Geriatric Giants Flashcards
What are the 6 geriatric giants?
Pressure Sores Instability Immobility Incontinence Intellectual impairment Iatrogenic (medication)
What are the extrinsic risk factors for pressure sores?
- Excessive uniaxial pressure
- Friction and shear forces
- Impact injury
- Heat
- Moisture
- Posture
What are the intrinsic risk factors for pressure sores?
- Infection
- Age
- Disease
- Sensory loss
- Immobility
- Body type
- Poor nutrition
Where are pressure sores commonly found?
BONY PROMINENCES (sacrum, heels, shoulders)
What are the factors that can lead to stress incontinence?
MOST COMMON TYPE
- surgical damage during prostatectomy or hysterectomy
- medications
- childbirth
- weak/damaged pelvic floor or urethral sphinctre damage
- coughing, laughing, sneezing, exercise
- neurological conditions
- obesity
What are the factors that can lead to urge incontinence?
SECOND MOST COMMON TYPE
- too much alcohol/caffeine
- medications
- problems with the nervous system
- poor fluid intake
- often idiopathic
- tumours in the bladder
- UTIs
What actually happens in urge incontinence?
The bladder muscle gives wrong messages to the brain and the bladder may feel fuller than it actually is. This means that sometimes urine leaks before you have time to get to the toilet.
What are the factors that can lead to overflow incontinence?
- obstruction to the outflow of urine
- enlarged prostate gland
- bladder stones
- constipation
- damage to the bowel during surgery
What actually happens in overflow incontinence?
A pool of urine constantly remains in the bladder that cannot empty properly (chronic urinary retention), and pressure builds up behind this, causing the normal emptying mechanism to become faulty. Patients pass small trickles of urine very often, and feel like they never fully empty their bladder.
What are the factors that can lead to total incontinence?
- bladder fistula
- spinal cord injury
- congenital bladder problem
What actually happens in total incontinence?
This is urinary incontinence that is severe and continuous (ie. cant hold urine). Patients may pass large amounts of urine constantly, even at night
Which medications can cause urinary disturbance?
- ACE inhibitors
- Diuretics
- Some antidepressants
- HRT
- Sedatives
- Anticholinergics
- CCBs
- Antiparkinsonian medications
How can the cause of urinary incontinence be diagnosed?
- Bladder diary
- Examination (pelvic/vaginal/prostate/PR)
- Urinalysis
- Bladder USS
- Cytoscopy
- Urodynamic tests
How can bladder problems be treated (non-surgically)?
- Lifestyle changes
- Pelvic floor muscle training
- Bladder training
- Incontinence products
- Medications
- Urinary catheterisation
How can bladder problems be treated (surgically)?
- Tape procedures
- Colposuspension
- Sling procedures
- Urethral bulking agents
- Botox injections
- Sacral nerve stimulation
- Urinary diversion
What can cause bowel incontinence?
- Crohns, IBS, UC
- Weakened or damaged sphincter muscles following vaginal delivery/rectal surgery
- Nerve damage (DM, MS, stroke, spina bifida)
- Physical disability
- Learning disability/dementia
- Constipation
How can bowel incontinence be treated?
- Dietary changes
- Exercise
- Continence products/service
- Pelvic floor muscle training
- Bowel retaining
- Medication
- Enemas
- Surgery
Give some examples of drugs that have lots of drug interactions
- Warfarin
- NSAIDs
- SSRIs and TCAs
- Antiepileptics
- Beta blockers
- Certain abx (macrolides)
What is the common side effect of NSAIDS?
GI bleeding, worsening heart failure, worsening renal function
What are the common side effects of opiates?
Constipation, bradycardia, hypotension, urinary retention, psychosis
What are the common side effects of diuretics?
Hypotension, hyperglycaemia, gout, urinary retention, renal impairment
What are the common side effects of warfarin?
GI bleed, high INR
What are the common side effects of ACE inhibitors?
Hypotension, renal impairment
What are some complications of immobility and instability in the elderly?
- Pressure ulcers
- Contractures
- VTE
- Pneumonia (decreased ventilation)
- Constipation
- Urinary retention/infection
- Depression
How can cognitive function be assessed?
- MMSE
- AMTS
- 6CIT
- GP Cog
- IQ code
- Addenbrookes score
What are the key points of the Mental Capacity Act?
Can they remember the information?
Can they weigh up the information?
Can they communicate their decision?
Is it decision specific?
