Frailty/ Falls/ Delirium/ Incontinence Flashcards
(30 cards)
What is frailty?
A susceptibility state that leads to a person being more likely to lose function in the face of a given environmental challenge
Why are people living longer?
- Increased resources available
- Better economic conditions
- Improved screening programmes with earlier diagnosis and treatment
- Better outcomes following major events
What functions are reduced in aging?
- Reduced baroreflex sensitivity in the elderly
- Reduced peripheral vasoconstriction
- Reduced metabolic heat production
- Reduced sweat gland output
- Reduced skin blood flow
- Smaller increase in cardiac output
- Less redistribution of blood flow from renal and splanchnic circulations
What are the results of frailty syndromes?
- Falls
- Delirium
- Immobility
- Incontinence
What are the extrinsic factors involved in incontinence?
- Physical state and co-morbidities
- Reduced mobility
- Confusion
- Drinking too much or at the wrong time
- Medications
- Home circumstances
- Social circumstances
What are the functions of the bladder?
Urine storage
- Involves detrusor muscle relaxation with filling (>10cm pressure) to normal volume 400-600ml combined with sphincter contraction
Voluntary Voiding
- Involves voluntary relaxation of external sphincter and involuntary relaxation of internal sphincter and contraction of bladder
What causes stress incontinence?
Bladder outlet too weak
Weak pelvic floor muscles
What are the symptoms of stress incontinence?
Urine leak on movement, coughing, laughing, squatting
When is stress incontinence common?
Common in women with children, especially after menopause
What are the treatment options for stress incontinence?
Treatments include physiotherapy, oestrogen cream and duloxetine
– Surgical option – TVT/colposuspension 90% cure at 10 years
What causes urinary retention with overflow incontinence?
Bladder outlet too strong
Older men with BPH
What are the characteristic features of urinary retention with overflow incontinence?
Poor urine flow, double voiding, hesitancy, post micturition dribbling
Blockage to urethra
What causes urge incontinence?
Bladder muscle too strong
What are the features of urge incontinence?
Detrusor contracts at low volumes
Sudden urge to pass urine immediately
Can be caused by bladder stones or stroke
What is the treatment of urge incontinence?
Treat with anti-muscarinics (relax detrusor)
e.g. oxybutinin, tolterodine, solifenacin
– Bladder re-training sometimes helpful
What groups of drugs are used to relax detrusor muscle?
Antimuscarinics (relax detrusor)
– oxybutinin, tolterodine, solifenacin, trospium
• Beta-3 adrenoceptor agonists (relax detrusor)
– mirabegron
• Alpha-blockers (relax sphincter, bladder neck)
– tamsulosin, terazosin, indoramin
• Anti-androgen drugs (shrink prostate)
– finasteride, dutasteride
What casues a neuropathic bladder?
Under active bladder muscle
Leave a catheter in too long
No awareness of bladder filling resulting in overflow incontinence
What is the only effective treatment of a neuropathic bladder?
Catheterisation
When is a referal for incontinence needed at onset?
- Referral necessary at onset
• Vesico-vaginal fistula
• Palpable bladder after micturition or confirmed large residual volume of urine after micturition
• Disease of the CNS
• Certain gynaecological conditions (e.g. fibroids, procidentia, rectocele)
• Severe benign prostatic hypertrophy or prostatic carcinoma
• Patients who have had previous surgery for continence problems
• Others in whom a diagnosis has not been made- Faecal incontinence
– Referral after failure of initial management:
• Constipation or diarrhoea with normal sphincter
– Referral necessary at onset:
• Suspected sphincter damage
• Neurological disease
- Faecal incontinence
What is delirium?
Disturbed consciousness: hypoactive/ hyperactive/ mixed
Change in cognition: memory/ perceptual/ language/ illusions/ hallucinations
Acute onset and fluctuate
How common is Delirium?
20-30% of all in patients
What factors may precipitate delirium?
Infection (but not always a UTI!) • Dehydration • Biochemical disturbance • Pain • Drugs • Constipation/Urinary retention • Hypoxia • Alcohol/drug withdrawal • Sleep disturbance • Brain injury • Stroke/tumour/bleed etc • Changes in environment/emotional distress • Sometimes no idea and often multiple triggers
What is the 4AT score?
- Alertness
- AMT
- Attention
- Acute change or fluctuating course
When is drug treatment of deliruim indicated?
Only if danger to themselves or others or distress which cannot be settled in any other way
THIS SHOULD BE A CONSULTANT DECISION
