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Biomedical subjects

D S Chutka

Publications and source records attributed to D S Chutka.

9 recordsLinked to original sources
PubMed1998

Urinary incontinence in the elderly. Drug treatment options.

Urinary incontinence is commonly seen in the elderly. It has multiple complications and is often the reason an elderly person is forced to abandon independent living and enter a nursing home. There are multiple causes of urinary incontinence: it is not a single entity or a specific diagnosis. In most patients, the incontinence can be placed into 1 of the following 4 categories: detrusor overactivity (urge incontinence), overflow incontinence, stress incontinence (outlet incompetence) or functional incontinence. To understand the pathophysiology of urinary incontinence, some knowledge of the urinary tract anatomy and physiology is required. It is also important to know how the anatomy and physiology changes in response to the aging process. Successful treatment depends on the specific cause of the incontinence. If incorrectly diagnosed, various treatments may actually worsen the incontinence or cause other problems. Since most elderly patients do not volunteer a problem of urinary incontinence, questions regarding the presence of symptoms must be asked. In most patients, the specific type of incontinence can be diagnosed with a thorough medical history and physical examination. Several simple and widely available laboratory tests may also be useful in the evaluation. Occasionally, urological consultation or urodynamic testing should be performed. Once correctly diagnosed, there are a large number of pharmacological as well as nonpharmacological treatments (behavioural, surgical) available. This article concentrates on the pharmacological therapies for patients with various types of urinary incontinence. Since most patients with urinary incontinence are elderly, they are more susceptible to the effects as well as the adverse effects of medications. This must be taken into account before any pharmacological therapy is initiated. Although many elderly patients believe their symptoms of urinary incontinence to be a part of growing old, urinary incontinence is never a normal change of aging. With proper evaluation and treatment, the majority of patients with urinary incontinence can be helped or cured.

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PubMed1996

Urinary incontinence in the elderly population.

OBJECTIVE: To describe the causes, evaluation, and management of urinary incontinence in the elderly population. DESIGN: We reviewed pertinent articles in the medical literature and summarized the types of incontinence and contributing factors. RESULTS: Urinary incontinence is common in elderly patients and often has a major role in determining whether a person can remain independent in the community or requires nursing home placement. Urinary incontinence is not a single entity but rather several different conditions, each with specific symptoms, findings on examination, and recommended treatment. Thus, accurate classification is important for appropriate management. Because of the complexity of urinary incontinence, many physicians are uncomfortable with undertaking assessment and treatment. Hence, many patients are not asked about incontinence, and the condition remains untreated and often considered a natural consequence of the aging process. Urinary incontinence can be treated and either cured or alleviated with treatment. CONCLUSION: Elderly patients should be asked about symptoms of urinary incontinence because appropriate assessment and treatment can usually provide relief.

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PubMed1996

Geriatric health maintenance.

OBJECTIVE: To highlight articles pertaining to geriatric health maintenance and provide clinicians with current evidence supportive of or opposed to screening or treatment for various diseases and conditions. METHOD: We conducted a computer-assisted search of the relevant medical literature and summarized the results of pertinent studies in the elderly population. RESULTS: The geriatric population is progressively increasing in numbers. Unfortunately, no consensus exists about health maintenance in this population. To date, the United States Preventive Services Task Force has made several recommendations about preventive services; however, they did not specifically focus on the geriatric age-group. We outline their guidelines and discuss our clinical practices in a wide variety of encounters with geriatric patients. CONCLUSION: The efficacy of many screening tests and interventions for preventing illness in elderly patients is unclear. As the general population continues to age, further research in this area will be important.

Advance Directives↗
PubMed1995

Practical functional assessment of elderly persons: a primary-care approach.

OBJECTIVE: To describe simple, practical measures of physical and psychosocial function to detect problems and enhance the care of elderly patients. DESIGN: We reviewed pertinent articles and current standard textbooks of geriatrics; the most useful findings are summarized, and tools that can be used for functional assessment of the geriatric population are presented. RESULTS: Care of elderly patients necessitates a comprehensive review of key areas of function. Using only clinical judgment, physicians may overlook important clinical deficits common in older patients. Because of their length and complexity, many of the standard geriatric assessment tools are impractical for use by primary-care physicians. Certain simplified or condensed versions--such as the Functional Reach Test and the "Get Up and Go" Test--are efficient substitutes. In this article, we describe methods for practical identification of functional impairments, assessment of cognition and mood, evaluation of hearing and vision, and detection of problems with continence, nutrition, and social needs. Instruments for assessment of caregiver burden are also outlined. CONCLUSION: Use of the assessment tools presented herein can assist primary-care physicians in comprehensive evaluation of function in older patients.

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PubMed1995

Symposium on geriatrics--Part I: Drug prescribing for elderly patients.

OBJECTIVE: To describe the pharmacokinetic and pharmacodynamic changes that occur with aging and to discuss common problems noted with the use of medications often prescribed for elderly patients. DESIGN: We searched the medical literature, reviewed pertinent articles, and summarized drug-related information applicable to geriatric patients. RESULTS: Use of medications is common in the elderly population; most elderly persons take two or more different medications each day. Aging is associated with anatomic and physiologic changes that can have an effect on how medications are handled. Such changes include alterations in various volumes of drug distribution and in drug absorption, metabolism, and clearance. Elderly patients may also have increased or decreased drug effects because of alteration in receptor response. These changes in pharmacokinetics and pharmacodynamics may result in a prolonged drug half-life, an increased potential for drug toxicity, and a greater likelihood for adverse drug reactions. CONCLUSION: Medications for elderly patients should be prescribed only after the anatomic and physiologic changes of aging are understood and with increased surveillance for potential drug toxicity or adverse drug reactions.

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PubMed1995

Medical care of nursing home residents.

OBJECTIVE: To present an overview of the special challenges of providing medical care for nursing home residents. DESIGN: After researching the current medical literature, we summarized information on nursing home demographics, government regulations, and specific care issues for medical practice in nursing homes. RESULTS: Almost 2 million Americans currently live in more than 20,000 nursing homes nationwide, and these nursing home residents are increasingly older and more frail than in the past. Most nursing home residents receive multiple prescription medications, and many are cognitively and functionally impaired. Nursing home-acquired infections are a frequent occurrence, as are falls and fall-related injuries. Recent federal laws have had a major effect on medical care in the nursing home and have made physicians more accountable for the care provided. The use of physical restraints and psychotropic drugs has been severely restricted. CONCLUSION: The medical care of nursing home residents presents many challenges to primary-care physicians. Nevertheless, nursing home residents are among those patients in greatest need of competent, compassionate care. Despite numerous disincentives, provision of medical care for nursing home residents can be gratifying.

Accidental Falls↗
PubMed1995

Pressure ulcers: prevention and management.

OBJECTIVE: To describe important aspects of pressure ulcer prevention and management, especially in elderly patients. DESIGN: We reviewed pertinent published material in the medical literature and summarized effective strategies in the overall management of the elderly population with pressure ulcers. RESULTS: Pressure ulcers are commonly encountered in geriatric patients. The development of a pressure ulcer is associated with an increased risk of death. Certain well-recognized risk factors, such as immobility and incontinence, may predispose to the development of pressure ulcers; consequently, risk factor modification is an important aspect of prevention and treatment. For existing lesions, various innovative patient support surfaces and wound care products have been developed to alleviate pressure and to facilitate wound healing. The use of a particular product should be based on the clinical setting and the limited scientific evidence available. With treatment, most pressure ulcers eventually heal. CONCLUSION: Pressure ulcers are often, but not always, preventable. The occurrence of such an ulcer signals the possible presence of chronic comorbid disease and should prompt a search for underlying risk factors in patients for whom ulcer treatment is considered appropriate.

Humans↗
PubMed1990

Cardiovascular effects of the antidepressants: recognition and control.

The elderly frequently receive antidepressant medications that can affect cardiac conduction and rhythm, heart rate, and blood pressure. Because coexistent cardiovascular disease is common in the elderly, these medications must be used with caution, remembering that different antidepressants produce different cardiovascular effects. Fortunately, a variety of antidepressant medications are available, facilitating the selection of a safe agent for elderly patients who are at risk for cardiovascular side effects.

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