Department of Neuro-Urology, Tenon Hospital, Paris, France.
Department of Urology, University Hospital of Rennes, Rennes, France.
Neurourol Urodyn. 2019 Feb;38(2):770-778. doi: 10.1002/nau.23915. Epub 2019 Jan 8.
The primary aim is to explore the adherence predicting factors in clean intermittent self-catheterization (CISC) in patients aged over 65 years. The secondary aim is to assess whether in this population, the non-adherence risk is greater, compared with patients under 65.
All patients older than 65 that successfully learned CISC between January 2011 and January 2016 were included. A control population younger than 65 matched with sex, body mass index, and pathology was selected.
One hundered and thirteen (66.9%) out of the 169 patients older than 65 included were adherent at 1 month, and 80 (47.3%) at 6-12 months. Obesity (P = 0.027), a low PP test (Pencil and Paper test) score (P = 0.037), significant urinary stress incontinence (SUI) (P = 0.048), and prescription of CISC less than three per day (P = 0.03) were the risk factors predicting stopping CISC at 1 month, but none was associated with non-adherence at 6-12 months. Compared with the younger group, age was a risk factor for poor adherence at 1 month.
Obesity, low PP test score, and important SUI are factors of poor adherence to CISC at 1 month in older adults. Necessity of more than three CISC per day is in favor of treatment continuation, possibly due to absence of spontaneous voiding in these patients. Long-term adherence to CISC in older adults in this study remains close to adherence to other treatments prescribed in urinary disorders, and thus shows that CISC could be an easily purposed therapeutic option in this population, either on a long-term or transitory basis.
本研究的主要目的是探讨 65 岁以上患者行清洁间歇性自我导尿（CISC）的依从性预测因素。次要目的是评估与 65 岁以下患者相比，该人群的不依从风险是否更大。
纳入 2011 年 1 月至 2016 年 1 月期间成功学习 CISC 的所有 65 岁以上患者。选择了年龄、体重指数和病理与之匹配的 65 岁以下对照组患者。
169 例 65 岁以上患者中，113 例（66.9%）在 1 个月时依从，80 例（47.3%）在 6-12 个月时依从。肥胖（P=0.027）、低铅笔和纸测试（Pencil and Paper test）评分（P=0.037）、明显的尿失禁（stress incontinence，SUI）（P=0.048）和每天少于 3 次 CISC 处方（P=0.03）是 1 个月时停止 CISC 的预测因素，但这些因素与 6-12 个月时的不依从无关。与年轻组相比，年龄是 1 个月时依从性差的危险因素。
肥胖、低铅笔和纸测试评分和明显的尿失禁是老年人 1 个月时 CISC 依从性差的因素。每天需要进行超过 3 次 CISC 可能有利于治疗的持续，这可能是由于这些患者没有自发排尿。本研究中老年人对 CISC 的长期依从性与其他尿路疾病处方的治疗依从性相近，表明 CISC 可能是该人群的一种简单治疗选择，无论是长期还是临时治疗。
