1
|
Gaddis K, Woollen KC, Johnson LJ, Flaherty T, Byrnes JF. A structural vulnerability approach to older adult suicides: Trends and potential impacts of the COVID-19 pandemic in Clark County, NV (2017-2021). Forensic Sci Int Synerg 2024; 8:100454. [PMID: 38304716 PMCID: PMC10830507 DOI: 10.1016/j.fsisyn.2024.100454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 11/30/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024]
Abstract
The ongoing SARS-CoV-2 (COVID-19) pandemic has affected all aspects of life in the United States and around the world. This is particularly true for marginalized and vulnerable groups who face disproportionate levels of violence and premature death within their communities. While general impacts of the pandemic have been well-studied overall, little has been done to examine the correlation between COVID-19 and the risk of suicide among older adults. Older adults are particularly at risk because they face challenges including ageism, inadequate support systems, unreliable transportation, and frequent social isolation. Medicolegal casework offers a unique vantage of these issues, as it aims to identify manner of death which may be influenced by underlying structural vulnerabilities. The current research draws upon data collected from the Clark County Office of the Coroner/Medical Examiner. A sample of 871 older adults (aged 50+), whose manner of death was deemed a suicide between the years 2017-2021, were included in this analysis. Statistical analyses investigated differences between adults aged 50-64, 65-84, and 85+ years. Results suggest statistically significant changes in mechanism of death between pre-pandemic and pandemic periods, indicating a shift in risk factors related to social isolation and the home environment. Understanding such changes in trends directly affects the interpretation of skeletal data in forensic anthropology and thus, should be taken into consideration when developing structural vulnerability profiles. Furthermore, the inclusion of a structural vulnerability approach in forensic case reports has the potential to provide additional context for deaths by suicide and may help develop policies and procedures for mitigating future risk.
Collapse
Affiliation(s)
- Katherine Gaddis
- University of Nevada, Las Vegas, 4505 S. Maryland Pkwy., Las Vegas, NV, 89154, USA
| | - Katharine C. Woollen
- University of Nevada, Las Vegas, 4505 S. Maryland Pkwy., Las Vegas, NV, 89154, USA
| | - Liam J. Johnson
- University of Nevada, Las Vegas, 4505 S. Maryland Pkwy., Las Vegas, NV, 89154, USA
| | - Taylor Flaherty
- University of Nevada, Las Vegas, 4505 S. Maryland Pkwy., Las Vegas, NV, 89154, USA
| | - Jennifer F. Byrnes
- University of Nevada, Las Vegas, 4505 S. Maryland Pkwy., Las Vegas, NV, 89154, USA
| |
Collapse
|
2
|
Russell SG, Quigley R, Thompson F, Sagigi B, Miller G, LoGiudice D, Smith K, Strivens E, Pachana NA. Culturally Appropriate Assessment of Depression and Anxiety in Older Torres Strait Islanders: Limitations and Recommendations. Clin Gerontol 2023; 46:240-252. [PMID: 35694996 DOI: 10.1080/07317115.2022.2086090] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of the study was to assess the prevalence of anxiety and depression in older Aboriginal and Torres Strait Islander adults. METHODS A modified version of the PHQ-9 (KICA-dep) and the Geriatric Anxiety Inventory (GAI) were administered as part of a wider dementia prevalence study conducted in the Torres Strait. Results were compared to diagnoses obtained on Geriatric review to evaluate their applicability in the region. RESULTS A total of 236 participants completed the KICA-dep and 184 completed the GAI short form. Of these, 10.6% were identified with depression and 15.8% with anxiety. Some participants found questions about suicide ideation and self-harm offensive and others had difficulty understanding concepts on the GAI. The KICA-dep performed poorly in comparison to diagnosis on geriatric clinical review, so results are unlikely to reflect the true prevalence of depression in the region. CONCLUSIONS Further research is required to explore the underlying dimensions of depression and anxiety and terminology used to express mood symptoms in the Torres Strait. CLINICAL IMPLICATIONS • Current mental health screening tools are not applicable for the Torres Strait• More work is required to determine how symptoms of depression and anxiety are expressed within Torres Strait communities.
Collapse
Affiliation(s)
- Sarah G Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Fintan Thompson
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - Dina LoGiudice
- Faculty of Medicine, Dentistry, and Health Services, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - Kate Smith
- Centre for Aboriginal Medical and Dental Health, School of Medicine, University of Western Australia, Perth, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, Brisbane, Australia
| |
Collapse
|
3
|
Ou YC, Kao YL, Ho YH, Wu KY, Kuo HC. Intravesical Injection of Botulinum Toxin Type A in Patients with Refractory Overactive Bladder-Results between Young and Elderly Populations, and Factors Associated with Unfavorable Outcomes. Toxins (Basel) 2023; 15:toxins15020095. [PMID: 36828410 PMCID: PMC9967532 DOI: 10.3390/toxins15020095] [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: 12/14/2022] [Revised: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Intravesical botulinum toxin type A (BoNT-A) injection has been recognized as the standard treatment for refractory overactive bladder (OAB). However, its therapeutic efficacy and safety have not been thoroughly reviewed in elderly patients. This study aims to provide treatment outcomes for patients aged ≥75 years, and to identify factors associated with unfavorable outcomes. Patients receiving intradetrusor injections of 100 U onabotulinumtoxinA for refractory OAB between 2011 and 2021 were retrospectively reviewed. Urodynamic parameters, underlying comorbidities, subjective success, and unfavorable outcomes were assessed. A total of 192 patients were included, and 65 of them were classified into the elderly group. For the elderly group, 60.0% experienced subjective dryness, and 84.6% remained subjective success at 6 months after the injections. The prevalence rates of common unfavorable outcomes, including urinary tract infections, large post-void residual urine volume, and urinary retention, were 9.2%, 27.7%, and 12.3%, respectively. Multivariate analysis revealed that female, baseline urodynamic parameters, and diabetes mellitus were associated with unfavorable outcomes in the elderly group. Intravesical BoNT-A injections provide comparable therapeutic efficacy and safety concerns in elderly patients with refractory OAB. A thorough consultation for treatment benefits and possible adverse events is mandatory before the procedure.
Collapse
Affiliation(s)
- Yin-Chien Ou
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Yao-Lin Kao
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Yi-Hui Ho
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Kuan-Yu Wu
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 970, Taiwan
- Correspondence:
| |
Collapse
|
4
|
Shaw C, Gibson W. Assessing Quality-of-Life of Patients Taking Mirabegron for Overactive Bladder. Ther Clin Risk Manag 2023; 19:27-33. [PMID: 36647532 PMCID: PMC9840370 DOI: 10.2147/tcrm.s269318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Lower urinary tract symptoms (LUTS), including urgency, frequency, and urgency incontinence, are highly prevalent in the general population and increase in prevalence with increasing age. All LUTS, but notable urgency and urgency incontinence, are associated with negative impact on quality-of-life (QoL), with multiple aspects of QoL affected. Urgency and urgency incontinence are most commonly caused by overactive bladder (OAB), the clinical syndrome of urinary urgency, usually accompanied by increased daytime frequency and/or nocturia in the absence of infection or other obvious etiology, which may be treated with conservative and lifestyle interventions, bladder antimuscarinic drugs, and, more recently, by mirabegron, a β3 agonist. This narrative review describes the impact of OAB on QoL, quantifies this impact, and outlines the evidence for the use of mirabegron in the treatment of, and improvement in QoL in, people with OAB.
Collapse
Affiliation(s)
- Christina Shaw
- Division of Geriatric Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada,Correspondence: William Gibson, Division of Geriatric Medicine, University of Alberta, 1-198 Clinical Sciences Building, 11350 83 Ave NW, Edmonton, Alberta, T6E 2K4, Canada, Tel +1 780 248 1969, Fax +1 780 492 2874, Email
| |
Collapse
|
5
|
Mediating role of functional limitations in the association of urinary incontinence with depressive symptoms among middle-aged and older adults: The English Longitudinal Study of Aging. J Affect Disord 2022; 313:158-162. [PMID: 35793770 DOI: 10.1016/j.jad.2022.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/17/2022] [Accepted: 06/23/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the association of urinary incontinence with depressive symptoms, and to explore the mediating effect of functional limitations on this association. METHODS This cross-sectional study included 7039 adults aged 50 and over from the English Longitudinal Study of Aging (Wave 8). Urinary incontinence was defined as whether the participants experienced urinary incontinence in the past 12 months. Depressive symptoms were assessed based on the Center for Epidemiologic Studies-Depression Scale. Functional limitations included disability of activities of daily living, instrumental activities of daily living, mobility and large muscle groups limitation of the participants. Logistic regression based on Karlson/Holm/Breen (KHB) method was applied to estimate the association of urinary incontinence with depressive symptoms and explore the mediating effect of functional limitations. RESULTS Urinary incontinence was significantly associated with increased risk of depressive symptoms after controlling covariates (odds ratio = 1.75, 95 % confidence interval: 1.45-2.11). Functional limitations explained 36.96 % of this association. CONCLUSION Urinary incontinence might be associated with an increased risk of depressive symptoms among middle-aged and older adults and functional limitations partially mediate this association. Improving physically functional capacity might play an important role in preventing and managing depressive symptoms in elderly people with urinary incontinence.
Collapse
|
6
|
John G, Zanatta E, Polito P, Piantoni S, Fredi M, Coattrenec Y, Guemara R, Franceschini F, Truchetet ME, Cozzi F, Airò P, Chizzolini C. Urinary incontinence in systemic sclerosis: a prospective multicentre cohort study. Rheumatol Int 2022; 42:2141-2150. [PMID: 35945297 PMCID: PMC9548477 DOI: 10.1007/s00296-022-05178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Abstract
Investigate the natural history of urinary incontinence (UI) in systemic sclerosis (SSc) and assess its impact on quality of life (QoL). A longitudinal, international observational study followed 189 patients with SSc for a median duration of 5 years (IQR: 4.8–5.3). Presence, subtype and severity of UI, hospital admission and QoL were assessed using serial self-administered questionnaires. Mortality data came from national death registries. Multilevel mixed-effect logistic regressions explored factors associated with UI. Cox models adjusted the effects of UI on hospitalization and death for age, sex and subtype of SSc. Mean annual rates of new-onset UI and remission were 16.3% (95%CI 8.3%–24.2%) and 20.8% (95%CI 12.6–29.1), respectively. Among UI patients, 57.9% (95%CI 51.8–64.0) changed from one UI subtype to another. Between annual questionnaires, the severity of UI was the same in 51.1% (95%CI 40.8–61.4), milder or resolved in 35.2% (95%CI 25.3–44.9), and worse in 13.8% (95%CI 6.7–20.9). Anti-centromere antibodies, digestive symptoms, sex, age, neurological or urological comorbidities, diuretics and puffy fingers were all associated with UI. The two strongest predictors of UI and UI subtypes were a recent UI episode and the subtype of previous leakage episodes. UI at inclusion was not associated with hospital admission (adjusted HR: 1.86; 95%CI 0.88–3.93), time to death (aHR: 0.84; 95%CI 0.41–1.73) or change in QoL over time. Self-reported UI among SSc patients is highly dynamic: it waxes and wanes, changing from one subtype to another over time.
Collapse
Affiliation(s)
- Gregor John
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland. .,Department of Medicine, Geneva University, Michel-Servet 1, 1206, Geneva, Switzerland.
| | - Elisabetta Zanatta
- Department of Medicine, Rheumatology Unit, University Hospital of Padova, 35121, Padova, Italy
| | - Pamela Polito
- Department of Medicine, Rheumatology Unit, University Hospital of Padova, 35121, Padova, Italy
| | - Silvia Piantoni
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, 25123, Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, 25123, Brescia, Italy
| | - Yann Coattrenec
- Department of Pathology and Immunology, University Medical Centre, Geneva University, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland
| | - Romain Guemara
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, 25123, Brescia, Italy
| | - Marie-Elise Truchetet
- Department of Rheumatology, Bordeaux University and Bordeaux Hospital, Bordeaux, France
| | - Franco Cozzi
- Department of Medicine, Rheumatology Unit, University Hospital of Padova, 35121, Padova, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, 25123, Brescia, Italy
| | - Carlo Chizzolini
- Department of Pathology and Immunology, University Medical Centre, Geneva University, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland.,Department of Medicine, Geneva University, Michel-Servet 1, 1206, Geneva, Switzerland
| |
Collapse
|
7
|
Constable L, Abrams P, Cooper D, Kilonzo M, Cotterill N, Harding C, Drake MJ, Pardoe MN, McDonald A, Smith R, Norrie J, McCormack K, Ramsay C, Uren A, Mundy T, Glazener C, MacLennan G. Synthetic sling or artificial urinary sphincter for men with urodynamic stress incontinence after prostate surgery: the MASTER non-inferiority RCT. Health Technol Assess 2022; 26:1-152. [PMID: 35972773 PMCID: PMC9421661 DOI: 10.3310/tbfz0277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Stress urinary incontinence is common in men after prostate surgery and can be difficult to improve. Implantation of an artificial urinary sphincter is the most common surgical procedure for persistent stress urinary incontinence, but it requires specialist surgical skills, and revisions may be necessary. In addition, the sphincter is relatively expensive and its operation requires adequate patient dexterity. New surgical approaches include the male synthetic sling, which is emerging as a possible alternative. However, robust comparable data, derived from randomised controlled trials, on the relative safety and efficacy of the male synthetic sling and the artificial urinary sphincter are lacking. OBJECTIVE We aimed to compare the clinical effectiveness and cost-effectiveness of the male synthetic sling with those of the artificial urinary sphincter surgery in men with persistent stress urinary incontinence after prostate surgery. DESIGN This was a multicentre, non-inferiority randomised controlled trial, with a parallel non-randomised cohort and embedded qualitative component. Randomised controlled trial allocation was carried out by remote web-based randomisation (1 : 1), minimised on previous prostate surgery (radical prostatectomy or transurethral resection of the prostate), radiotherapy (or not, in relation to prostate surgery) and centre. Surgeons and participants were not blind to the treatment received. Non-randomised cohort allocation was participant and/or surgeon preference. SETTING The trial was set in 28 UK urological centres in the NHS. PARTICIPANTS Participants were men with urodynamic stress incontinence after prostate surgery for whom surgery was deemed appropriate. Exclusion criteria included previous sling or artificial urinary sphincter surgery, unresolved bladder neck contracture or urethral stricture after prostate surgery, and an inability to give informed consent or complete trial documentation. INTERVENTIONS We compared male synthetic sling with artificial urinary sphincter. MAIN OUTCOME MEASURES The clinical primary outcome measure was men's reports of continence (assessed from questions 3 and 4 of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form) at 12 months post randomisation (with a non-inferiority margin of 15%). The primary economic outcome was cost-effectiveness (assessed as the incremental cost per quality-adjusted life-year at 24 months post randomisation). RESULTS In total, 380 men were included in the randomised controlled trial (n = 190 in each group), and 99 out of 100 men were included in the non-randomised cohort. In terms of continence, the male sling was non-inferior to the artificial urinary sphincter (intention-to-treat estimated absolute risk difference -0.034, 95% confidence interval -0.117 to 0.048; non-inferiority p = 0.003), indicating a lower success rate in those randomised to receive a sling, but with a confidence interval excluding the non-inferiority margin of -15%. In both groups, treatment resulted in a reduction in incontinence symptoms (as measured by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form). Between baseline and 12 months' follow-up, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score fell from 16.1 to 8.7 in the male sling group and from 16.4 to 7.5 in the artificial urinary sphincter group (mean difference for the time point at 12 months 1.30, 95% confidence interval 0.11 to 2.49; p = 0.032). The number of serious adverse events was small (male sling group, n = 8; artificial urinary sphincter group, n = 15; one man in the artificial urinary sphincter group experienced three serious adverse events). Quality-of-life scores improved and satisfaction was high in both groups. Secondary outcomes that showed statistically significant differences favoured the artificial urinary sphincter over the male sling. Outcomes of the non-randomised cohort were similar. The male sling cost less than the artificial sphincter but was associated with a smaller quality-adjusted life-year gain. The incremental cost-effectiveness ratio for male slings compared with an artificial urinary sphincter suggests that there is a cost saving of £425,870 for each quality-adjusted life-year lost. The probability that slings would be cost-effective at a £30,000 willingness-to-pay threshold for a quality-adjusted life-year was 99%. LIMITATIONS Follow-up beyond 24 months is not available. More specific surgical/device-related pain outcomes were not included. CONCLUSIONS Continence rates improved from baseline, with the male sling non-inferior to the artificial urinary sphincter. Symptoms and quality of life significantly improved in both groups. Men were generally satisfied with both procedures. Overall, secondary and post hoc analyses favoured the artificial urinary sphincter over the male sling. FUTURE WORK Participant reports of any further surgery, satisfaction and quality of life at 5-year follow-up will inform longer-term outcomes. Administration of an additional pain questionnaire would provide further information on pain levels after both surgeries. TRIAL REGISTRATION This trial is registered as ISRCTN49212975. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 36. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Lynda Constable
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mary Kilonzo
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nikki Cotterill
- Faculty of Health and Applied Sciences (HAS), University of the West of England, Bristol, UK
| | - Chris Harding
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Marcus J Drake
- Bristol Urological Institute, University of Bristol, Bristol, UK
| | - Megan N Pardoe
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rebecca Smith
- Research and Innovation, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - John Norrie
- Usher Institute, Centre of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Kirsty McCormack
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alan Uren
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Tony Mundy
- Urology, University College Hospital, London, UK
| | - Cathryn Glazener
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
8
|
Bladder Dysfunction in Older Adults: The Botulinum Toxin Option. Drugs Aging 2022; 39:401-416. [PMID: 35696022 DOI: 10.1007/s40266-022-00950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/03/2022]
Abstract
Bladder dysfunction, which involves inadequacies of urine storage or emptying, increases with age. Conventional medications may have insufficient efficacy for patients with refractory lower urinary tract symptoms, and their concomitant adverse events (AEs) may be intolerable for the older adult population. For decades, the botulinum toxin type A (BoNT-A) injection has been an option for managing urine frequency, urge incontinence, and voiding dysfunction in the general population refractory to conventional management. This review focuses on studies of BoNT-A application in the management of bladder dysfunction in older adult patients aged ≥ 65 years. In this target population, intravesical BoNT-A injections provide similar efficacy in idiopathic overactive bladder to that in younger adults. Good clinical response has also been demonstrated in older adult patients presenting with storage dysfunction and with various concomitant underlying neurological diseases. However, caution must be taken for the AEs that occur after intravesical BoNT-A injection, including increased post-void residual urine, acute urine retention, and urinary tract infection. Most evidence shows that age is not a major determinant of AEs after adjusting for other factors. In contrast to its application in storage dysfunction, evidence for voiding dysfunction in older adults is scarce. In general, BoNT-A may be a reasonable option for older adult patients with refractory storage dysfunction because of its promising clinical response without significant systemic AEs. Overall, clinicians should be aware of the balance between the therapeutic efficacy of BoNT-A and local AEs in vulnerable members of this population.
Collapse
|
9
|
Peroni L, Armaingaud D, Sanchez S, Rothan-Tondeur M. Perceptions, representations and logics of action of urinary incontinence in institutionalised elderly people: a concurrent mixed study protocol. BMJ Open 2022; 12:e057639. [PMID: 35361648 PMCID: PMC8971776 DOI: 10.1136/bmjopen-2021-057639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Urinary incontinence (UI) is a major public health problem. It affects many institutionalised elderly people. In the literature, the phenomenon is well defined. Its frequency, risk factors, individual and social costs, as well as the different therapeutic approaches, are described. However, there are few publications on its representations, both from the point of view of the patient and that of the carers. However, the literature shows that a better understanding of the social representations of this phenomenon could be a vector for improving care. We aim at understanding the perception of UI, to model its representations and to understand and characterise the logics of action in terms of protection. METHODS AND ANALYSIS This will be a mixed-method concurrent study with a quantitative and a qualitative component. Data will be collected through 100 semistructured interviews, 8 focus groups and 10 000 surveys from 4 populations: institutionalised elderly people, caregivers, carers and individuals from the general population. The qualitative part will be analysed both manually and with ATLAS.Ti software, which will be used to centralise and organise all qualitative data collected. For the analysis of the quantitative part, a descriptive statistical analysis and a logistic regression type association will be carried out. These analyses will be enforced using R software. Then, an overlay and combination of quantitative and qualitative information for the triangulation analytical approach will be carried out. The study started in August 2021 and will continue until June 2022. ETHICS AND DISSEMINATION The study protocol was approved by the Descartes ethics and research committee on 1 June 2021, with the IRB number 00012021-43. The findings will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER This protocol was registered with the Research Registry on 12 July 2021 and is numbered researchregistry6965.
Collapse
Affiliation(s)
- Lea Peroni
- Université Sorbonne Paris Nord, Nursing Sciences Research chair, Laboratory Educations and Health Promotion (LEPS), (EA 3412), UFR SMBH, F-93017, Bobigny, France
- Korian SA, Korian Foundation for the Ageing Well, Paris, France
| | | | - Stéphane Sanchez
- Hospital of Troyes, Information and Medical Assessment Unit, Troyes, France
| | - Monique Rothan-Tondeur
- Université Sorbonne Paris Nord, Nursing Sciences Research chair, Laboratory Educations and Health Promotion (LEPS), (EA 3412), UFR SMBH, F-93017, Bobigny, France
- AP HP, Nursing Sciences Research chair, Paris, France
| |
Collapse
|
10
|
Martin SA, Tully PJ, Kahokehr AA, Jay A, Wittert GA. The bidirectional association between depression and lower urinary tract symptoms (LUTS) in men: A systematic review and meta-analysis of observational studies. Neurourol Urodyn 2022; 41:552-561. [PMID: 35019156 DOI: 10.1002/nau.24868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Recent evidence from observational studies suggests a bidirectional association between lower urinary tract symptoms (LUTS) and depression in men. We sought to systematically quantify the effect of the presence of LUTS on depression symptoms, compared to those without LUTS, in adult males, and vice versa. METHODS Electronic databases (MEDLINE, PsycINFO, SCOPUS, Embase) were examined for articles in English before March 2021. Observational studies of men aged over 18 years; reporting an association between LUTS and depression; including a validated scale for LUTS and depression symptoms were eligible for study inclusion. RESULTS Seventeen studies out of 1787 records identified 163 466 men with reported depression symptoms by LUTS status, while 10 studies reported 72 363 men with LUTS by depression symptoms. Pooled estimates showed a strong effect of LUTS presence on depression risk (OR: 2.89, 95% CI: 2.50-3.33), with a high degree of heterogeneity among the examined studies (I2 = 83%; τ2 = 0,06; p < 0.001). Subgroup analyses demonstrated differences by study region (Q value:13.7, df:4, p = 0.003), setting (7.8(2), p = 0.020), design (7.2(1), p = 0.003), quality (6.2(1), p = 0.013), and LUTS measure (40.9(3), p < 0.001). Pooled estimates also showed a strong effect of depression presence on LUTS risk in men (OR: 3.13, 95% CI: 2.72-3.60), with only moderate heterogeneity between studies (I2 = 58%; τ2 = 0,02; p = 0.001). CONCLUSIONS The strong relationship observed between LUTS and depression implies shared risk factors that cannot be solely attributed to the prostate. This has immediate implications for future studies and the assessment and management of patients with either condition.
Collapse
Affiliation(s)
- Sean A Martin
- Freemasons Centre for Male Health & Wellbeing, University of Adelaide, Adelaide, South Australia, Australia
| | - Phillip J Tully
- Freemasons Centre for Male Health & Wellbeing, University of Adelaide, Adelaide, South Australia, Australia.,School of Psychology, University of New England, Armidale, New South Wales, Australia
| | - Arman A Kahokehr
- Lyell McEwin Health Service, SA Health, Elizabeth Vale, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Urology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Alex Jay
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health & Wellbeing, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
11
|
The Frequency of Metabolic Syndrome in Aged Female Patients (Older Than 65 Years) With and Without Stress Urinary Incontinence: A Case-Control Study. Female Pelvic Med Reconstr Surg 2021; 28:e11-e15. [PMID: 34768259 DOI: 10.1097/spv.0000000000001122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of the study was to assess the incidence of metabolic syndrome (MetS) in aged patients (older than 65 years) with and without stress urinary incontinence (SUI). METHODS We evaluated the components of MetS in 460 SUI patients and 460 age-matched women without urinary incontinence from January 2009 to October 2019. Stress urinary incontinence was diagnosed by clinical complaint and the presence of involuntary urine leakage during physical activity. Definition of MetS was on the basis of the National Cholesterol Education Program Adult Treatment Panel III recommendations definition (NCEPATPIII) and the International Diabetes Federation criteria (IDF). RESULTS Totally, 460 SUI patients with the median age of 70 years were eventually included in the study. Subsequently, 460 age-matched controls were selected. The prevalence of MetS was more frequent in SUI patients based on the NCEPATPIII (43.04% vs 19.78%, P < 0.0001) and IDF criteria (45.22% vs 20.22%, P < 0.0001). Moreover, logistic regression analysis revealed that MetS significantly increased the risk of SUI (odds ratio = 3.06, 95% confidence interval = 2.28-4.09) according to the NCEPATPIII definition and (odds ratio = 3.26, 95% confidence interval = 2.43-4.34) on the basis of IDF criteria compared with controls. Patients in the SUI group had a statistically higher body mass index (P < 0.0001), larger waist (P < 0.0001), higher level of fasting blood glucose (P = 0.0001), triglycerides (P = 0.00), and systolic blood pressure (P = 0.0001) than controls. Patients with SUI demonstrated a statistically worse symptom score in all aspects compared with controls (P < 0.0001). CONCLUSIONS The prevalence of MetS was higher in older women with SUI than in an age- and sex-matched control group without clinical SUI. Further studies are warranted to determine the pathophysiology mechanism of SUI and MetS.
Collapse
|
12
|
Park GR, Park S, Kim J. Urinary Incontinence and Depressive Symptoms: The Mediating Role of Physical Activity and Social Engagement. J Gerontol B Psychol Sci Soc Sci 2021; 77:1250-1258. [PMID: 34752603 DOI: 10.1093/geronb/gbab212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study investigates longitudinal within-person associations between urinary incontinence (UI) and depressive symptoms among older women. Drawing on activity theory, this study also adds to limited knowledge about the mediating role of physical activity and social engagement in the association between UI and depressive symptoms. METHOD Using six waves of a nationally representative longitudinal study of older adults in Korea between 2008 and 2018, this study examined the relationship between UI and depressive symptoms among women aged 70 and over. Fixed effects models were estimated to account for unobserved time-invariant confounding factors. Sobel mediation tests were conducted to formally test for mediation. RESULTS Fixed effects estimates showed that, after adjusting for a wide array of time-varying covariates, having UI is positively associated with depressive symptoms among older women (b = 0.238, p < 0.05). Results revealed that individuals who begin to experience UI tend to have less frequent social interactions and participate in fewer social activities. UI, however, is only marginally associated with a decrease in physical activity. Reductions in physical activity, social connections, and social activities jointly explain about 22% of the association between UI and depressive symptoms, rendering it statistically insignificant. DISCUSSION UI poses a threat to psychological well-being among older women. This is partly explained by a decrease in physical activity and disruption in social engagement. This study reaffirms the significance of the programs that promote physical and social activity among older adults.
Collapse
Affiliation(s)
- Gum-Ryeong Park
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada.,Korea Institute for Health and Social Affairs, Sejong, Republic of Korea
| | - Sujeong Park
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea
| | - Jinho Kim
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea.,Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea.,Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
13
|
Kaur T, Kumari R, Sharma JB, Pandey K, Uppal B, Deb KS. A Cross-sectional Case-control Study of Depression in Incontinent Women. J Midlife Health 2021; 12:132-136. [PMID: 34526748 PMCID: PMC8409716 DOI: 10.4103/jmh.jmh_98_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 12/26/2020] [Accepted: 05/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Urinary incontinence (UI) presents in over 50% menopausal women affecting their quality of life leading to depression and hence needs addressal and treatment as very few of them seek medical help. Aims: Our aim was to determine the prevalence of depression, and the correlation of severity of UI with depression in incontinent women versus continent controls. Methodology: A cross-sectional case–control study of previously diagnosed 100 incontinent women (Stress/Urgency/Mixed) was done over a period of 3 months. The severity of UI was assessed on Patient Incontinence Severity Assessment (a form of Likert scale) and depression was assessed on a validated Patient Health Questionnaire-9 scale. Statistical Analysis: The statistical analysis was performed using SPSS version 19.0. RESULTS: Most of our cases were 51–60 years, with Urge UI being the most predominant (88%). Hundred percent of our incontinent patients were depressed, with 48% and 45% being severely and moderately severely depressed, respectively. A highly significant correlation was found between the severity of incontinence, amount of leakage, leaking pattern, and depression. Conclusion: All of our incontinent patients were depressed, with the severity of depression increasing with the severity of incontinence.
Collapse
Affiliation(s)
- Tanudeep Kaur
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - J B Sharma
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Kavita Pandey
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Bharti Uppal
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | | |
Collapse
|
14
|
Zhang RQ, Xia MC, Cui F, Chen JW, Bian XD, Xie HJ, Shuang WB. Epidemiological survey of adult female stress urinary incontinence. BMC WOMENS HEALTH 2021; 21:172. [PMID: 33888113 PMCID: PMC8061196 DOI: 10.1186/s12905-021-01319-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Abstract
Background The prevalence of stress urinary incontinence (SUI) in adult female in Taiyuan and what are the related risk factors are not clear. The aim of this study was to provide a basis for exploring the prevention and treatment of SUI in adult female in Taiyuan. Methods A voluntary online questionnaire was used to investigate adult female in the community and surrounding townships of Taiyuan. Most of the questionnaires refer to the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms, and adapt to the specific circumstances of the region. Data were analyzed using SPSS software (version 22.0). Results A total of 4004 eligible questionnaires were obtained. The prevalence of SUI in adult female in Taiyuan was 33.5%. Univariate analysis and multivariate logistic regression analysis showed that place of residence, smoking, body mass index, diet, number of deliveries, mode of delivery, dystocia, menopause, oral contraceptives, urinary tract infection, making the bladder empty faster by pushing down and holding urine were risk factors for adult female stress urinary incontinence in Taiyuan. Conclusion The prevalence of SUI in adult female in Taiyuan was high, and based on risk factors identified in this survey, population-level intervention strategies should be developed for the prevention and treatment of adult female SUI in Taiyuan. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01319-z.
Collapse
Affiliation(s)
- Rui Qin Zhang
- Department of First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Man Cheng Xia
- Department of First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Fan Cui
- Department of First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Jia Wei Chen
- Department of First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Xiao Dong Bian
- Department of First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Hong Jie Xie
- Department of First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Wei Bing Shuang
- Department of First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001, Shanxi, China. .,Department of Urology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China.
| |
Collapse
|
15
|
Nahon I. Physiotherapy management of incontinence in men. J Physiother 2021; 67:87-94. [PMID: 33753017 DOI: 10.1016/j.jphys.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- Irmina Nahon
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Australia.
| |
Collapse
|
16
|
Prevalence and predictors of continence containment products and catheter use in an acute hospital: A cross-sectional study. Geriatr Nurs 2021; 42:433-439. [PMID: 33684628 DOI: 10.1016/j.gerinurse.2021.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 01/02/2023]
Abstract
Although incontinence is common in hospital, the prevalence and predictors of continence aid use (continence wear and catheters) are poorly described. A one-day cross-sectional study was conducted in a large university hospital assessing consecutive inpatients (≥55) for their pre-admission and current use of continence aids. Barthel Index, Clinical Frailty Scale and Charlson Co-morbidity scores were recorded. Appropriateness was defined by local guidelines. 355 inpatients, median age 75±17 years, were included; 53% were male. Continence aid use was high; prevalence was 46% increasing to 58% for those ≥75. All-in-one pads were the most common, an overall prevalence of 31%. Older age, lower Barthel and higher frailty scores were associated with continence aid use in multivariate analysis. Inappropriate use of aids was high at 45% with older age being the only independent predictor. Continence aids are often used inappropriately during hospitalisation by older patients. Concerted efforts are required to address this issue.
Collapse
|
17
|
Burdens and Educational Needs of Informal Caregivers of Older Adults With Urinary Incontinence: An Internet-Based Study. Rehabil Nurs 2021; 46:172-178. [PMID: 33591086 DOI: 10.1097/rnj.0000000000000317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe the burden and educational needs of informal caregivers of care-dependent older adults with urinary incontinence (UI). DESIGN A cross-sectional, descriptive survey of informal caregivers recruited through Google Ads was performed. METHODS An online survey, including the Overactive Bladder-Family Impact Measure, was used to assess five areas of the experience of the informal caregiver that may be affected by caring for a person with UI and their educational needs. FINDINGS Respondents (n = 77) reported a substantial impact of their care recipients' UI on their lives, with concern, travel, and social subscales most affected. However, 42% never sought treatment on behalf of their care recipient. Educational needs included UI treatment strategies and guidance to select appropriate supplies. CONCLUSIONS Caregivers underreported their care recipient's UI and need substantially more support from healthcare providers to manage the condition. CLINICAL RELEVANCE Nurses should assess for UI among care-dependent older adults and, if present, provide information and strategies to lessen the impact on caregiver lives.
Collapse
|
18
|
Kwon J, Lee HJ, Joo JH, Park EC. Urinary incontinence status changes and depressive symptoms among middle-aged and older women: Using data from a survey of the Korean Longitudinal Study of Aging. J Affect Disord 2021; 279:549-553. [PMID: 33142157 DOI: 10.1016/j.jad.2020.10.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Urinary incontinence (UI) affects 200 million people worldwide and is a common problem in middle-aged and older women. The symptoms of UI in women are known to have a variety of effects on their health. Therefore, this study aimed to identify the effects of changes in UI status on depressive symptoms and identify determinants of the progression of UI among South Korean women 45 years old and above. METHODS Data were collected from the Korean Longitudinal Study of Aging from 2012 to 2016. Participants were categorized into five groups by the results of a prior panel survey on UI status: "Recovered," "Better," "Same," "Worse," and "No symptoms of urinary incontinence." We used the generalized estimating equation model and performed subgroup analyses based on age, working status, household income, perceived health status, and the number of chronic medical conditions. RESULTS A total of 3,957 middle-aged and older women were included in the analysis. Those with a change to "worse" UI status (β: 0.408, P=0.005) had higher depressive symptom scores than those who reported "no symptoms of UI." Conversely, those with a "better" (β: -0.271, P=0.0131) or "recovered" (β: -0.518, P=0.0020) UI status had lower depressive symptom scores than those with "no symptom of UI". Younger women and those with a "better" or "recovered" status showed a tendency of having fewer depressive symptoms. Older women and those with a "worse" status showed a tendency of having more depressive symptoms. LIMITATIONS The cause of UI could not be evaluated. Changes in UI status were evaluated based on self-reported data. CONCLUSION This study showed that a change in UI status is associated with depression in middle-aged and older Korean women. It is important to consider UI management to relieve depressive symptoms.
Collapse
Affiliation(s)
- Junhyun Kwon
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hyeon Ji Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Jae Hong Joo
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
19
|
Northwood M, Ploeg J, Markle-Reid M, Sherifali D. The Complexity of Living with Diabetes and Urinary Incontinence for Older Adults with Multiple Chronic Conditions Receiving Home Care Services: An Interpretive Description Study. Glob Qual Nurs Res 2021; 8:2333393621993452. [PMID: 33628868 PMCID: PMC7882747 DOI: 10.1177/2333393621993452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 12/29/2022] Open
Abstract
Over 40% of older adults with diabetes receiving home-care services experience urinary incontinence. However, experiential knowledge is lacking on how these older adults live with diabetes and incontinence. Interpretive description methodology was used to explore the experiences of 18 older adults with diabetes and urinary incontinence receiving home-care services in Ontario, Canada. Five themes emerged from the findings: (a) enduring urinary incontinence: "patch it in pads"; (b) struggling to manage diabetes, incontinence, and multiple chronic conditions: "a balancing act"; (c) covering the costs of care: "I can't afford it"; (d) counting on a caregiver: "he does everything"; and (e) home-care services not meeting my needs: "it's not individual." These findings suggest that living with urinary incontinence and diabetes is a complex and challenging experience. This evidence could inform the provision of comprehensive home care to support self-care for this population.
Collapse
Affiliation(s)
| | | | | | - Diana Sherifali
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, ON, Canada
| |
Collapse
|
20
|
Abstract
Overactive bladder (OAB) and frailty are multidimensional syndromes, and the prevalence of both increases with age. Little evidence exists for a direct association between OAB and frailty, but urinary urgency may well be a precursor of frailty in older people. Frail older adults are no less deserving of treatment than fit older adults, and lifestyle, behavioral, and pharmacological interventions remain the primary options for treatment, with some evidence for efficacy. Data on onabotulinumtoxinA therapy or percutaneous tibial nerve stimulation in frail older adults are sparse. Frail older adults are often excluded from drug trials, but evidence is accumulating that antimuscarinics and, to a lesser extent, beta-adrenergic agonists are safe, well-tolerated, and effective in older adults. Cognitive impairment associated with frailty should not be used as justification for avoiding the use of antimuscarinics. More studies are required to better understand the association between OAB and frailty, as both are associated with poor outcomes and may be amenable to intervention. Drug trials for OAB treatments should be encouraged to include frail older adults, as this population is highly affected yet often excluded.
Collapse
|
21
|
Increased Healthcare Resource Utilization and Direct and Indirect Costs in Patients with Depression and Comorbid Overactive Bladder: Evidence From a Retrospective, Matched Case-Control Cohort Analysis. Adv Ther 2020; 37:4599-4613. [PMID: 32910419 PMCID: PMC7547960 DOI: 10.1007/s12325-020-01485-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 11/17/2022]
Abstract
Introduction This study sought to compare healthcare resource utilization (HCRU), costs, and workplace productivity among patients with depression, with and without overactive bladder (OAB). Methods This retrospective, case–control cohort analysis compares HCRU, costs, and workplace productivity among propensity score matched patients with depression and OAB (case cohort) and patients with depression without OAB (control cohort). Patients were aged 18 years or older, insured/on Medicare, and had diagnosed depression and an antidepressant medication claim pre index. First OAB-related event was index for cases; controls were assigned a proxy (study period 12 months). Comparisons of HCRU and costs and regression models assessed the relationship between OAB and costs. For the workplace productivity subset analyses cases and controls were balanced on baseline covariates for the short-term disability analyses but as they were unbalanced for the absentee analyses, multivariate regression analyses were used for this subset. Results The study criteria were met by 39,085 cases and 308,736 controls, from which, 37,997 patients were successfully matched 1:1 (mean age 55 years; 81% female). Most depression-related HCRU measures were similar across cohorts; however, outpatient visits, ER visits, and number of unique depression medications were significantly higher (all p < 0.05) among cases. Cases also had 13% higher total depression-related costs (p < 0.0001). Total mean (standard deviation [SD]) depression-related costs were $1796 ($4235) for cases versus $1597 ($3863) for controls (p < 0.0001). For workplace productivity (absentee data: cases [n = 686], controls [n = 642]; short-term disability data: cases [n = 4395], controls [n = 4433]) absentee outcomes were similar across cohorts. However, a higher percentage of cases used short-term disability benefits compared to controls (21.3% versus 16.9%; p < 0.0001) and cases experienced more case days (11.0 versus 8.6 mean days) and received higher mean payments than controls ($1226 versus $1033; p < 0.0001) in this subset. Conclusions OAB was associated with 13% higher depression-related costs and 4.4% more cases used short-term disability benefits. Electronic Supplementary Material The online version of this article (10.1007/s12325-020-01485-w) contains supplementary material, which is available to authorized users.
Collapse
|
22
|
Davis NJ, Clark PC, Johnson TM, Wyman JF. Feasibility of Tele-Prompt: A tablet-based prompted voiding intervention to support informal caregivers of older adults with urinary incontinence. Geriatr Nurs 2020; 41:411-420. [PMID: 31987698 DOI: 10.1016/j.gerinurse.2020.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/01/2020] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
Urinary incontinence (UI) is a highly prevalent condition, burdening older adults and their informal caregivers. This study explored the development and feasibility of a 6-week evidence-based, educational/skill building program delivered via tablet-personal computer aimed at developing informal caregiver UI knowledge; and enhancing informal caregiver skill set in prompted voiding and toileting strategies. Caregivers also received individualized weekly coaching sessions from a nurse expert. Feasibility and preliminary efficacy were tested in three caregiver/care-recipient dyads. Recruitment of eligible participants through community-based resources was a challenge to feasibility. Most caregivers found the technology acceptable, but adherence to prompted voiding was inconsistent. All caregivers rated the intervention highly, reported improvements in their care-recipient's urine leakage, found access to a UI expert beneficial, and would recommend it to a friend. The results suggest that the tablet-facilitated intervention was feasible and acceptable to informal caregivers and showed promise for improving both caregiver and care recipient outcomes.
Collapse
Affiliation(s)
- Nicole J Davis
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, United States; School of Nursing, Clemson University, 605 Grove Rd. Greenville, SC 29605, United States.
| | - Patricia C Clark
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, United States.
| | - Theodore M Johnson
- Schools of Medicine, Public Health and Nursing, Emory University, 1841 Clifton Rd NE, Atlanta, GA 30329, United States; Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, 1670 Clairmont Rd., Atlanta, GA 30033, United States.
| | - Jean F Wyman
- School of Nursing, University of Minnesota, 5-140 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, United States.
| |
Collapse
|
23
|
Grzybowska ME, Wydra D. 24/7 usage of continence pads and quality of life impairment in women with urinary incontinence. Int J Clin Pract 2019; 73:e13267. [PMID: 30230139 DOI: 10.1111/ijcp.13267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/04/2018] [Indexed: 12/01/2022] Open
Abstract
AIMS To compare quality of life (QoL) in women with urinary incontinence (UI) using continence pads during the day versus all day and night; to identify risk factors for a 24-hour pad use; to calculate quality-adjusted life years (QALY). METHODS A cross-sectional study in 331 women with lower urinary tract symptoms referred to urogynaecologic examination was conducted. Main outcome measures were the scores of King's Health Questionnaire (KHQ), clinical data, and KHQ-derived utility values. RESULTS A total of 270 women with UI were recruited: 176 (57.3%) using continence pads only during the day (group I) and 94 (30.6%) for 24 hours (group II). The groups did not differ in terms of age, menopause, parity, type of UI, stage of POP-Q, and percentage of sexually active subjects. Group II had significantly higher body mass index (BMI) and lower education than group I (P < 0.05). QoL was significantly deteriorated in group II in KHQ Global score and in all domains except one (General Health). Risk factors for 24 hours pad use were as follows: BMI ≥ 30 vs BMI 25-30 (OR = 2.02 (1.09-3.73), P = 0.037), higher scores in KHQ Severity measures (OR = 1.03 (1.02-1.04), P < 0.001), KHQ Global score (OR = 1.03 (1.02-1.05), P < 0.001) and primary compared to secondary (OR = 0.4 (0.19-0.84)) or higher education (OR = 0.41 (0.18-0.94), P < 0.05). Annual QALY was significantly lower in group II (0.9288 ± 0.03 vs 0.9432 ± 0.03, P < 0.001). CONCLUSION One-third of women with UI used continence pads for 24 hours. Among these patients QoL and QALY were found lower compared to women using continence pads only during the day. KHQ Severity measures domain was an independent predictor for a 24-hour usage of continence pads.
Collapse
Affiliation(s)
- Magdalena Emilia Grzybowska
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdańsk, Gdańsk, Poland
| | - Dariusz Wydra
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdańsk, Gdańsk, Poland
| |
Collapse
|
24
|
Hälleberg Nyman M, Forsman H, Wallin L, Ostaszkiewicz J, Hommel A, Eldh AC. Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care-A process evaluation of an implementation intervention in the orthopaedic context. J Eval Clin Pract 2019; 25:282-289. [PMID: 29411463 DOI: 10.1111/jep.12879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery. METHODS A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed. RESULTS Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit. CONCLUSION To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.
Collapse
Affiliation(s)
- Maria Hälleberg Nyman
- School of Health Sciences, Örebro University, Örebro, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Henrietta Forsman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lars Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research, Barwon Partnership, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Ami Hommel
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Department of Orthopaedics, Skaane University Hospital, Lund, Sweden
| | - Ann Catrine Eldh
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| |
Collapse
|
25
|
Shaw C, Rajabali S, Tannenbaum C, Wagg A. Is the belief that urinary incontinence is normal for ageing related to older Canadian women's experience of urinary incontinence? Int Urogynecol J 2019; 30:2157-2160. [PMID: 30796477 DOI: 10.1007/s00192-019-03906-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 02/07/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Many women consider urinary incontinence (UI) a normal part of ageing. This belief may contribute to delays in treatment seeking. This study examined the relationship among holding that belief, UI type and severity, impact on quality of life, management and healthcare seeking in a sample of older community-dwelling Canadian women. METHODS This was a secondary analysis of a controlled trial examining the impact of continence promotion workshops on UI self-management. All women who consented and provided baseline data were included in this analysis regardless of eligibility for the main study. RESULTS The sample included 4446 women (2022 with UI) of mean (SD) age 78.2 (9.0) years and BMI 26.6 (5.6). The belief that UI is normal for ageing was held by 2149 women [48.3% (83.7% of 1798 incontinent women)] and was not associated with age [adjusted odds ratio (OR) (95% CI): 1.00 (0.99, 1.01), p = 0.72] or perception of overall health. Women with this belief had more impaired QoL compared with the women who felt UI was not normal for ageing [mean (SD) 83.9 (19.4) vs. 87.4 (18.6) (p < 0.01)]. This belief remained unaffected by daily UI and pad use up to 2/day. CONCLUSIONS More than two-thirds of women thought UI normal for ageing. This belief was not associated with age or perception of overall health. More severe incontinence and greater quantities of pad use did not make women less likely to hold this belief.
Collapse
Affiliation(s)
- Christina Shaw
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 1-198 Clinical Sciences Bldg, 11350 83 Ave, Edmonton, AB, T6G 2P4, Canada
| | - Saima Rajabali
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 1-198 Clinical Sciences Bldg, 11350 83 Ave, Edmonton, AB, T6G 2P4, Canada
| | - Cara Tannenbaum
- Michel Saucier Chair of Pharmacy, University of Montreal, Montreal, QC, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 1-198 Clinical Sciences Bldg, 11350 83 Ave, Edmonton, AB, T6G 2P4, Canada.
| |
Collapse
|
26
|
Martin SA. Re: Rhee et al. "Longitudinal study of the relationship between lower urinary tract symptoms and depressive symptoms". J Psychosom Res 2019; 116:113-114. [PMID: 30654987 DOI: 10.1016/j.jpsychores.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Sean A Martin
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, Australia.
| |
Collapse
|
27
|
Nazaripanah NS, Momtaz YA, Mokhtari F, Sahaf R. Urinary incontinence and sleep complaints in community dwelling older adults. ACTA ACUST UNITED AC 2018; 11:106-111. [PMID: 30083298 PMCID: PMC6056063 DOI: 10.5935/1984-0063.20180020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sleep disorder is associated with poor quality of life in old age. Therefore, it
is imperative to identify contributing factors leading to sleep disorder. The
current study aimed to examine the impact of urinary incontinence on sleep
complaint after controlling for potential sociodemographic and health
covariates. Materials and Methods: A cross-sectional study was
conducted on a sample of 184 community dwelling older adults 60 years and older
in Yazd, Iran, 2016. In order to obtain the sample a multistage proportional
random sampling technique was employed. Sociodemographic characteristics, sleep
complaint, and urinary incontinence were collected from medical records.
Statistical analyses were performed using SPSS version 24. A multiple logistic
regression analysis was used to examine the impact of urinary incontinence on
sleep complaint after controlling for potential covariates.
Findings: A total of 184 respondents with a mean age of
68.48±6.65 years (age range, 60-87 years) were included in the study.
About 70% of the respondents were women, 72.8% were married, 68.5% were not
formally educated, and 21.7% were living alone. The prevalence of sleep
complaint and urinary incontinence were 27.2% (95% CI: 21-34) and 22.3% (95% CI:
17-29), respectively. The results of the multiple logistic regression analysis
revealed respondents with urinary incontinence were four times more likely to
suffer from sleep complaint than those without urinary incontinence after
adjusting for potential covariates (AOR=4.04, 95% CI: 1.74-9.35,
p<0.001). Conclusion: Based on the results
of this present study, which showed that urinary incontinence independently
contributed to sleep complaint among older adults, it is necessary to employ
effective interventions for controlling urinary incontinence to reduce sleep
complaints.
Collapse
Affiliation(s)
- Neda Sadat Nazaripanah
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran.,Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran
| | - Yadollah Abolfathi Momtaz
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran.,Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Gerontology - Serdang - Selangor - Malaysia
| | - Farideh Mokhtari
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran.,Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran
| | - Robab Sahaf
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran
| |
Collapse
|
28
|
Hahn SR, Bradt P, Hewett KA, Ng DB. Physician-patient communication about overactive bladder: Results of an observational sociolinguistic study. PLoS One 2017; 12:e0186122. [PMID: 29140974 PMCID: PMC5687746 DOI: 10.1371/journal.pone.0186122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/10/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction Overactive bladder (OAB) and urinary incontinence are common problems that have significant impact on quality of life (QOL). Less than half of sufferers seek help from their physicians; many who do are dissatisfied with treatment and their physicians’ understanding of their problems. Little is known about the sociolinguistic characteristics of physician-patient communication about OAB in community practice. Methods An IRB-approved observational sociolinguistic study of dialogues between patients with OAB and treating physicians was conducted. Study design included semi-structured post-visit interviews, post-visit questionnaires, and follow-up phone calls. Conversations were analyzed using techniques from interactional sociolinguistics. Results Communication was physician- rather than patient-centered. Physicians spoke the majority of words and 83% of questions were closed-ended. The impact of OAB on QOL and concerns about and adherence to treatment were infrequently addressed by physicians, who were poorly aligned with patients in their understanding. These topics were addressed more frequently when open-ended questions successfully eliciting elaborated responses were used in ask-tell-ask or ask-tell sequences. Discussion Clinical dialogue around OAB is physician-centered; topics critical to managing OAB are infrequently and inadequately addressed. The use of patient-centered communication is correlated with more discussion of critical topics, and thus, more effective management of OAB.
Collapse
Affiliation(s)
- Steven R. Hahn
- Albert Einstein College of Medicine, Bronx, New York, United States of America
- Jacobi Medical Center, Bronx, New York, United States of America
| | - Pamela Bradt
- Medical Affairs, Americas Astellas Pharma Global Development, Inc., Northbrook, Illinois
| | - Kathleen A. Hewett
- Ogilvy CommonHealth Behavioral Insights, Parsippany, New Jersey, United States of America
- * E-mail:
| | - Daniel B. Ng
- Medical Affairs, Americas Astellas Pharma Global Development, Inc., Northbrook, Illinois
| |
Collapse
|
29
|
|
30
|
Jamieson HA, Schluter PJ, Pyun J, Arnold T, Scrase R, Nisbet-Abey R, Mor V, Deely JM, Gray L. Fecal Incontinence Is Associated With Mortality Among Older Adults With Complex Needs: An Observational Cohort Study. Am J Gastroenterol 2017; 112:1431-1437. [PMID: 28762377 DOI: 10.1038/ajg.2017.200] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 05/30/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Fecal incontinence (FI) is a problem in growing older populations. Validating a suspected association between FI and mortality in community dwelling older adults could lead to improved planning for and management of the increasing complex older population. In a large cohort of New Zealand older adults, we assessed the prevalence of FI, urinary incontinence (UI), combined FI and UI, and their associations with mortality. METHODS This study consisted of a retrospective analysis of international standardized geriatric assessment-home care (InterRAI-HC) data from community-dwelling adults aged 65 years or older, who met the criteria required for the InterRAI-HC, having complex needs and being under consideration for residential care. The prevalence of UI and FI was analyzed. Data were adjusted for demography and 25 confounding factors. Mortality was the primary outcome measure. RESULTS The total cohort consisted of 41,932 older adults. Both UI and FI were associated with mortality (P<0.001), and risk of mortality increased with increased frequency of incontinence. In the adjusted model, FI remained significantly related to survival (P<0.001), whereas UI did not (P=0.31). Increased frequency of FI was associated with an increased likelihood of death (hazard ratio 1.28). CONCLUSIONS This large national study is the first study to prove a statistically significant relationship between FI and mortality in a large, old and functionally impaired community. These findings will help improve the management of increasingly complex older populations.
Collapse
Affiliation(s)
- Hamish A Jamieson
- Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand.,Older Persons Inpatient Health Services, Burwood Hospital, Christchurch, New Zealand
| | - Philip J Schluter
- Department of Health Sciences, University of Canterbury, Christchurch, New Zealand.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Juno Pyun
- Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Ted Arnold
- Department of Surgery, University of Otago-Christchurch, Christchurch, New Zealand
| | - Richard Scrase
- Canterbury District Health Board, Christchurch, New Zealand
| | - Rebecca Nisbet-Abey
- Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Vincent Mor
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island, USA
| | - Joanne M Deely
- Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Len Gray
- Academic Unit of Geriatric Medicine, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
31
|
Szczypior M, Połom W, Markuszewski M, Ciura K, Buszewska-Forajta M, Jacyna J, Markuszewski M, Matuszewski M. Overactive bladder treatment: application of methylene blue to improve the injection technique of onabotulinum toxin A. Scand J Urol 2017; 51:474-478. [PMID: 28816073 DOI: 10.1080/21681805.2017.1362467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to test the addition of methylene blue (MB) to onabotulinum toxin A (BTX-A) solution in overactive bladder (OAB) treatment, as a means of facilitating observation of the injection site and assessing the distribution of the drug under the bladder mucosa during injection. Pharmacological interactions between BTX-A and MB were also evaluated. MATERIALS AND METHODS The study was conducted between December 2014 and April 2016 on 30 patients: six males and 24 females (median age 57.7, range 23-80 years) diagnosed with OAB, who qualified for intravesical BTX-A injection. Each received 100 IU of BTX-A (Botox®; Allergan), dissolved in 9.5 ml of 0.9% NaCl with the addition of 0.5 ml of MB. Cystoscopy with submucosal injection of the solution was performed systematically, including the bladder triangle. For pharmacological evaluation, quantitative determination of MB was performed on a capillary electrophoresis system with diode array detection. RESULTS In the course of 600 injections, the addition of MB facilitated the observation of the procedure; the exact distribution of the solution could not be observed in only 43 injections in seven patients. The range of distribution of the drug varied from 1 to 2.5 cm. Pharmacological evaluation based on visual observations and experiments showed that pharmaceutical interactions do not occur between MB and this commercially available formulation of BTX-A. CONCLUSIONS Applying a coloured solution of BTX-A significantly facilitates observation of the procedure and assessment of drug distribution. There are no pharmaceutical interactions between MB and BTX-A.
Collapse
Affiliation(s)
- Michał Szczypior
- a Department of Urology , Medical University of Gdansk , Gdansk , Poland
| | - Wojciech Połom
- a Department of Urology , Medical University of Gdansk , Gdansk , Poland
| | | | - Krzesimir Ciura
- b Department of Physical Chemistry , Medical University of Gdansk , Gdansk , Poland
| | | | - Julia Jacyna
- c Department of Biopharmaceutics and Pharmacodynamics , Medical University of Gdansk , Gdansk , Poland
| | - Michał Markuszewski
- c Department of Biopharmaceutics and Pharmacodynamics , Medical University of Gdansk , Gdansk , Poland
| | - Marcin Matuszewski
- a Department of Urology , Medical University of Gdansk , Gdansk , Poland
| |
Collapse
|
32
|
The influence of duloxetine on detrusor overactivity in rats with depression induced by 13-cis-retinoic acid. Int Urogynecol J 2017; 29:987-995. [PMID: 28762178 PMCID: PMC6004276 DOI: 10.1007/s00192-017-3424-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/30/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to assess the efficacy of duloxetine in an animal model of detrusor overactivity induced by depression. METHODS After 6 weeks of 13-cis-retinoic acid administration at a dose of 1 mg/kg/day, rats were given duloxetine at a dose of 1 mg/kg. This was followed by conscious cystometry, a forced swim test, and locomotor activity measurement. The levels of corticotropin-releasing factor (CRF) in the hypothalamus, amygdala and plasma were also determined. RESULTS Duloxetine treatment led to a reduction in detrusor overactivity symptoms induced by the retinoid. Decreases were observed in cystometric parameters including the detrusor overactivity index, and the amplitude and frequency of nonvoiding contractions, while increases were seen in bladder compliance and the volume threshold to elicit nonvoiding contractions. No statistically significant differences were found in basal pressure, threshold pressure, micturition voiding pressure, postvoid residual , volume threshold, voiding efficiency, intercontraction interval, bladder contraction duration or relaxation time. Duloxetine also reduced the immobility time to that observed in control animals, while it did not affect locomotor activity. Its effects also included lowering of the CRF levels in the hypothalamus, amygdala and plasma, which increased following the prior administration of the retinoid. The plasma level of 13-cis-retinoic acid in rats corresponded to the levels found in humans. CONCLUSIONS This is the first study showing the efficacy of duloxetine in an animal model of detrusor overactivity induced by depression. Further studies in patients with detrusor overactivity and coexisting depression are warranted to confirm these experimental results.
Collapse
|
33
|
Jansen APD, Muntinga ME, Bosmans JE, Berghmans B, Dekker J, Hugtenburgh J, Nijpels G, van Houten P, Laurant MGH, van der Vaart HCH. Cost-effectiveness of a nurse-led intervention to optimise implementation of guideline-concordant continence care: Study protocol of the COCON study. BMC Nurs 2017; 16:10. [PMID: 28239296 PMCID: PMC5320796 DOI: 10.1186/s12912-017-0204-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 02/09/2017] [Indexed: 11/10/2022] Open
Abstract
Background Guidelines on urinary incontinence recommend that absorbent products are only used as a coping strategy pending definitive treatment, as an adjunct to ongoing therapy, or for long-term management after all treatment options have been explored. However, these criteria are rarely met and a significant share of long-term product users could still benefit from therapeutic interventions recommended in guidelines for urinary incontinence. Better implementation of these guidelines can potentially result in both health benefits for women and long-term cost savings for society. The aim of the COCON study is to evaluate the (cost-)effectiveness of a nurse-led intervention to optimise implementation of guideline-concordant continence care in comparison with usual care for urinary incontinent women aged 55 years and over who use absorbent products. Methods This randomised clinical trial compares usual care with a nurse-led intervention to optimise implementation of guideline-concordant continence care. Women (anticipated N = 160) are recruited in 12 community pharmacies in three Dutch regions, and are eligible for trial entry when they are 55 years and over, community-dwelling and long-term users of absorbent products (≥4 months) reimbursed by health insurance. Measurements are administered at baseline, 3, 6 and 12 months. Primary outcome is severity of urinary incontinence (ICIQ-UI SF); other outcomes include health related quality of life (EQ-5D-5 L), use of absorbent products (in accordance with the recommended criteria in guidelines) (yes/no), and societal costs. Mixed model analysis will be performed to compare (the course) of outcomes between groups. The economic evaluation will be performed from a societal perspective. The implementation process is investigated using the Tailored Implementation for Chronic Diseases (TICD) framework. Discussion Results will add to current knowledge of the (cost-)effectiveness of nurse-led primary healthcare to improve guideline-concordant care for older women with urinary incontinence. In addition, the results will provide more insight into care needs and health service utilization of this group of women, as well as into use of absorbent products in accordance with the recommended criteria in guidelines. Finally, results will increase our understanding of the intervention’s uptake and could provide useful insights for future dissemination and sustenance. Trial registration Dutch Trial Register NTR4396, registered 13-January-2014 Electronic supplementary material The online version of this article (doi:10.1186/s12912-017-0204-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Aaltje P D Jansen
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Maaike E Muntinga
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences and Amsterdam Public Health research institute, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Bary Berghmans
- Maastricht University, Maastricht, The Netherlands; Pelvic care Center Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Janny Dekker
- Department of General Practice, University of Groningen; University Medical Center Groningen, Groningen, The Netherlands
| | - Jacqueline Hugtenburgh
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands
| | - Giel Nijpels
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Miranda G H Laurant
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Science, IQ healthcare, Nijmegen, The Netherlands
| | - Huub C H van der Vaart
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
34
|
Takahashi K, Sase E, Kato A, Igari T, Kikuchi K, Jimba M. Psychological resilience and active social participation among older adults with incontinence: a qualitative study. Aging Ment Health 2016; 20:1167-1173. [PMID: 26179274 DOI: 10.1080/13607863.2015.1065792] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Incontinence restricts participation in social activities among older adults. However, some older adults participate in social activities despite this condition. This study aimed to describe how older adults with incontinence could be resilient and actively participate in social activities. METHODS We conducted semi-structured interviews with 11 socially active older adults with incontinence (age 70-90; nine women and two men) at their homes or in private areas of day-service centres in Chiba, Japan. We coded salient narratives by using thematic analysis and extracted themes. Finally, we developed a conceptual model and illustrated the interactions among themes. RESULTS We identified seven themes that affected active social participation; five of these pertained to psychological characteristics ('motivation to be socially active', 'psychological stress of incontinence', 'desire to interact with others', 'willingness to perform physical exercise', and 'confidence in managing incontinence') and the remaining two pertained to supporting environmental factors ('assistive devices' and 'accessible toilet'). Three psychological themes ('desire to interact with others', 'willingness to perform physical exercise', and 'confidence in managing incontinence') were intertwined with supporting environmental factors and increased the participants' 'motivation to be socially active'. CONCLUSION Older adults with incontinence can actively participate in the society when they have desire to interact with others, willingness to perform physical exercise, and confidence in managing incontinence. These psychological characteristics are important for being resilient in the face of incontinence and for active social participation.
Collapse
Affiliation(s)
- Kyo Takahashi
- a Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan.,b Department of Social Rehabilitation, Research Institute , National Rehabilitation Center for Persons with Disabilities , Saitama , Japan
| | - Eriko Sase
- a Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | | | | | - Kimiyo Kikuchi
- a Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | - Masamine Jimba
- a Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| |
Collapse
|
35
|
Siff LN, Jelovsek JE, Barber MD. The effect of major depression on quality of life after surgery for stress urinary incontinence: a secondary analysis of the Trial of Midurethral Slings. Am J Obstet Gynecol 2016; 215:455.e1-9. [PMID: 27133008 DOI: 10.1016/j.ajog.2016.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/16/2016] [Accepted: 04/20/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Depression has been associated with symptom amplification, functional impairment, and lower incontinence-specific quality of life in women with urinary incontinence. Although depression has been shown to impact both subjective and objective outcomes after many different surgeries, there are limited data on the effects of major depression on postoperative outcomes after antiincontinence surgery. OBJECTIVE The purpose of this study was to determine whether major depression affects urinary incontinence severity and quality of life after midurethral sling surgery. STUDY DESIGN This was a secondary analysis of the Trial of Midurethral Slings. Participants were assigned randomly either to a retropubic or transobturator sling for stress urinary incontinence. Each was classified as having major depression or not by the validated depression screening Patient Health Questionnaire-9. Pre- and postoperative urinary incontinence severity (which was assessed by the International Consultation on Incontinence Questionnaire), urinary incontinence-specific quality of life (which was assessed by the Incontinence Impact Questionnaire and the Urinary Distress Inventory), and sexual function (which was assessed by the Prolapse/Urinary Incontinence Sexual Questionnaire) was compared between groups at baseline and at 12 months. RESULTS Five hundred twenty-six patients were included: 79 patients (15%) had major depression before surgery; 447 patients (85%) did not. Baseline incontinence severity was higher in women with major depression than in those without (International Consultation on Incontinence Questionnaire, 14.7 ± 4.1 vs 12.9 ± 4.0; P < .001). Similarly, baseline quality of life and sexual function were worse in depressed women than in nondepressed women (Incontinence Impact Questionnaire, 235.6 ± 95.8 vs 134.8 ± 89.8; P < .001; Urinary Distress Inventory, 162.7 ± 46 vs 128.6 ± 41.3; P < .001; and Prolapse/Urinary Incontinence Sexual Questionnaire-12, 27.2 ± 7.3 vs 33.9 ± 6.4; P < .001). After adjustment for differences between groups, baseline major depression did not negatively affect 12-month incontinence severity or quality of life. However, at 12 months after surgery, despite significant improvement in sexual function scores in depressed women, the 12-month scores were still significantly worse in the major depression group (Prolapse/Urinary Incontinence Sexual Questionnaire-12, 34.1 ± 7.1 vs 37.7 ± 6.1; P < .001); multivariable analysis showed independent association of baseline major depression with 12-month sexual function. At 12 months, 83% of those women (66/79) with baseline major depression were no longer depressed. CONCLUSION Women with major depression who are planning surgery for stress urinary incontinence have worse quality of life than nondepressed women. However, women with major depression improve significantly more than those without major depression such that, at 12 months postoperatively, incontinence severity and quality of life are not different between groups. Sexual function is worse before and after the operation for depressed women.
Collapse
Affiliation(s)
- Lauren N Siff
- Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH.
| | - J Eric Jelovsek
- Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Matthew D Barber
- Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
36
|
Effectiveness of Pelvic Floor Muscle Training for Urinary Incontinence. J Wound Ostomy Continence Nurs 2016; 43:291-300. [DOI: 10.1097/won.0000000000000227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Wróbel A, Rechberger T. An animal model of detrusor overactivity induced by depression. J Pharmacol Toxicol Methods 2016; 80:19-25. [PMID: 27050558 DOI: 10.1016/j.vascn.2016.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/18/2016] [Accepted: 04/01/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Depression is frequently found in patients suffering from overactive bladder. The aim of the study was to verify whether the 13-cis-retinoic acid, a synthetic retinoid used in the treatment of acne, which was proven to induce depressive changes in both humans and animals, can cause detrusor overactivity symptoms in conscious rats. METHODS In order to assess the 13-cis-retinoic acid impact on the behavioural parameters, after 6weeks of intraperitoneal administration of retinoid in a dose of 1mg/kg/day, a forced swim test and cystometry were performed, and the locomotor activity of animals was assessed. The control group received a mixture of DMSO and physiological saline at a 1:1 ratio. RESULTS 13-cis-retinoic acid caused cystometric parameter changes analogous to those observed in people with a urodynamic diagnosis of detrusor overactivity. The retinoid caused also an extension of the immobility time in the forced swim test which is consistent with increased depression-related behaviour, with no impact on the locomotor activity of rats. The intravenous administration of solifenacin succinate in a single dose of 0.03mg/kg turned out to reverse changes in the cystometric parameters modified by 13-cis-retinoic acid treatment. The histopathological analysis of bladders did not show any lesions in the upper layer of the umbrella cells, urothelium or muscles. The retinoid concentration level achieved in the animals tested turned out to be identical to that occurring in humans. DISCUSSION 13-cis-retinoic acid can induce detrusor overactivity symptoms that are reversed by solifenacin succinate.
Collapse
Affiliation(s)
- Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland.
| | - Tomasz Rechberger
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
| |
Collapse
|
38
|
Tannenbaum C, van den Heuvel E, Fritel X, Southall K, Jutai J, Rajabali S, Wagg A. Continence Across Continents To Upend Stigma and Dependency (CACTUS-D): study protocol for a cluster randomized controlled trial. Trials 2015; 16:565. [PMID: 26652168 PMCID: PMC4676178 DOI: 10.1186/s13063-015-1099-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/02/2015] [Indexed: 12/01/2022] Open
Abstract
Background Urinary incontinence occurs in 40 % of women aged 65 years and over; however, only 15 % seek care and many delay healthcare seeking for years. Incontinence is associated with depression, social isolation, reduced quality of life, falls and other comorbidities. It is accompanied by an enormous cost to the individual and society. Despite the substantial implications of urinary incontinence on social, psychological and physical well-being of older women, the impact of continence promotion on urinary symptom improvement and subsequent effects on falls, quality of life, stigma, social participation and the cost of care remains unknown. Methods This study is a mixed methods multi-national open-label 2-arm parallel cluster randomized controlled trial aiming to recruit 1000 community-dwelling incontinent women aged 65 years and older across Quebec, Western Canada, France and United Kingdom. Participants will be recruited through community organizations. Data will be collected at 6 time points: baseline and 1 week, 3 months, 6 months, 9 months and 12 months after baseline. One of the primary objectives is to evaluate whether the continence promotion intervention improves incontinence symptoms (measured with the Patient Global Impression of Improvement questionnaire, PGI-I) at 12 months post intervention compared to the control group. Other co-primary outcomes include changes in incontinence-related stigma, fall reduction, and incremental cost-effectiveness ratio and quality-adjusted life years. Data analysis will account for correlation of outcomes (clustering) within community organizations. A qualitative sub-study will explore stigma reduction. Discussion Community-based continence promotion programs may be a cost-effective strategy to reduce urinary incontinence, stigma and falls among older women with untreated incontinence, and simultaneously improve quality of life and healthy active life expectancy. Trial registration ClinicalTrials.gov: NCT01858493, registered 13 May 2013
Collapse
Affiliation(s)
- Cara Tannenbaum
- Institut Universitaire de Gériatrie de Montréal, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
| | | | - Xavier Fritel
- Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.
| | - Kenneth Southall
- École d'Orthophonie et d'Audiologie, Université de Montréal, Montréal, QC, Canada.
| | - Jeffrey Jutai
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
| | - Saima Rajabali
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada.
| |
Collapse
|
39
|
Jung HB, Kim HJ, Cho ST. A current perspective on geriatric lower urinary tract dysfunction. Korean J Urol 2015; 56:266-75. [PMID: 25874039 PMCID: PMC4392025 DOI: 10.4111/kju.2015.56.4.266] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/09/2015] [Indexed: 01/17/2023] Open
Abstract
Lower urinary tract dysfunction-such as urinary incontinence (UI), detrusor overactivity, and benign prostatic hyperplasia-is prevalent in elderly persons. These conditions can interfere with daily life and normal functioning and lead to negative effects on health-related quality of life. UI is one of the most common urologic conditions but is poorly understood elderly persons. The overall prevalence of UI increases with age in both men and women. Elderly persons often neglect UI or dismiss it as part of the normal aging process. However, UI can have significant negative effects on self-esteem and has been associated with increased rates of depression. UI also affects quality of life and activities of daily living. Although UI is more common in elderly than in younger persons, it should not be considered a normal part of aging. UI is abnormal at any age. The goal of this review is to provide an overview of the cause, classification, evaluation, and management of geriatric lower urinary tract dysfunction.
Collapse
Affiliation(s)
- Ha Bum Jung
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyung Jee Kim
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
| | - Sung Tae Cho
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| |
Collapse
|
40
|
Browne C, Salmon N, Kehoe M. Bladder dysfunction and quality of life for people with multiple sclerosis. Disabil Rehabil 2015; 37:2350-8. [PMID: 25801920 DOI: 10.3109/09638288.2015.1027007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Bladder dysfunction affects 75% of people with multiple sclerosis (MS). People with MS are reluctant to seek treatment for this distressing symptom. This is the first-known study to explore in depth how bladder dysfunction interferes with quality of life for people with MS. METHODS Nineteen individual semi-structured interviews were conducted (M = 8, F = 11). Participants had a definite diagnosis of MS, aged between 37 and 64 years and had at least one bladder dysfunction symptom. The audio-recorded interviews lasted up to 90 min and were transcribed verbatim. RESULTS Thematic analysis within NVivo10 yielded two key themes: (1) Disruptions and loss and (2) ways of knowing. "Disruptions and Loss" explores how bladder dysfunction interrupted daily living activities and how this contributed to experiencing loss. "Ways of knowing" portrays the types of knowledge that existed around bladder dysfunction. Participants described using their experiential knowledge to self-manage bladder symptoms without advice from healthcare providers. CONCLUSIONS Bladder dysfunction imposes major disruptions on daily life. People with MS attempt to self-manage their bladder symptoms, despite current barriers to navigating existing healthcare infrastructure. Understanding these barriers and the individual strategies employed by people with MS are the first steps in facilitating independent management of bladder dysfunction. Implications for Rehabilitation Each individual's experience of bladder dysfunction is unique. Healthcare professionals must be prepared to discuss all disruptions and losses associated with bladder dysfunction for people with MS. People with MS have a vast range of knowledge in relation to their own bladder symptoms and healthcare professionals need to explore their existing self-management strategies during assessment. People with MS and healthcare professionals need to be educated on the wider health implications relating to bladder dysfunction.
Collapse
Affiliation(s)
- Catherine Browne
- a Department of Clinical Therapies , University of Limerick , Limerick , Ireland and
| | - Nancy Salmon
- a Department of Clinical Therapies , University of Limerick , Limerick , Ireland and
| | - Maria Kehoe
- b Community Physiotherapy Department , Kildare/West Wicklow, Co. Kildare , Ireland
| |
Collapse
|
41
|
Wheeler TL, Illston JD, Markland AD, Goode PS, Richter HE. Life Space Assessment in Older Women Undergoing Non-Surgical Treatment for Urinary Incontinence. ACTA ACUST UNITED AC 2014; 4:809-816. [PMID: 25525562 DOI: 10.4236/ojog.2014.414112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Urinary incontinence (UI) impacts all aspects of life activities. This study aims to characterize change in mobility within the community utilizing the Life Space Assessment (LSA) questionnaire in women undergoing non-surgical UI treatment. DESIGN Prospective cohort study, performed from July 2007 to March 2009, which followed women seeking non-surgical UI treatment and assessed their mobility and symptoms using LSA, Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7) at baseline and 2, 6, and 12 months post-treatment. Estimated Percent Improvement (EPI) and Patient Satisfaction Question (PSQ) were obtained post-treatment. SETTING Outpatient tertiary-care clinic. PARTICIPANTS 70 ambulatory, community-dwelling women, aged 65 years or older, seeking non-surgical care for UI. INTERVENTION Multi-component behavioral and/or pharmacologic therapies. MEASUREMENTS We hypothesized LSA would improve with treatment. Repeated measures analysis with Tukey's HSD and backwards selection linear regression model were performed. RESULTS LSA score decreased from baseline to 2 months (mean±SD; 63±29 to 56±28, p<0.001) and was sustained at 6 and 12 months (54±28, 54±28). UDI scores improved from 36±23 to 25±24, p<0.001, at 2 months, and improvement persisted at 6 and 12 months (22±22, 21±24). Improvements in UDI and patient perceived improvement in UI were not associated with LSA change. Age, race, and depression impacted LSA, which decreased 1-point for each additional year of age (p=0.004), 6-points for each point higher on the Geriatric Depression Scale (GDS) (p=0.002), and 6-points for African American race (p=0.048). CONCLUSION Decreased mobility represented by LSA was related to age, depression, and race, but not UI symptom improvement.
Collapse
Affiliation(s)
- Thomas L Wheeler
- Department of Obstetrics and Gynecology, University of South Carolina School of Medicine-Greenville, Greenville, SC
| | - Jana D Illston
- Department of Obstetrics and Gynecology, University of South Carolina School of Medicine-Greenville, Greenville, SC
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - Patricia S Goode
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
42
|
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.
Collapse
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.
| | | | | | | | | | | | | |
Collapse
|
43
|
Ghaderi F, Oskouei AE. Physiotherapy for women with stress urinary incontinence: a review article. J Phys Ther Sci 2014; 26:1493-9. [PMID: 25276044 PMCID: PMC4175265 DOI: 10.1589/jpts.26.1493] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/27/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This review article is designed to expose physiotherapists to a physiotherapy
assessment of stress urinary incontinence (SUI) and the treatment and possibly preventive
roles that they might play for women with SUI. Specifically, the goal of this article is
to provide an understanding of pelvic floor muscle function and the implications that this
function has for physiotherapy treatment by reviewing articles published in this area.
[Methods] A range of databases was searched to identify articles that address
physiotherapy for SUI, including the Cochrane Library, Medline, and CINAHL. [Results]
According to the articles identified in our databases research, greater improvements in
SUI occur when women receive a supervised exercise program of at least three months. The
effectiveness of physiotherapy treatment is increased if the exercise program is based on
some principles, such as intensity, duration, resembling functional task, and the position
in which the exercise for pelvic floor muscles is performed. Biofeedback and electrical
stimulation may also be clinically useful and acceptable modalities for some women with
SUI. [Conclusion] We concluded that the plan for physiotherapy care should be
individualized for each patient and include standard physiotherapy interventions.
Collapse
Affiliation(s)
- Fariba Ghaderi
- Department of Physiotherapy, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Iran
| | - Ali E Oskouei
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Iran
| |
Collapse
|
44
|
Morrisroe SN, Rodriguez LV, Wang PC, Smith AL, Trejo L, Sarkisian CA. Correlates of 1-year incidence of urinary incontinence in older Latino adults enrolled in a community-based physical activity trial. J Am Geriatr Soc 2014; 62:740-6. [PMID: 24618012 DOI: 10.1111/jgs.12729] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The prevalence of urinary incontinence (UI) among older urban Latinos is high. Insight into etiologies of and contributing factors to the development of this condition is needed. This longitudinal cohort study identified correlates of 1-year incidence of UI in older community-dwelling Latino adults participating in a senior center-based physical activity trial in Los Angeles, California. Three hundred twenty-eight Latinos aged 60 to 93 participating in Caminemos, a randomized trial to increase walking, were studied. Participants completed an in-person survey and physical performance measures at baseline and 1 year. UI was measured using the International Consultation on Incontinence item: "How often do you leak urine?" Potential correlates of 1-year incidence of UI included sociodemographic, behavioral, medical, physical, and psychosocial characteristics. The overall incidence of UI at 1 year was 17.4%. Incident UI was associated with age, baseline activity of daily living impairment, health-related quality of life (HRQoL), mean steps per day, and depressive symptoms. Multivariate logistic regression models revealed that improvement in physical performance score (odds ratio (OR) = 0.69, 95% confidence interval (CI) = 0.50-0.95) and high baseline physical (OR = 0.60, 95% CI = 0.40-0.89) and mental (OR = 0.62, 95% CI = 0.43-0.91) HRQoL were independently associated with lower rates of 1-year incident UI. An increase in depressive symptoms at 1 year (OR = 4.48, 95% CI = 1.02-19.68) was independently associated with a higher rate of incident UI. One-year UI incidence in this population of older urban Latino adults participating in a walking trial was high but was lower in those who improved their physical performance. Interventions aimed at improving physical performance may help prevent UI in older Latino adults.
Collapse
Affiliation(s)
- Shelby N Morrisroe
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | | | | | | | | | | |
Collapse
|
45
|
Yu P, Hailey D, Fleming R, Traynor V. An exploration of the effects of introducing a telemonitoring system for continence assessment in a nursing home. J Clin Nurs 2014; 23:3069-76. [DOI: 10.1111/jocn.12538] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Ping Yu
- School of IS and IT; Faculty of Engineering and Information Sciences; University of Wollongong; Wollongong NSW Australia
| | - David Hailey
- School of IS and IT; Faculty of Engineering and Information Sciences; University of Wollongong; Wollongong NSW Australia
| | - Richard Fleming
- School of Nursing and Midwifery; Faculty of Science, Health and Medicine; University of Wollongong; Wollongong NSW Australia
| | - Victoria Traynor
- School of Nursing and Midwifery; Faculty of Science, Health and Medicine; University of Wollongong; Wollongong NSW Australia
| |
Collapse
|
46
|
Moreno G, Mangione CM, Kimbro L, Vaisberg E. Guidelines abstracted from the American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 update. J Am Geriatr Soc 2014; 61:2020-6. [PMID: 24219204 DOI: 10.1111/jgs.12514] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
47
|
John G, Gerstel E, Jung M, Dällenbach P, Faltin D, Petoud V, Zumwald C, Rutschmann OT. Urinary incontinence as a marker of higher mortality in patients receiving home care services. BJU Int 2013; 113:113-9. [DOI: 10.1111/bju.12359] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Gregor John
- Department of Internal Medicine; Perineology Unit; Geneva University Hospitals (HUG); Geneva Switzerland
| | - Eric Gerstel
- Department of Epidemiology; Perineology Unit; Geneva University Hospitals (HUG); Geneva Switzerland
| | - Michel Jung
- Department of Internal Medicine; Perineology Unit; Geneva University Hospitals (HUG); Geneva Switzerland
| | - Patrick Dällenbach
- Department of Gynecology and Obstetrics; Perineology Unit; Geneva University Hospitals (HUG); Geneva Switzerland
| | - Daniel Faltin
- Department of Gynecology and Obstetrics; Perineology Unit; Geneva University Hospitals (HUG); Geneva Switzerland
| | - Véronique Petoud
- Institution Genevoise de Maintien à Domicile (IMAD); Geneva Switzerland
| | - Catherine Zumwald
- Institution Genevoise de Maintien à Domicile (IMAD); Geneva Switzerland
| | - Olivier T. Rutschmann
- Department of Community, Primary Care and Emergency Medicine; Geneva School of Medicine; Geneva University Hospitals; Geneva Switzerland
| |
Collapse
|
48
|
Xu D, Kane RL. Effect of urinary incontinence on older nursing home residents' self-reported quality of life. J Am Geriatr Soc 2013; 61:1473-81. [PMID: 23927875 DOI: 10.1111/jgs.12408] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the effect of urinary incontinence (UI) on elderly nursing home (NH) residents' self-reported quality of life (QOL), especially on the specific QOL domains most closely associated with UI. DESIGN Retrospective cross-sectional study using the Minimum Data Set (MDS) and Minnesota Nursing Home Report Card data in 2010 to compare overall QOL and its domains of residents with and without UI using propensity scores and inverse probability weighting (IPW) adjustments to reduce selection bias. SETTING All Medicare- or Medicaid-licensed NHs in Minnesota. PARTICIPANTS All residents aged 65 and older except those with conditions that could readily overwhelm the effect of UI on QOL, such as coma and cerebral palsy. MEASUREMENTS Urinary incontinence (UI) was defined as leakage two or more times a week (score ≥ 2 on MDS 5-point scale), and continence was defined as continent or usually continent (score 0 or 1 on MDS 5-point scale). QOL was assessed using a self-reported QOL questionnaire that measured general QOL, not QOL specific to UI symptoms. RESULTS Urinary incontinence (UI) prevalence was 65.8% in 10,683 older NH residents. Self-reported QOL was good (>0.7 on a scale from 0 to 1) in 8,620 eligible residents in 371 NHs. Mood and meaningful activity domains had lower scores; dignity had the highest score. UI was associated with being older and female, ADL dependence, impaired cognitive ability, Alzheimer's disease, non-Alzheimer's dementia, bowel incontinence, diabetes mellitus, and long-term NH stay. Bivariate analysis found that residents with UI had lower QOL than those without. Using IPW to reduce selection bias, it was found that, although UI was not associated with overall QOL, it decreased the QOL domains of dignity, autonomy, and mood. CONCLUSION To improve the QOL of residents with UI, attention should be paid to dignity, autonomy, and mood.
Collapse
Affiliation(s)
- Dongjuan Xu
- School of Public Health, University of Minnesota, Minneapolis, Minnesota; School of Nursing, Shandong University, Jinan, Shandong Province, China
| | | |
Collapse
|
49
|
SAKAKIBARA R, ITO T, YAMAMOTO T, UCHIYAMA T, YAMANISHI T, KISHI M, TSUYUSAKI Y, TATENO F, KATSURAGAWA S, KUROKI N. Depression, Anxiety and the Bladder. Low Urin Tract Symptoms 2013; 5:109-20. [DOI: 10.1111/luts.12018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 02/20/2013] [Accepted: 02/20/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Ryuji SAKAKIBARA
- Division of Neurology, Department of Internal Medicine, Sakura Medical Center; Toho University; Sakura Japan
| | - Takashi ITO
- Division of Neurology; Chiba University; Chiba Japan
| | | | | | | | - Masahiko KISHI
- Division of Neurology, Department of Internal Medicine, Sakura Medical Center; Toho University; Sakura Japan
| | - Yohei TSUYUSAKI
- Division of Neurology, Department of Internal Medicine, Sakura Medical Center; Toho University; Sakura Japan
| | - Fuyuki TATENO
- Division of Neurology, Department of Internal Medicine, Sakura Medical Center; Toho University; Sakura Japan
| | | | - Nobuo KUROKI
- Mental Health Clinic, Sakura Medical Center; Toho University; Sakura Japan
| |
Collapse
|
50
|
da Rocha NS, Schuch FB, Fleck MPDA. Gender differences in perception of quality of life in adults with and without chronic health conditions: the role of depressive symptoms. J Health Psychol 2013; 19:721-9. [PMID: 23479301 DOI: 10.1177/1359105313478644] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previous studies have shown that chronic conditions have a negative impact on quality of life. Furthermore, this impact appears to be different in males and females, but it is not yet clear what factors may mediate this relationship. Females with chronic health conditions had poorer quality of life in the physical and psychological domains as compared to males with chronic health conditions. The difference between male and female patients in the psychological domain disappeared when the analysis was adjusted for confounding factors such as age, presence of a chronic health condition, socioeconomic status, and depressive symptoms.
Collapse
|