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護理SCI晨讀：尿失禁與老年護理院居民全因死亡率增加相關(guān)：一項薈萃分析


【護理SCI晨讀：尿失禁與老年護理院居民全因死亡率增加相關(guān)：一項薈萃分析】護理SCI晨讀：尿失禁與老年護理院居民全因死亡率增加相關(guān)：一項薈萃分析
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護理SCI晨讀：尿失禁與老年護理院居民全因死亡率增加相關(guān)：一項薈萃分析
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摘要

目的 尿失禁是老年人常見的綜合征 ， 但尚不清楚尿失禁是否與老年人療養(yǎng)院居民的死亡風(fēng)險相關(guān) 。
方法 對PubMed ， Cochrane ， Embase ， CINAHL和Web of Science數(shù)據(jù)庫進行了系統(tǒng)的回顧和薈萃分析 。 使用紐卡斯爾-渥太華量表（NOS）評估納入研究的質(zhì)量 。 使用隨機效應(yīng)或固定效應(yīng)模型對薈萃分析進行匯總 ， 并使用I2統(tǒng)計量檢查研究之間的異質(zhì)性 。
發(fā)現(xiàn) 最終分析納入六項隊列研究 ， 共有1,656名參與者 。 每項研究的NOS得分均大于6 。 尿失禁與療養(yǎng)院死亡率較高顯著相關(guān) ， 危險比（HR）為1.20（95％置信區(qū)間[CI] 1.12–1.28 ， I 2 = 41.6％） 。 在亞組分析中 ， 根據(jù)地區(qū) ， 癡呆狀況和隨訪時間 ， 尿失禁與死亡風(fēng)險增加之間存在顯著相關(guān)性 ， 亞洲國家/地區(qū)合并HR為2.02（95％CI 1.32–3.11 ， I 2 = 0％） 。 西方國家/地區(qū)為1.18（95％CI 1.11–1.26 ， I 2 = 41.6％） ， 癡呆患者為1.17（95％CI 1.09–1.26 ， I 20％） ， 無癡呆患者為1.35（95％CI 1.13–1.60 ， I 2 = 58.9％） ， 隨訪期為1年的研究為1.16（95％CI 1.07–1.25 ， I 2 = 43.2％） 。 隨訪期為1年以上的研究為1.30（95％CI 1.15-1.48 ， I 2 = 24.5％） 。
結(jié)論 尿失禁與老年人療養(yǎng)院居民的死亡風(fēng)險增加相關(guān) 。 因此 ， 有必要使用工具（例如膀胱過度活動癥癥狀評分 ， 膀胱控制自我評估問卷 ， 三個失禁問題）篩查正在經(jīng)歷尿失禁或有尿失禁風(fēng)險的療養(yǎng)院老年人 。 此外 ， 早期的干預(yù)策略 ， 例如減肥 ， 戒煙 ， 盆底肌肉訓(xùn)練以及藥物和外科治療 ， 將有助于降低尿失禁的風(fēng)險并防止療養(yǎng)院居民發(fā)生不良后果 。
臨床相關(guān)性 在我們的研究中 ， 我們發(fā)現(xiàn)住在療養(yǎng)院的患有尿失禁的老年人比沒有尿失禁的老年人有更高的死亡風(fēng)險 。 因此 ， 居住在療養(yǎng)院中的老年人的尿失禁特別令人關(guān)注 。 早期發(fā)現(xiàn)和干預(yù)對患有尿失禁的老年人很重要 ， 應(yīng)該讓護理人員意識到這一點 。
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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