Frequency of Urinary Tract Infections in Adults and the Elderly

With the increase in knowledge in healthcare fostered by huge investments in research, time has come to develop a strong intervention framework to combat the prevalence of urinary tract infections (UTI). Adults and the elderly are more vulnerable to such infections. Unlike in younger adults, where it is hard to find a distinction between symptomatic UTI and asymptomatic bacteriuria, older adults are less likely to manifest signs of localized genitourinary. Normally, as one ages, they experience changes in immune functions; thus, the increased number of comorbidities and exposure to nosocomial pathogens put the elderly individuals at a higher risk of developing this kind of infections. Moreover, institutionalized adults have been associated with a greater impairment to important bodily functions and higher incidences of cognitive deficits. Such characteristics always predispose this population group to higher rates of UTI. It is also important to note that the most notable risk factor, linked to UTI in older adults in institutions, is the presence of a urinary catheter just like in older adults in communities and those with history of UTI. A number of medical comorbidities, such as dementia and stroke, which are known to naturally predispose people to bladder and bowel incontinence, have been linked with symptomatic urinary tract infections in adults and the elderly as well. According to empirical theory, a research should discover and describe facts. Thus, a study on UTI must seek to gather important facts that are observable and verifiable. This paper builds on this subject by discussing the findings of other related studies, identifying the problems that have inspired the research as well as the research question, and further showing the methodology for this research as well as offering the implications of this study for the practice.

Problem Statement

UTI is quite prevalent in long-term care facilities, which causes hospitalization as the result of bacterial infection. Hence, a concrete data on the frequency of infections will help in a quick diagnosis and the development of a framework to solve the problem in the nursing practice.

Review of Literature

Adult UTI Infections

UTI is one of the leading infections in local primary care. In their research, Wei Tan and Chlebicki (2016) have found that the incidences of this kind of infection in male adults under 50 years is low, while the likelihood of adult females developing UTI is 30 times more than men. It has also been discovered that bacteria Escherichia coli continues to be the predominant uropathogen causing acute community-acquired uncomplicated urinary tract infections. The most useful fist-line antibiotic in response to the infection in amoxicillin-clavulanate. This research is important in this study by hypothesizing that the frequency of UTI is highest in females than in males and identifying where the most affected group are found.

Frequency of UTI Among Adults

UTIs are common among adults who are less likely to show localized genitourinary symptoms. While conducting their research, Rowe and Juthani-Mehta (2013) pointed to lack of any evidence regarding the approach of diagnosing UTI. Their research has also highlighted the incidences of overtreatment of UTI with antibiotics due to lack of agreeable gold standard definition for treating this kind of infection. Moreover, this continues to pose a significant problem, eventually leading to negative consequences such as the development of organism that are resistant to many drugs. Rowe and Juthani-Mehta (2013) have noted that further studies of ways of fostering accuracy of diagnosis of UTI are required, thereby inspiring this study to start by focusing on the frequency of infections as a first move to developing intervention.

UTI in Patients in Long-Term Care Facilities

UTIs are common among those living in long-term care facilities, and one common practice in most of these facilities is the prescription of antibiotics to UTI patients despite absence of symptoms. Genao and Buhr (2012) state that this approach is known to inflict more harm in patients than good, thereby leading to the increased rates of negative drug effects as well as more recurrent infections, caused by drug-resistant bacteria. Moreover, this antibiotic therapy hardly improves the occurrence of genitourinary symptoms, such as malodorous urine, or even leads to the enhanced rates of mortality. This makes it imperative to avoid the confusion of UTIs with asymptomatic bacteriuria. For purposes of this study, this article helps in the identification of the right study population who can provide the requisite data needed.

Prevalence of UTI Among the Elderly in Khartoum State

UTI is more prevalent with aging of a population made up of both men and women. Adlan, Alobaid, El Nima, and Waggiallah (2017) have also noted that elderly women experience the incidences of urinary tract infections more frequently that men do, with many infections being asymptomatic. Adlan et al. (2017) have further observed that the prevalence of bacteriuria in the elderly population is estimated to be three times higher in women than in men. This research also is useful for this study in constructing hypothesis that UTI is more frequent in women than men.

UTI in Elderly Women

Symptomatic urinary tract and asymptomatic bacteriuria infections affecting older women are majorly encountered in outpatient practice. Mody and Juthani-Mehta (2014) concluded that in order to establish a solid diagnosis of symptomatic UTI in elderly women, there must be a careful clinical evaluation with the possibility of conducting laboratory assessment using urine culture and urinalysis. Their study has helped in building a hypothesis for this research.

UTI in Institutionalized and Non-Institutionalized Elderly Persons in Korea

The incidences of UTI always increase with age and they are more common in elderly patients who are institutionalized than the ones at home. This is attributed to the fact that institutionalized patients are more exposed to bacterial infections from the incontinence of urine, poor perineal hygiene, and fecal contamination (Huh, 2016). Huh (2016) has also noted that UTIs are the 2^nd most common infection in elderly care facilities, making up 25% of occurrences of infection in elderly populations residing at home. These findings are used in this study to hypothesize that institutionalized elderly persons experience the incidences of UTI more frequently than non-institutionalized ones.

Purpose Statement

This study will determine the frequency of UTIs in adults and elderly persons to unveil a better intervention mechanism than the existing ones by targeting patients according to their age, gender, and residence. For instance, if institutionalized elderly patients experience more frequent incidences of UTIs, then the emphasis can be made on improving sanitary and hygienic conditions in care facilities. This will provide vital data that can be used by nurses to improve care environments to prevent infections.

Hypotheses

1. UTI occurs more frequently in adult and elderly women than men;
2. UTI is more frequent in institutionalized patients than non-institutionalized ones;
3. The frequency of UTIs is higher in adults and elderly patients than children.

Design of the Study

Type of Research Design

This will be a quantitative research as it focuses on gathering data in numbers in relation to the incidences of urinary tract infections in the target population. This will also be a cross-sectional study.

Study Population

The study will be conducted in Boston Metropolitan area with the population of 10,000 individuals. The area has 15 care facilities for the elders, 11 clinics, and 3 inpatient hospitals. This research will focus only on adult and elderly patients, with the equal number of male and female patients. From this population, the research will focus on 500 patients.

Inclusion and Exclusion Criteria

Medical history. Researchers will only include patients with history of urinary tract infection: presently under treatment, recovering, and fully recovered. Medical history will have to be available before the admission in the research to ensure that the study only collects valid data from reliable sources.

Age. The research will only allow patients who are between 30-40 years for adults and at least 60 years for the elderly since the study focuses on adults and the elderly as the respondents for the study with the cases of UTI. The researchers will request for identification information from each participant to verify their age before admitting them in the study.

Residential. To participate in the research, one has to be a resident of the study population either at home, hospital, or in a case facility. This is to enhance accuracy of data as it relates to the sample population.

Sampling Technique

This research will use stratified random sampling. The participants will be divided into 3 strata, namely age (adults (30-40 years), elderly (60 years and above)), residence, (institutionalized patient and non-institutionalized patients), and gender (male and female patients).

Power Analysis Using GPower

To minimize all probabilities of failing to take note of real effect (false negative and type II error), GPower will be used to choose the ideal sample size for the study to avoid certain level of type Ii error in comparison of proportions, means, Variance and Regressions and Correlations. Researchers will choose a power level for the study along 2-sided significance level, where one intends to accept or even reject null hypothesis for various statistical tests. Further, 5% significance level will be selected for this study as the probability of experiencing type I error and Power standard at 80%.

Research Variable Table

Variable	Conceptual Definition	Operational Definition	Level of Measurement	Descriptive Statistic
Independent Variable	Age	Refers to the actual age of a participant in relation to the date of birth (Creswell, 2013). The elderly are those aged 60 years and above, while adults in this context are between 30 to 40 years.	Interval	Range
	Gender	The sex of participant (either male or female) (Creswell, 2013)	Ratios	Mode
	Residence	The place where a patient receives treatment. Patients are either institutionalized or non-institutionalized	Categorical data	Numbers and percentages
Dependent Variable	Frequency of UTI	Refers to the number of cases of UTI and the number of incidences of UTI per patient.	Ordinal	Mean, Median, Variance

Methodology

Data Collection

Each stratum will be divided in equal numbers. Data will be collected through structured questionnaires. The researchers will go to the hospitals and clinics and give the questionnaires to the doctors who have access to the medical records of the patients. They will be required to provide information on the number of male and female patients in their facilities under UTI treatment, the number of admissions and readmissions over a month. Additionally, patients under home treatment will be recruited. They will receive flyers containing information on the importance of the research and contact information of the researchers. The willing respondents will receive questionnaires via email in order to maintain anonymity and avoid possible biasness. This instrument in data collection is the most appropriate one since it can be used to collect great deal of information within a short period of time.

Ethical and Legal Considerations

Beneficence. The research will be conducted in such a way that it will not harm patients. In the case of elderly patients, the researchers will ask the caregivers to fill the questionnaires on their behalf and avoid deeply personal questions that can affect a patient emotionally.

Justice. This principle demands equity in the selection of participants. Thus, the study will avoid a participant who may be unfairly coerced into participating in the study such as prisoners who have met all inclusion criteria and those who do not like the study. Since this study only includes individuals diagnosed with UTI, the findings will benefit their well-being in terms of intervention framework developed afterwards.

Autonomy. This is the right of a person to freely determine the activities that they will and will not participate in a research (Creswell, 2013). To respect full autonomy, every person will be briefed on everything they are required to do so that they could make reasoned judgment regarding the effect of participation and decide to participate without any coercive influence. Further, the researchers will obtain informed consent from the institutions where patients receive treatment and from caregivers of non-institutionalized patients. The informed consent will fully disclose the risks associated with the nature of the study, benefits, and extended chance to ask any relevant question before choosing to participate or not to participate.

Statistical Plan (Analysis)

1. Alpha level (p level)

The rejection or acceptable of the hypothesis of the study will be based on significance level.

2. Statistical tests

Mann-Whitney U-test will be employed to test the difference between male and female patients as well as institutionalized and non-institutionalized ones on a continuous measure. Correlational test will be used as well to demonstrate the relationship between the two variables. Additionally, ANOVA will be used to analyze covariance and compare the relationship among the groups in this study.

How Confounding Variables Will Be Avoided

The study will use the randomization of the subjects of the study in various categories to break any possible link between confounders and exposure. This will reduce all potential for confounding by forming homogenous groups that will be compared with all variables.

Interpretation

Descriptive statistics, such as mean, median, variance, mode, and standard deviation, will be used to describe the data. They will be represented in tables, scatter plots, and figures.

Implications for the Practice

The study will unveil new nursing practices that can be employed to minimize the risks of contacting this infection in various settings while one ages. Knowing the frequency of contracting UTI will help build a framework for the intervention for the patients of different ages. The findings of the study can also be integrated in curriculums on health studies to teach students on the strategies that can be employed to reduce the frequency of prevalence of UTIs.

Future studies will need to focus on the effective strategies for mitigating the occurrence of UTI in adult and elderly patients.