Geris

Question 1

Define frailty.

Answer 1

A decrease in reserve or capacity to tolerate an insult that is not attributed to disease, comorbidity or age alone (though they contribute):

• Weakness (grip strength)
• Slowness of gait
• Weight loss
• Exhaustion
• Low activity levels

Classical defined by signficant sarcopenia. The kind of person that could live for another ten years but wouldn’t survive if they got pneumonia.

Question 3

What are the risk factors for functional decline in the elderly?

Answer 3

• Cognitive impariement
• Depression
• Disease burden (co-morbidities)
• Increased and decreased body mass index
• Lower extremity functional limitation
• Low frequency of social contacts
• Low level of physical activity
• No alcohol use compared to moderate use
• Poor self-perceived health
• Smoking
• Vision impairement

Question 4

WHat are the different types of incontinence?

Answer 4

• Urge
• Stress
• Functional
• Overflow

Question 5

Describe stress incontinence.

Answer 5

• Caused by laxity of pelvic floor muscles
  
  • allows proximal urethra to drop below the pelvic floor
  • ↓ urethral/vesicle angle allows bladder pressure to exceed urethral pressure briefly at times of strain
• Associated withcystocele
  
  • bulging of bladder wall into the upper anterior vaginal wall
  • ↓ estrogen
  • history of vaginal childbirth
• Presentation
  
  • symptoms
    
    • leak with cough or laughing (presumably due to elevated intra-abdominal pressure)
• Treatment
  
  • topical vaginal estrogen
  • Kegel exercises to strengthen pelvic floor muscles
  • α-adrenergic agonists to ↑ muscle tone of bladder neck
  • surgical procedures available if difficult to treat

Question 6

Describe urge incontinence.

Answer 6

• Caused by involuntary bladder contraction
  
  • result of ↑ detrusor muscle activity
• Most common type
• Presentation
  
  • symptoms
    
    • ↑ urinary frequency
    • small volume voids
    • nocturia
• Treatment
  
  • anticholinergics to ↓ parasympathetic tone of detrusor muscle

Question 7

Describe functional incontinence.

Answer 7

• Inability to arrive to the toilet in a timely fashion due to some condition (eg, delirium, dementia, immobility, and so forth)
  
  • these patients have the ability to hold urine and empty their bladder
  • in other words, the patient has a medical condition that makes it difficult for the patient to arrive to the bathroom within a reasonable time frame

Question 8

Describe overflow incontinence.

Answer 8

• Overdistended bladder and urinary retention → dribbling and inability to empty bladder
• Etiology:
  
  • impaired detrusor contractility
    
    • neurogenic
      
      • i.e., diabetes mellitus, B12 deficiency, alcoholism
    • pathologies affecting the spinal cord
      
      • i.e., spinal stenosis, multiple sclerosis, tumors
    • medications
      
      • i.e., anticholinergics, alpha agonists, calcium channel blockers, opioids, psychotherapeutics
  • bladder outlet obstruction
    
    • i.e., benign prostatic hyperplasia (BPH), pelvic organ prolapse (advanced), iatrogenic (i.e., pelvic surgery), fibroids
• Presentation
  
  • involuntary small volume voids and dribbling
    
    • can occur during the day and night
  • urinary hesitancy
• Treatment
  
  • guided by etiology
  • identify reversible causes and address them
    
    • stopping medications
  • catheterization may be necessary
    
    • may be temporary or permanent
  • cholinergic agonists to ↑ detrusor muscle tone (for bladder atony)
  • α-adrenergic antagonists to ↓ tone of bladder neck

Question 9

Differentiate dementia, delirium and depression from eachother.

Answer 9