الفهرس 
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Abstract
Nocturia is the most common and under-recognized urinary symptom, experienced by the majority of older adults and its prevalence increase with advancing age. Nocturia in older adults is associated with a range of debilitating effects including sleep disturbance, decreased day time energy, falls, depression and social isolation.
Aim of the study:
The present study aimed to identify the relationship between nocturia, sleep quality and day time energy of the community dwelling older adults.
Research tools and method:
Design: descriptive correlational research design
Setting: The study was conducted in seven outpatient clinics in the main university hospital in Alexandria namely geriatric, urology, diabetic, general medical, endocrine, hematology and gastrointestinal clinic.
Subjects: The study subjects consisted of 130 older adults attending the previously mentioned setting and fulfill the following criteria: aged 60 years and above, able to communicate effectively, accept to participate in the study, have no urinary incontinence and suffering from nocturia.
Tools of the study: two tools were used for data collection.
Tool (1): Socio-demographic and clinical data of the older adult patients structured interview schedule was developed by the researcher through review of relevant literature and it was consisted of two parts:
A. Socio-demographic data of the elders such as age, sex, marital status, level of education and monthly income.
B. Clinical data of the study older adults as, frequency of nocturia, duration of having nocturia, presence of comorbidities and type of medications consumed.
Tool (2): Sleep quality and Day Time Energy of older adult patients with nocturia structured interview schedule was composed of two parts:.
Part 1: Pittsburgh sleep quality index (PSQI); was used in the current study to assess sleep quality of older adult patients with nocturia; it was adopted and modified by the researcher. As causes of sleep disturbance other than nocturia were excluded.
Part two: Day time energy of older adults with nocturia was developed by the researcher after review of recent literature to assess daytime energy of older adult patients with nocturia and their ability to do the social, leisure and daily life activities in the last 2 weeks.
Each older adult who fulfilled the inclusion criteria was individually interviewed by the researcher in the waiting area of the outpatient clinics to collect the necessary data. The interview time ranged from 25 to 35 minutes depending on the level of co-operation of the elderly persons and presence of quite environment. Data collection started from the beginning of November till the end of January. The statistical package for social science (SPSS) was utilized for data analysis and tabulation. The level of significance selected for this study was ―P‖ equal or less than 0.05.
The main results obtained were as follows:
The age of the study older adults ranged from 60 to 80 years with a mean of 66.5±5.1 years. Males were more prevalent than females; they constituted 58.5%, and 70% were married, 28.5%were widows and widowers and 1.5% was divorced. Concerning the educational level, 48.5% of them were illiterate, 21.5% had basic education, 13.8% were able to read and write, 10% completed secondary education while only 6.2 had university education and above. As for the occupation of the study older adults before retirement, 45.4% had a skilled work, 34.6% had no work and this included the house wifes, and 17.7% were employees.
It was found that 21.5% of the study older adults were from the general medical clinic, 18.5% from the urology clinic, 16.9% of the study older adults from the geriatric and hematology clinic, 16.2% from the diabetic clinic and few percent of the study older adults 6.2% and 3.8% from the gastrointestinal and endocrine clinics respectively.
As regards to the presence of comorbidities, 43.1% of the study older adults were diabetic, 33.8% were hypertensive, 16.9% had blood diseases, 16.2% had cardiac diseases and musculoskeletal diseases, 14.6% had GIT and hepatic diseases, 13.8% had renal diseases, 12.3% had prostate enlargement, 6.9% had respiratory diseases and 5.4% had cancer. Only 5.4% didn’t suffer from any other diseases except nocturia. Diabetes mellitus was the prevailing chronic disease affecting the studied subjects, so, antidiabetic medication were the most commonly used 38.5% followed by antihypertensive drugs 33.8%. Only 0.8% didn’t take any medication.
Regarding the duration of having nocturia, it ranged from 0.16 -23 years with a mean of 5.58 ± 4.87 years. More than one half of the study older adults 53.1% reported that they had nocturia for less than five years, 24.6% had nocturia for five to less than ten years, 14.6% had nocturia for ten to less than fifteen years and 7.7% for fifteen years or more.
Concerning the frequency of having nocturia, the present study showed that all older adults in the current study had nocturia with different level of frequency as follow; 45.4% of older adults in the present study awake twice at night to void, 33.8% awake three times to void and 20.8% awake four times or more to void.
As for sleep quality, it was noticed that 31.5% of the study older adults had poor sleep quality, 46.9% had fairly good sleep quality and 21.5% had good sleep quality.
High statistically significant difference (p= <0.000) was found between sleep quality and frequency of having nocturia.
As regards the level of day time energy, 39.2% of the study older adults reported low level of day time energy, 33.1% had moderate level of daytime energy and 27.7% had high level of day time energy.
High statistically significant difference (p= <0.000) was found between level of day time energy and frequency of having nocturia
There was statistically significant difference between the duration of having nocturia, sleep quality and level of day time energy (p= 0.032, P=0.005) respectively.
High statistically significant difference (p= <0.000) was found between sleep quality and level of daytime energy of the study older adults.
Conclusion:
Based on the findings of the present study it can be concluded that, poor sleep quality and low level of day time energy are associated with nocturia in the majority of the study older adults with a statistically significant relationship.
The main recommendations are:
4. Nurses in the outpatient clinics are required to focus on the problem of nocturia in older adults, its causes and how it affects sleep quality and daytime energy during assessment of older adult patients.
5. Faculty members of the gerontological nursing department prepare educational booklets about nocturia in older adults, its consequences and the importance of seeking medical help to be available for those who attend to the different outpatient clinics.
6. In-service health education programs to be planned by the faculty members of the gerontological nursing department and offered on regular basis to the nurses at the different outpatient clinics where geriatric patients attend. The program should include age related changes that affect urinary system, correction of misconceptions about nocturia and the importance of adherence to the therapeutic regimens of nocturia to prevent complications.