الفهرس 
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Abstract
Urinary tract infection is a serious health problem encountered among geriatric patients, and affecting as many as 1 in 10 geriatric population annually worldwide. With advancing age the incidence of urinary tract infection increases and considered a dangerous health problem among those category of this population. There are many factors are associated with occurrence of urinary tract infection among geriatric patients such as length of hospitalization, use of indwelling urinary catheter, positive history of urinary tract infection, poor nutrition status(overweight), presence of medical diseases. Moreover, age, amount of fluid intake, dependency and cognitive impairment.
The aim of this study is to determine factors associated with ur(inary tract infection among geriatric patients.
Design: The study followed a descriptive exploratory research design.
Setting: The study was conducted in Alexandria Main University Hospital and Health Insurance Hospital (Gamal Abder- Nasser).
Subjects: The study subjects comprised geriatric patients admitted to the previously mentioned settings. The inclusion criteria were:-
Geriatric patients aged 60 years and above, diagnosed with urinary tract infection, able to communicate effectively, and willing to participate in the study. Their number amounted to 200 geriatric patients.
Tools:
Data was collected using four tools
Tool I: Socio- demographic and clinical data structured interview schedule.
This tool was developed by the researcher. It consists of four parts:
Part 1: Socio-demographic characteristics of the study subjects such as age, sex, marital status, level of education, and income.
Part 2: Health profile of the study subjects such as past medical, surgical, and urological history, type of medications used.
Part 3: Anthropometric measurements as measuring weight, height and calculation of body mass index.
Part 4: Assessment sheet for dehydration and environmental factors related to hospital:-
1- Hydration status: the patient was observed for signs and symptoms of dehydration.
2- Environmental factors which may predispose for urinary tract infection.
Tool II: - The Mini- Mental State Examination (MMS)
The MMS scale was developed by Folestien, etal (1975). (65) It was used to assess the cognitive function of the study subjects. It includes questions related to orientation, registration, attention, calculation, recall and language. Items were scored on 5 points likert scale and ranged from ( 0-30) and classified as follows:
0-17 severe cognitive impairment
18- 23 mild cognitive impairment
24- 30 normal cognitive function
Tool III:- Geriatric Depression Scale- short form(GDS-15). It is a 15 items self- report instrument that developed by Yesavage et al (1983) (66) to assess depression and general well-being in the geriatric patients. The geriatric patients choose the best answer either yes (1) or no(0) for how he/ she had felt over the past week. Items were scored on 5 points likert scale and ranged from( 0-15) items and classified as follow:-
0-4 no depression
5-8mild depression
9-11 moderate depression
12- 15 severe depression
Tool IV:- Barthel Index Scale (BI)
The Barthel index scale was developed by Barthel et al (1965). (67)This tool was used in older adults to assess geriatric patient’s activities of daily living. The scale consists of 10 items namely feeding, dressing, bathing, toileting, controlling bladder, controlling bowel, moving from chair to bed and return, getting in and out of toilet, walking on level surface, ascend and descend stairs. The score of zero is given for each response when geriatric patients can’t meet criteria as defined dependent, one was given when need help, and two was given when he was dependent. Items were scored on 5 points likert scale the total score ranged from ( 0- 20) and classified as follows:-
0-7 dependant
8-12 independent with assistance
13- 20 independent
Method
Official letter was issued from the Faculty of Nursing, Alexandria University and forwarded to the directors of Main University Hospital and Health insurance hospital ( Gamal Abdel Nasser) to obtain their approval to carry out the study. The directors of the hospital were informed about the purpose of the study, the date and time of data collection. Tool I (socio-demographic and clinical data structured interview schedule) was developed by the researcher. The reliability result are (r= 0.858) tool II( r=0.801),tool III (r=0.837) tool IV(r=0.798) and Arabic version of tool II,III,IV were used in this study. A pilot study was carried out on 20 geriatric patients selected from Alexandria Main University Hospital (these patients were not included in the study sample).Data was collected during a period of four months from Mid- February till Mid –June 2015.
The main results obtained were as follow:
The majority of studied subjects aged from 60 to less than75years with a mean age of 68.31±3.09years. More than half of geriatric patients with urinary tract infection were males. More than three quarter of the studied subjects were married, (46.0%) of geriatric patients with urinary tract infection were illiterate. 44.0% of studied subjects reported an income of less than 500 LE per month.
Renal diseases were the most common disease among studied subjects, followed by diabetes mellitus (54.5%). More than three quarter of study subjects (88.5%) used anti-inflammatory and analgesic medications followed by (54.5%) consumed anti-diabetic medications, and bronchodilators was taken by 1.5% of geriatric patients. More than three quarter of studied subjects (77.5%) were overweight, with a mean of 28.56±1.73kg
More than half (60%) of study subjects is catheterized currently. No nursing care was done for more than half (51.5%) of the study subjects. In relation to presence of depression (3.0%) of the study subjects did not suffer from depression, followed by (44.0%) suffered from mild depression, while (46.0%) had moderate depression, and the rest (7.0%) complain from severe depression.
More than half (55.0%) of the study subjects were independent with assistance in activities of daily living, more than one quarter (28.5%) were independent, while the rest(16.5%)were dependent in activities of daily living.
In relation to cognitive impairment,the majority of studied subjects(84.0%) had mild cognitive impairment, while, the rest (16.0%) had normal cognitive function.
As regard performance of hygienic care practices, more than half of geriatric patients (53.5%)didn’t perform hygienic practices, while more than two fifth(46.5%)perform hygienic care practices. More than half of study subjects (60.5) complain from manifestations of dehydration.
Statistically significant association were found between geriatric patients with urinary tract infection and their length of hospital stay, diseases as diabetes mellitus, stroke, depression, renal stone, cardiovascular diseases ), body mass index, use of urinary catheter, cognitive status, and dependency. But no statistically significant association found between geriatric patients with urinary tract infection and their age, amount of fluid intake.
Conclusion:
It can be concluded from the findings of the present study that, urinary tract infection is a dangerous health problem among geriatric patients. Several factors were found to be significantly associated with urinary tract infection among geriatric patients such as length of hospital stay, body mass index, use of indwelling urinary catheter, and previous history of urinary tract infection, Moreover, presence of medical diseases, cognitive impairment, and dependency. While factors as age, and amount of fluid intake not significantly associated with urinary tract infection.
The main recommendations were:
I- Recommendations geared to geriatric patients
5- Encourage older adults to pay attention to personal hygiene, especially taking into account the perineum to be cleaned after each toilet from front to back, using cotton underwear and changing it continuously during the day.
6- Older adults should consume well-balanced diet that contains all food elements especially diet rich in vitamins, protein and focus on drinking daily requirements 2-2.5 liter to raise the body immunity and resistance to infection.
II- Recommendations geared to nursing personnel and medical staff
1- In-service training programs should be planned for and offered on a regular basis to health care providers to update their knowledge and improve their performance. The training program should include preventive measures about the latest approaches of prevention urinary tract infection, how to care for catheterized older adults.
2- Checking the availability of privacy in the bathrooms, taking into consideration the cleanliness by cleansing material as Chloride, Dettol and providing a good water supply.
3- Medical staff should be encouraged to minimize the use of catheter as much as possible and to try to find alternatives to catheter as use of condom to reduce infection.
Recommendations for future research
3. Study the effect of training program for nursing staff on applying preventive measures of urinary tract infection on the incidence of urinary tract infection
4. Study the effect of use of cranberry on prophylaxis and treatment of urinary tract infection among geriatric patients .