Association between nocturia and frailty among elderly males in a veterans administration population
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ORIGINAL ARTICLE
Association between nocturia and frailty among elderly males in a veterans administration population Thomas F. Monaghan1 · Adrian S. Wagg2 · Donald L. Bliwise3 · Christina W. Agudelo1 · Kyle P. Michelson1 · Syed N. Rahman1 · Matthew R. Epstein1,4 · Rebecca Haddad5,6 · Karel Everaert5 · Jason M. Lazar7 · Jeffry P. Weiss1 Received: 30 August 2019 / Accepted: 12 November 2019 © Springer Nature Switzerland AG 2019
Abstract Background The relationship between frailty and nocturnal voiding is poorly understood. Aim To characterize the association between frailty, as defined by a frailty index (FI) based upon the Canadian Study of Health and Aging (CSHA) criteria, and nocturia, defined by measures of nocturnal urine production. Methods Real-world retrospective analysis of voiding diaries from elderly males with lower urinary tract symptoms (LUTS) at an outpatient urology clinic. Males ≥ 65 years with ≥ 2 nocturnal voids were included. A modified FI was calculated from the LUTS database, which captured 39 variables from the original CSHA FI. Patients were divided into 3 groups by modified FI: low (≤ 0.077) (n = 59), intermediate (> 0.077 and 1 indicates that NUV exceeds functional bladder capacity and nocturia or enuresis occurs NUV/(sleeping hours); NUP ≥ 90 mL/h indicates nocturnal polyuria NUV/TUV; NPi > 0.20-0.33 (age-dependent) may be used as an alternative criterion for nocturnal polyuria (Number of nightly voids − [Ni − 1]); NBCi > 0 indicates that nocturia occurs at voided volumes less than MVV; NBCi > 2 is associated with severe nocturia Time between when the individual goes to bed with the intention of sleeping to the time of first unintended awakening
Nocturnal voids 24-h volume Nocturnal urine volume (NUV) Maximum voided volume (MVV) Nocturnal maximum voided volume (NMVV) Nocturia index (Ni) Nocturnal urine production (NUP) Nocturnal polyuria index (NPi) Nocturnal bladder capacity index (NBCi) First uninterrupted sleep period (FUSP) Table modified from [11]
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Aging Clinical and Experimental Research
of conditions in the item pool. This approach was also used in the original description of the FI [2]. Many studies have employed FI as a categorical variable and defined frailty using FI thresholds, which often differed depending on the population under study [2–4, 12]. The distribution of FI scores in our sample differed from the gamma shaped distribution typically reported in those studies and instead clearly represented a biomodal distribution (Fig. 1). In view of this, we divided our sample into groups representing low, intermediate, and high levels of frailty, based on corresponding FI cut points of ≤ 0.077, {> 0.077 and
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