Geriatric syndrome Flashcards
Four types of urinary incontinence
Stress
Urge
Overflow
Functional
Cause of stress UI
- Weak pelvic floor muscles (e.g. from childbirth, pregnancy, menopause)
- Bladder outlet/urethral sphincter weakness
- Post-urologic surgery (e.g. prostatectomy)
Cause of urge UI
- Detrusor overactivity
- Local genitourinary conditions (e.g. tumours, diverticula)
- CNS disorders (e.g. stroke, dementia, PD)
Cause of overflow UI
- Obstruction by prostate, strictures
- Acontractile bladder associated with DM or spinal cord injury
- Neurogenic (e.g. MS)
- Medication-induced
Causes of functional UI
- Severe dementia
- Psychological conditions
- Pain and immobility
Transient causes of UI
Delirium
Infection
Atrophic vaginitis
Pharmaceuticals
Psychological
Excessive urine output (e.g. from hyperglycaemia)
Reduced mobility / reversible urinary retention (e.g. drug-induced)
Stool impaction
Drugs that can contribute to UI
- 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
Management of stress UI
- Kegel’s exercise
- Topical estrogens
- Duloxetine
- Surgery/devices
Management of urge UI
- Kegel’s exercise
- Treat BPH
- Topical estrogens
- Beta-3 agonist
- Antimuscarinics
- Bolutinum toxin injections
- Sacral nerve stimulation
Management of overflow UI
Bladder obstruction
- Treat BPH/strictures accordingly
- Treat uterine prolapse in women
- Bowel habit optimisation
Bladder under activity
- Bethanechol
- Clean intermittent catherisation
Fall risk assessment
- 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
STOPPFall drugs
- Orthostatic drugs (alpha blockers, central antihypertensives, vasodilators, diuretics)
- Opioids
- Psychotropics (antidepressants, antipsychotics, benzos, Z-hypnotics)
- Anticonvulsants
- Anticholinergics
Dangerous etiologies of dizziness
- Stroke/TIA
- STEMI/arrhythmias
- Active bleeding and hypovolemia
- Tumors
- Brain infections
- Other infections (pneumonia)
- Meds
4ATs
Used for detection of delirium
- Alertness
- Abbreviated mental test 4 (DOB, Age, Place, current year)
- Attention (counting down months, simple calculations)
- Acuity
Causes of delirium
Infections
Withdrawals
Acute metabolic disorders
Trauma
CNS pathology
Hypoxia
Deficiencies
Endocrinopathies
Acute vascular
Toxins/substances
Heavy metals
Management of acute agitation
- 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
Monitoring for withdrawing benzodiazepines
Anxiety, insomnia, agitation
Possibly delirium, seizures, confusion
Monitoring for withdrawing antipsychotics
Recurrence of psychotic symptoms
Possibly insomnia
Monitoring for withdrawing opioids
Recurrence of pain
Possibly MSK symptoms, restlessness, GI symptoms, anxiety, insomnia, diaphoresis, anger, chills
Monitoring for withdrawing antidepressants
Recurrence of depression, flu-like symptoms, anxiety, irritability, insomnia
Possibly headache, malaise, GI symptoms
Monitoring for withdrawing antiepileptics
Seizures
Possibly anxiety, restlessness, insomnia, headache
Monitoring for withdrawing diuretics
Fluid overload, hypertension
Monitoring for withdrawing alpha blockers
Hypertension
Possibly headache, palpitations
Monitoring for withdrawing vasodilators
Angina
Monitoring for withdrawing antihistamines
Return of symptoms
Possibly anxiety, insomnia
DRP screening
Indication
Efficacy
Drug-disease interaction
Drug-drug interaction
Dose
Dosing instructions
Duplication
Duration
Cost-effectiveness
What does the MAI not have?
- ADR
- Failure to receive treatment
- Untreated indications
Risk factors for delirium
Age at least 65 y.o.
Cognitive impairment (current or previous)
Current hip fracture
Severe illness
Comprehensive geriatric assessment
Functional status (BADL, IADL)
Medical review
Cognitive/mood assessment
Medication & nutrition optimisation
Social resources
ABCDEF framework
Accurate diagnosis
Behavioural & psychological symptoms
Caregiver stress
Drugs and disabilities
End of life discussion
Financial support
BADL
Dressing
Eating
Ambulating
Toileting
Hygiene
IADL
Shopping
Housekeeping
Accounting
Food preparation
Taking medications
Telephone
Transport
Non-pharmacological measures for urinary incontinence
Kegel’s exercise
Weight loss
Reduced urinary irritants
Normalise bowel habits
Timed voiding
Incontinence products
