Various conditions of the elderly

Question 1

Urinary incontinence - causes in men

Answer 1

o Enlarged prostate
o TURP
o Confusion or sedation

Question 2

Urinary incontinence - causes in women

Answer 2

o Functional incontinence
o Stress incontinence (incompetent sphincter)
o Urge incontinence (detrusor instability, organic brain damage) other causes are UTI, diabetes, diuretics, senile vaginitis, urethritis.
o Confusion or sedation

Question 3

Urinary incontinence - management

Answer 3

o Treat the cause
o Check kidney function
o Pelvic floor exercise for stress incontinence
o For urge incontinence examine for spinal cord and CNS signs
o Treat urethritis and vaginitis
o Aim to keep bladder volume below that which trigger emptying
o Consider absorbents pads.
o May need surgical intervention after uro-dynamic study

Question 4

! Fall - Causes

Answer 4

o Drugs. (sedative, antihypertensive)
o Poor environment
o Medical conditions (Parkinson’s, Cataract)
o For most cases no real cause.

Question 5

Falls - points in Hx

Answer 5

o Question any possibility of CNS, cardiac or musculoskeletal abnormalities.
o Drugs: Metoclopramide, Prochlorperazine
o Exact mechanism
o Alcohol

Question 6

Falls - examination

Answer 6

o Should be done for the CNS, cardiac and musculoskeletal systems
o For the consequences of fall. Cuts, bruises, fractures (especially femur), head injury.

Question 7

Falls - management

Answer 7

o	Treat the cause
o	Review medication
o	Reassure the patient
o	Teach exercises
o	Get involved in care plan if needed
o	Aiding measures (external hip protectors)

Question 8

Postural hypotension - what can it lead to?

Answer 8

Fall & lack of mobility

Question 9

Postural hypotension - when is it common?

Answer 9

Common at night or after meal or on exercise.

Question 10

Postural hypotension - Causes

Answer 10

o Venous insufficiency to the legs
o Autonomic neuropathy.
o Drugs. Ex: diuretics, nitrates, antihypertensives, sedatives

Question 11

Postural hypotension - Management

Answer 11

o Reduce or stop the drugs.
o Advice the patient to stand up slowly.
o Leg compression stocking.
o Indomethacin-or cortisone fluid reserving drugs.

Question 12

Hypothermia - what is it?

Answer 12

It is the condition when body temperture declines below 35°C

Question 13

Hypothermia - causes

Answer 13

o Impaired homeostasis.

o Low room temp-poverty. Poor housing.

o Diseases-impaired thermoregulation.

• Pneumonia
• MI
• Autonomic neuropathy
• Reduced awareness to cold (ex: dementia ,acute confusional state)
• Increased heat loss (psoriasis)
• Increased exposure to cold (falls at night)
• Drugs (antidepressant, major tranquilisers
• Alcohol

Question 14

Hypothermia - clinical features

Answer 14

Above 32: mild pallor, apathy, tachycardia

Below 32: bradycardia with irregularities (including VF), hypotension, impaired consciousness and coma

Question 15

What does usually maintain normal temperature? When is it altered?

Answer 15

• The hypothalamus normally maintains core temperature at 37°C. This is altered in fever, or hypothalamic disorders.

Question 16

Hypothermia - Cx

Answer 16

o	Cardiac arrhythmia.
o	Pneumonia.
o	Pancreatitis.
o	Acute renal failure.
o	Intravascular coagulation.

Question 17

Hypothermia - Ix

Answer 17

o	Urgent U&E. 
o	Blood glucose. 
o	Serum amylase.
o	Blood culture. 
o	Blood gases. 
o	ECG ➤ could show J wave

Question 18

Hypothermia - Management

Answer 18

o Take urgent blood for investigation.
o IV fluid to correct the electrolyte imbalance.
o Cardiac monitor.
o Antibiotics.
o Urinary catheter to assess urinary function
o Slowly re-warm: rapid lead to hypotension 1⁄2 degree / hour-hot drink in warm room.
o Observe-rectal temp, BP, pulse, respiration/ 1/2H.

Question 19

Hypothermia - Prognosis

Answer 19

o Depends on age and hypothermia.

o Age>70, temp <32°C, then mortality >50%.