Predictive factors of urinary tract infections among the oldest old in the general population. a population-based prospective follow-up study

Monique Aa Caljouw,Jacobijn Gussekloo,Herman Jm Cools,Wendy Pj Den Elzen

doi:10.1186/1741-7015-9-57

Monique Aa Caljouw, Jacobijn Gussekloo + Show 2 more

Open Access

https://doi.org/10.1186/1741-7015-9-57

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Journal: BMC Medicine	Publication Date: May 16, 2011
Citations: 130	License type: cc-by

Affiliation: Leiden University Medical Center

Abstract

BackgroundUrinary tract infections (UTI) are common among the oldest old and may lead to a few days of illness, delirium or even to death. We studied the incidence and predictive factors of UTI among the oldest old in the general population.MethodsThe Leiden 85-plus Study is a population-based prospective follow-up study of 86-year-old subjects in Leiden, The Netherlands. Information on the diagnosis of UTI was obtained annually during four years of follow-up from the medical records and interviews of treating physicians. A total of 157 men and 322 women aged 86 years participated in the study. Possible predictive factors were collected at baseline, including history of UTI between the age of 85 and 86 years, aspects of functioning (cognitive impairment (Mini-Mental State Examination (MMSE) < 19), presence of depressive symptoms (Geriatric Depression Scale (GDS) > 4), disability in activities of daily living (ADL)), and co-morbidities.ResultsThe incidence of UTI from age 86 through 90 years was 11.2 (95% confidence interval (CI) 9.4, 13.1) per 100 person-years at risk. Multivariate analysis showed that history of UTI between the age of 85 and 86 years (hazard ratio (HR) 3.4 (95% CI 2.4, 5.0)), impaired cognitive function (HR 1.9 (95% CI 1.3, 2.9)), disability in daily living (HR 1.7 (95% CI 1.1, 2.5)) and urine incontinence (HR 1.5 (95% CI 1.0, 2.1)) were independent predictors of an increased incidence of UTI from age 86 onwards.ConclusionsWithin the oldest old, a history of UTI between the age of 85 and 86 years, cognitive impairment, ADL disability and urine incontinence are independent predictors of developing UTI. These predictive factors could be used to target preventive measures to the oldest old at high risk of UTI.

Highlights

Urinary tract infections (UTI) are common among the oldest old and may lead to a few days of illness, delirium or even to death
Two-thirds of the population was female and 22% of the participants were institutionalised in long-term care facilities
A total of 44% of the participants reported urine incontinence and in almost 20% of the participants incontinence was diagnosed by the general practitioner or elderly care physician

Summary

Introduction

Urinary tract infections (UTI) are common among the oldest old and may lead to a few days of illness, delirium or even to death. The incidence of UTI increases with age in both men and women [3,4,5], and increases from 12 to 29 per 100 person-years at risk in community-dwelling elderly populations [5,6] to 44 to 58 per 100 residents per year at risk in long term care facilities [7,8]. These UTI are often complicated, involving the presence of structural or functional abnormalities of the genitourinary tract [9]. Preventive strategies are best applied to those at risk; factors associated with UTI in ambulatory older patients in the community setting have not been described

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