Geriatric syndrome

Question 1

Four types of urinary incontinence

Answer 1

Stress
Urge
Overflow
Functional

Question 2

Cause of stress UI

Answer 2

• Weak pelvic floor muscles (e.g. from childbirth, pregnancy, menopause)
• Bladder outlet/urethral sphincter weakness
• Post-urologic surgery (e.g. prostatectomy)

Question 3

Cause of urge UI

Answer 3

• Detrusor overactivity
• Local genitourinary conditions (e.g. tumours, diverticula)
• CNS disorders (e.g. stroke, dementia, PD)

Question 4

Cause of overflow UI

Answer 4

• Obstruction by prostate, strictures
• Acontractile bladder associated with DM or spinal cord injury
• Neurogenic (e.g. MS)
• Medication-induced

Question 5

Causes of functional UI

Answer 5

• Severe dementia
• Psychological conditions
• Pain and immobility

Question 6

Transient causes of UI

Answer 6

Delirium
Infection
Atrophic vaginitis
Pharmaceuticals
Psychological
Excessive urine output (e.g. from hyperglycaemia)
Reduced mobility / reversible urinary retention (e.g. drug-induced)
Stool impaction

Question 7

Drugs that can contribute to UI

Answer 7

• Antihistamines
• Decongestants
• Benzos
• Opioids
• Anticholinergics/antimuscarinics/cholinestrase inhibitors
• Spamolytics
• ACE inhibitors
• Alpha blockers
• Alpha agonists
• Calcium channel blockers
• Antiarrhythmics
• Diuretics
• Antidepressants (SNRI, TCA)
• Gabapentin/pregabalin
• Muscle relaxants
• PO Estrogens
• Beta-3 agonists
• Thiazolinediones
• Alcohol/caffeine

Question 8

Management of stress UI

Answer 8

• Kegel’s exercise
• Topical estrogens
• Duloxetine
• Surgery/devices

Question 9

Management of urge UI

Answer 9

• Kegel’s exercise
• Treat BPH
• Topical estrogens
• Beta-3 agonist
• Antimuscarinics
• Bolutinum toxin injections
• Sacral nerve stimulation

Question 10

Management of overflow UI

Answer 10

Bladder obstruction
- Treat BPH/strictures accordingly
- Treat uterine prolapse in women
- Bowel habit optimisation

Bladder under activity
- Bethanechol
- Clean intermittent catherisation

Question 11

Fall risk assessment

Answer 11

• History of falls
• Meds
• Gait, balance and mobility
• Visual acuity
• Other neuro conditions
• Muscle strength
• Heart rate and rhythm
• Postural hypotension
• Feet and footware
• Environmental hazards

Question 12

STOPPFall drugs

Answer 12

• Orthostatic drugs (alpha blockers, central antihypertensives, vasodilators, diuretics)
• Opioids
• Psychotropics (antidepressants, antipsychotics, benzos, Z-hypnotics)
• Anticonvulsants
• Anticholinergics

Question 13

Dangerous etiologies of dizziness

Answer 13

• Stroke/TIA
• STEMI/arrhythmias
• Active bleeding and hypovolemia
• Tumors
• Brain infections
• Other infections (pneumonia)
• Meds

Question 14

4ATs

Answer 14

Used for detection of delirium
- Alertness
- Abbreviated mental test 4 (DOB, Age, Place, current year)
- Attention (counting down months, simple calculations)
- Acuity

Question 15

Causes of delirium

Answer 15

Infections
Withdrawals
Acute metabolic disorders
Trauma
CNS pathology
Hypoxia
Deficiencies
Endocrinopathies
Acute vascular
Toxins/substances
Heavy metals

Question 16

Management of acute agitation

Answer 16

• SC/IM/PO Haloperidol 0.3-1 mg BD, max 5 mg/day
• PO Quetiapine 6.25-12.5 mg BD, max 100 mg/day
• PO Olanzapine 1.25-2.5 mg, max 10 mg/day
• PO/IV/SC Lorazepam 0.5-1 mg

Question 17

Monitoring for withdrawing benzodiazepines

Answer 17

Anxiety, insomnia, agitation
Possibly delirium, seizures, confusion

Question 18

Monitoring for withdrawing antipsychotics

Answer 18

Recurrence of psychotic symptoms
Possibly insomnia

Question 19

Monitoring for withdrawing opioids

Answer 19

Recurrence of pain
Possibly MSK symptoms, restlessness, GI symptoms, anxiety, insomnia, diaphoresis, anger, chills

Question 20

Monitoring for withdrawing antidepressants

Answer 20

Recurrence of depression, flu-like symptoms, anxiety, irritability, insomnia
Possibly headache, malaise, GI symptoms

Question 21

Monitoring for withdrawing antiepileptics

Answer 21

Seizures
Possibly anxiety, restlessness, insomnia, headache

Question 22

Monitoring for withdrawing diuretics

Answer 22

Fluid overload, hypertension

Question 23

Monitoring for withdrawing alpha blockers

Answer 23

Hypertension
Possibly headache, palpitations

Question 24

Monitoring for withdrawing vasodilators

Answer 24

Angina

Question 25

Monitoring for withdrawing antihistamines

Answer 25

Return of symptoms
Possibly anxiety, insomnia

Question 26

DRP screening

Answer 26

Indication
Efficacy
Drug-disease interaction
Drug-drug interaction
Dose
Dosing instructions
Duplication
Duration
Cost-effectiveness

Question 27

What does the MAI not have?

Answer 27

• ADR
• Failure to receive treatment
• Untreated indications

Question 28

Risk factors for delirium

Answer 28

Age at least 65 y.o.
Cognitive impairment (current or previous)
Current hip fracture
Severe illness

Question 29

Comprehensive geriatric assessment

Answer 29

Functional status (BADL, IADL)
Medical review
Cognitive/mood assessment
Medication & nutrition optimisation
Social resources

Question 30

ABCDEF framework

Answer 30

Accurate diagnosis
Behavioural & psychological symptoms
Caregiver stress
Drugs and disabilities
End of life discussion
Financial support

Question 31

BADL

Answer 31

Dressing
Eating
Ambulating
Toileting
Hygiene

Question 32

IADL

Answer 32

Shopping
Housekeeping
Accounting
Food preparation
Taking medications
Telephone
Transport

Question 33

Non-pharmacological measures for urinary incontinence

Answer 33

Kegel’s exercise
Weight loss
Reduced urinary irritants
Normalise bowel habits
Timed voiding
Incontinence products