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International Journal of Urology (2014) 21, 1253–1257
doi: 10.1111/iju.12569
Original Article: Clinical Investigation
Individually tailored ultrasound-assisted prompted voiding for institutionalized older adults with urinary incontinence Eiji Iwatsubo,1 Motofumi Suzuki,2 Yasuhiko Igawa3 and Yukio Homma2 1
Department of Internal Medicine and Urinary Care, Kitakyushu Koga Hospital, Fukuoka, and Departments of 2Urology and Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
3
Abbreviations & Acronyms ADL = activities of daily living NA = not available Correspondence: Yukio Homma M.D., Ph.D., Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Email: [email protected] Received 18 February 2014; accepted 16 June 2014. Online publication 21 July 2014
Objectives: To assess individually tailored ultrasound-assisted prompted voiding as a means of managing urinary incontinence in hospitalized elderly patients. Methods: A total of 88 incontinent elderly individuals who were inpatients in general hospitals were included. Each individual’s mean bladder volume before starting to void (voided urine volume plus residual urine volume) was regarded as the optimal bladder volume. Bladder volume was regularly monitored with an ultrasound device, and when the urine volume had reached the individual’s optimal bladder volume, the subject was prompted to void. The outcomes were evaluated on the basis of scores on a four-grade scale for items in six domains: urine volume, voiding function, urinary control, physical and cognitive function for toileting, and caregivers’ burden in regard to continence care. The score for use of a pad/diaper, an item of urinary control domain, was used as the primary outcome measure. Results: A total of 80 participants were included for analysis. After ultrasound-assisted prompted voiding care for a 4-week period, the score for use of a pad/diaper in 50 out of 80 participants (62.5%) had decreased, and 21 out of 80 participants (26.3%) no longer required the use of a pad/diaper at all. The scores of the other 30 out of 80 participants (37.5%) were unchanged. The improvement was not significantly affected by patients’ backgrounds at baseline. The mean scores in the domains of urinary control, physical function, cognitive function and caregivers’ burden improved significantly. Conclusion: The present preliminary study suggests that individually tailored ultrasoundassisted prompted voiding can improved urinary incontinence of institutionalized elderly patients. Further studies are worth carrying out.
Key words: cognitive impairment, continence aids, dependent elderly, urinary incontinence, voiding function.
Introduction The majority of institutionalized elderly persons suffer urinary incontinence.1–4 Urinary incontinence entails sanitation problems, affects the dignity of sufferers and increases caregivers’ burden. Urinary incontinence in dependent elderly persons is closely associated with impairment of ADL and cognitive function.4 Management of urinary incontinence is an urgent task for the globally aging society, especially in Japan, which has the longest life expectancy in the world (http://www.who.int/gho/publications/world_health_statistics/EN_WHS2013_Full.pdf). In incontinent older adults, bladder volume might exceed the optimal bladder capacity as a result of impaired sensation, leading to urinary leakage. Urinary incontinence of institutionalized older adults is usually managed by continence care, which is classified into four categories: bladder training, habit retraining, timed voiding and prompted voiding.5 In prompted voiding care, a commonly used method, the incontinent persons are asked at regular intervals whether they have a desire to void, and when the response is yes, they are prompted to go to the toilet. Proper voiding in the toilet is praised and encouraged for the next time. These approaches have been shown to reduce wet episodes by approximately half, and to increase the number of proper voidings as a proportion of the total number of voidings;6–8 however, these approaches or modified approaches have not been adequately studied to date.1 Urinary incontinence is a manifestation of dysfunction of the lower urinary tract, and might not be properly managed by nursing care alone. Despite such urological common sense, just 3% of incontinent elderly persons in nursing homes in Japan have been found to have consulted a urologist.2 Although personalized care should be the core for patients with urinary incontinence, because of the shortage of nurses specializing in continence care even a basic urological assessment is unfeasible.9 © 2014 The Japanese Urological Association
1253
E IWATSUBO ET AL.
Table 1
Scoring system for assessment items
Domain/item
Urine volume Total urine volume Nocturnal urine volume Nocturia polyuria index† Voiding function Urinary frequency Mean urine volume per voiding Mean residual urine ratio‡ Urinary control Expression of desire to void Physical ability to void Use of pad/diaper§ Physical function Cognitive function Caregivers’ burden in regard to urinary care Mental stress
Score 0
1
2
3
International Journal of Urology (2014) 21, 1253–1257
doi: 10.1111/iju.12569
Original Article: Clinical Investigation
Individually tailored ultrasound-assisted prompted voiding for institutionalized older adults with urinary incontinence Eiji Iwatsubo,1 Motofumi Suzuki,2 Yasuhiko Igawa3 and Yukio Homma2 1
Department of Internal Medicine and Urinary Care, Kitakyushu Koga Hospital, Fukuoka, and Departments of 2Urology and Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
3
Abbreviations & Acronyms ADL = activities of daily living NA = not available Correspondence: Yukio Homma M.D., Ph.D., Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Email: [email protected] Received 18 February 2014; accepted 16 June 2014. Online publication 21 July 2014
Objectives: To assess individually tailored ultrasound-assisted prompted voiding as a means of managing urinary incontinence in hospitalized elderly patients. Methods: A total of 88 incontinent elderly individuals who were inpatients in general hospitals were included. Each individual’s mean bladder volume before starting to void (voided urine volume plus residual urine volume) was regarded as the optimal bladder volume. Bladder volume was regularly monitored with an ultrasound device, and when the urine volume had reached the individual’s optimal bladder volume, the subject was prompted to void. The outcomes were evaluated on the basis of scores on a four-grade scale for items in six domains: urine volume, voiding function, urinary control, physical and cognitive function for toileting, and caregivers’ burden in regard to continence care. The score for use of a pad/diaper, an item of urinary control domain, was used as the primary outcome measure. Results: A total of 80 participants were included for analysis. After ultrasound-assisted prompted voiding care for a 4-week period, the score for use of a pad/diaper in 50 out of 80 participants (62.5%) had decreased, and 21 out of 80 participants (26.3%) no longer required the use of a pad/diaper at all. The scores of the other 30 out of 80 participants (37.5%) were unchanged. The improvement was not significantly affected by patients’ backgrounds at baseline. The mean scores in the domains of urinary control, physical function, cognitive function and caregivers’ burden improved significantly. Conclusion: The present preliminary study suggests that individually tailored ultrasoundassisted prompted voiding can improved urinary incontinence of institutionalized elderly patients. Further studies are worth carrying out.
Key words: cognitive impairment, continence aids, dependent elderly, urinary incontinence, voiding function.
Introduction The majority of institutionalized elderly persons suffer urinary incontinence.1–4 Urinary incontinence entails sanitation problems, affects the dignity of sufferers and increases caregivers’ burden. Urinary incontinence in dependent elderly persons is closely associated with impairment of ADL and cognitive function.4 Management of urinary incontinence is an urgent task for the globally aging society, especially in Japan, which has the longest life expectancy in the world (http://www.who.int/gho/publications/world_health_statistics/EN_WHS2013_Full.pdf). In incontinent older adults, bladder volume might exceed the optimal bladder capacity as a result of impaired sensation, leading to urinary leakage. Urinary incontinence of institutionalized older adults is usually managed by continence care, which is classified into four categories: bladder training, habit retraining, timed voiding and prompted voiding.5 In prompted voiding care, a commonly used method, the incontinent persons are asked at regular intervals whether they have a desire to void, and when the response is yes, they are prompted to go to the toilet. Proper voiding in the toilet is praised and encouraged for the next time. These approaches have been shown to reduce wet episodes by approximately half, and to increase the number of proper voidings as a proportion of the total number of voidings;6–8 however, these approaches or modified approaches have not been adequately studied to date.1 Urinary incontinence is a manifestation of dysfunction of the lower urinary tract, and might not be properly managed by nursing care alone. Despite such urological common sense, just 3% of incontinent elderly persons in nursing homes in Japan have been found to have consulted a urologist.2 Although personalized care should be the core for patients with urinary incontinence, because of the shortage of nurses specializing in continence care even a basic urological assessment is unfeasible.9 © 2014 The Japanese Urological Association
1253
E IWATSUBO ET AL.
Table 1
Scoring system for assessment items
Domain/item
Urine volume Total urine volume Nocturnal urine volume Nocturia polyuria index† Voiding function Urinary frequency Mean urine volume per voiding Mean residual urine ratio‡ Urinary control Expression of desire to void Physical ability to void Use of pad/diaper§ Physical function Cognitive function Caregivers’ burden in regard to urinary care Mental stress
Score 0
1
2
3
