general preventative health care measures to suggest to your elderly pts?
smoking cessation (prevent vascular, chronic lung dz, CA and osteoporosis)
exercise and move
safety programs to prevent MVAs, falls and burns
5 common geriatric problems
HTN urinary incontinence falls osteoporosis dementia
if orthostatic changes are apparent, how do you need to position the pt to check their BP?
in the standing position
BP readings which are major risk factors for CVD in the elderly?
isolated systolic HTN greater than 140/ less than 90 and systolic/diastolic HTN of greater than 140/greater than 90
initial therapy that should be used in hypertensive elderly pt?
what is the indicated first line drug therapy for pts presenting with isolated systolic HTN?
long-acting calcium channel blocker
three things urinary incontinence, osteoporosis, falls and dementia have in common?
more prevalent in the elderly
can result from physiologic and pathologic changes that occur with age
can result in significant functional decline in the individual
is urinary incontinence considered a normal part of aging?
what are incontinence patients predisposed to?
skin breakdown pressure sores social isolation dspression UTIs falls (nocturnal trips to the bathroom)
acute onset incontinence most likely dt what?
problems outside the lower urinary tract and often reversible
main causes of acute urinary incontinence?
infection, inflammation or impaction
MC cause of acute urinary incontinence?
most common drug class noted to cause incontinence?
also narcotics, anticholinergics, psychotropic drugs
T/F: acute onset of incontinence in a pt w/known or suspected malignancy is a medical emergency
pt presents w/triad of acute urinary incontinence, acute or sub-acute dementia and wide based gait suspect what?
normal pressure hydrocephalus
4 categories of chronic urinary incontinence?
definition of stress incontinence?
leakage of urine which can follow any increase in intra-abdominal pressure
usu dt pelvic floor muscle weakness, diminished resistance to pressure by the urinary sphincters
definition of urge incontinence?
involuntary loss of urine while suddenly feeling the need or urge to urinate
generally dt involuntary and inappropriate detrusor muscle contractions
aka spastic bladder or overactive bladder
what is the MC form of chronic incontinence?
MC causes of chronic urge incontinence?
usu dt nerve damage of some sort
irritation to bladder wall such as cystitis, bladder stones, bladder carcinoma, constipation
definition of overflow incontinence? causes?
leaking of urine from distended bladder can be dt outlet obstruction, pelvic mass, urethral fibrosis, spinal cord pts, pts w/diabetic neuropathy, pts on medications
what two reflexes are usu absent in overflow incontinene?
anal reflex and saddle sensation
definition of functional incontinence? causes?
person does not recognize the need to go, don’t know where the bathroom is, or can’t get to the bathroom in time
causes include confusion, dementia, poor eyesight, poor mobility or being in a situation where they can’t reach a toilet
questions to ask to evaluate for incontinence?
frequency and pattern of urination any sense or urgency, hesitancy, dribbling, interrupted stream, sense of incomplete void? current pattern of BMs fluid intake medication list! caffeine use EtOH use distance to toilet ease in use of toilet consider asking pt to keep a 1-2 d voiding diary
PEs to do with a pt presenting with urinary incontinence?
abd exam rectal exam pelvic exam neuro exam functional status exam
initial lab to do with all pts w/urinary incontinence?
check for markers of infxn, if (+) send for C and S
also assess for hematuria, glucosuria, proteinuria
other steps to consider for a pt w/incontinence?
refer to urologist
abd/pelvic U/S, MRI, cytoscopy, measurement of bladder volume, IVP
tx options for urinary incontinence?
establishing a toilet regime kegel exercises: 10 reps per set, consider 3-5 sets per day topical estrogen for women good perineal care decrease use or avoid use of EtOH and caffeine always consider food sensitivities eliminate use of NutraSweet electrical stimulation
herbal tx options for urinary incontinence?
althea officinalis equisetum arvense hypericum sambucus nigra serenoa repens zea mays piper methysticum scutellaria glycyrrhiza glabra mullien root tincture
herbs tx options for prostatic hypertrophy?
homeopathics for “urge to urinate”
apis argentum nitricum belladonna causticum chimaphila kali carb merc-c
conventional tx of urge incontinence
anticholinergic meds (oxybutynin, propantheline, lavoxate)
MC cause of injury related morbidity in the elderly?
falls- 7% of fall-related deaths occur in the elderly
things that lead to more falls in the elderly?
lack of maintenance of postural and gait stability (CNS and MS systems)
cardiac, respiratory and metabolic factors
fluctuations in BP, orthostatic hypotension, post-prandial hypotension
how does gait change in the elderly?
decreased step length
decreased gait velocity
increased double stance time
increase in sway
risk of falling increases with increases in ____?
the combination of what 3 things increases the elderly’s risk of falling?
age related loss of physical mechanisms needed to maintain good posture and gait stability + increased chronic disease + environmental challenges (tripping over rugs or pets)= increased risk of falling
how to reduce the risk of falls?
vision problems- r/o need for change in glasses prescription or cataract extraction
hearing problems- assess for cerumen, schedule for formal audiology testing
home safety assessment
improve cognitive station, muscle mass, bone health, CV and pulmonary health