subtype has distinct risk factors, and elderly residents of nursing homes with a history of CVD and pelvic or spinal surgery who experience constipation should be closely monitored. Reducing time spent in bed and engaging in active rehabilitation including walking and muscle strengthening may aid in UI prevention and treatment.
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Affiliation(s)
- Hongyan Tai
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shunying Liu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Haiqin Wang
- Geriatric Department, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongzhuan Tan
- Xiangya School of Public Health, Central South University, Changsha, China
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Kańtoch A, Grodzicki T, Wójkowska-Mach J, Heczko P, Gryglewska B. Explanatory survival model for nursing home residents- a 9-year retrospective cohort study. Arch Gerontol Geriatr 2021; 97:104497. [PMID: 34411924 DOI: 10.1016/j.archger.2021.104497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE There is a gap in the literature regarding the analysis of long-term survival and mortality risk factors among disabled and multimorbid institutionalized populations. The study aimed to analyze 9-year survival, investigate mortality factors, and develop an explanatory survival model for nursing home residents. MATERIALS AND METHODS A retrospective cohort study with a 9-year follow-up (2009-2018) was conducted among 96 residents of a nursing home with Barthel index ≤ 40. The study was based on baseline measurements performed in 2009, which included results obtained on geriatric scales: Mini Nutritional Assessment Short-Form (MNA-SF) and Abbreviated Mental Test Score (AMTS). Information on demographics, comorbidities, pharmacotherapy, transfers and deaths came from medical records. Kaplan-Meier curves were used to estimate and present survival data. Factors associated with mortality were determined using Cox proportional hazard models. RESULTS The median survival was 2.9 years. Mortality during the follow-up period was 83%. Kaplan-Meier curves showed that residents with normal nutritional status (p = 0.002) and taking aspirin (p = 0.005) had a better 9-year survival. The multivariable Cox regression model revealed that the risk of mortality (Hazard Ratio, HR) increased in older age (HR=1.04), male gender (HR=2.08), with risk of malnutrition (HR=3.91), malnutrition (HR=4.84), and presence of urinary incontinence (HR=2.14). The aspirin use was the strongest protective factor against death (HR=0.40). CONCLUSION The aspirin use was associated with better long-term survival for nursing home residents. Factors associated with higher mortality among residents include older age, male gender, poor nutritional status, and urinary incontinence. BRIEF SUMMARY We are the first to report the beneficial effects of a low-dose of aspirin on the long-term survival of disabled, institutionalized populations with multimorbidity. Furthermore, this study presents an explanatory model of survival for nursing home residents and identifies the long-term mortality risk factors among disabled residents with multimorbidity.
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Affiliation(s)
- Anna Kańtoch
- Jagiellonian University Medical College, Faculty of Medicine, Department of Internal Medicine and Gerontology, University Hospital in Kraków, 2 Jakubowskiego Str., Building I, 30-688 Kraków, Poland
| | - Tomasz Grodzicki
- Jagiellonian University Medical College, Faculty of Medicine, Department of Internal Medicine and Gerontology, University Hospital in Kraków, 2 Jakubowskiego Str., Building I, 30-688 Kraków, Poland
| | - Jadwiga Wójkowska-Mach
- Jagiellonian University Medical College, Faculty of Medicine, Department of Microbiology, 18 Czysta Str., 31-121 Kraków, Poland
| | - Piotr Heczko
- Jagiellonian University Medical College, Faculty of Medicine, Department of Microbiology, 18 Czysta Str., 31-121 Kraków, Poland
| | - Barbara Gryglewska
- Jagiellonian University Medical College, Faculty of Medicine, Department of Internal Medicine and Gerontology, University Hospital in Kraków, 2 Jakubowskiego Str., Building I, 30-688 Kraków, Poland.
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Huang P, Luo K, Wang C, Guo D, Wang S, Jiang Y, Huang W, Zhang W, Ding M, Wang J. Urinary Incontinence Is Associated With Increased All-Cause Mortality in Older Nursing Home Residents: A Meta-Analysis. J Nurs Scholarsh 2021; 53:561-567. [PMID: 34021695 DOI: 10.1111/jnu.12671] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Urinary incontinence is a syndrome common in older adults, but it is not clear whether urinary incontinence is associated with the risk for mortality in elderly nursing home residents. METHODS We conducted a systematic review and meta-analysis in PubMed, Cochrane, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science databases. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. The meta-analysis was summarized using a random-effects or fixed-effects model, and the heterogeneity among studies was examined using the I2 statistic. FINDINGS Six cohort studies with 1,656 participants were included in the final analysis. The NOS score for each study was greater than 6. Urinary incontinence was significantly associated with a higher risk for mortality in nursing homes, with a hazard ratio (HR) of 1.20 (95% confidence interval [CI] 1.12-1.28, I2 = 41.6%). The significant association of urinary incontinence with increased mortality risk was observed in subgroup analysis according to region, status of dementia, and follow-up period, with a pooled HR of 2.02 (95% CI 1.32-3.11, I2 = 0%) for Asian countries, 1.18 (95% CI 1.11-1.26, I2 = 41.6%) for Western countries, 1.17 (95% CI 1.09-1.26, I2 = 0%) for patients with dementia, 1.35 (95% CI 1.13-1.60, I2 = 58.9%) for patients without dementia, 1.16 (95% CI 1.07-1.25, I2 = 43.2%) for studies with a follow-up period of 1 year, and 1.30 (95% CI 1.15-1.48, I2 = 24.5%) for studies with a follow-up period of more than 1 year. CONCLUSIONS Urinary incontinence is associated with an increased risk for death among residents of care facilities. Therefore, it was necessary to screen the elderly dwelling in nursing homes who were experiencing or at risk for urinary incontinence with useful tools (e.g., overactive bladder symptom score, bladder control self-assessment questionnaire, three incontinence questions). In addition, early interventions strategies, such as weight loss, stopping smoking, pelvic floor muscle training, and medical and surgical treatments would contribute to decreasing the risk for urinary incontinence and preventing adverse outcomes in nursing home residents. CLINICAL RELEVANCE In our study, we found that the elderly with urinary incontinence who resided in nursing homes had a higher risk for mortality than those without urinary incontinence. Therefore, urinary incontinence in the elderly residing in nursing homes is of particular concern. Early detection and intervention are important for the elderly with urinary incontinence, and caregivers should be made aware of this importance.
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Affiliation(s)
- Pan Huang
- Lecturer, College of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Kai Luo
- Medical student, Department of Medicine, JingGangshan University, Ji'an, Jiangxi Province, China
| | - Chunyan Wang
- Medical student, Department of Medicine, JingGangshan University, Ji'an, Jiangxi Province, China
| | - Dawei Guo
- Medical student, Department of Medicine, JingGangshan University, Ji'an, Jiangxi Province, China
| | - Shixuan Wang
- Medical student, Department of Medicine, JingGangshan University, Ji'an, Jiangxi Province, China
| | - Yuan Jiang
- Medical student, Department of Medicine, JingGangshan University, Ji'an, Jiangxi Province, China
| | - Wenxuan Huang
- Medical student, Ji'an Social Organization Cultivation and Development Center, Ji'an, Jiangxi Province, China
| | - Weiqiangxin Zhang
- Medical student, Department of Medicine, JingGangshan University, Ji'an, Jiangxi Province, China
| | - Mei Ding
- Medical student, Department of Medicine, JingGangshan University, Ji'an, Jiangxi Province, China
| | - Jiang Wang
- Lecturer, College of Nursing, JingGangshan Univeristy, Ji'an, Jiangxi, 343009, China.,Lecturer, Department of Medicine, JingGangshan University, Ji'an, 343009, China
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Abstract
BACKGROUND Various factors affect the mortality of older adult residents of long-term care facilities. To provide adequate nursing care for older adults, it is necessary to understand the factors that affect their risk of mortality. PURPOSE This study was designed to (a) evaluate the 24-month survival rate and (b) identify the underlying cause of death in various dimensions, including cognitive, psychological, and physical function; nutritional status; and chronic disease. METHODS A longitudinal study was carried out between 2011 and 2013 at seven long-term care facilities. The participants comprised 276 residents who were all older than 65 years old. Baseline measurements included cognitive function (Mini-Mental State Examination for Dementia Screening), psychological function (Cornell Scale for Depression in Dementia), physical function (Barthel Index), nutritional status (Mini Nutritional Assessment, mid-arm circumference, and calf circumference), and chronic disease status (hypertension, diabetes mellitus, chronic respiratory disease, heart disease, and urinary incontinence). Data analysis included univariate and multivariate logistic regression to identify the main factors affecting mortality. RESULTS In 2011 (baseline), the mean age of the participants was 80.46 years (SD = 7.08) and most were female (73.6%). At the 24-month follow-up, 94 (34.1%) of the participants had died. The major factors affecting mortality were as follows: cognitive dysfunction (OR = 3.12, 95% CI [1.41, 6.90]), mid-arm circumference (< 22.5 cm; OR = 2.32, 95% CI [1.35, 3.96]), and urinary incontinence (OR = 2.04, 95% CI [1.16, 3.61]). CONCLUSIONS According to the findings, special attention is needed at the end of life to improve the quality of life of older adults with cognitive dysfunction, malnutrition (low mid-arm circumference), and urinary incontinence who reside in long-term care facilities.
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García-Gollarte JF, García-Andrade MM, Santaeugenia-González SJ, Solá Hermida JC, Baixauli-Alacreu S, Santabalbina FJT. Risk Factors for Mortality in Nursing Home Residents: An Observational Study. Geriatrics (Basel) 2020; 5:geriatrics5040071. [PMID: 33050016 PMCID: PMC7709674 DOI: 10.3390/geriatrics5040071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose: Identifying mortality risk factors in people living in nursing homes could help healthcare professionals to individualize or develop specific plans for predicting future care demands and plan end-of-life care in this population. This study aims to identify mortality risk factors in elderly nursing home (NH) residents, based on variables adapted to this environment, routinely collected and easily accessible to their healthcare professionals. Methods: A prospective, longitudinal, observational study of NH residents aged 65 years and older was carried out collecting sociodemographic, functional and cognitive status, nutritional variables, comorbidities, and other health variables. These variables were analyzed as mortality risk factors by Cox proportional hazard models. Results: A total of 531 residents (75.3% female; average age 86.7 years (SD: 6.6)) were included: 25.6% had total dependence, 53.4% had moderate to severe cognitive impairment, 84.5% were malnourished or at risk of malnutrition, and 79.9% were polymedicated. Risk of mortality (hazard ratio, HR) increased in totally dependent residents (HR = 1.52; p = 0.02) and in those with moderate or severe cognitive impairment ((HR = 1.59; p = 0.031) and (HR = 1.93; p = 0.002), respectively). Male gender (HR = 1.88; p < 0.001), age ≥80 years (HR = 1.73; p = 0.034), hypertension (HR = 1.53; p = 0.012), atrial fibrillation/arrhythmia (HR = 1.43; p = 0.048), and previous record of pneumonia (HR = 1.65; p = 0.029) were also found to be mortality drivers. Conclusion: Age and male gender (due to the higher prevalence of associated comorbidity in these two variables), certain comorbidities (hypertension, atrial fibrillation/arrhythmia, and pneumonia), higher functional and cognitive impairment, and frequency of medical emergency service care increased the risk of mortality in our study. Given their importance and their easy identification by healthcare professionals in nursing homes, these clinical variables should be used for planning care in institutionalized older adults.
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Affiliation(s)
- José Fermín García-Gollarte
- Medical Department Grupo Ballesol, Universidad Católica de Valencia, La Eliana, 46183 Valencia, Spain;
- Correspondence:
| | | | - Sebastiá J. Santaeugenia-González
- Chronic Care Program, Ministry of Health, Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care, 08500 Barcelona, Spain;
| | - José Carlos Solá Hermida
- Medical Department Grupo Ballesol, Universidad Católica de Valencia, La Eliana, 46183 Valencia, Spain;
| | - Susana Baixauli-Alacreu
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Francisco José Tarazona Santabalbina
- Geriatric Service, Hospital Universitario de la Ribera, 46600 Alzira, Spain;
- Division of Geriatric Medicine, 7GPR+3M Doha, Qatar
- CIBERFES, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, 0 28029 Madrid, Spain
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Padrón-Monedero A, Pastor-Barriuso R, García López FJ, Martínez Martín P, Damián J. Falls and long-term survival among older adults residing in care homes. PLoS One 2020; 15:e0231618. [PMID: 32379771 PMCID: PMC7205288 DOI: 10.1371/journal.pone.0231618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 03/28/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives To assess the association between having suffered a fall in the month prior to interview and long-term overall survival in nursing-home residents. Methods Retrospective cohort study conducting an overall survival follow-up of 689 representative nursing-home residents from Madrid, Spain. Residents lived in three types of facilities: public, subsidized and private and its information was collected by interviewing the residents, caregivers and/or facility physicians. Residents contributed to follow-up time from their baseline interviews until death or being censored at the end of the 5-year follow-up period. The association between suffering a fall during the month prior to interview and long-term overall survival was analyzed using Cox proportional hazards models. To adjust for potential confounders we used progressive adjusted models. We then repeated the analyses with severity of the fall (no fall, non-severe, severe) as the main independent variable. Results After a 2408 person-year follow-up (median 4.5 years), 372 participants had died. In fully-adjusted models, residents who had suffered any kind of fall in the previous month showed virtually the same survival rates compared to non-fallers (hazard ratio (HR) = 1.03; 95% CI = 0.75–1.40). There was a weak graded relationship between increased fall severity and survival rates for the non-severe fall group (HR = 0.92; 95% CI = 0.58–1.45) and the severe fall group (HR = 1.36; 95% CI = 0.73–2.53) compared with residents who had not suffered any kind of fall. The hazard ratios for severe falls were higher in men, residents with less comorbidity, fewer medications, and those functionally independent. Conclusion We found no associations between having suffered a fall in the month prior to interview and long-term survival; neither did we find a marked association when severity of fall was accounted for in the whole population. In some subgroups, however, the results merit further scrutiny.
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Affiliation(s)
- Alicia Padrón-Monedero
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPAZ, Madrid, Spain
- Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas—CIBERNED), Madrid, Spain
| | - Roberto Pastor-Barriuso
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública—CIBERESP), Madrid, Spain
| | - Fernando J. García López
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas—CIBERNED), Madrid, Spain
| | - Pablo Martínez Martín
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas—CIBERNED), Madrid, Spain
| | - Javier Damián
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas—CIBERNED), Madrid, Spain
- * E-mail:
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Omissions of Care in Nursing Home Settings: A Narrative Review. J Am Med Dir Assoc 2020; 21:604-614.e6. [DOI: 10.1016/j.jamda.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
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Nursing Home Length of Stay in 3 Canadian Health Regions: Temporal Trends, Jurisdictional Differences, and Associated Factors. J Am Med Dir Assoc 2019; 20:1121-1128. [DOI: 10.1016/j.jamda.2019.01.144] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 12/19/2022]
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Rodríguez-García MDP, Ayala A, Rodríguez-Blázquez C, Martínez-Martín P, Forjaz MJ, Damián J. Features and impact of missing values in the association of self-rated health with mortality in care homes: a longitudinal study. Health Qual Life Outcomes 2019; 17:111. [PMID: 31255183 PMCID: PMC6599327 DOI: 10.1186/s12955-019-1184-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 06/19/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Self-rated health (SRH) is a health measure used in studies of older adults. The objective of this study is to analyze SRH as a predictor of mortality in the institutionalized older population and the characteristics of those who do not provide information about their SRH on health questionnaires. METHODS This is a 15-year follow-up study of older adult residents in nursing or care homes in of Madrid, Spain. SRH was measured on a 5-point Likert type scale. The association between answering the SRH question and socio-demographic and health characteristics was evaluated through prevalence ratio (PR), estimated by Poisson regression models. Survival rates associated with SRH were studied through a multivariate Cox regression. RESULTS The sample has a mean age of 83.4 (standard deviation, SD = 7.3), with 75.7% women. Twelve percent did not answer the SRH item. Those who did not answer showed a higher probability of disability (Barthel index, PR = 0.76, 95% confidence interval = 0.67-0.86) and/or dementia (PR = 8.03, 3.38-19.03). A trend for higher mortality was observed in those persons who did not respond (adjusted hazard ratio HR = 1.26, 0.75-2.11). The mortality rate was 32% higher for those who declared poor SRH in comparison with those who reported good SRH (adjusted HR = 1.32, 1.08-1.6). CONCLUSIONS There is an elevated number of people who do not respond to the SRH item, mainly those with disabilities and cognitive deterioration. Lack of response to SRH is a good indicator of 15-year mortality for persons institutionalized in care or nursing homes.
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Affiliation(s)
| | - Alba Ayala
- National School of Public Health, Institute of Health Carlos III and REDISSEC, Avda Monforte de Lemos 5, 28029 Madrid, Spain
| | | | - Pablo Martínez-Martín
- National Center of Epidemiology, Institute of Health Carlos III and CIBERNED, Madrid, Spain
| | - Maria João Forjaz
- National School of Public Health, Institute of Health Carlos III and REDISSEC, Avda Monforte de Lemos 5, 28029 Madrid, Spain
| | - Javier Damián
- National Center of Epidemiology, Institute of Health Carlos III and CIBERNED, Madrid, Spain
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Borges CL, Fernandes BKC, Cavalcante MLSN, Barbosa RGB, Peixoto Junior AA, Menezes LCGD. Fatores de risco para incontinência urinária em idosos institucionalizados. ESTIMA 2019. [DOI: 10.30886/estima.v16.726_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: Analisar os fatores de risco para incontinência urinária (IU) em idosos institucionalizados. Métodos: Estudo transversal, analítico, documental realizado por coleta em 203 prontuários de uma instituição de longa permanência no nordeste do Brasil. Foram utilizados um instrumento para caracterização sociodemográfica e de saúde e os valores do Mini Exame do Estado Mental (MEEM). Os dados foram analisados a partir da estatística descritiva, inferencial e por regressão logística múltipla. Resultados: A prevalência de IU foi de 42,36% e maior em mulheres (66,28%), mais velhos (média: 79,62 anos) e dependentes (89,53%). Houve associação entre idade (p = 0,01), sexo (p = 0,024), estado civil (p = 0,007), religião (p = 0,015), com quem residia antes da institucionalização (p = 0,033), grau de dependência (p < 0,001), valores do MEEM (p < 0,001) e doenças cardiovasculares (p < 0,001) e neurológicas (p < 0,001). Os fatores de risco para IU foram quantidade de doenças [odds ratio (OR) = 1,17; intervalo de confiança de 95% (IC95%) = 1,02-1,34], consumo de cinco a nove medicamentos (OR = 4,07; IC95% = 1,14-14,52), ser solteiro (OR = 2,09; IC95% = 1,30-8,01), dependente (OR = 3,27; IC95% = 1,33-8,04) e ter baixa pontuação no MEEM (OR = 0,88; IC95% = 0,85-0,93). Conclusão: Os resultados revelam a importância de estudar IU nessa população para identificar precocemente os fatores de risco passíveis de prevenção.
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Borges CL, Fernandes BKC, Cavalcante MLSN, Barbosa RGB, Peixoto Junior AA, Menezes LCGD. Risk factors for urinary incontinence in institutionalized elderly. ESTIMA 2019. [DOI: 10.30886/estima.v16.726_in] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: To analyze the risk factors for urinary incontinence (UI) in institutionalized elderly. Methods: Cross-sectional, analytical, documentary study done by collection in 203 medical records of a long-stay institution in northeastern Brazil. An instrument for sociodemographic and health characterization and the values of the Mini Mental State Examination (MMSE) were used. The data were analyzed from the descriptive, inferential and multiple logistic regression. Results: The prevalence of UI was 42.36% and higher in women (66.28%), older (mean: 79.62 years) and dependent (89.53%). There was an association between age (p = 0.01), sex (p = 0.024), marital status (p = 0.007), religion (p = 0.015), with whom resided before institutionalization (p = 0.033), degree of dependency (p < 0.001), MMSE values (p < 0.001) and cardiovascular (p < 0.001) and neurological diseases (p < 0,001). The risk factors for UI were number of diseases (OR = 1.17; 95%CI = 1.02-1.34), consumption of five to nine medications (OR = 4.07, 95% CI = 1.14-14.52), single (OR = 2.09, 95% CI = 1.30-8.01),dependent (OR = 3.27, 95% CI = 1.33-8.04) and had a low MMSE score (OR = 0.88, 95% CI= 0.85-0.93). Conclusion: The results reveal the importance of studying UI in this population to identify early risk factors that can be prevented.
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Yoo R, Spencer M. Continence Promotion and Successful Aging: The Role of the Multidisciplinary Continence Clinic. Geriatrics (Basel) 2018; 3:geriatrics3040091. [PMID: 31011126 PMCID: PMC6371153 DOI: 10.3390/geriatrics3040091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 11/16/2022] Open
Abstract
Incontinence is a common yet under-recognized issue that impacts quality of life, especially for older adults in whom there is often a multifactorial etiology. A retrospective chart review was performed on a representative sample of patients seen at our multidisciplinary continence clinic in Vancouver, Canada from January to December 2017 inclusive. Initial assessment was performed by the nurse continence advisor (NCA) or geriatrician depending on the source of referral. The pelvic floor physiotherapist (PFP) could then be consulted based on perceived need. The average age at assessment was 76 years old (range 29⁻102), with 82% of patients ≥65 years and 27% ≥85 years old. The majority of patients were referred for bladder incontinence (72%), with the remaining patients referred for bowel incontinence (28%) or pessary care (7%). Referrals came from a variety of sources including physicians (62%), nurses (22%), allied health care providers (12%) and self-referral (5%). Multimorbidity was common, with 40% of patients having a Charlson Comorbidity Index ≥6. The same proportion of patients (40%) were on ≥5 prescription medications. Many patients were functionally dependent for either instrumental activities of daily living (52%) or activities of daily living (25%). Non-pharmacologic treatments were commonly recommended, with the majority of patients counselled on lifestyle changes (88%) and taught Kegel exercises (70%). For patients seen by the geriatrician, modifications were made to non-continence medications in 50% of cases and medical comorbidities were optimized in 39% of cases. In terms of pharmacologic therapy, over-the-counter (OTC) medications were initiated in 45% of patients whereas continence-specific prescription medications were started in 17% of patients. A multidisciplinary continence clinic can play an important role in promoting successful aging by assessing and treating medical causes of incontinence in medically complex older adults.
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Affiliation(s)
- Rhena Yoo
- MD Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
| | - Martha Spencer
- Division of Geriatric Medicine, Providence Health Care, Vancouver, BC, V6Z 1Y6, Canada.
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Chong E, Chan M, Lim WS, Ding YY. Frailty Predicts Incident Urinary Incontinence Among Hospitalized Older Adults—A 1-Year Prospective Cohort Study. J Am Med Dir Assoc 2018; 19:422-427. [DOI: 10.1016/j.jamda.2017.12.103] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 12/29/2017] [Indexed: 12/27/2022]
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Sri‐on J, Tirrell GP, Kamsom A, Marill KA, Shankar KN, Liu SW. A High-yield Fall Risk and Adverse Events Screening Questions From the Stopping Elderly Accidents, Death, and Injuries (STEADI) Guideline for Older Emergency Department Fall Patients. Acad Emerg Med 2018; 25:927-938. [PMID: 29575248 DOI: 10.1111/acem.13413] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The objectives were to examine whether responses to the Stopping Elderly Accidents, Death, and Injuries (STEADI) questions responses predicted adverse events after an older adult emergency department (ED) fall visits and to identify factors associated with such recurrent fall. METHODS We conducted a prospective study at two urban, teaching hospitals. We included patients aged ≥ 65 years who presented to the ED for an accidental fall. Data were gathered for fall-relevant comorbidities, high-risk medications for falls, and the responses to 12 questions from the STEADI guideline recommendation. Our outcomes were the number of 6-month adverse events that were defined as mortality, ED revisit, subsequent hospitalization, recurrent falls, and a composite outcome. RESULTS There were 548 (86.3%) patients who completed follow-up and 243 (44.3%) patients experienced an adverse event after a fall within 6 months. In multivariate analysis, seven questions from the STEADI guideline predicted various outcomes. The question "Had previous fall" predicted recurrent falls (odds ratio [OR] = 2.45, 95% confidence interval [CI] = 1.52 to 3.97), the question "Feels unsteady when walking sometimes" (OR = 2.34, 95% CI = 1.44 to 3.81), and "Lost some feeling in their feet" predicted recurrent falls. In addition to recurrent falls risk, the supplemental questions "Use or have been advised to use a cane or walker," "Take medication that sometimes makes them feel light-headed or more tired than usual," "Take medication to help sleep or improve mood," and "Have to rush to a toilet" predicted other outcomes. CONCLUSION A STEADI score of ≥4 did not predict adverse outcomes although seven individual questions from the STEADI guidelines were associated with increased adverse outcomes within 6 months. These may be organized into three categories (previous falls, physical activity, and high-risk medications) and may assist emergency physicians to evaluate and refer high-risk fall patients for a comprehensive falls evaluation.
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Affiliation(s)
- Jiraporn Sri‐on
- Department of Emergency Medicine Vajira Hospital Navamindradhiraj University BangkokThailand
| | - Gregory Philip Tirrell
- Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston MA
| | - Anucha Kamsom
- Department of Biostatistic Vajira Hospital Navamindradhiraj University BangkokThailand
| | - Keith A. Marill
- Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston MA
| | - Kalpana Narayan Shankar
- Department of Emergency Medicine Boston Medical Center Boston University School of Medicine Boston MA
| | - Shan W. Liu
- Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston MA
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Esparza AO, Tomás MÁC, Pina-Roche F. Experiences of women and men living with urinary incontinence: A phenomenological study. Appl Nurs Res 2017; 40:68-75. [PMID: 29579501 DOI: 10.1016/j.apnr.2017.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022]
Abstract
AIMS To explore and understand, from a gender-based perspective, the quality-of-life experiences of men and women who suffer from urinary incontinence. BACKGROUND Urinary incontinence (UI) is a major health problem with significant social, psychological, occupational, sexual and economic effects leading to a substantial decrease in quality of life. Although this condition is increasingly frequent in men, research has tended to focus on women, adopting a quantitative approach. DESIGN The data were examined using interpretive phenomenological analysis (IPA). METHODS The data were collected through a semi-structured interview conducted between January and June 2016. An inductive discourse content analysis was performed in three stages: preparation, organization and report. Participants were recruited until data saturation was achieved. FINDINGS A sample of 33 participants was recruited: 17 women and 16 men. Gender-specific features were found. Six categories emerged: (i) normalization of incontinence; (ii) verbalization of the problem; (iii) social isolation; (iv)experienced feelings and emotions; (v) impact on daily routine; (vi) self-care strategies to address the problem in the most suitable way. CONCLUSION Urinary incontinence has a negative effect on the quality of life of men and women. However, there are gender differences as to how this phenomenon is experienced, particularly with regard to its psychological and social dimensions. A comprehensive, targeted assessment of the needs of these men and women is required on the part of professional nurses.
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Affiliation(s)
| | - Miguel Ángel Cánovas Tomás
- Department of Nursing, Spain Faculty of Health Sciences, University of Murcia, Spain; Research Group of Urology, Morales Meseguer Hospital, Murcia, Spain.
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