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Here is what I wrote on my first paper and got a 75% on it. The references need to make sure they are peered reviewed and the specific areas need to be covered, PICOT and SMART.
I am also trying to add that using the Purewick devices at home for elderly can reduce UTIs. Maybe making it affordable or free will help the elderly while at home, sleeping and having falls from having to get up in the middle of the night to urinate. If they had this device they it can help. Mostly UTIs in the Elderly population and how to help or prevent them.
Literature Review
Mary Rivas-Peralez
Nightingale College
BSN 355-05
Brenda Branch RN, BSN, MSN
June 16, 2024
There are many elderly females that
are diagnosed with Urinary Tract Infections (UTI) more often than elderly men,
middle aged adults, or children. Urinary tract infections are common in
the elderly and cover a range of conditions from asymptomatic bacteriuria to
urosepsis. Risk factors for developing symptomatic UTIs include
immunosenescence, exposure to nosocomial pathogens, multiple comorbidities, and
a history of UTIs (Rodriguez-Manas
2020). Educating
the elderly population will help decrease or prevent the need for
hospitalization due to not being able to recognize the early signs and symptoms
of UTIs. Preventing UTIs in elderly
women will help reduce hospitalization stays, reduce permanent kidney injury,
and prevent other injuries like falls that can increase risk of permanent
injuries or death. Education needs to
start at a younger age, middle age, to insure when the patient reaching age 65
and older, they are aware and prepared to look for the warning signs and
preventing the complications related with UTIs.
While trying to find different
methods to conduct my research using UTIs in the elderly female population or
prevention of UTIs in the elderly female population, I found that using google
and researching on Nightingale library and the book Concept of Nursing Practice
helped me find many sources needed to compile my research. I also searched for sources that were
developed in the last five years. Using
google has many sites that provided great information as in risk factors, signs
and symptoms, and what medications can help when recognizing a symptom. Doing proper research and reading each
article and choosing the ones that point out the most important information and
treatments are the sites I focused on more.
Trying to find stats how the different age groups and sex varies has
been difficult to find. I normally try
to stay with the same website or company because I have become familiar with
navigating through and finding information a need. The sites also have great citation information,
separates each meaning to the disease, and explains thoroughly the information
that is needed to understand the disease or illness.
The project proposal is ways to
prevent UTIs in elderly women to prevent hospitalization or other life-threatening
conditions that can lead to death. Women
65-years-old and older have an increased risk of developing UTIs, this increase
grows 10% higher than prior ages. The
percentage grows to 30% with more frequent diagnosis of UTIs once the elderly
women are age 85 years of age and older.
The overall objective will be to increase education about warning signs
and symptoms associated with UTIs and preventing the need for hospitalizations
due to missed signs and symptoms. This narrative review considers the
characteristics of UTIs – prevalence and incidence, disease burden, risk
factors, and clinical presentation – in the elderly, and examines current
treatment options to manage UTIs in the community (Rodriguez-Manas 2020).
Urinary
tract infection (UTI) is a common infection in the elderly, mainly due to
age-related risk factors like malnutrition, inadequately controlled diabetes
mellitus, poor bladder control leading to urinary retention or incontinence,
constipation, long-term hospitalizations, vaginal atrophy, prostate
hyperplasia, unhygienic living conditions, and altered mental state (Dutta et al
2022). In the elderly population there
are many that either live in poverty or live alone with no one to help them
with their daily needs as in going to the grocery store, getting regular
checkups at their doctors’ office, or just to stop by the post office. Malnutrition and bladder control are two of
the most leading causes to hospitalizations.
Many elderly females do not recognize the warning signs and fail to get
treatment when necessary. Lack of treatment can lead to hospitalization due to
the symptoms progressing after not being treated in a timely manner.
Based
on a prospective cross-sectional cohort study by Wojszel ZB et al., it is
concluded that symptoms of UTI are atypical in the elderly population;
amongst the people with UTI who participated in the study, only 11% had a
fever. Atypical symptoms like delirium were reported in 28.9% of older adults,
followed by other symptoms like hypotension (20%) and tachycardia (Dutta et al
2022). After reading many different
articles about the reoccurrence of UTIs in the elderly population, the studies
show no change in the percentage of illnesses since 2022. Other
studies have shown that many elderly women end up needing hospitalized due to
asymptomatic bacteriuria, this occurs in 6 to 16 % age 65 and older and 20% age
80 and older, therefore undiagnosed until the symptoms become so severe that
hospitalization is needed. When this occurs some patients may need longer stays
in the hospital or may develop permanent damage due to the time frame or
continuous/recurrent infections.
Urinary
incontinence is one important factor that increases the risks of the elderly
female to be diagnosed with a UTI. This
occurs mostly during sleep, which increases the risk of getting UTIs. Being able to use assistive devices at home,
like purewicks can reduce these problems.
Many are not familiar with the device or cannot afford it for home
use. Making this device affordable can
help reduce the reoccurrence of UTIs due to incontinence. Median capture rate was over 95% for healthcare provider-placed
devices and over 98% for self-placed devices, regardless of BMI.
Overall, 84.5% of
participants rated the device as either “comfortable” or “very comfortable”.
Device placement was rated “very easy” by 95.7% of healthcare providers and
“very easy” or “somewhat easy” by 95.7% of participants. Device removal was
rated “very easy” by 100% of healthcare providers and over 90% of participants
in all cohorts (Bleeker & Glover 2019).
Being able to use the devices while at home can reduce the level of UTIs
for patient who have constant incontinence concerns. Making the device affordable for the elderly
females upon discharge from the hospital can help patients feel confident about
using the device after having successful use while in the hospital.
While
being able to use the device while being hospitalized and having success with
the device this can convince the patient to agree to continue use while at home
to reduce UTI infections. Elderly
patients are not only more prone to UTIs but are also more likely to have
comorbidities and require multiple medications. The option to use a device that
acts in a physical manner (barrier effect) without pharmacological properties,
and with potential to reduce antimicrobial use, has obvious appeal in this
patient population (Rodriguez-Mañas 2020).
If after being hospitalized with UTI and being able to utilize assistive
devices during antibiotic treatments can help prove successful use of the
device and should show proof that continued use at home can assist with the
preventative treatments for UTIs. If
using these devices while in the hospital during admission for UTI and the
infection was resolved, then continued use while at home should be approved and
continued without high cost to the patient.
The
Purewick medical equipment and supplies sold through this website are not
covered by Medicare, Medicaid or Commercial Insurance and are cash sales only
(purewick 2022). Devices that show
reduce or resolved infections should be able to be utilized for home use. Just like the foley catheters that are for
home use and covered through many insurance companies, Purewick for the elderly
females should be given the opportunity to be able to use at home. If success was established in the hospital
then continued use should be approved for home use.
As
of today the only device approved for home use is the foley catheter. This
device has proven to cause UTI in hospitalized patients that are using
postoperatively or for other purposes.
Although the purewick device can only be used while sleeping, it can
prove success and show decrease in other injuries such as falls late at night
due to multiple trips to the bathroom.
Being able to use the device can prevent further injury and damage to
the kidneys and other organs.
Despite
the high prevalence of UTIs in the elderly, treatment options are limited (Rodriguez-Mañas
2020). Although there have been
successful treatments many insurance companies do not agree for these types of
equipment to be used in the home settings.
Foley catheters have proven to cause UTIs, the need for further or
updated useful equipment should be approved especially with the success use
while in the hospital. The overall
outcome of treating UTIs, patient being able to ambulate with feeling tied down,
preventing falls at night, and improved overall sleep can help the elderly
patient decrease infection rates. UTIs
can cause permanent damage to the kidney or the body can become resistant to
continuous use of antibiotics, being able to have successful devices other than
a foley catheter in the home setting can reduce recurrent UTIs in elderly
females.
References:
Bleeker E., Koehlmoos A., Glover E.
External catheters and reducing adverse
effects in female inpatients
(2019)
Dutta C, Pasha K, Paul S, Abbas MS, Nassar ST, Tasha T, Desai
A, Bajgain A, Ali A, Mohammed L. Urinary Tract Infection Induced Delirium in
Elderly Patients: A Systematic
https://nwcommons.nwciowa.edu/cgi/viewcontent.cgi?article=1026&context=celebrationofresearch Published 2019. Accessed 2022
https://www.purewickathome.com/all-products
Review. Cureus. 2022 Dec 8;14(12):e32321. doi: 10.7759/cureus.32321.
PMID: 36632270; PMCID: PMC9827929
Rodriguez-Mañas L. Urinary tract infections in the elderly: a
review of disease characteristics and current treatment options. Drugs Context.
2020 Jul 8;9:2020-4-13. doi: 10.7573/dic.2020-4-13. PMID: 32699546; PMCID:
PMC7357682
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