title: A multicomponent behavioural and drug intervention for nocturia in elderly men: rationale and pilot results.
abstract: OBJECTIVES To evaluate the number of medical and urological conditions associated with nocturia in a cohort of older men who were primary-care enrolees, and to assess the feasibility and efficacy of using a multicomponent intervention to reduce nocturia and its bother. SUBJECTS AND METHODS Men aged > or =50 years and with two or more episodes of nocturia were recruited from the primary-care clinics at one Veterans Affairs Medical Center to participate in a 4-week, open-label, prospective pilot study. A multicomponent intervention composed of behavioural therapy and targeted drug therapy was administered according to a specified protocol based upon identified risk factors for nocturia. Outcome measures included self-reported nocturia and bother on the American Urological Association (AUA)-7 Symptom Index, 3-day bladder diaries and self-reported sleep-related measures recorded using 7-day sleep diaries. RESULTS Fifty-five men completed the protocol (mean age 67 years, sd 8.3); they had a mean of 4.5 of nine defined conditions potentially related to nocturia. Highly prevalent conditions included moderate-to-severe benign prostatic hyperplasia (87%), hypertension (86%) and urinary frequency (71%). The mean diary-recorded nocturia decreased from 2.6 to 1.9 (P < 0.001), and bother score reduced from 3.1 to 1.1, representing a change from a 'medium' to a 'very small' problem (on a 5-point scale). Sleep diary-derived measures also improved significantly (time to initiate sleep, time to return to sleep after awakening, quality of sleep). CONCLUSIONS Given that individual older patients often have multiple coexistent risk factors for nocturia, identifying a principal cause of nocturia, a concept emphasized in treatment guidelines, proved to be difficult. Implementing a multicomponent behavioural intervention combined with drug(s) was feasible in older men and reduced nocturia frequency, bother from nocturia, and time to initiate sleep, within 4 weeks. These promising results merit repeating using a randomized, controlled trial.
authors.affiliation: Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Emory University School of Medicine, Atlanta, GA, USA. camille.vaughan@emory.edu
authors.forename: Camille P
authors.initials: CP
authors.lastname: Vaughan
authors.forename: Yohannes
authors.initials: Y
authors.lastname: Endeshaw
authors.forename: Zobair
authors.initials: Z
authors.lastname: Nagamia
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Ouslander
authors.forename: Theodore M
authors.initials: TM
authors.lastname: Johnson
mesh_terms: D000081:Acetamides / Q000627:therapeutic use; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000368:Aged; D001521:Behavior Therapy / Q000379:methods; D001559:Benzhydryl Compounds / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003408:Cresols / Q000627:therapeutic use; D004812:Epidemiologic Methods; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D053158:Nocturia / Q000209:etiology / Q000628:therapy*; D010665:Phenylpropanolamine / Q000627:therapeutic use; D011224:Prazosin / Q000031:analogs & derivatives / Q000627:therapeutic use; D011470:Prostatic Hyperplasia / Q000150:complications; D011743:Pyrimidines / Q000627:therapeutic use; D000068737:Tolterodine Tartrate; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000150:complications
chemical_list: D000081:Acetamides; D000317:Adrenergic alpha-Antagonists; D001559:Benzhydryl Compounds; D003408:Cresols; D006993:Hypnotics and Sedatives; D018727:Muscarinic Antagonists; D011743:Pyrimidines; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; C041226:Terazosin; C085665:zaleplon; D011224:Prazosin