URINARY INCONTINENCE尿失禁.pptVIP

URINARY INCONTINENCE IN THE AGING PATIENT September 2007 Deb Mostek Definition UI is the involuntary loss of urine that is objectively demonstrable and a social or hygienic problem. International Continence Society Prevalence of UI 15-30% of community dwelling persons 65 years and older. FM until age 80 years, then M=F Up to 50% in LTC GU Age-Related Changes Detrusor overactivity (20% of healthy continent) BPH ? PVR , ? nocturia, ? UO later in day Atrophic vagintis urethritis ? ability to postpone voiding, ? total bladder capacity, ? detrusor contractility ? urine concentrating ability, ? flow DuBeau CE.Urinary Incontinence.Geriatric Review Syllabus Fifth Ed.2002-2004.139-148 Risk Factors for UI Impaired mobility Depression Stroke Diabetes Parkinson’s Disease Dementia (moderate to severe) 1/3 have multiple conditions FI, Obesity, CHF, Constipation, TIAs, COPD, Chronic cough, Impaired mobility ADLs Consequences of UI Cellulitis, Pressure ulcers, UTI Falls with fractures Sleep deprivation Social withdrawal, depression Embarrassment (50%), interference with activities ? Caregiver burden, contributes to institutionalization Costs $16 billion Types of Urinary Incontinence Transient UI (Acute) Established UI (Chronic) Urge UI Stress UI Mixed UI Overflow UI “Functional” UI Transient Incontinence Lower urinary tract pathology Precipitated by reversible factor 1/3 Community dwelling 1/2 Hospitalized incontinent aged patients Causes: Delirium, UTI, Meds, Psychiatric disorders, ? UO, Stool impaction Restricted mobility Causes of Transient (Acute) Incontinence D Delirium I Infection A Atrophic Vulvovaginitis P Psychological P Pharmacologic agents E Endocrine, excessive UO R Restricted Mobility S Stool impaction Source: Resnick NM. Urinary incontinence in the elderly. Med Grand Rounds. 1984;3:281-290. Pharmacologic Causes Opioids Calcium channel blockers Anti-Parkinsons drugs