Other Geriatric Syndromes: Incontinence, Pressure Injury, Sensory Impairment, Sleep, and Elder Mistreatment
Incontinence
Transient causes follow DIAPPERS: Delirium, Infection, Atrophic vaginitis, Pharmaceuticals, Psychological, Excess fluids, Restricted mobility, Stool impaction. Persistent types: urge (overactive bladder), stress (pelvic floor weakness), overflow (retention, obstruction, neuropathy), and functional. Check post-void residual before treating; avoid anticholinergics in frail older adults when possible.
Pressure injury
Risk factors: immobility, malnutrition, moisture, sensory loss, friction, and shear. Use the Braden scale; reposition, offload, manage moisture, optimize nutrition, and stage accurately. Do not massage reddened skin; avoid prolonged head-of-bed elevation when possible.
Sensory, sleep, mistreatment
Presbycusis and vision loss increase isolation, falls, and delirium; screen and provide aids. Sleep changes with age, but insomnia should be treated with CBT-I, not benzodiazepines; screen for sleep apnea and REM behavior disorder. Elder mistreatment includes physical, sexual, emotional, financial abuse, neglect, and self-neglect; ask privately and report per mandate.
Traps: calling incontinence normal aging; missing fecal impaction as a cause of urinary retention and delirium; staging pressure injuries by appearance alone; and sedating older adults for sleep.
Worked example: an 88-year-old with new urinary incontinence and confusion-check for urinary retention, fecal impaction, infection, and medications. Treat the cause rather than starting an antimuscarinic.
Rule of thumb: new incontinence is a symptom, not a diagnosis; look for a reversible cause first.