The Bladder at Night during Hospitalisation: Towards optimal care for elderly patients with nocturia

Abstract

Objective This study aimed to describe the characteristics of nocturia in older hospitalised patients and to explore knowledge, beliefs and experiences associated with night toileting while in hospital in order to identify unmet care needs. Methods A multisite mixed methods cross‐sectional study of older hospitalised adults who were admitted for ≥2 days was conducted using a standardised researcher‐administered questionnaire. An additional cohort 16 older hospitalised adults with nocturia >twice per night were interviewed to understand the experience and impact of nocturia during hospitalisation. Results Nocturia was experienced by 260 out of 308 participants. In‐hospital nocturia was significantly correlated with nocturia in the month preceding admission, high diurnal voiding frequency and nocturnal urinary urgency. Bother was attributed to multiple nocturia episodes. Participants had poor knowledge and understanding of nocturia and believed the symptom to be a normal occurrence; only 20% had discussed management with staff. Disrupted sleep and fear of falling were common in older immobile participants with nocturia. Conclusion Nocturia is highly prevalent in hospitalised older people. Toileting multiple times at night bothers patients, disrupts sleep, heightens a fear of falling yet is rarely addressed in ward management plans. A screening process to identify, assess, provide education and intervene for nocturia has the potential to improve wellbeing, safety at night and to address risk factors.

Determinants of Bladder Care at Night in a Subacute Ward for Aged Patients

“…This is in contrast to findings from patient interviews that clarified an overwhelming preference to pass urine in a toilet 16. Patients attribute lack of toilet use while in hospital to coldness, difficulty, long wait time for nurses, tiredness, fear of walking at night, the challenge of opening and closing toilet doors, and confusion associated with use of continence products 17. Men, in particular, may be provided with a urinal without being given the option to walk to the toilet.…”

“…16 Patients attribute lack of toilet use while in hospital to coldness, difficulty, long wait time for nurses, tiredness, fear of walking at night, the challenge of opening and closing toilet doors, and confusion associated with use of continence products. 17 Men, in particular, may be provided with a urinal without being given the option to walk to the toilet. Urinals can tip over, fail to catch the entire stream of urine, and use assumes independent removal of containment products.…”

Nocturnal Bladder Dysfunction: A Conceptual Framework Underlying Estimate of Cost

“…Two authors reported that between 15-28% of all falls incidents on the ward were related to toileting at night, half of these occurring at the bedside and most related to the early stage of mobilizing [10,11]. Although up to 50% of older low functioning patients admitted a fear of falling at night, less than one third called the night nurse for assistance to void [12]. Nocturnal falls were associated with use of multiple prescription medication (median of 9), intravenous therapy and dependence for mobility or use of a mobility aid [11].…”

“…Open Access Journal of Gerontology & Geriatric Medicine incontinence, comorbidity, health status and all sub-domains on the EQ-5D bar pain i.e. includes mobility limitations [7,12]. Postvoid UI was more common in men reporting multiple nocturia episodes per night as compared to men who slept all night [13].…”