Common problems in the elderly include urinary incontinence, adverse drug reactions, dizziness, and falls. Urinary incontinence is caused by factors like UTIs, constipation, and medications and is managed through bladder retraining, medications, or surgery depending on the type. Adverse drug reactions are common in the elderly due to polypharmacy and age-related changes; management involves minimizing medications and reviewing them regularly. Dizziness can be due to various causes like hypotension, arrhythmias, or neurological conditions; evaluation depends on the type of dizziness. Falls are addressed through exercise, medication management, environmental modifications, and safety education.

1. Common Problems in the Elderly
• Urinary Incontinence
• Adverse Drug Reactions
• Dizziness
• Falls
• Delirium
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2. Urinary Incontinence
• Defined as the involuntary loss of urine
• Seen in all age groups, but more prevalent in
those over 65 years
• Causes social and hygiene problems
• Can lead to skin damage if severe

3. Urinary Incontinence
Contributory Factors
• UTI
• Severe Constipation
• Drugs (eg. Diuretics)
• Hypergylcemia
• Hyercalcemia
• Restricted mobility
• Acute confusion

4. Urinary Incontinence
Investigations
• Maintain a diary to ascertain patter of urinary
loss
• USG: Measure residual urine
• Assess for vaginal prolapse and atrophic
vaginitis (women)
• Per rectal exam: assess prostate (men)

5. Urinary Incontinence
Management
Urge incontinence: due to detrusor overactivity
(urgency and frequency)
•Bladder retraining
•Antimuscarinic drugs, e.g. solifenacin, tolterodine
Stress incontinence: weakness of the pelvic floor muscles allows leakage of urine
when intra-abdominal pressure rises
•Pelvic floor muscle retraining
•Surgical interventions
Overflow incontinence: obstruction to bladder outflow
(Residual volume > 100mL)
•Surgical relief (e.g. prostatectomy)
•Intermittent catherization
Other (e.g. severe stroke, dementia)
•Timed toileting

6. Adverse Drug Reactions
• Can result in symptoms, abnormal physical
signs, and altered laboratory tests
• Account for 20% of admissions in those aged
over 65 years
• Partly because the elderly receive more
prescribed drugs than younger people

7. Adverse Drug Reactions
Risk Factors
• Polypharmacy
• Age-related changes in pharmacodynamic and
pharmacokinetic factors
• Impaired homeostatic mechanisms like
baroreceptor responses, plasma volume and
electrolyte control
• Non-adherence

8. Adverse Drug Reactions
Polypharmacy
• Defined as the use of four or more drugs
• Factors leading to polypharmacy:
– Multiple pathology
– Poor patient education
– Lack of routine review of medications
– Patients expectations of prescribing
– Over use of drug interventions by doctors
– Attendance at multiple specialist clinics
– Poor communication between specialists

9. Common ADRs in the elderly
Drug Class Adverse Reaction
NSAIDs GI Bleeding
Peptic ulceration
Renal Impairment
Diuretics
ACE Inhibitors
Renal impairment
Hypotension/Postural Hypotension
Electrolyte imbalance
Warfarin Bleeding
β-Blockers Hypotension/Postural Hypotension
Bradycardia or Heart block
Opiates Constipation or urinary retention
Vomiting
Delirium
Antidepressants Delirium
Hypotension/Postural Hypotension
Falls
Benzodiazepines Delirium
Falls
Anticholinergics Constipation or urinary retention

10. Adverse Drug Reactions
Management
• ADRs should be considered in any presenting
complaint
• Minimize amount and dosage of drugs
• Ensure patient understands and adheres to
dosage regime
• Review medication regularly
• Discontinue drugs that are no longer needed
or contraindicated

11. Dizziness
• Occurs in 30% of those over 65 years
• Multifactorial
• Also described as lightheadedness, vertigo, or
unsteadiness

12. Dizziness
Acute Onset
• Hypotension due to arrhythmia, MI, GI bleed
or pulmonary embolism
• Onset of posterior fossa stroke
• Vestibular neuronitis

13. Dizziness
Lightheadedness
• Suggestive of reduced cerebral perfusion
• Due to
– Structural cardiac disease (Left ventricular
dysfunction or aortic stenosis)
– Arrhythmia
– Vasovagal syndrome
– Postural hypotension
– Anti-hypertensive medications

14. Dizziness
Vertigo
• Suggestive of labyrinthine or brainstem
disease
• Commonly due to benign positional vertigo
• If other brain stem signs present, do an MRI to
exclude a cerebello-pontine angle lesion

15. Dizziness
Unsteadiness
• Suggestive of joint or neurological disease
• Examine gait, joints and do a CNS examination
• Usually improved with physiotherapy
• If patient has history of falls, do specific
interventions
– Exercise training
– Correct medication
– Correct visual impairments
– Home environmental hazard assessment
– Safety education