title: [Initial assessment criteria for urination problems of the elderly--comparison of criteria for patients/caregivers/nurses, general practitioners, and urologists].
abstract: As the population ages rapidly, we need to establish a cost-effective system to assess and treat urination problems of the elderly. Recently, criteria have been developed for urologists to assess benign prostatic hyperplasia using the International Prostate Symptom Score (I-PSS), QoL index, urination function (maximal flow rates and residual urine volume) and prostate volume. It is suggested that patients with moderate to severe urination problems as measured by these criteria need to be treated but those with mild problems have no need for treatment. We examined whether these criteria can be applied to the general urination problems of elderly men and women, with 112 men and 21 women aged 50 and over as subjects. Furthermore, we set Level I criteria for the elderly themselves, their families or nurses taking care of them, using I-PSS and QoL index, and Level II criteria for general practitioners, using I-PSS, QoL index and residual urine volume, in addition to Level III criteria for urologists (omitting prostate volume in women). Correspondence rates among severities of urination problems at Level I, II and III, and sensitivities and specificities of Level I and II criteria were investigated. One hundred twenty-one patients of 124 with moderate to severe urination problems at Level III needed to be treated and eight of nine with mild urination problems did not. As a whole, our findings suggested that 129 of 133 patients (97.0%) were correctly assessed at Level III. We found that Level III criteria were valid for general urination problems of the elderly, not just benign prostatic hyperplasia. While 102 and 111 patients were judged as having moderate or severe urination problems, respectively, at Level I and Level II, and all of these were diagnosed as having moderate or severe problems at Level III, 22 (71.0%) of 31 and 13 (59.1%) of 22 patients judged as having mild urination problems at Level I and Level II were diagnosed as having moderate problems at Level III. Although specificities of Level I and Level II criteria were 100%, sensitivities improved from 82.3% (102/124) to 89.5% (111/124), adding residual urine measurement to the I-PSS and QoL scores. Polyuria of more than 2,000 ml per day was noted in 33 patients (24.8%). At Level I, residual urine of 50 ml or more was noted in 9 (29.0%) patients with mild urination problems, in 22 (24.2%) with moderate problems and in 4 (36.4%) with severe problems. Assessment criteria for general practitioners should include a frequency-volume chart and measurement of residual urine. When the elderly are judged as having moderate or severe urination problems according to either Level I or II criteria, they need treatment. However, more than half of the elderly, judged as having mild problems according to those criteria, need treatment from the standpoint of urologists.
authors.affiliation: Department of Urology, National Chubu Hospital.
authors.forename: Kikuo
authors.initials: K
authors.lastname: Okamura
authors.forename: Katsushi
authors.initials: K
authors.lastname: Nagahama
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Usami
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Nagata
authors.forename: Takashige
authors.initials: T
authors.lastname: Abe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Katsuno
authors.forename: Keizo
authors.initials: K
authors.lastname: Kawano
authors.forename: Shigenori
authors.initials: S
authors.lastname: Sato
authors.forename: Masaki
authors.initials: M
authors.lastname: Harada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010820:Physicians; D010821:Physicians, Family; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014555:Urination Disorders / Q000175:diagnosis*