Giants of Geriatrics Part 2 Lecture.docx

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Western University
Health Sciences
Health Sciences 2711A/B
Aleksandra Zecevic

HS 2711B Giants of Geriatrics, Part 2: Week 8 February 26th, 2014 Giants of Geriatrics • Clusters of chronic diseases with diminished possibility for recovery, afflicting most very old people 1. Immobility 2. Instability 3. Incontinence  The involuntary and inappropriate passage of urine and/or feces 4. Intellectual Impairment  Brain failure (malfunction of all or nearly all of the brain)  Delirium  Dementia • Why giants?  Number of people afflicted  Dependence on others for care  They can interconnect (immobility  instability) 3. Normal Bladder Function • Normal average amount of urine secreted – 100 ml per hour • Sensations of bladder states:  Fullness – 300ml, 3 hours after fluid intake; easily suppressed  Discomfort of full bladder – 600 ml, after 6 hours  Desperation – 750 ml or more; irresistible desire to urinate, leaking starts Incontinence • Symptoms  Leakage of urine during exercise, laughing, coughing, sneezing, or lifting  Inability to hold urine until you get to a toilet  Urine dribbles after urinating  Smell of urine on clothes or in the house • Prevalence  Up to 25 million adultAmericans  1 in 3 persons over the age of 60  Twice as common in women than in men (by giving birth and pregnant – changes in our pelvic floor cause it more for women)  Frustrating, embarrassing, debilitating condition (wakes you up, restricts activities, irritates skin, affects quality of life)  Only 25% seek help usually after 4 (men) – 6 (women) years  2008-2009  1 in 8 community dwelling Canadians over the age of 65 suffer from urinary incontinence  9% men and 14% women over the age of 65  19% for men and 22% women – over the age of 85 Mechanisms of Incontinence • Incontinence occurs if the muscles of the bladder suddenly contract, but the sphincter suddenly relaxes • The most common cause of incontinence is from stress incontinence • Magnesium  pumpkin seeds are the best sources of magnesium and help with the muscles involved Types of Incontinence Pelvic floor muscles weaken due to changes resulting from pregnancy, childbirth or menopause 1. Stress – most common. Urine leaks during lifting, coughing, sneezing, laughing, exercise. Caused by overstretched pelvic muscles due to child bearing 2. Urge – nerves controlling the bladder are overactive and involuntary action of bladder muscle occurs. Happens in sleep, after drinking water, when hearing running water… 3. Overflow – enlarged 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 Alzheimer’s disease of severe arthritis that prevents a person from reaching a toilet 5. Mixed – usually stress and urge incontinence together 6. Transient – temporarily leakage occurs due to an acute infection or medication Treatment • Kegal exercise • Electrical stimulation to pelvic muscles • Biofeedback to track bladder and urethral muscle contractions • Bladder timing training • Absorbent pads • Medications • Non-surgical devices – pessaries (a rubber ring that pressures the urethra to prevent urine from leaking) • Surgical treatments – pulling dropped bladder up; catheterization • Implants to close urethra Is Incontinence Inevitable • No – it is not inevitable with age • It is treatable and curable at all ages • Embarrassment is not helpful • Enco
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