Upcoming event

Association between nocturia and frailty among elderly males in a veterans administration population

  • Matthew R. Epstein,
  • Thomas F. Monaghan,
  • Adrian S. Wagg,
  • Donald L. Bliwise,
  • Christina W. Agudelo,
  • Kyle P. Michelson,
  • Syed N. Rahman,
  • Rebecca Haddad,
  • Karel Everaert,
  • Jason M. Lazar,
  • Jeffrey P. Weiss

Publication: Aging Clinical and Experimental Research, November 2020

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 < 0.179) (n = 58), and high (≥ 0.179) (n = 41). Diary parameters were compared using the Kruskal–Wallis test and pairwise comparisons with the Wilcoxon rank-sum test and Bonferroni adjustment.

Results

The high frailty group was characterized by higher nocturnal urine volume (NUV), maximum voided volume (MVV), nocturnal maximum voided volume (NMVV), and nocturnal urine production (NUP). The presence of comorbid diabetes mellitus did not explain this effect.

Conclusion

Elderly males seeking treatment for LUTS with a high frailty burden are disproportionately affected by excess nocturnal urine production. Future research on the mechanistic relationship between urine production and functional impairment is warranted.

Commented by van Kerrebroeck

In this real-world retrospective analysis of voiding diaries from elderly males with lower urinary tract symptoms (LUTS) at an outpatient urology clinic, the relationship between frailty and nocturnal voiding was analyzed. Frailty was defined by a frailty index (FI, based upon the Canadian Study of Health and Aging criteria), and nocturia was diagnosed by measures of nocturnal urine production. Males ≥ 65 years with ≥ 2 nocturnal voids were included, and 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 < 0.179) (n = 58), and high (≥ 0.179) (n = 41). The high frailty group was characterized by higher nocturnal urine volume (NUV), maximum voided volume (MVV), nocturnal maximum voided volume (NMVV), and nocturnal urine production (NUP). The authors conclude that elderly males seeking treatment for LUTS with a high frailty burden are disproportionately affected by excess nocturnal urine production and state that future research on the mechanistic relationship between urine production and functional impairment is needed.