Lower urinary tract symptoms and falls risk among older women receiving home support: a prospective cohort study

Prevalence of LUTS in young female population attending tertiary care centre

OBJECTIVE

To obtain the prevalence of lower urinary tract symptoms (LUTS) in young female population in tertiary care centre.

METHOD

We conducted a descriptive and analytic study with ques tionnaire based data collection. All subjects were interviewed using conventional method and International Consultation on Incontinence Questionnaire (ICIQ) Female LUTS form in the urology outpatient department, SMS medical college and hospital, Jaipur (India).

RESULT

Total 1278 patients enrolled in study. Using the well-structured questionnaire using ICIQ-FLUTS form, the prevalence of LUTS was 78.01% while conventional method having only 35.8%. This result revealed that LUTS is a common condition among young Indian female population with vaginal delivery as the common risk factor.

CONCLUSION

Screening for LUTS using a structured questionnaire identified a significantly higher prevalence of LUTS than the conventional method. The ICIQ-FLUTS form is a robust questionnaire that can be recommended for use in epidemiological research as well as routine clinical practice.

Benefits of a digital health technology for older nursing home residents. A de-novo cost-effectiveness model for digital health technologies to aid in the assessment of toileting and containment care needs

The aim of this study was first, to introduce a comprehensive, de-novo health economic (HE) model incorporating the full range of activities involved in toileting and containment care (T&CC) for people with incontinence, capturing all the potential benefits and costs of existing and future Digital Health Technologies (DHT) aimed at improving continence care, for both residential care and home care. Second, to use this novel model to evaluate the cost-effectiveness of the DHT TENA SmartCare Identifi in the implementation of person-centred continence care (PCCC), compared with conventional continence care for Canadian nursing home residents. The de-novo HE model was designed to evaluate technologies across different care settings from the perspective of several stakeholders. Health states were based on six care need profiles with increasing need for toileting assistance, three care stages with varying degrees of toileting success, and five levels of skin health. The main outcomes were incremental costs and quality-adjusted life years. The effectiveness of the TENA SmartCare Identifi was based primarily on trial data combined with literature and expert opinion where necessary. Costs were reported in CAD 2020. After 2 years, 21% of residents in the DHT group received mainly toileting as their continence care strategy compared with 12% in the conventional care group. Conversely, with the DHT 15% of residents rely mainly on absorbent products for incontinence care, compared with 40% with conventional care. On average, residents lived for 2.34 years, during which the DHT resulted in a small gain in quality-adjusted life years of 0.015 and overall cost-savings of $1,467 per resident compared with conventional care. Most cost-savings were achieved through reduced costs for absorbent products. Since most, if not all, stakeholders gain from use of the DHT-assisted PCCC, widespread use in Canadian residential care facilities should be considered, and similar assessments for other countries encouraged.

A non-interventional cross-sectional re-contact study investigating the relationship between overactive bladder and frailty in older adults in Japan

Background

Increasing age is associated with frailty and a higher prevalence of overactive bladder (OAB). Given the rapidly increasing proportion of older adults in Japan, a better understanding of the relationship between frailty and OAB is needed to inform future healthcare planning. This study assessed the association between frailty and OAB in older adults in Japan and evaluated the impact on their health-related quality of life (HRQoL).

Methods

This was a cross-sectional re-contact study of respondents who previously completed the National Health and Wellness Survey 2018 in Japan. Participants were aged ≥65 years and Japanese speakers and readers. As part of a customized online survey, participants were screened for frailty using the Kihon Checklist (frail = scores ≥8 points) and OAB using the overactive bladder symptom score (OAB = total score ≥ 3 points and ≥ 2 points on question 3). The primary endpoint was the odds ratio of frailty in older adults with and without OAB assessed using a multivariable logistic regression model. Secondary endpoints were the prevalence rates of OAB and frailty. Exploratory endpoints assessed HRQoL using the Medical Outcomes Study 12-Item Short Form Survey Instrument version 2 (SF-12v2).

Results

Overall, 2953 participants were included: 150 (5.1%) were frail OAB, 416 (14.1%) non-frail OAB, 287 (9.7%) frail non-OAB, and 2100 (71.1%) non-frail non-OAB. There was a statistically significant correlation between frailty and OAB demonstrated by an adjusted odds ratio (95% CI) of 2.78 (2.18–3.54; p <  0.001). The prevalence (95% CI) of OAB was 34.3% (29.9–38.8) in frail and 16.5% (15.1–18.0) in non-frail older adults; the prevalence of frailty was 26.5% (22.9–30.1) and 12.0% (10.7–13.3) in older adults with and without OAB. HRQoL was assessed in 150 participants per group. The adjusted HRQoL analyses showed significantly lower scores in participants who were frail OAB vs. frail non-OAB for most of the SF-12v2 scores/sub-component scores.

Conclusions

These data highlight the statistically significant positive correlation between frailty and OAB among older adults in Japan and may provide valuable information on the burden of OAB and frailty on older adults to healthcare professionals when considering future healthcare planning.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02756-7.

[Quality of life for wearers of a suprapubic or transurethral bladder catheter as lifelong permanent care]

Hintergrund

Die Anlage eines transurethralen Dauerkatheters (DK) oder suprapubischen Harnblasenkatheters (SPK) in lebenslanger Indikation stellt einen Eingriff mit relevanten Komplikationen, Komorbiditäten und möglichen Auswirkungen auf die katheterassoziierte Lebensqualität des Betroffenen dar. Letztere wurde aber bisher noch nicht untersucht.

Methodik

Zur Anwendung kam ein validiertes Assessment zur katheterbezogenen Lebensqualität mit 25 Items in 5 Domänen. Befragt wurden im Rahmen eines Katheterwechsels Patienten mit einem DK oder SPK in lebenslanger Intention, die diesen mindestens 3 Monate trugen.

Ergebnisse

Fragebögen von 357 Patienten, davon 260 Männer und 97 Frauen, 193 mit SPK und 162 mit DK (2 ohne Angabe) lagen vor. Patienten mit DK waren mit 78,9 ± 11,1 Jahren signifikant älter als solche mit SPK mit 74,4 ± 12,6 Jahren (p < 0,001). Der mittlere Gesamtlebensqualitätsscore lag bei 4,1 ± 0,9 Punkten auf einer Skala von 1 (maximal beeinträchtigte Lebensqualität) bis 5 (keine Beeinträchtigung der Lebensqualität). Es zeigten sich u. a. mit niedrigeren Scores eine vermehrte Angst vor Katheterlecks, Angst vor Uringeruch und Harnwegsinfektionen und vor schmerzhaften Katheterwechseln. Diese Sorgen waren v. a. bei Frauen, solchen mit Harninkontinenz, Trägern eines Katheters ≥ 18 Ch und bei Patienten < 70 Jahren vorhanden. Frauen mit einem SPK wiesen eine schlechtere Bewertung ihrer Lebensqualität als Männer mit SPK auf.

Schlussfolgerung

Die gefundenen Ergebnisse sollten in die Aufklärung zu einer lebenslangen Katheterableitung einfließen bzw. im Kontext möglicher Alternativen wie z. B. einer operativen Desobstruktion oder einer Hilfsmittelversorgung mit dem Patienten bzw. Betreuungspersonen besprochen werden.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00120-021-01642-1) enthält weitere Tabellen mit detaillierten Ergebnissen der Fragen der 5 abgefragten Domänen.

Computer-controlled closed-loop drug infusion system for automated hemodynamic resuscitation in endotoxin-induced shock

Background

Hemodynamic resuscitation in septic shock requires aggressive fluid replacement and appropriate use of vasopressors to optimize arterial pressure (AP) and cardiac output (CO). Because responses to these drugs vary between patients and within patient over time, strict monitoring of patient condition and repetitive adjustment of drug dose are required. This task is time and labor consuming, and is associated with poor adherence to resuscitation guidelines. To overcome this issue, we developed a computer-controlled closed-loop drug infusion system for automated hemodynamic resuscitation in septic shock, and evaluated the performance of the system in a canine model of endotoxin shock.

Methods

Our system monitors AP, CO and central venous pressure, and computes arterial resistance (R), stressed blood volume (V) and Frank-Starling slope of left ventricle (S). The system controls R with noradrenaline (NA), and V with Ringer’s acetate solution (RiA), thereby controlling AP and CO. In 4 dogs, AP and CO were measured invasively. In another 4 dogs, AP and CO were measured less invasively using clinically acceptable modalities, aiming to make the system clinically feasible. In all 8 dogs, endotoxin shock was induced by injecting Escherichia coli lipopolysaccharide, which significantly decreased AP from 95 (91–108) to 43 (39–45) mmHg, and CO from 112 (104–142) to 62 (51–73) ml·min⁻¹·kg⁻¹. The system was then connected to the dogs, and activated. System performance was observed over a period of 4 h.

Results

Our system immediately started infusions of NA and RiA. Within 40 min, RiA increased V to target level, and NA maintained R at target level, while S was concomitantly increased. These resulted in restoration of AP to 70 (69–71) mmHg and CO to 130 (125–138) ml·min⁻¹·kg⁻¹. Median of absolute performance error, an index of precision of control, was small in AP [2.5 (2.1–4.5) %] and CO [2.4 (1.4–5.5) %], which were not increased even when the variables were measured less invasively.

Conclusions

In a canine model of endotoxin shock, our system automatically improved and maintained AP and CO at their target values with small performance error. Our system is potentially an attractive clinical tool for rescuing patients with septic shock.

Electronic supplementary material

The online version of this article (10.1186/s12871-017-0437-9) contains supplementary material, which is available to authorized users.

Associations Between Bladder Dysfunction and Falls in People with Relapsing-Remitting Multiple Sclerosis

BACKGROUND

Bladder dysfunction and falls are common in people with multiple sclerosis (MS), but associations between these problems are unclear. We sought to clarify the association between specific types of bladder dysfunction and prospectively recorded falls in people with MS.

METHODS

Fifty-one people aged 18 to 50 years with relapsing-remitting MS and mild-to-moderate disability (Expanded Disability Status Scale score ≤6.0) completed a self-report questionnaire regarding urinary incontinence, urgency, and frequency at baseline and then prospectively recorded their falls daily for 3 months using fall calendars. Participants were classified as recurrent fallers (two or more falls) or nonrecurrent fallers (fewer than 2 falls) for one regression model and then as fallers (one or more falls) or nonfallers (no falls) for another regression model. Associations between baseline bladder dysfunction and faller status were assessed using logistic regression adjusted for the potential confounders of age, sex, and disability.

RESULTS

Fifteen participants were recurrent fallers, 36 were nonrecurrent fallers, 32 were fallers, and 19 were nonfallers. After adjusting for age, sex, and disability, there was a significant association between urinary urgency with incontinence and recurrent falls in the 3 months after baseline (odds ratio, 57.57; 95% CI, 3.43-966.05; P = .005).

CONCLUSIONS

Urinary urgency with incontinence is associated with recurrent falls in people with relapsing-remitting MS with mild-to-moderate disability. Further research is needed to better understand the mechanisms underlying this association and to evaluate the effect of bladder management programs on falls.

Nocturia is often inadequately assessed, diagnosed and treated by physicians: results of an observational, real-life practice database containing 8659 European and US-American patients

AIMS

The aim of this study was to investigate the quality and timing of the diagnosis and treatment of nocturia in real-life practice in European and US-American patients to obtain better insights into the management of nocturia in different Western healthcare systems.

METHODS

Data were drawn from the "LUTS Disease Specific Programme," a real-life survey of physicians and patients in France, Germany, Spain, UK and the USA. Physicians completed a patient record form for lower urinary tract symptoms (LUTS) patients. Patients filled out a self-completion form, indicating - among other items - information on the mean number of day- and night-time voids during the last 7 days, and questions on the management of LUTS in daily practice.

RESULTS

In total, 8659 patients were analysed. The majority of patients initially consulted a physician because of worsening of LUTS frequency (43%-58%) or severity (44%-55%). Only 37% of all LUTS diagnoses, regardless of the appearance or severity of nocturia, were based on bladder diaries. Patients took approximately 1 year to consult a medical professional following the onset of LUTS. At the initial visit, most patients received advice on behavioural strategies. Regardless the type of LUTS and physician, 59% of men received α-blockers and 76% of women antimuscarinics.

CONCLUSIONS

Data show that patients with nocturia and LUTS accept their symptoms for a considerable period before they seek help or ultimately receive treatment. They may therefore be enduring significant negative impact on their quality-of-life which could be avoided. Physicians rarely use bladder diaries and primarily use antimuscarinics (women) or α-blockers (men). Improved awareness of nocturia among patients and physicians could improve the management of nocturia.

Urinary Incontinence as a Predictor of Death: A Systematic Review and Meta-Analysis

Background

The association between urinary incontinence (UI) and increased mortality remains controversial. The objective of our study was to evaluate if this association exists.

Methods

We performed a systematic review and meta-analysis of observational studies comparing death rates among patients suffering from UI to those without incontinence. We searched in Medline, Embase and the Cochrane library using specific keywords. Studies exploring the post-stroke period were excluded. Hazard ratios (HR) were pooled using models with random effects. We stratified UI by gender and by UI severity and pooled all models with adjustment for confounding variables.

Results

Thirty-eight studies were retrieved. When compared to non-urinary incontinent participants, UI was associated with an increase in mortality with pooled non adjusted HR of 2.22 (95%CI 1.77–2.78). The risk increased with UI severity: 1.24 (95%CI: 0.79–1.97) for light, 1.71 (95%CI: 1.26–2.31) for moderate, and 2.72 (95%CI: 1.90–3.87) for severe UI respectively. When pooling adjusted measures of association, the resulting HR was 1.27 (95%CI: 1.13–1.42) and increased progressively for light, moderate and severe UI: 1.07 (95%CI: 0.79–1.44), 1.25 (95%CI: 0.99–1.58), and 1.47 (95%CI: 1.03–2.10) respectively. There was no difference between genders.

Conclusion

UI is a predictor of higher mortality in the general and particularly in the geriatric population. The association increases with the severity of UI and persists when pooling models adjusted for confounders. It is unclear if this association is causative or just reflects an impaired general health condition. As in most meta-analyses of observational studies, methodological issues should be considered when interpreting results.

Advancing a Comprehensive Approach to the Study of Lower Urinary Tract Symptoms

PURPOSE

Lower urinary tract symptoms are common in the United States population, leading to significant economic, quality of life and public health issues. The burden will increase as the population ages, and risk factors for lower urinary tract symptoms, including diabetes and obesity, remain highly prevalent. Improving clinical management and establishing the knowledge base to prevent lower urinary tract symptoms will require a comprehensive research approach that examines factors beyond the lower urinary tract. While the study of extra-lower urinary tract factors has increased recently, current urological research does not systematically account for the broad set of potential contributing factors spanning biological, behavioral, psychological/executive function and sociocultural factors. A comprehensive assessment of potential contributors to risk, treatment response and progression is necessary to reduce the burden of this condition in the United States.

MATERIALS AND METHODS

We considered challenges to continuing the predominantly lower urinary tract dysfunction centric approach that has dominated previous research of lower urinary tract symptoms.

RESULTS

We developed a new, comprehensive framework for urology research that includes a broader set of potential factors contributing to lower urinary tract symptoms. This framework aims to broaden research to consider a comprehensive set of potential contributing factors and to engage a broad range of researchers in the investigation of as many extra-lower urinary tract factors as possible, with the goal of improving clinical care and prevention.

CONCLUSIONS

We propose a new framework for future urology research, which should help to reduce the medical and economic burden of lower urinary tract symptoms in the United States population.

Toileting behaviour and related health beliefs among Chinese female nurses

AIMS

To investigate the toileting behaviours that female nurses used to empty their bladders, health beliefs related to toileting behaviour and the relationships between the health beliefs and toileting behaviour based on the Health Belief Model.

METHODS

A stratified cluster sampling strategy was used to recruit 636 female nurses from three tertiary hospitals in China. Reliable and valid questionnaires were used to assess female nurses' toileting behaviour and health beliefs related to toileting behaviour. The structural equation model was applied to explore the relationships between health belief constructs and toileting behaviour.

RESULTS

The most common unhealthy toileting behaviour was that of delayed voiding. More than half of the nurses (53.6%) often or always delayed emptying their bladders when they were busy. Approximately one-third of female nurses often or always crouched over the toilet to empty their bladders when not at home. Nearly two-thirds often or always worried about the cleanliness of public toilets. Of all the participants, 67.5% of female nurses had at least one type of lower urinary tract symptom (LUTS); however, the majority did not believe that they were susceptible to these symptoms. Moreover, they had misconceptions that premature voiding would reduce the risk, relieve the symptoms and prevent the recurrence of LUTS.

CONCLUSIONS

Many female nurses engaged in unhealthy toileting behaviours and might not know what types of toileting behaviours are healthy. Nurses play an important role in patient education and are a major source of health information for society. It is particularly important to look more closely at toileting behaviour among nurses and implement education and training to promote healthy toileting behaviour and, in turn, optimise bladder health.

Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands

Objective

Incontinence is an important health problem. Effectively treating incontinence could lead to important health gains in patients and caregivers. Management of incontinence is currently suboptimal, especially in elderly patients. To optimise the provision of incontinence care a global optimum continence service specification (OCSS) was developed. The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands.

Method

A decision analytic model was developed comparing the current care pathway for urinary incontinence in the Netherlands with the pathway as described in the OCSS. The new care strategy was operationalised as the appointment of a continence nurse specialist (NS) located with the general practitioner (GP). This was assumed to increase case detection and to include initial assessment and treatment by the NS. The analysis used a societal perspective, including medical costs, containment products (out-of-pocket and paid by insurer), home care, informal care, and implementation costs.

Results

With the new care strategy a QALY gain of 0.005 per patient is achieved while saving €402 per patient over a 3 year period from a societal perspective. In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%), or receive care for containment only. In both of these groups no health gains were achieved.

Conclusion

Implementing the OCSS in the Netherlands by locating a NS in the GP practice is likely to reduce incontinence, improve quality of life, and reduce costs. Furthermore, the study also highlighted that various areas of the continence care process lack data, which would be valuable to collect through the introduction of the NS in a study setting.

Factors Affecting Gynecologic and Sexual Assessment in Older Women: A Lesson for Primary Care Providers

Guidelines for screening of cervical cancer and pelvic exams for older women have recently changed. These changes may have unexpected sequelae in women over 65 years of age. This manuscript provides a review of gynecologic screening recommendations for older women in the U.S. and potential ramifications of these recent changes. Peer reviewed guidelines from the American College of Obstetrics and Gynecology, U.S. Preventative Task Force Services, the American Cancer Society, The Centers for Disease Control, and multiple original research articles and reviews were reviewed for this manuscript. Women over 65 are at greatest risk to develop late stage diagnoses of cancers, pelvic organ disease, incontinence, and infections. Clinicians will need to acutely consider this fact when communicating and screening this population. We conclude that practitioners should be aware of the new guidelines and should consider including gynecologic health history and symptom analysis as part of annual exams in women of all ages.

Urinary incontinence in the prediction of falls in hospitalized elderly

Objective Analyzing the effect of urinary incontinence as a predictor of the incidence of falls among hospitalized elderly. Method Concurrent cohort study where 221 elderly inpatients were followed from the date of admission until discharge, death or fall. The Kaplan-Meier methods, the incidence density and the Cox regression model were used for the survival analysis and the assessment of the association between the exposure variable and the other variables. Results Urinary incontinence was a strong predictor of falls in the surveyed elderly, and was associated with shorter time until the occurrence of event. Urinary incontinence, concomitant with gait and balance dysfunction and use of antipsychotics was associated with falls. Conclusion Measures to prevent the risk of falls specific to hospitalized elderly patients who have urinary incontinence are necessary.