important to remember about ED
Decrease sexual activity assoc w/
- poor health/social issues
- Partner availability
-Dec libido/ED
ED is prevalent but not part of healthy aging. Frequently caused by age-associated disease or its treatment
Level of sexual activity, interest, and enjoyment in younger years, determines sexual behavior with aging
Vascular causes of ED
Most common cause of ED
-DM
-HTN
-HLD/CAD/PAD
-smoking
ED predicts future major atherosclerotic vascular disease (MI/stroke)
Neurologic causes of ED
Those that
-impair the parasympathetic sacral spinal cord or peripheral efferent autonomic fibers to the penis
-impair penile smooth muscle relaxation that prevent the vasodilation necessary for erection
Causes: prostate CA tx (surgery and radiation), spine injury (level/degree determines extent of ED), autonomic dysfunction dz (DM, stroke, Parkinson’s)
Psychogenic causes of ED
prevalence decreases with age
-may occur via increased sympathetic stimulation to sacral spinal cord that inhibit parasympathetic dilator nerves
-Causes: relationship conflicts, performance anxiety, childhood SA, fear of STI’s, widower’s guilt
are anti-htn meds associated with ED?
yes almost all are
Can lower BP below critical threshold needed to maintain blood flow for erection
Higher incidences w/BB, Clonidine, thiazide diuretics.
Drugs that should not be prescribed together
BB & ED meds
Nitrates & ED meds
Patient education with sildenafil
-S/E: rhinitis, headaches, flushing, dyspepsia, transient visual disturbance
-contraindicated for use with nitrates (profound fatal hypotension)
Contra in a-blocker
-absorption is attenuated (weak) when taken with/before fatty meal (meal can counteract med and have no effect)
Female sexuality age-associated changes
menopausal changes
-cultural expectations
-relationship problems
-previous sexual experiences
-chronic illnesses
-depression
Intercourse Frequency Dec w/aging. Sexuality important for older women
Low testosterone symptoms
not a cause of ED
-this is a libido problem
-also giving testosterone will not improve ED symptoms
Stress incontinence factors
-damage to pelvic flor supports (levator ani, connective tissues)- urethra compress failure when intra-abd pressure inc.
-sphincter failure (surgical damage or severe atrophy, sub sacral spinal injury-rare, proximal urethra failure during bladder filling)
Impaired urethral sphincter support/closure associated with coughing/sneezing/laughing/physical activity
Leak occurs after not with cough, large in vol. Difficult to stop.
Urinary incontinence
-impaired bladder emptying due to the bladder outlet obstruction/detrusor underactivity (^ PVR)
urinary incontinence with impaired bladder emptying
results from detrusor underactivity, bladder outlet obstruction, or both
-outlet obstruction (prostate or urethral scarring)
-intrinsic bladder smooth muscle damage
-peripheral neuropathy
-damage to spinal cord or spinal bladder
most common type of incontinence in both genders
urge incontinence
- detrusor overactivity (DO) uninhibited bladder contraction
may be:
-age related
-idiopathic
-secondary to lesion in central inhibitory pathway
bladder outlet obstruction or less commonly local bladder irritation (stones, infection, tumor)
Management of urinary incontinence
- lifestyle changes (weight loss, decrease fluids)
- behavioral therapy (bladder training & kegel exercising)
- Drugs (oxybutynin)
- Surgery (botox injections, bladder slings and suspension)
Antimuscarinic agents and UI
moderately effective for urge, overactive bladder, and mixed UI
-contraindicated in patients with narrow angle glaucoma, impaired gastric emptying, or urinary retention
-work by increasing bladder capacity
Medications that affect urinary incontinence
Alcohol, ace inhibitors, loop diuretics, Thiazolidinediones
adrenergic agonists (men) adrenergic blockers (women)
anti-cholinergics, calcium channel blockers, cholinesterase inhibitors, estrogen (oral), NSAID
GABAergic agents, narcotic analgesics, antipsychotics, sedative hypnotics, TCAs
Q: What are transitions of care?
Movement of a patient from any health care setting, provider, or level of care to another (e.g., ED → inpatient → home → PCP). Also called handoffs, handovers, or transfers.
occur within the hospital setting or across health care settings
22% of Medicare beneficiaries experienced care transitions of some kind
Why are transitions particularly important for older adults?
Bc they have
multiple chronic conditions, complex therapeutic regimens, and frequent transitions,
making them vulnerable to errors, readmissions, and adverse events.
Q: What is a common statistic for older adult transitions within 30 days?
~40% of older adults experience two or more transitions within 30 days post-hospital discharge.
suboptimal transitions threaten safety
result in adverse events, med errors, and inaccurate/incomplete information transfer
-almost half of all medication errors occur during hospital admission or discharge
-inaccurate or incomplete information can result in: delayed diagnosis, duplication of medical services, hospital readmission, reduce patient and provider satisfaction
