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护理SCI晨读：尿失禁与老年护理院居民全因死亡率增加相关：一项荟萃分析


【护理SCI晨读：尿失禁与老年护理院居民全因死亡率增加相关：一项荟萃分析】护理SCI晨读：尿失禁与老年护理院居民全因死亡率增加相关：一项荟萃分析
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护理SCI晨读：尿失禁与老年护理院居民全因死亡率增加相关：一项荟萃分析
本文插图


摘要

目的 尿失禁是老年人常见的综合征 ， 但尚不清楚尿失禁是否与老年人疗养院居民的死亡风险相关 。
方法 对PubMed ， Cochrane ， Embase ， CINAHL和Web of Science数据库进行了系统的回顾和荟萃分析 。 使用纽卡斯尔-渥太华量表（NOS）评估纳入研究的质量 。 使用随机效应或固定效应模型对荟萃分析进行汇总 ， 并使用I2统计量检查研究之间的异质性 。
发现 最终分析纳入六项队列研究 ， 共有1,656名参与者 。 每项研究的NOS得分均大于6 。 尿失禁与疗养院死亡率较高显著相关 ， 危险比（HR）为1.20（95％置信区间[CI] 1.12–1.28 ， I 2 = 41.6％） 。 在亚组分析中 ， 根据地区 ， 痴呆状况和随访时间 ， 尿失禁与死亡风险增加之间存在显著相关性 ， 亚洲国家/地区合并HR为2.02（95％CI 1.32–3.11 ， I 2 = 0％） 。 西方国家/地区为1.18（95％CI 1.11–1.26 ， I 2 = 41.6％） ， 痴呆患者为1.17（95％CI 1.09–1.26 ， I 20％） ， 无痴呆患者为1.35（95％CI 1.13–1.60 ， I 2 = 58.9％） ， 随访期为1年的研究为1.16（95％CI 1.07–1.25 ， I 2 = 43.2％） 。 随访期为1年以上的研究为1.30（95％CI 1.15-1.48 ， I 2 = 24.5％） 。
结论 尿失禁与老年人疗养院居民的死亡风险增加相关 。 因此 ， 有必要使用工具（例如膀胱过度活动症症状评分 ， 膀胱控制自我评估问卷 ， 三个失禁问题）筛查正在经历尿失禁或有尿失禁风险的疗养院老年人 。 此外 ， 早期的干预策略 ， 例如减肥 ， 戒烟 ， 盆底肌肉训练以及药物和外科治疗 ， 将有助于降低尿失禁的风险并防止疗养院居民发生不良后果 。
临床相关性 在我们的研究中 ， 我们发现住在疗养院的患有尿失禁的老年人比没有尿失禁的老年人有更高的死亡风险 。 因此 ， 居住在疗养院中的老年人的尿失禁特别令人关注 。 早期发现和干预对患有尿失禁的老年人很重要 ， 应该让护理人员意识到这一点 。
Abstract
Purpose Urinary incontinence is a syndrome common in older adults, but it is not clear whether urinary incontinence is associated with the risk for mortality in elderly nursing home residents.
Methods We conducted a systematic review and meta-analysis in PubMed, Cochrane, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science databases. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. The meta-analysis was summarized using a random-effects or fixed-effects model, and the heterogeneity among studies was examined using the I2 statistic.
Findings Six cohort studies with 1,656 participants were included in the final analysis. The NOS score for each study was greater than 6. Urinary incontinence was significantly associated with a higher risk for mortality in nursing homes, with a hazard ratio (HR) of 1.20 (95% confidence interval [CI] 1.12–1.28, I2 = 41.6%). The significant association of urinary incontinence with increased mortality risk was observed in subgroup analysis according to region, status of dementia, and follow-up period, with a pooled HR of 2.02 (95% CI 1.32–3.11, I2 = 0%) for Asian countries, 1.18 (95% CI 1.11–1.26, I2 = 41.6%) for Western countries, 1.17 (95% CI 1.09–1.26, I2 = 0%) for patients with dementia, 1.35 (95% CI 1.13–1.60, I2 = 58.9%) for patients without dementia, 1.16 (95% CI 1.07–1.25, I2 = 43.2%) for studies with a follow-up period of 1 year, and 1.30 (95% CI 1.15–1.48, I2 = 24.5%) for studies with a follow-up period of more than 1 year.
Conclusions Urinary incontinence is associated with an increased risk for death among residents of care facilities. Therefore, it was necessary to screen the elderly dwelling in nursing homes who were experiencing or at risk for urinary incontinence with useful tools (e.g., overactive bladder symptom score, bladder control self-assessment questionnaire, three incontinence questions). In addition, early interventions strategies, such as weight loss, stopping smoking, pelvic floor muscle training, and medical and surgical treatments would contribute to decreasing the risk for urinary incontinence and preventing adverse outcomes in nursing home residents.
Clinical Relevance In our study, we found that the elderly with urinary incontinence who resided in nursing homes had a higher risk for mortality than those without urinary incontinence. Therefore, urinary incontinence in the elderly residing in nursing homes is of particular concern. Early detection and intervention are important for the elderly with urinary incontinence, and caregivers should be made aware of this importance.

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