The situation of infection in the elderly in Spain: a multidisciplinary opinion document.

Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed.

[Immobility syndrome in patients being care for in a home care unit]. / Síndrome de inmovilidad en pacientes atendidos en una unidad de ayuda a domicilio.

OBJECTIVES: to asses in a group of elderly patients included in a Home Care Unit, the level of immobility, the functional status based on the Katz's index and the Red Cross scale, and their medical, psychological and social consequences. METHODS: assessment of elderly patients visited during three consecutive months, through and standardized protocol with 14 items related with the previous aspects. RESULTS: 114 elderly patients (71% females) were visited during this time. The mean age was 82.4 years. 71 patients (65.7%) had immobility, with a mean age of 83.4 years and females predominance. Based on the level of immobility, 24 patients were in bed and 44 patients were able to be in bed-armchair. 74% of the patients were severely disabled on the activities daily living (Katz G); 85% of the patients had a severe physical disability (Red Cross scale 4-5), whereas a lower percentage (36%) had severe mental disability (Red Cross scale 4-5). Neurological disorders were the most frequent etiology of immobility (72%), with only one cause in 27 patients, two causes in 20 patients and more than three causes in 24 patients. Medical consequences were the most frequent, mainly urinary and chest infections, pressure sores and constipation. CONCLUSIONS: Immobility's syndrome represents a common medical problem in the geriatric care, related specially with the neurological and osteo-articular disorders, conditioning a high mobility.

[Treatment with propantheline for urinary incontinence caused by bladder instability in the elderly]. / Tratamiento con propantelina de la incontinencia urinaria por inestabilidad vesical en pacientes ancianos.

We conducted a clinical study of a group of aged patients with established urinary incontinence due to vesical instability, in order to assess clinical response to propantheline. Mixed forms of vesical instability were excluded (associated to stress or lower urinary tract obstruction). All patients received propantheline orally at a dosage of 15 mg/6 hours. Modifications in the urinary symptomatology and the impact on functional capacity were analyzed at 3, 6 and 12 months of treatment. We observed a positive response in 63.4% of patients (36.6% curative and 26.8% improvement). Such response was observed during the first three months of treatment and persisted during the twelve months of clinical follow-up. Adverse effects were uncommon and well-tolerated by patients, being mouth dryness the most frequent symptom.

[Urinary incontinence and bacteriuria in women]. / Incontinencia urinaria y bacteriuria en la mujer.

We analyzed the urodynamic data and their relationship with significant bacteriuria in 103 consecutive female patients (mean age = 55.7 yrs) with urinary incontinence. Significant bacteriuria was observed in 25.2% of the cases. E. coli was the pathogen most frequently isolated (70.3%). Significant bacteriuria was demonstrated in 29.3% of the patients with urge-incontinence. The most frequent type of incontinence in patients with bacteriuria was no urodynamic reproduction of urinary incontinence (42.8%). Bladder instability was not associated with significant bacteriuria (27.2%). Significant bacteriuria was observed in 75% of the patients with lower urinary tract obstruction, 66.6% of the patients who voided by abdominal straining and 26.3% of those with postvoiding residual urine. These findings indicate that urine culture should be done in patients with no urodynamic reproduction of urinary incontinence. There was no statistically significant correlation between urge-incontinence/bladder instability and significant bacteriuria. Consequently, antibiotics should not be used routinely in female urinary incontinence.

[Clinical and diagnostic characteristics of bladder instability in urinary incontinence in the elderly]. / Características clínicas y diagnósticas de la inestabilidad vesical en la incontinencia urinaria del anciano.

Urinary incontinence is a common disease in elderly people, and the vesical instability is the most frequent cause. A prospective clinical study was done in elderly subjects with established urinary incontinence, produced by vesical instability, to find out if the analysis of several clinical parameters (general and urinary) together with the physical exam, are enough to establish a definitive diagnosis of vesical instability. The most characteristic urinary symptoms were urge incontinence (100%) and diurnal frequency (72%). Physical exam was normal in most patients. Our findings show that the clinical history and physical exam alone do not provide enough information to adequately characterize vesical instability, so, besides these parameters, an urodynamic study is needed to establish the originating mechanism of the urinary incontinence.

[Toward a simplified method of classifying urinary incontinence in the elderly based on a multivariate analysis of 948 cases]. / Hacia un método simplificado de tipificación de la incontinencia urinaria del anciano, basado en el análisis multivariante de 948 casos.

OBJECTIVE: The present study analyzes the main clinical types of urinary incontinence in the elderly population and its clinical-urodynamic correlation to facilitate definitive diagnosis. METHODS/RESULTS: The study was conducted in 948 elderly patients (382 male, 566 female; mean age 72.4 years) with urinary incontinence. Patient clinical and urodynamic records were reviewed. The most common clinical types were urge-incontinence (56.4%) and incontinence with coughing associated with urge-incontinence (32.3%); the latter type was the most common in women. The most frequent urodynamic diagnoses were isolated bladder instability (29.9%), followed by obstruction (15.6%) and stress incontinence (14%). CONCLUSIONS: The most common symptom in bladder instability was urge-incontinence, while incontinence with coughing was found to be the most common symptom in urinary stress incontinence. A significant correlation was found between the postvoid residual urine and the main urodynamic diagnoses. Multivariate analysis showed that classification by clinical types of incontinence together with measurement of residual urine can facilitate diagnosis, although this approach has a low sensitivity for the main forms of isolated incontinence. The mixed forms require a urodynamic study.