Health Sciences 2711A/B Lecture Notes - Lecture 5: Biofeedback, Abdominal Wall, Longitudinal Study
27 Jun 2018
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Giants of Geriatrics Part 2: Incontinence and Intellectual
impairment
Giants of Geriatrics
clusters of chronic diseases with diminished possibility for recovery afflicting most very
old people
affect each other
1. immobility - reflects on incontinence
2. instability
3. incontinence - immobility or stability makes problems greater
4. intellectual impairment - experience incontinence
Why giants?
number of people afflicted
dependence on other for care
they can interconnect (immobility -> instability)
1. Incontinence
the involuntary and inappropriate passage of urine and/or feces
need management strategies
2. intellectual impairment
Brain failure (malfunction of all or nearly all of the brain)
whole brain is involved
not stroke because stroke is localized
Delirium
syndrome - frequent in hospitals
alternate level of consciousness
Dementia - Alzheimer's is most common
Normal Bladder Function
Normal average amount of urine secreted - 100 mL/hour
sensations of bladder state:
fullness - 300mL, 3 hours after fluid intake; easily surpressed
discomfort of full bladder - 600mL after 6 hours
desperation - another hour; 750mL or more; irresistible desire to urinate, leaking
starts
How does it feel to be incontinent?
when you cannot control passing of urine
happens when you are a child
associate uncontrollable passing of urine as something is wrong
after surgery, certain medications, paralyzation, pregnant women
silent, hidden thing
commercial side of things are opening up discussion
Symptoms
leakage of urine during exercise, laughing, coughing, sneezing or lifting
whenever you push muscle leakage can start
inability to hold urine until you get to a toilet
urine dribbles after urinating
smell of urine on clothes or in the house
Prevalence
25 millions American adults
1 in 3 persons over the age 60
twice as common in women than in men
Frustrating, embarrassing, debilitating condition
Wakes you up, restricts activities, irritates skin, affects QOL)
only 25% seek help usually after 4(men)-6(women) years
thinking things will return but they usually don’t
1 in 8 canadiana community dwelling suffer form incontinence
Mechanisms of incontinence
pelvic floor muscles weaken due to changes resulting from pregnancy, childbirth or
menopause stretching especially
enlarged or removed prostate - pushes everything arounf
removal causes everything to drop
bladder infant of slower ab, leaning against abdominal wall
body stores urine like a balloon in bladder as more unrine accumulates
kidneys bring urine into bladder
muscle on pelvic floor are thin and cross like pull system
after pregnancy things never return to original length pulling everything down more
major mechanism why bladder and muscle activity around bladder is affected
10-12 pregnancies, muscles are so weak bladder starts protruding through
vagina
Types of incontinence
1. stress
Most common
related to muscles
Urine leaks during lift, coughing, sneezing, laughing, exercise
caused by overstretched pelvic muscles due to child bearing
2. Urge
nerve control become less efficient
Nerves controlling bladder are overactive and involuntary action of bladder
muscle occurs
control of opening sphincter and pressing of bladder is no longer conscious
usual due to outside instances
happen in sleep, after drinking water, when hearing running water
3. overflow
emlarged prostate constricts the urethra preventing complete bladder emptying
rare in women
4. functional
Untimely urination due to other medical conditions that impair thinking, moving
or communicating such as alzhimer’s disease or severe arthritis that prevents a
person from reaching a toilet
urinating in areas other than washroom
5. mixed
usually stress and urge incontinence together
6. transient
Temporarily leaking occurs due to acute infection, pregnancy or medication
Treatment
Kegel Exercise - muscle can be trained no matter how weak
electrical stimulation to pelvic muscles
biofeedback to track bladder and urethral muscle contraction
bladder timing training
absorbent pads
medications
non-surgical devices - pessaries
surgical treatments - pulling dropped bladder up; catheterization
implants to close urethra
Is incontinence inevitable
no!
it is treatable and curable at all ages
embarrassment is not helpful
encourage the elder to see a doctor and address underlying medical condition
open up the conversation, talk about it
Intellectual impairment
Brain failure - brain malfunction in all or nearly all brain due to pathological change in
the brain tissue or functional change in brain nutrition
includes dementia and delirium; excludes hemorrhage, infarct, tutor or abscess
Causes of cognitive impairment
intrinsic - develops slow and runs long
follow person until death
Alzihmers, parkinsons, huntington
extrinsic - develops rapidly and runs short reversible course
alcohol, toxic, metabolic, endocrine
characteristics: wandering, confusion, disorientation, incontinence
Retained features:
Document Summary
Giants of geriatrics part 2: incontinence and intellectual impairment. Why giants? number of people a icted dependence on other for care they can interconnect (immobility -> instability: incontinence the involuntary and inappropriate passage of urine and/or feces need management strategies, intellectual impairment. Brain failure (malfunction of all or nearly all of the brain) whole brain is involved not stroke because stroke is localized. Delirium syndrome - frequent in hospitals alternate level of consciousness. 1 in 3 persons over the age 60 twice as common in women than in men. Wakes you up, restricts activities, irritates skin, a ects qol) only 25% seek help usually after 4(men)-6(women) years thinking things will return but they usually don"t. 1 in 8 canadiana community dwelling su er form incontinence. 10-12 pregnancies, muscles are so weak bladder starts protruding through vagina. Urine leaks during lift, coughing, sneezing, laughing, exercise caused by overstretched pelvic muscles due to child bearing: urge nerve control become less e cient.
