Monday, February 15, 2010

Urological problems in old age

The extension of life expectancy is one of the most dramatic achievements of the 20th century. Elderly population, over 65 years, is the fastest growing age group. Rcent Census shows how the age pyramid is showing increase in old age population.

The typical general problems in elderly population are:
• Change in dexterity, decreased mobility : because age related tremors or Parkinsonism/stroke etc.
• Altered Mentation, Sleep pattern: because of age related amnesia
• Comorbidity: HTN, stroke, diabetes, Alzheimer's etc
• Concomitant drug intake: multiple comorbidities
The typical urological problems along with abovesaid general geratric problems are:
• Aging Bladder: Prostatic enlargement& Bladder instability- causing frequency of urination,weak stream ,urgency,nocturia.Nocturia and urgency can be dangerous as the old frail people can have falls and fractures adding to their woes while rushing to the toilets in the night time.Many of Prostatic problems can be treated with medicines avoding the agony.Those people who have severe problems can be easily ttreated surgically with LASER.LASER prostatectomy can offer effective treatment in elderly people with co-morbidities without complications as in routine conventional surgeries.
• Hormonal alterations (age related decline in androgen production):Many people experience erectile dysfunction which they ignore or feel shy to express to doctors passing off as age related problem.Testosterone supplemenation with or without PDE-5 inhibitors help in restoring manhood in may such people.
• Tendency to excrete more water during night: causing nocturnal trips to toilets disturbing a sound sleep.There are nasal sprays available to decrease nocturnal excretion of extra urine.
• Malignancy: Carcinoma prostate : Many western countries have successfully started screening programme(Digital Rectal Examination and Sr PSA) in aged popultation which might result in early detection of cancer and resultant less morbidity.
• Incontinence:Overactive Bladder or weak sphicters because of aging /multiple vaginal births/bladder changes can cause miserable life in females leading to social embarassment. Medications to decrease overactivity or increasing the bladder capacity may reduce the incontinence.Ostrogen topical supplementation in elderly females may enhance local defense mechanism
• Urinary tract infections :Old people may not exhibit same symptoms like dysuria, fever,LUTS like young adults instead they present with lethargy, confusion, weakness or new onset incontinence. Unabated infections if not treated early :may lead to urospepsis with high mortality so Appropriate antibiotics with or without Foley catheterisation/Intermittent catheterisation is the treatment in many patients.Caution has to be exercised when giving antibiotics as the tolerance to antibiotics is always not like young adults.
These are the common urological problems in geriatric population.Many simple measures such as medications for prostate enlargement, antibiotics for infection ,anti-incontinence medications for urine leakage can solve the majority of the issues.Testosterone supplemenation in properly screened aging population can restore not only the erectile dysfunction but feeling of general well being,muscle mass,hemoglobin etc.Challenges in old age are limited mental & functional ability which interferes with learning, motivation, and cooperation needed for successful treatment.So may elderly people suffer in silence.Apart from curing the specific illesses strategies are needed that help to address these psychosocial issues and needs in older patients. As the proportion of elderly people is on the rise, special emphasis should be laid down on the their needs and suitability to treatment.

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