Clinical Report: Gross Hematuria in Nonagenarians—Prevalence, Predictors, and Outcomes

Overview

In nonagenarian patients admitted to a urological ward, gross hematuria (GH) is a common cause of hospitalization, often linked to underlying urological conditions and antithrombotic therapy. Frailty, assessed by the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS), and GH-related admissions are associated with increased dependency and altered discharge outcomes.

Background

The population aged 85 and older is rapidly increasing in Europe, with nonagenarians projected to more than double in Austria by 2050. Urological diseases such as benign prostatic hyperplasia, bladder cancer, and urinary incontinence peak in incidence after age 80, posing challenges for healthcare systems. Gross hematuria is a frequent symptom in elderly urological patients and may be influenced by anticoagulant or antiplatelet therapies commonly prescribed for cardiovascular conditions. Understanding risk factors and outcomes related to GH in this vulnerable population is critical to optimizing care and preserving autonomy.

Data Highlights

Key Findings

• Nearly half of nonagenarian urological admissions were due to gross hematuria.
• Risk factors for GH admissions included age, sex, antithrombotic therapy, indwelling catheters, and history of bladder cancer.
• Higher frailty scores (CSHA-CFS ≥5) were associated with worse survival and increased risk of GH-related admissions.
• GH-related hospitalizations were linked to increased dependency, including higher rates of catheter dependence and discharge to nursing homes.
• Intensified treatment for GH (e.g., bladder irrigation, clot evacuation) correlated with greater changes in social service utilization.

Clinical Implications

Clinicians should recognize gross hematuria as a common and significant cause of hospitalization in nonagenarians, often complicated by frailty and comorbidities. Frailty assessment using CSHA-CFS can aid in risk stratification and guide decision-making regarding invasive interventions and discharge planning. Early identification of patients at risk for increased dependency may facilitate tailored support to preserve autonomy and optimize resource allocation.

Conclusion

Gross hematuria is a prevalent and impactful condition in nonagenarian urological patients, with frailty and comorbidities influencing outcomes. Integrating frailty assessment into clinical practice can improve management strategies and discharge planning in this growing patient population.

References

1. European demographic projections and urological disease incidence
2. CSHA-CFS validation and prognostic value in elderly patients
3. Impact of antithrombotic therapy on hematuria in elderly
4. Previous study on nonagenarian admissions for gross hematuria