An algorithmic approach to the diagnosis of urinary incontinence in elderly females has been evaluated in a prospective series of 65 patients by comparing the clinical diagnosis arrived at using a modified form of a published algorithm with the subsequent urodynamic findings. The general validity of the concept was confirmed. The major errors in clinical diagnosis occurred in subjects with stress incontinence, emphasizing that presentation with this symptom was likely to warrant urodynamic study. In patients with detrusor instability it was shown to be possible to predict the likely response to conventional management of their incontinence after three months, on the basis of an arithmetic score derived from the cystometric findings.
An outline is given of simple urodynamic investigations applicable to elderly subjects. The type of patient presenting primarily to geriatric departments with urinary incontinence, whose management is aided by such studies, is described under various clinical groupings. The requirement for urodynamic studies and the best means of providing these for the elderly patient is discussed.
A simple method of measuring bowel transit quantitatively using radio-opaque markers is described. A group of asymptomatic elderly people were investigated to establish normal bowel transit times and the results compared with those in a group of people who complained of constipation on admission to hospital. All the symptomatic patients were screened to exclude an organic cause for the constipation as well as having transit studies to determine bowel function. The information obtained can be helpful in managing the symptom.
A case-matched study was performed to assess the social effects of surgical complications of operative fixation of fractures of the proximal femur. Fifty-two patients aged over sixty-five, half with deep wound infection, the remainder with serious early mechanical problems requiring revision surgery to correct these, had their hospital fatality, length of stay, mobility and social dependency at admission and on discharge compared with patients free from such complications. Deep wound infection was associated with a high fatality and in the survivors a prolonged period in hospital, a marked decline in mobility and without exception a great increase in social dependency; patients having revision surgery had a longer hospital admission, considerable alteration in social circumstances but a little decline in mobility and no significant increase in fatality when compared with matched cases.
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