Urinary Incontinence In Older People Research Articles

尿失禁対策としての骨盤底筋運動の実際

尿失禁対策としての骨盤底筋運動の実際

Briefs With Tapes Versus Pull Ups for Urinary Incontinence in Older People With Mild to Moderate Dementia (CUPID)

Briefs With Tapes Versus Pull Ups for Urinary Incontinence in Older People With Mild to Moderate Dementia (CUPID)

8 Improving Identification and Assessment of Urinary Incontinence in Older People

Abstract Introduction Urinary incontinence is very common in the older people and wrongly considered a normal part of aging. The prevalence of UI is 39.1% in people with frailty and 19.4% in those without (Veronese et al. European Geriatric Medicine, 2018, 9(5), 571–578). Despite the high prevalence of urinary incontinence, its detection and management remain suboptimal. A comprehensive multidisciplinary continence assessment is recommended to assess and manage urinary incontinence in older patients (NICE CG171). Methods Plan, Do, Study, Act (PDSA) cycle audit was conducted to identify the practices for identification and assessment of urinary incontinence on a care of elderly ward. Data was collected on a structured proforma containing six standards prospectively. Following the results of first cycle, a strategy was developed and implemented. Results Strategy Cycle 1 (35 patients) results were disseminated to the Divisional Safety and Quality Committee, ward teams, educational sessions held for multidisciplinary teams, involved Trust's continence advisor, displayed multidisciplinary teams prompt sheets, trialled new nursing documentation booklet, discussed continence status at daily board round and conducted audit cycle 2 (28 patients) after 4 months. Conclusions PDSA cycle audit with involvement of multidisciplinary teams, presentation to the Divisional Quality and Safety Committee combined with regular educational sessions and prompt about continence status at the daily board round led to better detection and improved management of urinary incontinence. We recommend other clinical teams to follow our strategy to improve the urinary incontinence care in older people without any additional resource.

Managing urinary incontinence in older people in hospital: a best practice implementation project.

This project aimed to improve care in managing urinary incontinence in older patients admitted to a medium-to-long-stay hospital by developing and implementing strategies to improve the compliance with best practice in managing urinary incontinence and decrease its prevalence. Urinary incontinence (UI) is a major problem in hospitalized older people and is of great significance to public health. The application of evidence-based recommendations for this problem could be expected to improve the quality of care. The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in healthcare practice. Participants were evaluated at baseline and at two follow-ups at three and six months after key strategies had been implemented. The location of this implementation project was the functional rehabilitation ward of a medium-to-long-stay Spanish hospital. In baseline audit there were four process criteria with a high level of compliance: two criteria with 35% and 44% respectively and one criterion without compliance. Action was taken to address the four barriers identified, leading to an increase in all cases except one, which was related to the characteristics of the patient. Prevalence of urinary incontinence decreased at follow-up. The development and implementation of strategies improved quality of care. This project obtained positive results in patient health, and the implementation of the strategies used decreased the prevalence of urinary incontinence in patients.

Think Dry: Optimalisation of Diagnostic Process of Urinary Incontinence in Older People

Think Dry: Optimalisation of Diagnostic Process of Urinary Incontinence in Older People

Pharmacist-led academic detailing intervention in primary care: a mixed methods feasibility study.

Background Academic detailing is a form of continuing medical education in which a trained health professional such as a physician or pharmacist visits prescribers in their practice to provide evidence-based information. While academic detailing has been adopted in other countries, this strategy is not routinely used in Ireland. Objective The aim of this study was to assess the feasibility and acceptability to General Practitioners (GPs) of a pharmacist-led academic detailing intervention in Ireland. Setting General Practice in County Cork, Ireland. Method A mixed methods feasibility study comprising a pharmacist-led academic detailing intervention on urinary incontinence in older people, quantitative data from patient medical records, and qualitative data from focus groups with GPs. The medical records for all patients aged ≥ 65years who were attending a participating GP with a diagnosis of urinary incontinence were analysed using a before-after approach. The measures of prescribing assessed before and after the intervention were: LUTS-FORTA criteria, Drug Burden Index, and the Anticholinergic Cognitive Burden scale. Focus groups were carried out with GPs who participated in the academic detailing intervention. Main outcome measure The quantitative prescribing patterns of the GPs and their qualitative responses from the focus groups. Results Twenty-three GPs participated in the academic detailing intervention from a selection of different types of general practice. The medical records of 154 patients were analysed. There was minimal or no change in any of the prescribing measures used. Fourteen GPs attended focus groups. GPs considered the topic of urinary incontinence as relevant to general practice. Participants appreciated the succinct nature of the information in the educational materials but expressed a preference for a more easily retrievable format, such as an online version rather than paper-based. Conclusion This study demonstrated that a pharmacist-led academic detailing intervention was acceptable to GPs in Ireland. Further research is needed in a larger population evaluating the impact and cost effectiveness of academic detailing to optimise patient care.

Consensus document on the detection and diagnosis of urinary incontinence in older people

Urinary incontinence (UI), one of the Geriatric Giants, is a very common problem in the older person. It especially affects those with comorbidities, polypharmacy and functional impairment, physical as well cognitive, in whom the prevalence could be as high as 70–80%. Despite its very negative effects on quality of life (QOL), UI is still largely undetected and undertreated, due to many different reasons. UI produces numerous negative effects on QOL in older persons. Patients’ perception of the impact of UI on their lifestyle is very important, and even mild UI could have a significant impact on QOL. Unfortunately, both detection and index consultation for UI are low, as is the percentage of older persons that receive effective treatment (about 30–50%), in spite of the valid management options available. Also, older persons are less likely than younger age groups to discuss incontinence with their physician and only about half of those with incontinence seek help for their symptoms. Geriatricians should be in the frontline of the detection and diagnosis of UI, which can be considered as the ‘Frequently Forgotten Geriatric Giant’. To this effect a multidisciplinary European group of professionals developed this scientific document in order to present the current “state of the art” on the management of Urinary Incontinence in the older population. The aim of this Consensus Document is to increase awareness, as well as knowledge of this under-recognized Geriatric Syndrome, and to facilitate and improve the clinical management of older people with UI.

Consensus document on the management of urinary incontinence in older people

Urinary incontinence (UI), one of the geriatric giants, is a very common problem in the older person. It especially affects those with comorbidities, polypharmacy and functional impairment, physical as well cognitive, in whom the prevalence could be as high as 70–80%. Despite its very negative effects on quality of life (QOL), UI is still largely undetected and undertreated, due to different, but incomprehensible reasons. UI produces numerous negative effects on QOL in older persons. Patients’ perception of the impact of UI on their lifestyle is very important, and even mild UI could have a significant impact on QOL. Unfortunately, both detection and index consultation for UI are low, as is the percentage of older persons that receive effective treatment (about 30–50%), in spite of the valid management options available. Also, older persons are less likely than younger age groups to discuss incontinence with their physician and only about half of those with incontinence seek help for their symptoms. Geriatricians should be in the frontline of the detection and diagnosis of UI, which can be considered as the ‘Frequently Forgotten Geriatric Giant’. To this effect, a multidisciplinary European group of professionals developed this scientific document in order to present the current “state of the art” on the management of urinary incontinence in the older population. The aim of this consensus document is to increase awareness, as well as knowledge of this under-recognized geriatric syndrome, and to facilitate and improve the clinical management of older people with UI.

Comprehensive Assessment of Compliance with Antimuscarinic Drug Treatment in the Case of Urge Urinary Incontinence of Older Patients.

To investigate the heterogeneous factors affecting the stability of patients older than 60 years in the UI treatment with Antimuscarinics. The prevalence of Urge Incontinence (UI) in older persons reaches 29.3%. The symptoms of urinary incontinence in older people reduce the health related life quality. In 1257 patients over 60 years (857 (68.2%) women - average age 67.8, 400 (31.8%) men - 71.4), who received AM for one year, demographic, socio-economic and health parameters were studied. OABq-SF questionnaires, MOS SF-36, urination diaries, uroflowmetry, income information from the tax offices and outpatient records were used. The compliance to AM treatment within 6 months was retained in 44.2%, and within the year - 26.8% of older patients. At least 40% of the total number of patients refused to continue the treatment for medical reasons. The persons taking Solifenacin (p≤ 0.01), Trospium (p≤ 0.05), or Darifenacin (p≤ 0.05), suffering from severe UI symptoms (p≤ 0.01), and experiencing minor side effects (p≤ 0.01), well-informed about UI treatment methods (p≤ 0.01) prevailed among the treatment compliant patients. At least 20.4% of the patients discontinued their treatment due to economic reasons. The persons with significantly larger annual income (p≤ 0.05) and annual medical cost (p≤ 0.01) prevailed among the treatment compliant patients. About 12.2% of the patients stopped their treatment for reasons related to the social background and psychological status. In this experiment, we found that AM treatment compliance in older patients, in addition to medical parameters and health conditions, is largely affected by the economic as well as social, demographic and psychological factors. The study results can be claimed by practitioners involved in correcting UI symptoms in older people.

Urinary incontinence in older people.

function of the brain, bladder and body. In older people there are many risk factors for urinary incontinence that are unrelated to the urinary tract: as such incontinence is rightly considered a geriatric giant. Types and pathophysiology

Use of continence pads to manage urinary incontinence in older people.

Urinary incontinence is a symptom that should be investigated and whenever possible treated in order to enable the person to regain continence. Sometimes, it is not possible or appropriate to promote continence, and the focus shifts to that of managing incontinence sensitively to enable the person to maintain dignity and avoid the complications of poorly managed urinary incontinence. This article examines how nurses and health professionals can promote wellbeing by assessing a person's need for incontinence pads, enabling the person to use the appropriate type of pad and minimising risks of skin damage, odour, embarrassment, and leakage.

New horizons: urinary incontinence in older people

Urinary incontinence is a common complaint in older people, and is associated with significant impact on the individual, their carers and the wider healthcare system. As the numbers of frail elderly people increase, so will the burden of incontinence. This review examines recent developments in research into the aetiology, physiology, pathology and treatment of urinary incontinence and lower urinary tract symptoms in older people, and explores potential future developments which might reduce or ameliorate both urinary incontinence and its effects on frail older people. These include increasing understanding of the importance of central control of continence, the role of the urothelium as a sensory organ, novel targets for pharmacological treatments and surgical and invasive interventions.

Perceptions and barriers that influence the ability to provide appropriate incontinence care in nursing home residents: Statements from nursing staff

Urinary incontinence is a common medical condition among nursing home residents. Urinary incontinence in older people has a multifactorial etiology and is therefore more difficult to assess and treat than urinary incontinence in younger people. Previous research has shown that incontinence care in nursing home residents often is inadequate and little systematized. The aim of this study was to identify perceptions and barriers that influence the ability of the nursing staff to provide appropriate incontinence care. This was a qualitative study using focus-group methodology. Data were collected from three focus-group interviews with 15 members of the nursing staff from six different units in a nursing home. The focus-group interviews were recorded on tape, transcribed verbatim and analyzed according to qualitative content analysis. Three topics and eight categories were identified. The first topic, Perceptions and barriers associated with residents, consisted of one category: “physical and cognitive problems”. The second topic, Perceptions and barriers associated with nursing staff, consisted of three categories: “lack of knowledge”, “attitudes and beliefs” and “lack of accessibility”. The third topic, Perceptions and barriers associated with organizational culture, consisted of four categories: “rigid routines”, “lack of resource”, “lack of documentation” and “lack of leadership”. The findings from this study show that there are many barriers that might influence the possibilities of nursing staff to provide appropriate incontinence care to residents in nursing homes. However, it can nevertheless seem like opinions and the attitude of nursing staff, together with a lack of knowledge about UI, are the most important barriers to provide appropriate incontinence care.

Urinary incontinence in older people: an overview

Lower urinary tracts symptoms (LUTS) and urinary incontinence (UI), defined as involuntary loss of urine, are very common in the general population and increase in prevalence in late life. All LUTS have a considerable impact on morbidity and quality of life. Urinary incontinence is seldom discussed by patients, many of whom delay seeking care. Despite increasing evidence for effective management, older people are frequently neither assessed nor treated. This article discusses the assessment and management of the main subtypes of incontinence likely to be encountered in generalist practice for both the physiologically fit and frail older person.

Systematic review of descriptive studies that investigated associated factors with the management of incontinence in older people in care homes

Incontinence is prevalent among older populations and residents in care homes. This paper is a review of descriptive studies that investigated associated factors related to managing urinary incontinence in older people in care homes. A systematic literature review was undertaken. MEDLINE and CINHAL were searched from 1996-2010 using the Cochrane Incontinence Review Group search strings for urinary and faecal incontinence including all research designs. Sixteen studies were identified that reported on associated factors related to comorbidities, management preferences, policies, staff views and knowledge or methodological studies. Non-invasive methods involving toileting and use of pads were common management approaches. No studies aimed at maintaining continence were identified. Factors associated with incontinence need to also be considered when planning and managing care for individuals, and developing and designing systems of care within care homes. Further study in care home populations to change or inform practice and provide effective care is warranted. Preventive studies that maintain continence are required. Older people and their families should be involved with decisions regarding their preferred care, goals, management and outcomes for managing incontinence, promoting or maintaining continence.

Most Bothersome Symptom and Symptom Specific Goal Achievement in Patients With Benign Prostatic Obstruction: A Prospective Open Label Study

We evaluated symptom specific goal achievement, and the correlations between goal achievement and traditional outcome measures after pharmacological therapy in patients with benign prostatic obstruction. Men 50 years old or older with lower urinary tract symptoms secondary to benign prostatic obstruction and International Prostate Symptom Score 8 or greater were enrolled and treated with 10 mg alfuzosin XL for 12 months. Before treatment, face-to-face interviews were conducted to identify the single most bothersome symptoms and to set treatment goals for the symptoms in individual patients. After treatment, patients described perceptions of goal achievement using a 5-point Likert scale. Changes in International Prostate Symptom Score/quality of life score, International Continence Society male short form questionnaire, 3-day voiding diary and uroflowmetry parameters were analyzed to evaluate the correlations between goal achievement and traditional outcome measures. Of 108 most bothersome symptoms slow stream (26.9%) was the most frequently reported followed by increased daytime frequency (21.3%) and nocturia (19.4%). After treatment the median score of goal achievement was 3 points with no significant difference among most bothersome symptoms. Changes in quality of life score (correlation coefficient -0.247, p=0.020) and maximal flow rate (correlation coefficient 0.254, p=0.021) were correlated with goal achievement. For men with most bothersome symptoms of storage, changes in the number of micturition and urgency episodes per 24 hours were correlated with goal achievement. For men with most bothersome symptoms of voiding the International Prostate Symptom Score voiding score was correlated with goal achievement. Assessing goal achievement for most bothersome symptoms can be a useful outcome measure in patients with benign prostatic obstruction with heterogeneous symptoms or goals reflecting change in quality of life.

Granskning av sjuksköterskors omvårdnadsdokumentation rörande urininkontinens hos äldre personer

Aim: The purpose with this study was to examine the nurses' documented assessment, investigation, treatment and evaluation of urinary incontinence in older people living in a nursing home.Background: The incidence of urinary incontinence in older people living in a nursing home is a problem worldwide. To achieve a good and safe care, careful nursing documentation is necessary. According to previous studies there are imperfections in the nurses' records of urinary incontinence.Method: The study examined the quantity and quality of 67 nursing records implemented on the basis of the Cat-ch-ing model.Findings: The outcome was that nurses' records of urinary incontinence were deficient. Documentation of investigation and assessment of urinary incontinence were rare in the nurses' records. The result showed that the documented treatment usually offered to the older person was made up of testing and prescription of absorbent incontinence products.Conclusion: Weakness in the documentation of urinary incontinence could for the older person lead to persisted disorder or worse. The imperfections in the nursing records influence the possibility, for the older person, to receive a good and safe care.

Management of Urinary Incontinence in the Elderly

Urinary incontinence in older people remains a poorly researched area of care, despite the scale and impact of the problem both to older people and to healthcare providers in terms of service delivery and cost. Whilst there are relatively few data specifically regarding interventions in older people, there is much that can be gained from existing evidence without too much extrapolation. This article deals with the assessment and management of urinary incontinence in the elderly, reviews the current evidence and speculates upon future directions.

Management of urinary incontinence in older people

AbstractOur series Prescribing in older people gives practical advice for successful management of the special problems experienced by this patient group. Here, the authors describes the drug management of urinary incontinence. Copyright © 2008 Wiley Interface Ltd

Overactive bladder syndrome in older people

The overactive bladder symptom complex (OAB) is the commonest cause of urinary incontinence in older people, and is usually due to underlying detrusor overactivity, and as such is a treatable condition. Older people are a heterogeneous group, which includes fit community-dwelling individuals and those with significant medical comorbidity; thus the requirements of care for this group are many and varied. The International Continence Society definition of the frail elderly, those aged >65 years with continence problems, who by virtue of comorbidity are house-bound or living in an institution, is clearly not applicable to all. However, many conditions begin to appear in later life and practitioners need to be aware of the need to manage these, and their treatment, when dealing with older people. Studies of medication for OAB have included the elderly and there is evidence of an equivalent benefit in younger people. The impact of treatment on the cognitively impaired and those receiving acetylcholinesterase inhibitors is discussed.