Urinary incontinence in the elderly: part 3 of a series of articles on incontinence.

BACKGROUND: Urinary incontinence is a common and distressing complaint in the elderly. Its causes include structural changes in vesical muscle as well as impaired neural control and age-related changes of the lower urinary tract. Incontinence can also be a side effect of medication. METHODS: The PubMed database was selectively searched for publications containing the terms "urinary incontinence" and "elderly." Studies with a high level of evidence were chosen as the main basis for this review. RESULTS: The individualized diagnostic evaluation of the incontinent elderly patient should generally be non-invasive. The evaluation may reveal urinary incontinence of several different types: stress incontinence, overactive bladder, and mixed incontinence. The treatment generally involves medication, such as anti-muscarinic agents, alpha-receptor blockers, and/or serotonin/noradrenalin reuptake inhibitors, combined with modifications of personal behavior, such as bladder training, altered fluid intake, and pelvic floor contraction. A number of minimally invasive surgical techniques can be useful for patients in operable condition, whenever such an operation seems reasonable in view of the patient's overall situation. CONCLUSION: Urinary incontinence in the elderly can be readily evaluated, and the currently available forms of treatment often bring satisfactory relief with an economical use of medical resources and with little or no additional discomfort for the patient.

[Changing Patient Trends and Clinical Work Practices in the Psychogeriatric Day Hospital "Klinikum am Europakanal, Erlangen"] / Strukturen und Veränderungen im multimodalen Behandlungskonzept der Gerontopsychiatrischen Tagesklinik des Klinikums am Europakanal Erlangen.

OBJECTIVES: The aim is to describe and analyse the concepts of multimodal clinical work and the impact of changing patient trends on clinical work practices in our Psychogeriatric Day Hospital since it opened in 1986. METHOD: Day hospital statistics concerning length of stay, referral rates and readmission over the years were analysed. In two evaluation studies, client satisfaction and daily living activities were assessed. RESULTS: There is firm evidence for the effectiveness of day hospital treatment, as demonstrated by the results of the evaluation studies. In the last two years the average length of day hospital stay reduced significantly, while referrals for day hospital treatment increased rapidly. Despite these changes, the number of staff has stayed the same from 1986 to now. CONCLUSION: For day hospital intervention to remain effective in the light of changing patients trends, adequate time needs to be given for diagnostic and therapeutic procedures including psycho-educational work with patients' family members. This is not only a question of cost-effectiveness, but also an ethical approach bearing in mind future trends towards an increasingly aging population where demand will increase for this type of provision.

[Gedächtniszentrum Erlangen (Memory Centre Erlangen) - Gerontopsychiatric Day-Care] / Gedächtniszentrum Erlangen - eine teilstationäre gerontopsychiatrische Einrichtung.

Two years ago the multiprofessional team of the Memory Centre Erlangen took up its work. Besides complete diagnoses of the cause of memory impairment, the work of the Memory Centre focusses on a special cognitive stimulation intervention. After completing assessment, namely self- and non-self anamnesis, psychometric tests and medical examinations, an individual treatment program for every patient will be development. In most instances the treatment program includes the participation in a special cognitive training. Adapting the SIMA-Program, psychomotor exercises, encoding strategies, retrieval techniques, attention and general cognitive speed arc trained in a group of 10 memory-impaired patients. After the 12-week treatment period a postintervention assessment is conducted in the same order as the preintervention assessment to evaluate the efficacy of the treatment. The data of a first evaluating study limited by sample size (20 patients) reveale that this intervention effects in a positive way the patient's cognitive performance. Patients with MCI (Mild Cognitive Impairment) show significant improvement in attention, general cognitive speed and short-term memory. Even patients with a dementia-diagnosis appeare to benefit from the cognitive stimulating intervention: After a 12-week time period no deterioration of cognitive ability is observed. Besides in attention, general cognitive speed and short-term memory an improvement can be reported.

[Structures and changes in the combined modality treatment concept at a gerontopsychiatric Europakanal Erlangen Day Care Clinic]. / Strukturen und Veränderungen im multimodalen Behandlungskonzept der Gerontopsychiatrischen Tagesklinik des Klinikums am Europakanal Erlangen.

OBJECTIVES: The aim is to describe and analyse the concepts of multimodal clinical work and the impact of changing patient trends on clinical work practices in our Psychogeriatric Day Hospital since it opened in 1986. METHOD: Day hospital statistics concerning length of stay, referral rates and readmission over the years were analysed. In two evaluation studies, client satisfaction and daily living activities were assessed. RESULTS: There is firm evidence for the effectiveness of day hospital treatment, as demonstrated by the results of the evaluation studies. In the last two years the average length of day hospital stay reduced significantly, while referrals for day hospital treatment increased rapidly. Despite these changes, the number of staff has stayed the same from 1986 to now. CONCLUSION: For day hospital intervention to remain effective in the light of changing patients trends, adequate time needs to be given for diagnostic and therapeutic procedures including psycho-educational work with patients' family members. This is not only a question of cost-effectiveness, but also an ethical approach bearing in mind future trends towards an increasingly aging population where demand will increase for this type of provision.

[Erlangen Memory Center--a partial inpatient gerontopsychiatric facility]. / Gedächtniszentrum Erlangen--eine teilstationäre gerontopsychiatrische Einrichtung.

Two years ago the multiprofessional team of the Memory Centre Erlangen took up its work. Besides complete diagnoses of the cause of memory impairment, the work of the Memory Centre focusses on a special cognitive stimulation intervention. After completing assessment, namely self- and non-self anamnesis, psychometric tests and medical examinations, an individual treatment program for every patient will be development. In most instances the treatment program includes the participation in a special cognitive training. Adapting the SIMA-Program, psychomotor exercises, encoding strategies, retrieval techniques, attention and general cognitive speed arc trained in a group of 10 memory-impaired patients. After the 12-week treatment period a postintervention assessment is conducted in the same order as the preintervention assessment to evaluate the efficacy of the treatment. The data of a first evaluating study limited by sample size (20 patients) reveal that this intervention effects in a positive way the patient's cognitive performance. Patients with MCI (Mild Cognitive Impairment) show significant improvement in attention, general cognitive speed and short-term memory. Even patients with a dementia-diagnosis appeare to benefit from the cognitive stimulating intervention: After a 12-week time period no deterioration of cognitive ability is observed. Besides in attention, general cognitive speed and short-term memory an improvement can be reported.