Investig Clin Urol.  2017 Jan;58(1):70-76. 10.4111/icu.2017.58.1.70.

Prevalence and management status of urologic diseases in geriatric hospitals in South Korea: A field research

• Lee SH
• Suh J
• Kim HS
• Lee YJ
• Lee SR
• Kim KH
• Jeong CW

• KMID: 2365099
• DOI: http://doi.org/10.4111/icu.2017.58.1.70

Abstract

PURPOSE
We aimed to investigate the current management status of urologic diseases in geriatric hospitals in South Korea.
MATERIALS AND METHODS
Questionnaire surveys and in-depth person-to-person interviews were conducted at 13 hospitals within the Seoul and Incheon areas.
RESULTS
The study was carried out from July to December 2014; 75.6% of patients (1,858/2,458) and 77.5% (779/1,031) of medical personnel responded to our survey. All surveys and interviews were performed by urology specialists, fellows, residents, or nurses. The hospitals included in the study had an average of 215.2 beds (range, 110-367), 189.1 patients (range, 90-345), and 40.2 nurses (range, 10-83). The average number of physicians was 6.2 (range, 3-11), but none of these were certified urologists. Only 4 hospitals provided consultation services for urological disorders. In total, 64% of patients had urological disorders, although only 20.7% of patients were receiving medication. Most patients were being treated using urological interventions; diapers (49.7%), indwelling catheters (19.5%), clean intermittent catheters (12.2%), and external collection urinary drainage (7.9%). However, most interventions were inadequately implemented, and only 17% of the patients had been examined by a certified urologist. Urological complications were found in 20.2% of patients, and secondary complications occurred in 18.8%. Excluding redundant cases, the total prevalence of urological complications was 39.0%.
CONCLUSIONS
Urologic diseases are poorly managed, and no certified urologists work in geriatric hospitals. Therefore, more designated urologists are needed in geriatric hospitals.

Keyword

Health services for the aged; Patient care management; Surveys and questionnaires; Urinary incontinence; Urological diseases

MeSH Terms

Aged
Catheters
Catheters, Indwelling
Drainage
Health Services for the Aged
Humans
Incheon
Korea*
Patient Care Management
Prevalence*
Seoul
Specialization
Surveys and Questionnaires
Urinary Incontinence
Urologic Diseases*
Urology

Figure

• 

  Fig. 1 Twenty percent of patients replied that patients take urologic diagnosis before urologic intervention. However, there was no certified urologist working in geriatric hospitals we surveyed. So, only 7% of patients that consulted by urologist in other institution were exactly take urologic examination before treatment.

Reference

1. Lee SH, Cho ST, Na HR, Ko SB, Park MH. Urinary incontinence in patients with Alzheimer's disease: relationship between symptom status and urodynamic diagnoses. Int J Urol. 2014; 21:683–687.

2. Jung HB, Kim HJ, Cho ST. A current perspective on geriatric lower urinary tract dysfunction. Korean J Urol. 2015; 56:266–275.

3. Kupelian V, Fitzgerald MP, Kaplan SA, Norgaard JP, Chiu GR, Rosen RC. Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey. J Urol. 2011; 185:571–577.

4. Kirshen AJ. Urinary incontinence in the elderly: a review. Clin Invest Med. 1983; 6:331–339.

5. Ogama N, Yoshida M, Nakai T, Niida S, Toba K, Sakurai T. Frontal white matter hyperintensity predicts lower urinary tract dysfunction in older adults with amnestic mild cognitive impairment and Alzheimer's disease. Geriatr Gerontol Int. 2016; 16:167–174.

6. Chung RY, Leung JC, Chan DC, Woo J, Wong CK, Wong SY. Lower urinary tract symptoms (LUTS) as a risk factor for depressive symptoms in elderly men: results from a large prospective study in Southern Chinese men. PLoS One. 2013; 8:e76017.

7. Kim MS, Lee SH. Prevalence rate and associated factors of urinary incontinence among nursing home residents. J Korean Acad Nurs. 2008; 38:92–100.

8. Health Insurance Review & Assessment Service. 2013 Handbook of health insurance review & assessment service. 2014 [Internet]. Wonju: Health Insurance Review & Assessment Service;2016. cited 2016 Jul 5. Available at http://www.hira.or.kr/.

9. Lee SH, Kang JS, Kim JW, Lee SJ. Incontinence pad usage in medical welfare facilities in Korea. Int Neurourol J. 2013; 17:186–190.

10. Resnick NM. Voiding dysfunction and urinary incontinence. In : Beck JC, editor. Geriatric review syllabus: a core curriculum in geriatric medicine. New York: American Geriatrics Society;1991. p. 141–154.

11. Lee HS, Seo JT. Urinary incontinence and overactive bladder. J Korean Med Assoc. 2015; 58:886–891.

12. Resnick NM, Tadic SD, Yalla SV. Geriatric incontinence and voiding dysfunction. In : Kavoussi LR, Novick AC, Partin WA, Peters CA, editors. Campbell-Walsh urology. 10th ed. Philadelphia (PA): W.B. Saunders;2011. p. 2204–2222.

13. Cespedes RD, Gerboc JL. Other therapies for storage and emptying failure. In : Kavoussi LR, Novick AC, Partin WA, Peters CA, editors. Campbell-Walsh urology. 10th ed. Philadelphia (PA): W.B. Saunders;2011. p. 2186–2203.

14. Tsan L, Langberg R, Davis C, Phillips Y, Pierce J, Hojlo C, et al. Nursing home-associated infections in Department of Veterans Affairs community living centers. Am J Infect Control. 2010; 38:461–466.

15. Cotter M, Donlon S, Roche F, Byrne H, Fitzpatrick F. Healthcare-associated infection in Irish long-term care facilities: results from the First National Prevalence Study. J Hosp Infect. 2012; 80:212–216.

16. Koh H. Urinary tract infection in the elderly. J Korean Geriatr Soc. 2002; 6:243–252.

17. Caljouw MA, den Elzen WP, Cools HJ, Gussekloo J. Predictive factors of urinary tract infections among the oldest old in the general population. A population-based prospective follow-up study. BMC Med. 2011; 9:57.

18. Eriksson I, Gustafson Y, Fagerström L, Olofsson B. Urinary tract infection in very old women is associated with delirium. Int Psychogeriatr. 2011; 23:496–502.

19. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002; 113:Suppl 1A. 5S–13S.

20. Fujimura T, Makino M, Takagi M, Maki K, Murakami E, Tasaka Y, et al. The influence of incontinence on the characteristic properties of the skin in bedridden elderly subjects. Int J Dermatol. 2016; 55:e234–e240.

21. Korean Statistical Information Service. Number of medical personnel by specialized subjects [Internet]. Daejeon: Statistics Korea;2016. cited 2016 May 3. Available from: http://kosis.kr/statHtml/statHtml.do?orgId=354&tblId=DT_HIRA4K&vw_cd=&list_id=&scrId=&seqNo=&lang_mode=ko&obj_var_id=&itm_id=&conn_path=K1&path=#.

22. Esparcia A, Artero A, Eiros JM, Balaguer M, Madrazo M, Alberola J, et al. Influence of inadequate antimicrobial therapy on prognosis in elderly patients with severe urinary tract infections. Eur J Intern Med. 2014; 25:523–527.

23. Jang Y, Kwon BE, Kim HS, Lee YJ, Lee S, Kim SJ, et al. Knowledge and practice behaviors regarding urinary incontinence among korean healthcare providers in long-term care hospitals. Int Neurourol J. 2015; 19:259–264.