Managing Patients Through Other Geriatric Issues

Stephanie Chow, MD, MPH: Sleep disorder is very common among the older population. It’s something that geriatricians are always being asked about and patients often struggle with. There are various reasons for changes in the sleep pattern: Our sleep architecture changes as we age, so it’s more difficult to fall into that deeper sleep. There are not that many wonderful medications for insomnia, so often we encourage sleep hygiene as the first line—nonpharmacologic interventions. Try to set up the sleeping space as just the sleeping space, increasing daytime activity, so the body feels more tired, more stressed, more worked out. By the time evening comes, then it is the time for sleeping, so you’re training the body to wake up at the same time and go to sleep at the same time and reserving the bed for sleeping.

In addition to improving the sleep hygiene around the insomnia aspect, you can try to reduce light at nighttime, television blue light. There are various ways that geriatricians can teach families and patients how to make their bodies more sleepy when nighttime comes.

Urinary incontinence is a real challenge for many of our patients. Sometimes the factors are not necessarily having to do with the bladder itself or the urinary system. It may have to do with mobility or their ability to get to the toilet. It may have to do with remembering or their cognition as well, or their ability to communicate that they need assistance getting there. There are many reasons for incontinence of the bladder or the bowel. It’s a very important topic that perhaps the geriatricians may bring up, because it could be a sensitive question for our patients.

As we get older, pain is a common concern. It’s important for geriatricians to really identify where the source of the pain is coming from and what type of pain it is. Is it neurological? Is it musculoskeletal? What kind of pain are we working with, and what is the best nonpharmacologic and pharmacologic intervention? If we can go without the medication, that would be best. If there can be physical therapy or some other massage or other modality, we’ll work with that. If we need to move on to medications, we’ll determine—based on the patient’s physiological function, their comorbidities, their renal function, and their liver function—what is the best appropriate medication and how should it be dosed. Keeping in mind what the consequences of, for example, an opioid medication, are, you may also need to watch for other adverse effects such as constipation or other bowel dysfunctions.

Transcript edited for clarity.