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Urinary and fecal incontinence are common problems among older adults, with many not discussing symptoms with providers. Incontinence has a significant negative impact on quality of life and can contribute to caregiver strain. The evaluation of urinary and fecal incontinence should focus on potentially reversible or treatable contributing factors. Treatment often depends on the type of incontinence, and initial treatment should begin with behavioral approaches. Common behavioral treatments include dietary management, timed voiding, pelvic floor muscle exercises, and strategies to control urgency symptoms. Biofeedback should be considered for the treatment of fecal incontinence, along with other behavioral treatments. Pharmacologic treatments differ for urinary and fecal incontinence. Anti-muscarinic and beta-agonist drugs are available for the treatment of urinary incontinence. Pharmacologic treatments for fecal incontinence focus on improving stool consistency. Non-invasive office-based procedures have an important role for treating both types of incontinence.
The core principle that should guide any health professional caring for older adults and their families is that the "secret of caring for the patient is in caring for the patient." (Peabody). Practitioners must understand the most up-to-date biomedical and psychosocial aspects of aging, health, wellness, and disease, and strive to support the older adult to remain as active, functional, and engaged as possible. At the same time, practitioners must recognize and help patients and families understand when a palliative approach will be most effective at meeting their goals. The Choosing Wisely campaign launched the American Board of Internal Medicine provides targeted guidance to clinicians to provide care that is effective and efficient, consistent with the essential principles.
This fully updated seventh edition remains the pioneering text for practicing physicians and allied health staff confronted with the unique problems of an increasing elderly population. Dr Reichel's formative text is designed as a practical and useful guide for all health specialists. Emphasizing the clinical management of the elderly patient with simple to complex problems, this is a must-read for all practitioners who need practical and relevant information in a comprehensive format. Chapters have been updated and re-organized to reflect the clinical approach to aging, beginning with a general approach to the management of older adults, followed by a review of common geriatric syndromes, and proceeding to an organ-based review of care. The final section addresses principles of care, including care in special situations, psychosocial aspects of our aging society, and organization of care. Particular emphasis is placed on cost-effective, patient-centered care, including a discussion of the Choosing Wisely campaign.