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N M Resnick

Publications and source records attributed to N M Resnick.

69 records · Page 4Linked to original sources
PubMed1991

Evaluation of the causes and severity of geriatric incontinence. A critical appraisal.

The evaluation of urinary incontinence in the elderly differs from that in younger patients because of altered or nonspecific disease presentation, the different spectrum of pathophysiology, greater variation between individuals and, in some cases or settings, variable treatment goals. Evaluation must be multifactorial and extend beyond the genitourinary system, because many age-related conditions and the drugs used to treat them can cause or exacerbate urinary incontinence. Voiding records are a reliable measure of severity, although studies of their validity are still lacking. History-taking requires more time in this age group. Stress incontinence symptoms remain very sensitive, whereas obstructive symptoms fall in predictive value. Clinical algorithms based on a combination of symptoms and simple bedside examination and maneuvers may prove most useful in specific settings such as nursing homes. The targeting and interpretation of the physical examination must also change because of age-related conditions (e.g., BPH, atrophic vaginitis) and prevalent comorbid diseases, especially neurologic ones. The Q-tip, elevation, and pessary tests for stress incontinence offer little diagnostic or therapeutic information in the elderly. Routine laboratory tests should be performed to exclude reversible causes of urinary incontinence, while interpretation of the urinalysis must consider the prevalence of asymptomatic bacteriuria. No radiographic studies are routinely needed; bead-chain cystourethrography and IVU in particular probably offer little additional information. Voiding cystourethrography, although little studied, offers dynamic data that may be helpful, especially in evaluating outlet obstruction. Bedside cystometry is simple but may be insensitive to the most prevalent type of detrusor instability in the institutionalized elderly. Finally, multichannel urodynamic study is safe and feasible even in frail elderly patients and should be considered when empiric therapy is risky or has failed, complicated comorbidity exists, or surgery is anticipated.

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PubMed1989

'Senile' osteoporosis reconsidered.

Osteoporosis is a devastating, morbid, and costly condition whose ravages are felt most profoundly by women over age 70 years. Yet most research on its prevention and treatment has focused on perimenopausal women, although there are significant differences between perimenopausal and older women in factors related to bone mineral metabolism, rates of bone loss, the structural integrity of remaining bone, risk factors for fractures, and the types of fractures sustained. Currently recommended therapies, which slow bone loss in perimenopausal women, may be of less benefit for older women whose loss of bone has already slowed or ceased and whose remaining bone may be of inadequate quantity and quality to prevent fracture. Thus, the application of currently available modalities is unlikely to mitigate significantly the consequences of osteoporosis in this population. Further research is urgently needed, and some directions for future investigation are suggested.

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PubMed1989

The pathophysiology of urinary incontinence among institutionalized elderly persons.

Although 1 million institutionalized elderly persons have urinary incontinence, little is known about the causes of this problem. We conducted clinical and physiologic studies to determine the causes of established incontinence in a representative sample of 605 institutionalized elderly persons (mean age, 89 years), of whom 40 percent were chronically incontinent of urine. Detailed urodynamic studies in 94 of the 245 incontinent patients (77 women and 17 men; 38 percent) showed that detrusor overactivity was the predominant cause in 61 percent, with concomitant impaired detrusor contractility present in half these patients. Other causes among women were stress incontinence (21 percent), underactive detrusor (8 percent), and outlet obstruction (4 percent). Among the relatively few men in this sample, outlet obstruction accounted for 29 percent of the cases. In 35 percent of the patients, at least two coexisting probable causes of incontinence were identified. Diagnoses among patients with impaired mobility or mentation differed little from those in unimpaired patients. We conclude that the pathophysiology of incontinence in this population is complex; that detrusor hyperreflexia with normal contractility ("uninhibited bladder") accounts for the minority of cases (29 percent), even among patients with dementia; and that the causes of incontinence are as diverse in severely impaired elderly persons as in those who are unimpaired.

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PubMed1989

Diagnosis and treatment of incontinence in the institutionalized elderly.

A selective, stepped strategy will diagnose the cause of incontinence in most institutionalized elderly patients. It consists of rectifying the transient causes of incontinence, searching for serious and treatable underlying conditions, and then formulating a differential diagnosis. If the benefit of empiric therapy exceeds the risk it can be initiated, recalling that incontinence in these patients is multifaceted, and that small improvements in many areas unrelated to the urinary tract will often be sufficient to restore continence. If the risk of empiric therapy exceeds the benefit, further urodynamic testing is warranted since it is safe, feasible, and reproducible. Such an approach will minimize the use of invasive testing, indwelling catheters, and toxic medications. Coupled with optimism, creativity, and persistence, it can lead to substantial improvements in the lives of many incontinent institutionalized patients. Ultimately, the optimal care of incontinence in the nursing home will require an increased number of motivated and well-paid nursing assistants, less invasive diagnostic testing, and improved, better targeted therapy. Still, even in 1989, much can be done to "cure sometimes, relieve often, and comfort always."

Age Factors↗
PubMed1988

Incontinence in the nursing home patient.

Prevalent, morbid, and costly, urinary incontinence in the nursing home poses a major problem for patient, caregiver, and administrator alike. In this article, the authors review the pathophysiology of incontinence in the frail elderly, and give guidelines for how to diagnose and treat this common condition.

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PubMed1987

Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients.

Little is known about the causes of urinary incontinence in institutionalized elderly people, despite the fact that $8 billion is annually devoted to diapering those afflicted. We have identified a specific physiological abnormality--detrusor hyperactivity with impaired contractile function (DHIC)--that, although previously unrecognized, is the second most common (33%) cause of incontinence in this setting. Detrusor hyperactivity with impaired contractile function is a distinct physiological subset of detrusor hyperreflexia and presents with a seemingly paradoxical set of findings: the bladder is overactive but empties ineffectively. This imparied emptying is due to diminished detrusor contractile function and is associated with bladder trabeculation, a slow velocity of bladder contraction, little detrusor reserve power, and a significant amount of residual urine. Aside from its high prevalence, the importance of DHIC is that it may present as urinary retention, may closely mimic prostatic outlet obstruction, may explain why past therapeutic trials for detrusor hyperreflexia have failed, and may necessitate a change in the current nosology of bladder dysfunction. Furthermore, DHIC may represent a more advanced stage in the natural history of detrusor hyperreflexia, a stage characterized by deterioration of detrusor contractile efficiency. Thus, this previously unrecognized cause of incontinence in the elderly is common and raises several important issues.

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PubMedDate not supplied

Osteoporosis in the older woman: a reappraisal.

Osteoporosis is most acutely experienced by the elderly, yet little research has focused on this problem in this group. Recommendations for osteoporosis prevention and treatment in the elderly have been extrapolated from studies of perimenopausal women. However, there are substantial differences between perimenopausal and elderly women in factors related to bone metabolism, rate of bone loss, architecture of remaining bone, the types of fractures sustained, and risk factors for fracture. Finally, unlike the perimenopausal women, the majority of older women already have osteopenia, or bone loss. Each of these factors is reviewed, and its implications for treatment and future research are explored.

Age Factors↗
PubMedDate not supplied

Urinary incontinence.

Incontinence has about a 15 percent prevalence among elderly women. Some of the factors associated with incontinence are psychosocial implications of stigmatization, the decreased quality of life, and the economic considerations of nursing home costs. There are numerous, often misdiagnosed, reversible causes of incontinence, and many of the problems associated with aging may be alleviated if incontinence is treated symptomatically and controlled.

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