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Cassone M, Ameling J, Mody L, Patel S, Muyanja NS, Meddings J. Impact of external female urinary catheter use on urine chemistry test results. Am J Infect Control 2024; 52:919-924. [PMID: 38552717 DOI: 10.1016/j.ajic.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND We aimed to evaluate how urine chemistry tests are impacted by collection using a female external urinary catheter employing wicking and suction, to assess this catheter's potential as an alternative to transurethral catheters for collecting urine samples from incontinent patients. METHODS We obtained 50 random 40 mL refrigerated urine specimens from excess volume submitted to the Michigan Medicine Biochemical Laboratory. Specimens were split into a 10 mL "control" sample simulating voided urine, and a 30 mL paired "wicked" sample applied dropwise to and collected from a fresh PureWick system simulating collection from an incontinent patient. Each sample pair was tested for glucose, sodium, potassium, creatinine, urea, total protein, and derived ratios of sodium/creatinine, urea/creatinine, and protein/creatinine, then compared using Pearson correlation coefficients. Wicking materials were imaged via absorption contrast tomography on a laboratory X-ray microscope, to study the structure through which urine passes. RESULTS Control and wicked urine samples had very similar results for all chemical tests evaluated: strong Pearson correlation coefficients ranging from 0.955 (potassium) to 0.997 (glucose). Microscopic assessment of the amorphous wicking materials demonstrated an average pore spacing of 95.38 µm. CONCLUSIONS Common urine chemistry tests were unaltered by collection using the PureWick female external catheter system. This external device can be used to collect urine for chemistry tests as an alternative to transurethral catheters.
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Affiliation(s)
- Marco Cassone
- Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Jessica Ameling
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Lona Mody
- Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI; Medicine Service, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI; Geriatric Research Education and Clinical Center, Ann Arbor, MI
| | - Sanjeevkumar Patel
- Medicine Service, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI; Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Nancy S Muyanja
- Michigan Center for Materials Characterization, University of Michigan College of Engineering, Ann Arbor, MI
| | - Jennifer Meddings
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI; Medicine Service, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI; Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI; Center for Clinical Management Research, VA Ann Arbor Healthcare Center, Ann Arbor, MI.
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Zhang Y, Fang D, Luo Y, Wang C, Wan L, Cao Y, Xin H, Ding H. A large cross sectional study on diaper utilization and beneficial role in outdoor activity and emotions among incontinence elderly people. Sci Rep 2024; 14:6358. [PMID: 38491120 PMCID: PMC10943191 DOI: 10.1038/s41598-024-57055-5] [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: 01/26/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024] Open
Abstract
This study was designed based on a cross-sectional investigation conducted Shanghai, China. Demographic characteristics, diaper utilization, Activities of Daily Living (ADL) and emotion were collected by Unified Needs Assessment Form for Elderly Care Questionnaire. Cognition function was assessed by Mini-mental State Examination (MMSE) scale. Multivariate logistic regression was used for statistical analysis. The diaper utilization rate was 31.2%. Female, higher level of education, poorer ADL and cognition, more severe incontinence and financial dependence on others were facilitating factors for diaper usage (P < 0.05). The possibility of using diaper differed according to the intimacy of caregivers. Among incontinent individuals with relatively good ADL and cognition level, diaper utilization can significantly decrease the risk of going out only once a month (OR: 2.63 vs 4.05), and going out less than once a month (OR: 5.32 vs 6.53). Incontinence people who going out at least once a week had a lower risk of some negative emotion. Significantly, diaper utilization further decreased this risk. In conclusion, for incontinence elderly people with relatively independent ability, proper use of diaper may improve the frequency of outdoor activity and emotion. Nevertheless, diaper utilization should be decided based on elderly people's own will.
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Affiliation(s)
- Yunwei Zhang
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, 200031, People's Republic of China
| | - Dawei Fang
- Department of Cardiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, People's Republic of China
| | - Yashuang Luo
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, 200031, People's Republic of China
| | - Changying Wang
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, 200031, People's Republic of China
| | - Lingshan Wan
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, 200031, People's Republic of China
| | - Yifan Cao
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, 200031, People's Republic of China
| | - Hongyun Xin
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, 200031, People's Republic of China
| | - Hansheng Ding
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, 200031, People's Republic of China.
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Schmidt S, Neumann A, Muller J, Schweitzer A, Gölly KI, Brandl J. Digital assistance systems in the field of incontinence care for individuals in need of long-term care (EASY): study protocol of a stratified randomised controlled trial. BMC Geriatr 2023; 23:409. [PMID: 37403028 DOI: 10.1186/s12877-023-04135-2] [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: 08/17/2022] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND In general, urinary and faecal incontinence is a multifaceted problem that is associated with increasing burdens for those affected, a massive impairment of quality of life and economic consequences. Incontinence is associated with a high level of shame, which in particular reduces the self-esteem of those being incontinent and leads to additional vulnerability. Those affected by incontinence often perceive incontinence and the care they receiveas humiliating, hence they can no longer control their own urination; nursing care and cleansing support then lead to additional dependency. People with incontinence in need of care not uncommonly experience a poor communication and many taboos surrounding the issue as well as the use of force when incontinence products are changed. AIMS AND METHODS This RCT aims to validate the benefits of using a digital assistance system to optimise incontinence care and to enable statements concerning the effect of the assistance technology on nursing and social structures and processes as well as on the quality of life from the perspective of the person in need of care. In a two-arm, stratified, randomised, controlled interventional study, primarily incontinence-affected residents of four inpatient nursing facilities will be examined (n = 80). One intervention group will be equipped with a sensor-based digital assistance system, which will transmit care-related information to the nursing staff (via smartphone). The collected data will be compared to the data of the control group. Primary endpoints are falls occurring; secondary endpoints are quality of life and sleep, sleep disturbances and material consumption. In addition, nursing staff (n = 15-20) will be interviewed regarding the effects, experience, acceptance and satisfaction. DISCUSSION The RCT aims at the applicability and effect of assistance technologies on nursing structures and processes. It is assumed that, amongst other things, this technology may lead to a reduction of unnecessary checks and material changes, an improvement of life quality, an avoidance of sleep disturbances and thus an improvement of sleep quality as well as to a reduced risk of falling for people with incontinence in need of care. The further development of incontinence care systems is of social interest as this offers the prospect of improving the quality of care for nursing home residents with incontinence. TRAIL REGISTRATION Approval of the RCT is granted by the Ethics Committee at the University of Applied Sciences Neubrandenburg (Reg.-Nr.: HSNB/190/22). This RCT is registered at the German Clinical Trials Register on July 8th, 2022, under the identification number DRKS00029635.
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Affiliation(s)
- Stefan Schmidt
- Faculty of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Brodaer Strasse 2, Neubrandenburg, 17033, Germany.
| | - Alexandra Neumann
- Faculty of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Brodaer Strasse 2, Neubrandenburg, 17033, Germany
| | - Julie Muller
- Faculty of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, Brodaer Strasse 2, Neubrandenburg, 17033, Germany
| | | | | | - Julio Brandl
- AssistMe GmbH, Bachstrasse 12, Berlin, 10555, Germany
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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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Neuromodulation in the Older Woman: An Advanced Treatment Option for Urgency Urinary Incontinence. CURRENT GERIATRICS REPORTS 2023. [DOI: 10.1007/s13670-023-00379-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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6
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Omotunde M, Agholme F, Böhling A, Huige N, Schweigel H, Hayder-Beichel D, Reidy R, Wagg A. A post-market cluster randomized controlled trial of the effect of the TENA SmartCare Change Indicator™ on urinary continence care efficiency and skin health in older nursing home residents. Trials 2023; 24:80. [PMID: 36737838 PMCID: PMC9895969 DOI: 10.1186/s13063-022-07031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/16/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Urinary continence care for residents of nursing homes who are unable to communicate their toileting needs usually involves care aides manually checking continence products (pads) to determine the level of urine saturation prior to changing. The TENA SmartCare Change Indicator is a medical device which estimates urine saturation and notifies caregivers of the optimal time for pad changes. This study will seek to examine the effect of the TENA SmartCare Change Indicator on urinary continence care efficiency and skin health, in comparison to usual care. METHODS This cluster randomized controlled trial (NCT05247047) involving older nursing home residents with urinary incontinence unable to consistently indicate their toileting needs, and their care aides, will compare technology-based and usual continence care over a period of 8 weeks. Co-primary endpoints of superiority in continence care efficiency and non-inferiority in the maintenance of skin health will be assessed. Secondary outcomes will examine the resident quality of life, sleep quality, responsive behaviours, changes in pad use and leakage episodes outside the pad. Change in care aide work engagement, job satisfaction and rushed tasks will be assessed. Benefits and challenges with the use of the device for continence care will be identified from the perspectives of the care staff. DISCUSSION Urinary continence assessment and care in nursing homes is reported as suboptimal and threatening to dignity. Data on the utility and effect of technological solutions for improving urinary continence care are few and conflicting. If shown effective, this technological solution has the potential to improve the care for older residents and improve the working lives of caregiving staff who look after this most vulnerable section of the population. TRIAL REGISTRATION ClinicalTrials.gov NCT05247047. Registration date is Feb 18, 2022.
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Affiliation(s)
- Muyibat Omotunde
- grid.17089.370000 0001 2190 316XDivision of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - Fredrik Agholme
- grid.509222.eEssity Hygiene & Health AB, 405 03 Gothenburg, Sweden
| | - Arne Böhling
- Essity/BSN Medical GmbH, Schützenstraße 1-3, 22765 Hamburg, Germany
| | - Nicole Huige
- grid.509222.eEssity Hygiene & Health AB, 405 03 Gothenburg, Sweden
| | - Hardy Schweigel
- Essity/BSN Medical GmbH, Schützenstraße 1-3, 22761 Hamburg, Germany
| | - Daniela Hayder-Beichel
- Department of Health, Hochschule Neiderrhein-University of Applied Sciences, Reinarzstr 49, 47805 Krefeld, Germany
| | - Robert Reidy
- Staburo GmbH, Aschauer Strasse 26a, 81549 Munich, Germany
| | - Adrian Wagg
- grid.17089.370000 0001 2190 316XDivision of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, AB Canada
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7
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Zhang Y. The effect of incontinence on depression among older adults: a longitudinal study in China. Public Health 2022; 212:58-65. [DOI: 10.1016/j.puhe.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/09/2022] [Accepted: 08/30/2022] [Indexed: 11/11/2022]
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8
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Stefanacci RG, Yeaw J, Shah D, Newman DK, Kincaid A, Mudd PN. Impact of Urinary Incontinence Related to Overactive Bladder on Long-Term Care Residents and Facilities: A Perspective From Directors of Nursing. J Gerontol Nurs 2022; 48:38-46. [PMID: 35771072 DOI: 10.3928/00989134-20220606-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study assessed the impact of urinary incontinence (UI) on residents, staff, care processes, and quality measures in long-term care (LTC) settings. A 70-question quantitative online survey was sent to directors of nursing (DONs) who had worked for ≥1 year in a ≥100-bed facility (≥80% LTC beds). Of the 62% of residents with UI, 40% were always incontinent, and 81% used incontinence products for UI. Overall, 59% of DONs reported that UI management contributes to certified nursing assistant turnover. Approximately 36% of resident falls occurred while trying to get to the bathroom. LTC quality measures reported as significantly impacted by UI included urinary tract infection and falls with major injury. Only 14% of residents with UI were treated with medication. Most (75%) DONs were unaware of any link between anticholinergic medications and risk of cognitive side effects. These results highlight the need for improved UI treatment, awareness, and management in this population. [Journal of Gerontological Nursing, 48(7), 38-46.].
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Urinary Incontinence and Its Association with Physical and Psycho-Cognitive Factors: A Cross-Sectional Study in Older People Living in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031500. [PMID: 35162524 PMCID: PMC8835480 DOI: 10.3390/ijerph19031500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023]
Abstract
Urinary incontinence (UI) is a common geriatric syndrome affecting bladder health and is especially prevalent in nursing homes (NHs). The aim of the study was to determine the prevalence of UI and its associated factors in five Spanish NHs. UI (measured with Minimum Data Set 3.0), sociodemographic, and health-related variables were collected. Chi-square (or Fisher's) or Student's t-test (or Mann Whitney U) for bivariate analysis were used, with Prevalence Ratio (PR) as an association measure. The prevalence of UI was 66.1% (CI:95%, 53.6-77.2) in incontinent (n = 45, mean age 84.04, SD = 7.7) and continent (n = 23, mean age 83.00, SD = 7.7) groups. UI was significantly associated with frailty (PR = 1.84; 95%CI 0.96-3.53), faecal incontinence (PR = 1.65; 95%CI 1.02-2.65), anxiety (PR = 1.64; 95%CI 1.01-2.66), physical performance (PR = 1.77; 95%CI 1.00-3.11), and cognitive state (PR = 1.95; 95%CI 1.05-3.60). Statistically significant differences were found between incontinent and continent NH residents for limitations in activities of daily living (ADL), mobility, quality of life, sedentary behaviour, and handgrip strength. It can be concluded that two out of three of the residents experienced UI, and significant associated factors were mainly physical (sedentary behaviour, frailty, physical performance, ADL limitations, mobility, faecal incontinence, and handgrip strength) followed by psycho-cognitive factors (cognition, anxiety, and quality of life).
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Russell D, Stoddard MD, Morgan N, McDonald MV, Dignam R, Bowles KH, Prigerson HG, Chughtai B. Nurse perspectives on the psychosocial care of patients with urinary incontinence in home hospice: A qualitative study. Palliat Med 2022; 36:135-141. [PMID: 34479463 DOI: 10.1177/02692163211043378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Urinary incontinence is prevalent among patients receiving home hospice and presents multiple care management challenges for nurses and family caregivers. AIM This study sought to understand how urinary incontinence influences the psychosocial care of patients receiving home hospice and the strategies that nurses employ to maximize patient and family comfort. DESIGN Qualitative descriptive study using semi-structured interviews. SETTING/PARTICIPANTS Nurses employed at a large not-for-profit hospice agency in New York City. RESULTS Analyses of 32 interviews revealed three primary themes. First, nurses considered urinary incontinence to be associated with multiple psychosocial issues including embarrassment for patients and caregiver burden. Second, nurses described urinary incontinence as a threat to patient dignity and took steps to preserve their continence function. Third, nurses assisted patients and their families to cope with urinary incontinence through normalization, reframing incontinence as part of the disease process, mobilizing caregiving assistance, and encouraging use of continence supplies such as diapers and liners. CONCLUSION Urinary incontinence influences the psychosocial care of patients receiving home hospice and nurses employ strategies to maximize patient and family comfort. Additional research is needed to examine the psychosocial benefits of facilitated discussions with patients and family members about incontinence, provision of caregiving support, and distribution of comprehensive incontinence supplies to patients with fewer resources.
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Affiliation(s)
- David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA.,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Michelina D Stoddard
- Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA.,Weill-Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Natalie Morgan
- Department of Sociology, Appalachian State University, Boone, NC, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | | | - Kathryn H Bowles
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA.,Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
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Noyori SS, Nakagami G, Sanada H. Non-invasive Urine Volume Estimation in the Bladder by Electrical Impedance-Based Methods: A Review. Med Eng Phys 2021; 101:103748. [DOI: 10.1016/j.medengphy.2021.103748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 11/29/2022]
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Noyori SS, Nakagami G, Noguchi H, Mori T, Sanada H. A Small 8-Electrode Electrical Impedance Measurement Device for Urine Volume Estimation in the Bladder. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7174-7177. [PMID: 34892755 DOI: 10.1109/embc46164.2021.9631032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Urinary incontinence is prevalent among elderly people. Recent studies have demonstrated the effectiveness of continence care based on urine volume measurement for elderly people who maintain their urinary storage function, but have difficulty feeling bladder fullness owing to dementia or neurological disorders. Electrical impedance measurement is a feasible technique that can be adopted in the diaper or underwear for continuous and unobtrusive urine volume measurements. We developed a small sensor device that can measure electrical impedance with a resolution of 0.017 Ω, which is sufficiently small to capture abdominal impedance alterations triggered by urine accumulation. The results obtained from a preliminary feasibility test in a young healthy volunteer suggested that the 8-electrode electrical impedance measurement with linear regression can estimate urine volume in the bladder in humans for the first time.Clinical Relevance-Continence care for elderly people is essential; however, it is a huge burden for nurses and caregivers, because it involves taking patients to the toilet or changing diapers. This study proposes a continuous and unobtrusive measurement device for urine volume in the bladder. Via continuous monitoring and bladder fullness alert, the device will enable nurses and caregivers to provide personalized continence care without hindering their routine care.
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14
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Ostaszkiewicz J, Dickson-Swift V, Hutchinson A, Wagg A. A concept analysis of dignity-protective continence care for care dependent older people in long-term care settings. BMC Geriatr 2020; 20:266. [PMID: 32727481 PMCID: PMC7392826 DOI: 10.1186/s12877-020-01673-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/23/2020] [Indexed: 12/25/2022] Open
Abstract
Background Although codes of conduct, guidelines and standards call for healthcare practitioners to protect patients’ dignity, there are widespread concerns about a lack of attention to the dignity of older people who need assistance with toileting, incontinence or bladder or bowel care in health or social care settings that provide long-term care. Incontinence and care dependence threatens patient dignity. The aim of this research was to explore, describe and explain the concept of dignity as it relates to continence care for older people requiring long-term care. Methods The first four steps of Rodgers evolutionary method of concept analysis were followed. First, a comprehensive and systematic search of databases and key guidelines about continence care was undertaken to identify empirical research about dignity and continence care in older people in facilities that provide permanent residential or inpatient care of older people for day-to-day living. Data were extracted on the authors, date, sample, country of origin, and key definitions, attributes, contexts and consequences from each included record. Findings were inductively analysed and grouped according to whether they were the key attributes and antecedents of dignity in relation to continence care or the consequences of undignified continence care. Results Of 625 articles identified, 18 were included in the final analysis. Fifty individual attributes were identified that were categorised in 6 domains (respect, empathy, trust, privacy, autonomy and communication). A further 15 were identified that related to the environment (6 physical and 9 social). Key consequences of undignified continence care were also identified and categorised into 3 levels of impact (resident/family member, staff or organisation). Conclusions This research resulted in a conceptual understanding of dignity that can be used as a value or guiding principle in an ethic of care for older people who need assistance with toileting, incontinence or bladder or bowel care in long-term care settings.
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Affiliation(s)
- Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research - Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, VIC, 3220, Australia. .,School of Nursing and Midwifery, Deakin University, Gheringhap St, Geelong, VIC, 3220, Australia. .,National Ageing Research Institute, P.O Box 2127, Royal Melbourne Hospital, 21, Melbourne, VIC, 3530, Australia.
| | - Virginia Dickson-Swift
- Centre for Quality and Patient Safety Research - Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, VIC, 3220, Australia.,School of Nursing and Midwifery, Deakin University, Gheringhap St, Geelong, VIC, 3220, Australia
| | - Alison Hutchinson
- Centre for Quality and Patient Safety Research - Monash Health Partnership, Institute for Healthcare Transformation, Deakin University, Burwood, VIC, 3125, Australia
| | - Adrian Wagg
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Suzuki M, Okochi J, Iijima K, Murata T, Kume H. Nationwide survey of continence status among older adult residents living in long-term care facilities in Japan: The prevalence and associated risk factors of incontinence and effect of comprehensive care on continence status. Geriatr Gerontol Int 2020; 20:285-290. [PMID: 31991532 DOI: 10.1111/ggi.13872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/22/2019] [Accepted: 01/04/2020] [Indexed: 12/15/2022]
Abstract
AIM This study aimed to identify the prevalence of urinary, fecal and double incontinence among Japanese residents aged ≥65 years living in long-term care facilities. Furthermore, the association between baseline characteristics and changes in toileting activity after a 3-month comprehensive care among older individuals was investigated. METHODS We examined the prevalence of incontinence and its significant predictors. The association between the Functional Independence Measure score at baseline and each type of incontinence (urinary, fecal or double incontinence) was examined using a logistic regression model. Similarly, the association between the Functional Independence Measure score at baseline and improvement in toileting activity after a 3-month comprehensive care was examined. RESULTS In total, 2517 residents (670 men and 1847 women) were recruited. The prevalence rates of urinary, fecal and double incontinence were 66.9%, 42.8% and 41.1%, respectively. In multivariate analysis, the sum of the motor subscales after removing four continence items and the sum of the cognitive subscales of the Functional Independence Measure score at baseline were significantly associated with all types of incontinence. The sum of the motor subscales after removing four continence items of the Functional Independence Measure score was associated with improved toileting activity. CONCLUSIONS This study presented the prevalence of urinary, fecal and double incontinence among residents living in long-term care facilities in Japan. The Functional Independence Measure items at baseline were associated with not only continence status, but also improved toileting activity after 3-month comprehensive care. Geriatr Gerontol Int 2020; 20: 285-290.
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Affiliation(s)
- Motofumi Suzuki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Jiro Okochi
- Tatsumanosato Long-Term Care Health Facility, Osaka, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Taro Murata
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Abstract
Normal bladder function is achieved by most in childhood. Stroke affects 15 million people worldwide every year, with incontinence affecting over half these individuals in the initial post-stroke phase. Statistically it has been shown that incontinence can increase the morbidity risk of stroke victims. The social taboo surrounding continence issues has been a challenge for many years with individuals experiencing shame and isolation. This article looks at the normal physiology associated with continence and stroke. It suggests possible treatment options during the post-stroke rehabilitation phase to encourage improved patient experience and professionals' confidence and knowledge base when treating this group of patients.
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Affiliation(s)
- Sharon Holroyd
- Lead Clinical Nurse Specialist, Calderdale Bladder and Bowel Service, Beechwood Community Health Centre, Halifax
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Li HC, Chen KM, Hsu HF. Modelling factors of urinary incontinence in institutional older adults with dementia. J Clin Nurs 2019; 28:4504-4512. [PMID: 31429131 DOI: 10.1111/jocn.15039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/04/2019] [Accepted: 08/03/2019] [Indexed: 12/15/2022]
Abstract
AIMS AND OBJECTIVES This study applied structural equation modelling to explore the relationships among agitated behaviours, depression, cognitive function and activities of daily living, as well as associations between these factors and urinary incontinence). BACKGROUND A high prevalence of urinary incontinence is found among institutional older adults with dementia. People with urinary incontinence suffer from increased financial burden and social isolation and experience reduced quality of life. DESIGN Cross-sectional correlational research. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. METHODS In total, 226 older adults with dementia were recruited through convenience sampling at 15 long-term care facilities in southern Taiwan. The urinary incontinence frequency, agitated behaviours, depression, cognitive function and activities of daily living were evaluated using bladder records, the Cohen-Mansfield Agitation Inventory, the Cornell Scale for Depression in Dementia, the Mini-Mental State Examination and the Barthel Index, respectively. RESULTS Activities of daily living performance was found to be significantly associated with urinary incontinence; however, age, cognitive function, depression and agitated behaviours were not significantly related to urinary incontinence. Age did not have effects on any of the variables tested in this model, whereas activities of daily living performance was significantly associated with cognitive function and depression. Results further showed that cognitive function and depression were mediators between activities of daily living and agitated behaviours. CONCLUSION Enhanced activities of daily living independency directly reduced urinary incontinence, improved cognitive function, decreased degrees of depression and indirectly reduced agitated behaviours. RELEVANCE TO CLINICAL PRACTICE The findings could serve as a valuable reference for long-term care facilities in providing effective urinary incontinence care and prevention to older adults with dementia.
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Affiliation(s)
- Hui-Chi Li
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - Kuei-Min Chen
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hui-Fen Hsu
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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Noyori S, Nakagami G, Noguchi H, Mori T, Sanada H. Unintentional body movement parameters and pulse rate variability parameters are associated with the desire to void. Med Eng Phys 2019; 68:116-121. [PMID: 31000454 DOI: 10.1016/j.medengphy.2019.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 03/22/2019] [Accepted: 03/31/2019] [Indexed: 11/19/2022]
Abstract
Urinary incontinence is highly prevalent in elderly populations with physical and cognitive impairment. For the assessment and care of urinary incontinence, the desire to void is important. We have developed a bed sensor system that non-invasively and unconstrainedly measures the parameter changes of unintentional body movements. This study is aimed to evaluate the validity of measurement by the sensor system and parameters in healthy adults. We conducted experiments on 29 healthy adult volunteers. The parameters were unintentional body movement derived from changes in center of gravity and pulse rate variability (PRV) based on pulse wave measurements using a finger probe; further the relationship between the desire to void and measured parameters were examined. The body movement parameters at the buttock and thigh were associated with the desire to void (p < 0.050). All the PRV parameters trended significantly with desire to void as well (p < 0.050). The parameters achieved sensitivities of 0.18-0.88 in estimating strong desire to void, and 7 among 14 sensitivity measurements included in the receiver operating characteristic analysis exceeded 0.70. The body movement parameters and PRV parameters were useful in the estimation of the desire to void in healthy adults. To achieve accurate estimation, a combination of the PRV parameters and body movement parameters is required.
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Affiliation(s)
- Shuhei Noyori
- Department of Gerontological Nursing/Wound Care Management, The Division of Health Sciences and Nursing, Graduate School of Medicine The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Graduate Program for Social ICT Global Creative Leaders, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan.
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, The Division of Health Sciences and Nursing, Graduate School of Medicine The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Hiroshi Noguchi
- Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Taketoshi Mori
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, The Division of Health Sciences and Nursing, Graduate School of Medicine The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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Suzuki M, Miyazaki H, Kamei J, Yoshida M, Taniguchi T, Nishimura K, Igawa Y, Sanada H, Homma Y. Ultrasound-assisted prompted voiding care for managing urinary incontinence in nursing homes: A randomized clinical trial. Neurourol Urodyn 2019; 38:757-763. [PMID: 30620134 PMCID: PMC6849834 DOI: 10.1002/nau.23913] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/21/2018] [Indexed: 01/09/2023]
Abstract
Aims To determine whether ultrasound‐assisted prompted voiding (USAPV) care is more efficacious than conventional prompted voiding (CPV) care for managing urinary incontinence in nursing homes. Methods Thirteen participating nursing homes in Japan were randomized to CPV (n = 7) or USAPV care group (n = 6). Residents of the allocated nursing homes received CPV (n = 35) or USAPV (n = 45) care for 8 weeks. In the CPV group, caregivers asked the elderly every 2‐3 h whether they had a desire to void and prompted them to void when the response was yes. In the USAPV group, caregivers regularly monitored bladder urine volume by an ultrasound device and prompted them to void when the volume reached close to the individually optimized bladder capacity. Frequency‐volume chart was recorded at the baseline and after the 8‐week intervention to measure the daytime urine loss. Results The change in daytime urine loss was statistically greater in the USAPV (median, −80.0 g) than in the CPV (median, −9.0 g; P = .018) group. The proportion of elderly individuals whose daytime urine loss decreased by >25% was 51% and 26% in the USAPV and CPV group, respectively (P = .020). Quality‐of‐life measures of elderly participants showed no significant changes in both groups. The care burden scale score of caregivers was unchanged in the USAPV group (P = .59) but significantly worsened in the CPV group (P = .010) after the intervention. Conclusions USAPV is efficacious and feasible for managing urinary incontinence in nursing homes.
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Affiliation(s)
- Motofumi Suzuki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hideyo Miyazaki
- Department of Urology, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Jun Kamei
- Department of Urology, Graduate School of Medicine, Jichi Medical University, Shimotsuke-city, Tochigi, Japan
| | - Mikako Yoshida
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tamami Taniguchi
- Graduate Faculty of Medicine, Department of Health and Life Support Nursing Science, University of Yamanashi, Chuo-city, Yamanashi, Japan
| | | | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yukio Homma
- Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
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20
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Quality of care to nursing home residents with incontinence. Geriatr Nurs 2018; 40:166-173. [PMID: 30322735 DOI: 10.1016/j.gerinurse.2018.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 11/22/2022]
Abstract
Quality of care for residents with urinary incontinence (UI) living in nursing facilities was analyzed using data collected from 815 facilities for the Nursing Facility Quality Review in Texas. Overall, of the 1,560 residents, 48.4% (n = 755) experienced UI. The risk of developing UI over a ten-year-period in a nursing facility was 6%. Only 54% of residents with UI had a care plan for their incontinence. For those with a UI plan in their chart, 143 (35%) had a person entered UI plan developed based on that resident's voiding pattern and needs. Further, the creation of a UI plan of care by a RN for a person with UI was associated with a higher perceived level of health after controlling for gender, and age. Finally, the more satisfied the resident was with the response to their calls for help with voiding the more satisfied with the nursing facility.
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21
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Yang E, Lisha NE, Walter L, Obedin-Maliver J, Huang AJ. Urinary Incontinence in a National Cohort of Older Women: Implications for Caregiving and Care Dependence. J Womens Health (Larchmt) 2018; 27:1097-1103. [PMID: 29902123 DOI: 10.1089/jwh.2017.6891] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urinary incontinence (UI) can interfere with older women's ability to perform activities of daily living (ADLs), but little is known about factors that predispose incontinent women to become functionally dependent or compromise their ability to serve as caregivers to others. STUDY DESIGN UI, caregiving, and care-receiving behaviors were assessed by questionnaire in a national sample of community-dwelling older women. Multivariable models evaluated associations between incontinence and care dependence, assessed factors associated with care dependence among incontinent women, and compared health among female caregivers with and without incontinence. RESULTS Of the 1703 women, 27% reported weekly or more incontinence and 13% monthly incontinence. Women with weekly or more incontinence were more likely than women without incontinence to report receiving care for ADLs (AOR = 2.39, CI = 1.61-3.56) or instrumental ADLs (AOR = 1.94, CI = 1.42-2.63). Compared to 46% of women without incontinence, 60% of women with monthly or weekly incontinence reported unmet care needs (p = 0.0002). Factors associated with care dependence included more frequent incontinence, older age, marital status, and fair/poor health (p < 0.05 for all). Overall, 15% of women served as a caregiver for another adult, which did not differ by incontinence status (p = 0.84), but female caregivers with incontinence reported worse health than those without incontinence (p = 0.0004). CONCLUSIONS In this national cohort, older women with incontinence were more likely to be functionally dependent and have unmet care needs than those without incontinence, after adjustment for other factors. At least one in ten incontinent women served as caregivers, despite having worse health than female caregivers without incontinence.
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Affiliation(s)
- Emmy Yang
- 1 Icahn School of Medicine at Mount Sinai , New York, New York
| | - Nadra E Lisha
- 2 Department of Medicine, University of California San Francisco , San Francisco, California
| | - Louise Walter
- 2 Department of Medicine, University of California San Francisco , San Francisco, California.,3 Division of Geriatrics, Veterans Affairs Medical Center , San Francisco, California
| | - Juno Obedin-Maliver
- 4 Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco , San Francisco, California.,5 Division of Gynecology, Veterans Affairs Medical Center , San Francisco, California
| | - Alison J Huang
- 2 Department of Medicine, University of California San Francisco , San Francisco, California
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22
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Lai CK, Wan X. Using Prompted Voiding to Manage Urinary Incontinence in Nursing Homes: Can It Be Sustained? J Am Med Dir Assoc 2017; 18:509-514. [DOI: 10.1016/j.jamda.2016.12.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/26/2016] [Accepted: 12/30/2016] [Indexed: 11/29/2022]
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23
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Applications of the propensity score weighting method in psychogeriatric research: correcting selection bias and adjusting for confounders. Int Psychogeriatr 2017; 29:703-706. [PMID: 28095944 DOI: 10.1017/s1041610216002490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The propensity score (PS) weighting method is an analytic technique that has been applied in multiple fields for a number of purposes. Here, we discuss two common applications, which are (1) to correct for selection bias and (2) to adjust for confounding variables when estimating the effect of an exposure variable on the outcome of interest.
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24
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Bladder Control Problems in Elders. TOPICS IN GERIATRIC REHABILITATION 2016. [DOI: 10.1097/tgr.0000000000000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Suzuki M, Iguchi Y, Igawa Y, Yoshida M, Sanada H, Miyazaki H, Homma Y. Ultrasound‐assisted prompted voiding for management of urinary incontinence of nursing home residents: Efficacy and feasibility. Int J Urol 2016; 23:786-90. [DOI: 10.1111/iju.13156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/31/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Motofumi Suzuki
- Department of Urology Tokyo Teishin Hospital Tokyo Japan
- Department of Urology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Yasuhiro Iguchi
- Megumi Long‐Term Care Health Facility Departments of Continence Medicine Tokyo Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Mikako Yoshida
- Life Support Technology (Molten) Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Hiromi Sanada
- Gerontological Nursing/Wound Care Management Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Hideyo Miyazaki
- Department of Urology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Yukio Homma
- Department of Urology Graduate School of Medicine The University of Tokyo Tokyo Japan
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26
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Roig JJ, Souza DLBD, Lima KC. Urinary incontinence in institutionalized elderly: prevalence and impact on quality of life. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.003.ao17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AbstractIntroduction Urinary incontinence is a geriatric syndrome that generates strong economic and social impacts as well as emotional changes and negative consequences for the health of the elderly.Objective The objective of this work was to identify the prevalence of urinary incontinence and its associated factors, as well as its impact on quality of life of institutionalized elderly.Materials and methods A cross-sectional study was conducted herein, with 10 long-term institutions for the elderly of the municipality of Natal (Northeast Brazil). The Minimum Data Set was completed by caregivers to determine the presence of incontinence, and the Short Form of the International Consultation on Incontinence Questionnaire was answered by the elderly, to assess the frequency and amount of urinary leakage, the impact on quality of life, and the type of incontinence. The chi-square test and Fisher’s exact test were applied in the bivariate analysis, and logistic regression was utilized for multivariate analysis.Results The prevalence of urinary incontinence was 42.7% (95% CI: 34.8–50.8). The impact of this condition on daily life was mild in 46.5% of cases, moderate for 29.3% of cases, and severe in 24.1% of cases. The condition was associated with functional impairment (p < 0.001; RP: 4.13).Final considerations The prevalence of urinary incontinence in this sample, which presented cognitive ability to answer questionnaires, was over 40% with a high degree of severity. Approximately half of the incontinents referred a moderate-severe impact of incontinence. Control measures for this geriatric syndrome within the institutions are important to delay the decline of health and improve the quality of life of the residents.
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Affiliation(s)
- Javier Jerez Roig
- Universidade Federal do Rio Grande do Norte, Brazil; Hospital Can Misses, Spain
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Xu D, Liu N, Qu H, Chen L, Wang K. Relationships among symptom severity, coping styles, and quality of life in community-dwelling women with urinary incontinence: a multiple mediator model. Qual Life Res 2015. [PMID: 26198664 DOI: 10.1007/s11136-015-1070-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the relationships among symptom severity, coping styles, and quality of life (QOL) in community-dwelling women with urinary incontinence (UI). METHODS A total of 592 women with UI participated in this cross-sectional study. Bivariate Pearson's correlation was used to examine the correlations between symptom severity, coping styles, and QOL. Multivariate regression models and Sobel tests were used to test the mediating effect of coping styles. Additionally, a multiple mediator model was used to examine the mediating role of coping styles collectively. All regression models were adjusted for age, education, marital status, income, duration of UI, and type of UI. RESULTS Participants tended to use avoidant and palliative coping styles and not use instrumental coping style. Avoidant and palliative coping styles were associated with poor QOL, and partially mediated the association between symptom severity and QOL. Nearly 73% of the adverse effect of symptom severity on QOL was mediated by avoidant and palliative coping styles. CONCLUSIONS The use of avoidant and palliative coping styles was higher with more severe urine leakage, and QOL tended to be poorer. Coping styles should be addressed in UI management. It may be of particular value to look closely at negative coping styles and implement education and training of patients in improving their coping skills related to managing UI, which will in turn improve their QOL.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, China.,School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Nana Liu
- School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, China
| | - Haili Qu
- Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Liqin Chen
- School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, China
| | - Kefang Wang
- School of Nursing, Shandong University, No. 44, Wenhua Xi Road, Jinan, Shandong, China.
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Orme S, Morris V, Gibson W, Wagg A. Managing Urinary Incontinence in Patients with Dementia: Pharmacological Treatment Options and Considerations. Drugs Aging 2015; 32:559-67. [DOI: 10.1007/s40266-015-0281-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Iden KR, Ruths S, Hjørleifsson S. Residents' perceptions of their own sadness--a qualitative study in Norwegian nursing homes. BMC Geriatr 2015; 15:21. [PMID: 25888453 PMCID: PMC4356108 DOI: 10.1186/s12877-015-0019-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mood symptoms are highly prevalent among frail old people residing in nursing homes. Systematic diagnostics of depression is scarce, and treatment is not always in accordance with best evidence. The distinction between non-pathological sadness and depression may be challenging, and we know little of the older peoples' perspectives. The aim of this qualitative interview study was to explore residents' perceptions of their own sadness. METHODS We performed individual, semi-structured interviews with twelve older people residing in nursing homes with no dementia. The interview guide comprised questions on what made the informants sad and what prevented sadness. We recorded, transcribed verbatim and analysed the interviews using systematic text condensation. RESULTS The interviews revealed three main themes. I. Decay and loss of agency. The informants perceived their sadness to be caused by loss of health and functional ability, reliance on long-term care, dysfunctional technical aids and poor care. II. Loneliness in the middle of the crowd. Loss of family and friends, and lack of conversations with staff members and fellow patients were also sources of sadness. III. Relating and identity. The informants kept sadness at bay through: acceptance and re-orientation to their current life situation, maintaining narratives about their identity and belonging, and religiosity. CONCLUSIONS Nursing home nurses and doctors should identify and respond to sadness that is a rational response to manageable causes. Further, identifying and supporting residents' resources and coping strategies is a salutogenetic approach that may alleviate sadness.
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Affiliation(s)
- Kristina Riis Iden
- Research Unit for General Practice, Uni Research Health, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Sabine Ruths
- Research Unit for General Practice, Uni Research Health, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Stefan Hjørleifsson
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
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30
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Ranson RN, Saffrey MJ. Neurogenic mechanisms in bladder and bowel ageing. Biogerontology 2015; 16:265-84. [PMID: 25666896 PMCID: PMC4361768 DOI: 10.1007/s10522-015-9554-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/28/2015] [Indexed: 01/18/2023]
Abstract
The prevalence of both urinary and faecal incontinence, and also chronic constipation, increases with ageing and these conditions have a major impact on the quality of life of the elderly. Management of bladder and bowel dysfunction in the elderly is currently far from ideal and also carries a significant financial burden. Understanding how these changes occur is thus a major priority in biogerontology. The functions of the bladder and terminal bowel are regulated by complex neuronal networks. In particular neurons of the spinal cord and peripheral ganglia play a key role in regulating micturition and defaecation reflexes as well as promoting continence. In this review we discuss the evidence for ageing-induced neuronal dysfunction that might predispose to neurogenic forms of incontinence in the elderly.
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Affiliation(s)
- Richard N Ranson
- Department of Applied Sciences (Biomedical Sciences), Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK,
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31
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Hsu A, Conell-Price J, Stijacic Cenzer I, Eng C, Huang AJ, Rice-Trumble K, Lee SJ. Predictors of urinary incontinence in community-dwelling frail older adults with diabetes mellitus in a cross-sectional study. BMC Geriatr 2014; 14:137. [PMID: 25514968 PMCID: PMC4274753 DOI: 10.1186/1471-2318-14-137] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/11/2014] [Indexed: 12/17/2022] Open
Abstract
Background Diabetes mellitus is a potent risk factor for urinary incontinence. Previous studies of incontinence in patients with diabetes have focused on younger, healthier patients. Our objective was to characterize risk factors for urinary incontinence among frail older adults with diabetes mellitus in a real-world clinical setting. Methods We performed a cross-sectional analysis on enrollees at On Lok (the original Program for All-Inclusive Care of the Elderly) between October 2004 and December 2010. Enrollees were community-dwelling, nursing home-eligible older adults with diabetes mellitus (N = 447). Our outcome was urinary incontinence measures (n = 2602) assessed every 6 months as “never incontinent”, “seldom incontinent” (occurring less than once per week), or “often incontinent” (occurring more than once per week). Urinary incontinence was dichotomized (“never” versus “seldom” and “often” incontinent). We performed multivariate mixed effects logistic regression analysis with demographic (age, gender and ethnicity), geriatric (dependence on others for ambulation or transferring; cognitive impairment), diabetes-related factors (hemoglobin A1c level; use of insulin and other glucose-lowering medications; presence of renal, ophthalmologic, neurological and peripheral vascular complications), depressive symptoms and diuretic use. Results The majority of participants were 75 years or older (72%), Asian (65%) and female (66%). Demographic factors independently associated with incontinence included older age (OR for age >85, 3.13, 95% CI: 2.15-4.56; Reference: Age <75) and African American or other race (OR 2.12, 95% CI: 1.14-3.93; Reference: Asian). Geriatric factors included: dependence on others for ambulation (OR 1.48, 95% CI: 1.19-1.84) and transferring (OR 2.02, 95% CI: 1.58-2.58) and being cognitively impaired (OR 1.41, 95% CI: 1.15-1.73). Diabetes-related factors associated included use of insulin (OR 2.62, 95% CI: 1.67-4.13) and oral glucose-lowering agents (OR 1.81, 95% CI: 1.33-2.45). Urinary incontinence was not associated with gender, hemoglobin A1c level or depressive symptoms. Conclusions Geriatric factors such as the inability to ambulate or transfer independently are important predictors of urinary incontinence among frail older adults with diabetes mellitus. Clinicians should address mobility and cognitive impairment as much as diabetes-related factors in their assessment of urinary incontinence in this population.
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Affiliation(s)
- Amy Hsu
- VA Quality Scholars Fellow, Geriatrics and Extended Care, San Francisco VA Medical Center, 4150 Clement Street, 181G, San Francisco, CA 94122, USA.
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Managing therapeutic competition in patients with heart failure, lower urinary tract symptoms and incontinence. Drugs Aging 2014; 31:93-101. [PMID: 24357134 PMCID: PMC3907694 DOI: 10.1007/s40266-013-0145-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Up to 50 % of heart failure patients suffer from lower urinary tract symptoms. Urinary incontinence has been associated with worse functional status in patients with heart failure, occurring three times more frequently in patients with New York Heart Association Class III and IV symptoms compared with those with milder disease. The association between heart failure and urinary symptoms may be directly attributable to worsening heart failure pathophysiology; however, medications used to treat heart failure may also indirectly provoke or exacerbate urinary symptoms. This type of drug–disease interaction, in which the treatment for heart failure precipitates incontinence, and removal of medications to relieve incontinence worsens heart failure, can be termed therapeutic competition. The mechanisms by which heart failure medication such as diuretics, angiotensin-converting enzyme (ACE) inhibitors and β-blockers aggravate lower urinary tract symptoms are discussed. Initiation of a prescribing cascade, whereby antimuscarinic agents or β3-agonists are added to treat symptoms of urinary urgency and incontinence, is best avoided. Recommendations and practical tips are provided that outline more judicious management of heart failure patients with lower urinary tract symptoms. Compelling strategies to improve urinary outcomes include titrating diuretics, switching ACE inhibitors, treating lower urinary tract infections, appropriate fluid management, daily weighing, and uptake of pelvic floor muscle exercises.
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Epidemiology, Evaluation, and Treatment of Urinary Incontinence in Octogenarian Women. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0247-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shippee TP, Henning-Smith C, Kane RL, Lewis T. Resident- and Facility-Level Predictors of Quality of Life in Long-Term Care. THE GERONTOLOGIST 2013; 55:643-55. [PMID: 24352532 DOI: 10.1093/geront/gnt148] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 10/28/2013] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Although there is substantial research on quality of care in nursing homes (NH), less is known about what contributes to quality of life (QOL) for NH residents. This study assesses multiple domains of QOL and examines facility- and resident-level correlates for different domains. DESIGN AND METHODS Data come from (a) self-reported resident interviews using a multidimensional measure of QOL; (b) resident clinical data from the Minimum Data Set; and (c) facility-level characteristics from Minnesota Department of Human Services. We used factor analysis to confirm domains of QOL, and then employed cross-sectional hierarchical linear modeling to identify significant resident- and facility-level predictors of each domain. RESULTS We examined six unique domains of QOL: environment, personal attention, food, engagement, negative mood, and positive mood. In multilevel models, resident-level characteristics were more reliable correlates of QOL than facility characteristics. Among resident characteristics, gender, age, marital status, activities of daily living, mood disorders, cognitive limitations, and length of stay consistently predicted QOL domains. Among facility characteristics, size, staff hours, quality of care, and percent of residents on Medicaid predicted multiple QOL domains. IMPLICATIONS Examining separate domains rather than a single summary score makes associations with predictors more accurate. Resident characteristics account for the majority of variability in resident QOL. Helping residents maintain functional abilities, and providing an engaging social environment may be particularly important in improving QOL.
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Affiliation(s)
- Tetyana P Shippee
- Division of Health Policy and Management, University of Minnesota, Minneapolis.
| | | | - Robert L Kane
- Division of Health Policy and Management, University of Minnesota, Minneapolis
| | - Teresa Lewis
- Minnesota Department of Human Services, Division of Nursing Facility Rates and Policy, St. Paul
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