Gerriatrics

Question 1

What are the different types of urinary incontinence?

Answer 1

• Stress incontinence
• Urge incontinence
• Retention and overflow incontinence
• Neuropathic bladder

Question 2

What are the risk factors for incontinence in the elderly?

Answer 2

• Physical problem with bladder or urinary outlet
• Poor physical state
• Co-morbidities
• Reduced mobility
• Confusion (delirium, dementia)
• Diuretics
• Constipation
• Difficult Home/social circumstances

Question 3

Indications for referring to urinary specialists?

Answer 3

• After 3 months of pelvic floor exercises, cone therapy, habit retraining, and medication with no improvement
• Vesico-vaginal fistula
• Palpable bladder after micturition
• CNS disease
• certain Gynae conditions (fibroids, procidentia, rectocele, cystocele)
• BPH/prostatic carcinoma
• Previous incontinence surgery

Question 4

What is Stress incontinence and who is mainly affected?

Answer 4

Weak Bladder outlet and Pelvic floor muscles
Involuntary leakage on increased intrabdominal pressure (coughing, sneezing, exertion, laughing, squatting)

Common in women post-menopause - esp if they have had children

Question 5

How do you treat Stress incontinence?

Answer 5

• Physiotherapy - pelvic floor strengthening and stimulators
• Oestrogen cream and duloxetine
• Vaginal cones
• Biofeedback
• Kegel Exercisers
• Stop anti-cholinergics and sedative medications
• Surgical option - transvaginal tape, colposuspension

Question 6

What is Urge Incontinence and how do you treat it?

Answer 6

Bladder Muscle is too strong
Oversensitivity from infection, bladder stones or stroke
Treat with anti-muscarinics e.g. oxybutynin, tolterodine, solifenacin

Question 7

What is urinary retention with overflow incontinence? and who does it affect?

Answer 7

Bladder outlet obstruction, causing incomplete emptying

Common in men with BPH or prostatic cancer

Question 8

How does Urinary retention with overflow incontinence present?

Answer 8

Poor urine stream, double voiding, hesitancy, post-micturition dribbling and feeling of incomplete emptying

Question 9

How do you treat urinary retention with overflow incontinence?

Answer 9

• Alpha-blockers
• Anti-androgen
• Surgery (TURP)
• Catheterisation

Question 10

What is Neuropathic Bladder?

Answer 10

Bladder is Underactive, very rare
No awareness of bladder filling + leads to overflow incontinence
-> normally secondary to neurological disease
- Catheterisation to treat

Question 11

What is Sarcopenia?

Answer 11

Degenerative Skeletal Muscle loss
Component of frailty syndrome
Risk Factors: Diabetes, Elderly, Chronic disease, Inflammation, Nutritional deficiency, Endocrine dysfunction

Question 12

Discuss Osteoporosis in the elderly

Answer 12

Weak fragile bones, prone to # (hip, wrist, vertebrae)

Measure with FRAX, QFRACTURE, BMD (via DEXA scan)
T score from -1 to -2.5 is osteopenia
T score

Question 13

Treatment for osteoporosis

Answer 13

Calcium supplements
Vitamin D supplements
Bisphosphonates
Teriparatide
Denosumab

Question 14

Falling in the elderly,

risk factors?

Answer 14

Muscle weakness, >80y/o, cognitive impairment, visual deficit, previous falls, balance deficit, gait deficit, depression, impaired activities of daily living (ADLs), arthritis

Question 15

3 types of factors that cause falls

Answer 15

Intrinsic factors: gait and balance, visual problems, acute illness
Extrinsic factors: poor lighting, inappropriate footwear, environmental hazards
Situational factors: Urgency of micturition, Medications, Alcohol

Question 16

Causes of collapse

Answer 16

• Fall plus head injury
• Cardiac arrhythmias
• Syncope
• Seizure
• Hypoglycaemia