Fever with incontinence in the elderly: an approach for emergency medicine

72-year-old man develops a high fever and is taken to the ER by his concerned wife and daughter. During the intake interview, the wife reports that the man is experiencing worsening incontinence and occasionally complains of dysuria. Past medical records indicate that the man is already being treated and followed for hypertension and early Alzheimer’s disease, but the wife notes that it has become increasingly difficult to manage her husband’s confusion over the past week. An emergency physician receives the above information from the triage nurse. The nurse adds that the man and his family have been waiting for two hours and all three appear quite distressed. How could such a situation be managed? GERIATRICS AND DEMENTIA: CONSIDERATIONS FOR THE BEDSIDE The age of a patient carries important implications for patient assessment and treatment. The physiology of a healthy, older adult adapts to functioning with tissues that have deteriorated with age, achieving a state of compromised balance termed homeostenosis. 1 Patients in this subpopulation thus have a reduced capacity to respond and adapt to the stresses brought on by acute illness and are more vulnerable to such insults. This affects patient assessment, as it may be difficult to distinguish symptoms of underlying disease from those of acute illness. Determining the patient’s medical history, current medication regime and social circumstances is also challenging in an emergency setting. 2 Prospective treatments are limited in that they must not exacerbate or interact with existing conditions and treatments. Polypharmacy, in particular, disproportionately affects the elderly and contributes to increased adverse drug events, physician visits, emergency admissions and hospitalisations. 3 All the above can be further complicated by dementia in the patient. The patient’s history may need to be obtained from family members or caregivers present in the ER or staff at a care facility, potentially leading to mistakes in interpreting symptom severity or missing incipient problems entirely. Furthermore, the patient may be unwilling or unable to participate in diagnostic or interventional measures that become indicated through the course of care. 4

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