The pathophysiology of urinary incontinence among institutionalized elderly persons

Article Abstract:

Urinary incontinence, the inability to control the urinary bladder, afflicts approximately 1 million elderly Americans living in institutions, and it is the most common medical problem in nursing homes. The Surgeon General estimates the cost of urinary incontinence at approximately $8 billion, an amount greater than the combined expenditures on kidney dialysis and coronary artery bypass surgery. Despite its large economic cost to society, surprisingly little is known about the condition and its pathophysiologic basis. Urinary incontinence was studied among 605 elderly persons (average age 89), of whom 40 percent were chronically incontinent. Detailed pressure readings and radiologic examinations of the urinary tract were undertaken in these individuals, and the causes were seen to be complex. The condition has been previously attributed to increased detrusor activity (increased impingement upon the bladder), which leads to urinary leakage. Men accounted for only small percent of the patients, and in 29 percent of them, the cause was obstruction of the urinary tract. In the entire group, detrusor activity was the leading cause (61 percent), followed by stress incontinence, underactive detrusor activity, and obstructions. In 35 percent of all patients, there was more than one cause of the problem. The pathophysiology of incontinence in this group of patients is complex, often stemming from multiple causes, which are explored.

Health aspects, Urinary incontinence, Nursing home patients

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Current concepts: depression in the elderly

Article Abstract:

Depression in the elderly is caused by a variety of medical and psychiatric problems, and occurs in 10 percent of the elderly population and 20 percent of institutionalized elderly. Major depression does not usually manifest itself in the elderly and is primarily diagnosed in the younger years. Elderly depressed patients do not fall into categories set by the manual of mental disorders. Their depressive illness is considered to be a result of life stress and physical disease. The aging process itself is not responsible for depression; causes may include imbalanced hormone production and disruption of normal biological rhythms. Although symptoms are similar to those found in younger age groups, the elderly may experience more weight loss and are less inclined to report feelings of worthlessness and guilt. Management of the older adult with depression begins with removing the source, using antidepressant medication, psychotherapy and well monitored electroconvulsive therapy. The older patient may not recover fully after a depressive episode and some symptoms may linger. Suicide rates are highest among the elderly when compared to other age groups. However, depression in the elderly is more easily treated than other psychiatric disorders found in this age group.

Care and treatment, Methods, Dosage and administration, Psychotropic drugs, Depression in old age, Geriatric depression, Geriatric psychiatry

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Delirium in the elderly patient

Article Abstract:

A common psychological disorder of the elderly is the temporary loss of reasoning and attention, referred to as delirium or acute mental confusion. Delirium usually occurs suddenly, often at night, and it lasts for a brief time, usually less than one month. Several factors contribute to the onset of delirium, including the aging process of the brain, diseases affecting the brain's structure, a reduction in the body's ability to remain stable (reduced homeostasis), hearing and vision loss, higher incidence of chronic diseases, and other age-related changes in the body. The clinical features of delirium are outlined, as are diagnostic techniques, organic causes, and prevention and treatment of the disorder.

Diagnosis, Causes of, Geriatrics, Delirium

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