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interventions

Urinary Tract Infection in the Older Population: Not Always So Simple

Teaser: 

Michael Gordon, MD, MSc., FRCPC, 1 Nada Abdel-Malek, MPH, MD, CFPC (COE),2

1Emeritus Professor, University of Toronto, Toronto, ON. 2Department of Family and Community Medicine, Baycrest Health Sciences, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: Urinary tract infections (UTIs) are common in older adults, with prevalence increasing with each decade above sixty-five. UTIs in older adults can be multi-factorial in terms of etiology, risk factors, symptoms, and interventions. A history of heart failure and diabetes increases the risk of UTIs in older adults, and these patients should be closely monitored for symptoms of infection. An enlarged prostate and urinary retention can be an all too common scenario leading to UTIs in older men. UTIs can cause acute confusion and disorientation in older people and should be considered as a possible cause of such new onset symptoms. Physicians should be aware of the variety of presentations and implications of determining a UTI in older adults.
Key Words: urinary tract infections (UTIs), older adults, risk factors, symptoms, interventions confusion, disorientation, heart failure, diabetes, enlarged prostate, urinary retention.
Urinary tract infections (UTIs) are common among the North American population, with prevalence increasing in older adults. Those with a history of heart failure and diabetes are at increased risk.
With the introduction of antibiotics before WWII, and then during the ensuing decades, treatments for UTIs moved away from previously used home-grown remedies.
Physicians should be aware of the variety of presentations and implications of determining a UTI in older adults.
The first case study describes an 84-year-old man with acute onset confusion, disorientation, and urinary retention, who was admitted to the hospital and treated with antibiotics and a small dose of an antipsychotic.
UTIs can cause acute or sub-acute confusion and disorientation in older adults and should be considered as a possible cause of such symptoms.
An enlarged prostate and urinary retention is a recognized syndrome of UTIs in older men.
UTIs are a common cause of confusion and disorientation in older adults, and should be considered as a possible cause of these neurological symptoms.
A history of heart failure and diabetes increases the risk of UTIs in older adults, and these patients should be closely monitored for symptoms of infection.
An enlarged prostate and urinary retention can be the underlying cause of UTIs in older adults, and these patients should be evaluated for infection if this constellation of findings exist.
UTIs in older adults can be multi-factorial in terms of etiology, risk factors, symptoms, and interventions, and physicians should be aware of the variety of presentations and implications of determining a UTI in this population.
It is important to use broad-spectrum antibiotics in older adults with UTIs, especially if they are antibiotic-naive patients.
Older adults with UTIs are at risk of harm if they try to remove their catheter or IV; it is important to use soft restraints as needed to ensure patient safety.
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Psychoactive Medications and Falls

Psychoactive Medications and Falls

Teaser: 

James W. Cooper, RPh, PhD, BCPS, CGP, FASCP, FASHP, Emeritus Professor and Consultant Pharmacist, College of Pharmacy, University of Georgia, Athens, and Assistant Clinical Professor of Family Medicine, Medical College of Georgia, Augusta, GA, USA.
Allison H. Burfield, RN, PhD, Assistant Professor, School of Nursing, College of Health and Human Services, University of North Carolina-Charlotte, Charlotte, NC, USA.

The high incidence of falls among older adults leads to increased health care costs and decrements in functional status. Psychoactive medications consumed by older adults are often implicated in falls. This article briefly reviews the associations between falls and psychoactive medications, with a focus on the long-term care setting, and offers an assessment method and strategies to reduce the risk of certain classes of medications known to contribute to fall risk.
Key words: falls, medications, psychoactive load, interventions, older adults.

Preventing Delirium among Older Adults with Dementia

Preventing Delirium among Older Adults with Dementia

Teaser: 


Donna M. Fick, PhD, GCNS-BC, Associate Professor of Nursing, School of Nursing, Pennsylvania State University, University Park, PA, USA.
Ann Kolanowski, PhD, RN, FAAN, Elouise Ross Eberly Professor of Nursing, School of Nursing, Pennsylvania State University, University Park, PA, USA.

Delirium superimposed on dementia (DSD) is common, is associated with poor clinical and economic outcomes, and occurs across all settings of care. In this article, we briefly review outcomes of DSD, propose the idea of cognitive reserve as a possible mechanism for interventions that prevent and manage DSD, and present the evidence for delirium interventions. We conclude with implications for practice and suggest web-based resources for supporting best practices in the care of persons with DSD.
Key words: delirium, dementia, prevention, interventions, cognitive reserve.