Delirium, Urinary Incontinence, Visual impairment etc

Question 1

Delirium

• definition
• assessment

Answer 1

Acute onset, fluctuation, inattention
Plus - disorganised thinking, altered LOA, others

CAM - Confusion Assessment Method

Question 2

Delirium
RF
Mx

Answer 2

Dementia - highest RF
Medical illness, ETOH abuse, Depression
Poor func state, visual/hearing impairments etc

Mx - Haloperidol - first choice

Question 3

Visual impairment
causes
RF

Answer 3

Cataracts
Macular degeneration
Galucoma
Diabetic retinopathy

RF - age, DM, UV light

Question 4

Stress incontinence

Answer 4

Risk factors: obesity, pregnancy, vaginal delivery
Involuntary urinary leakage on exertion, sneezing, or coughing

Duloxetine hydrochloride (serotonin-reuptake inhibitor) for stress incontinence – shown in meta-analysis. SE nausea

Question 5

Urge incontinence

Answer 5

Detrusor instability - most common form

frequency and nocturnal incontinence, urgency, and associated with loss of large
urine volumes (> 100 mls)

anticholinergic drugs: oxybutinin - bladder relaxation, use limited by retention, confusion, constipation and dry mouth

Question 6

Overflow incontinence

Answer 6

Outlet obstruction (eg BPH) 
Atonic bladder (spinal chord disease, automatic neuropathy in DM, alcoholism, B12 deficiency, Parkinson‘s

Question 7

Mx of incontinence

Answer 7

1. Anticholinergics: reduced flow rate and increased residual
2. Stop Cholinergics: worsen urge symptoms
3. Alpha blockers: decreased outflow resistance eg labetalol
4. TCAs: increased outflow resistance, occasionally retention

Question 8

BPH Management

Answer 8

Alpha blocker (terazosin/Hytrin, doxazosin) +/- 5 alpha-reductase inhibitor (if
prostrate volume > 25 ml). I

Urinary condom in men is better than indwelling catheter if a urinary collection device is needed (excl retention), in terms of reduced infection and better patient comfort (J Am Geriatric Soc 2006;54:1055)

Question 9

Falls

Answer 9

Causes - reduced proprioception, reduced baroreflex sens, postural sway

Mx - check meds, stop psychotropics, group exercise
*no benefit in hip protectors

Question 10

Medications - risk of falls
1.
2.
3.

Answer 10

1. Antidepressants
2. Neuroleptics and antipsychotics
3. Benzos