Common Geriatric Syndromes: Incontinence, Pressure Injuries, Sensory Impairment
Urinary incontinence
Incontinence is never a normal consequence of aging and always deserves evaluation. Reversible causes follow the DIAPPERS mnemonic: delirium, infection, atrophic vaginitis/urethritis, pharmaceuticals, psychological causes, excess urine output (hyperglycemia, diuretics, congestive failure), restricted mobility, and stool impaction. Then classify: stress (leak with cough, urethral hypermobility), urge (detrusor overactivity, leakage with urgency), overflow (retention, often from anticholinergics or prostate enlargement), and functional (cannot reach the toilet in time). Treat urge incontinence first with bladder training, pelvic floor exercises, and habit retraining; if drugs are needed, prefer mirabegron or a beta-3 agonist over antimuscarinics, which worsen cognition. Indwelling catheters cause urinary tract infection, stones, and trauma - avoid them.
Fecal incontinence and constipation
Look for impaction, which causes overflow incontinence. Constipation is often from opioids, anticholinergics, calcium channel blockers, or iron; treat with fluids, fiber (if adequate hydration), osmotic agents, and activity.
Pressure injuries
Risk assessment with the Braden scale. Staging reflects tissue depth; do not massage reddened skin, keep the surface clean and moist, and use pressure-redistribution surfaces plus repositioning. Nutrition, moisture management, and offloading are essential. Deep tissue injury and unstageable wounds require careful description, not sharp debridement by the unwary.
Sensory impairment
Hearing loss is associated with cognitive decline, depression, and social isolation; screen with whispered voice or an audioscope and refer for amplification. Vision loss raises fall risk - check for cataracts, glaucoma, and macular degeneration, and address lighting and contrast.
Rule of thumb
Any new incontinence is a symptom, not a diagnosis: first ask about medications, constipation, and infection before prescribing a bladder drug.