Determinants of Bladder Care at Night in a Subacute Ward for Aged Patients: An Observational Study.

PURPOSE: The purpose of this study was to evaluate how bladder care at night correlates to patients' mobility status. DESIGN: This was an observational study. SUBJECTS AND SETTING: The sample comprises 63 aged care subacute patients who were observed over 3 consecutive nights in an inpatient subacute aged care ward located in Melbourne, Australia. Half of the participants were female; their mean age was 82.0 (standard deviation 8.2) years. Data were collected from December 2020 to March 2021. METHODS: Outcome variables included demographic and pertinent clinical characteristics, type and timing of toileting and/or bladder care provided, and mobility classification. Descriptive statistics were used to summarize the frequency of nocturnal bladder care provided each night and as a mean over the 3 nights. The relationship between the type of care units provided and other variables was explored using a 1-way analysis of variance; values ≤.05 were deemed statistically significant. RESULTS: Findings indicate that 27% (n = 17), 41% (n = 26), and 48% (n = 30) of participants required assistance to move in bed, sit up in bed, and stand from sitting, respectively. Care episodes for both incontinence and assistance with voiding were significantly associated with functional mobility in bed ( F = 5.52, P < .001; F = 2.14, P = .02) and with ambulation independence ( F = 3.52, P = .001; F = 2.04, P = .03) but not with age or ambulation distance. CONCLUSIONS: Care provided for urinary incontinence during the night was related to the need for physical support of ambulation and poor mobility in bed. Targeted input from a multidisciplinary team is warranted to facilitate change of practice at night.

Wake-up call: 4 out of 5 older hospitalised patients have nocturnal lower urinary tract symptoms.

OBJECTIVE: Nocturnal lower urinary tract symptoms (nLUTS) increase with age, frailty and comorbid systemic illness and affect many older people. The aim of this study was to describe the prevalence of nLUTS in a hospital aged-care sub-acute environment. METHODS: Prospective clinical audit based on semi-structured bedside interviews of older adult patients admitted to a tertiary hospital aged rehabilitation ward over a 7-month period. RESULTS: A total of 147 eligible patients were included in this clinical audit. The prevalence of nLUTS was 80% (76% nocturia; 54% nocturnal urgency; 32% nocturnal enuresis; 51% nocturnal incontinence). The incidence of any nLUTs was 37%. Half the sample reported daytime incontinence, which always co-existed with at least one nLUTS. CONCLUSION: Nocturnal lower urinary tract symptoms are a problem for four out of five older hospitalised patients. This highlights the need to screen for nLUTS early in the hospital admission and for implementation of a multidisciplinary team intervention to decrease morbidity and improve quality of life in this vulnerable population.

Presenting symptoms of COVID-19 and clinical outcomes in hospitalised older adults.

BACKGROUND: In July 2020, a COVID-19 outbreak was recognised in the geriatric wards at a subacute campus of the Royal Melbourne Hospital affecting patients and staff. Patients were also admitted to this site after diagnosis in residential care. AIMS: To describe the early symptoms and the outcomes of COVID-19 in older adults. METHODS: Patients diagnosed with COVID-19 at the facility in July or August 2020 were identified and their medical records were examined to identify symptoms present before and after their diagnosis and to determine their outcomes. RESULTS: Overall, 106 patients were identified as having COVID-19, with median age of 84.3 years (range 41-104 years); 64 were diagnosed as hospital inpatients after a median length of stay of 49 days, 31 were transferred from residential aged care facilities with a known diagnosis and 11 were diagnosed after discharge. There were 95 patients included in an analysis of symptom type and timing onset. Overall, 61 (64.2%) were asymptomatic at the time of diagnosis of COVID-19, having been diagnosed through screening initiated on site. Of these, 88.6% developed symptoms of COVID-19 within 14 days. The most common initial symptom type was respiratory, but there was wide variation in presentation, including fever, gastrointestinal and neurological symptoms, many initially not recognised as being due to COVID-19. Of 104 patients, 32 died within 30 days of diagnosis. CONCLUSIONS: COVID-19 diagnosis is challenging due to the variance in symptoms. In the context of an outbreak, asymptomatic screening can identify affected patients early in the disease course.