Geriatric challenge: how to cure incontinence with a screwdriver

Abstract

As a resident in geriatric medicine, I walked past the staff notice board one afternoon on the way to the emergency intake unit of the hospital with the knowledge that a long night was ahead of me. I cast a casual glance at the notices of forthcoming seminars, journal clubs, lectures, conferences – and one caught my eye. The next day at noon, a certain Professor Bernard Isaacs would be delivering a lecture on the topic of incontinence in the elderly. Well, the subject was certainly of interest to me, and we would most definitely be asked about incontinence in the imminent qualifying examination in geriatric medicine. On the other hand, I was sure that my exhaustion after a night in emergency would get the better of me and I would probably go home to sleep and miss the lecture. The night was, needless to say, rather eventful – an 90-year-old man with atrial fibrillation and pulmonary edema, a 76-year-old woman with dementia who fell and fractured her femur, a frail lady in her early 80s with pneumonia who required mechanical ventilation, to mention but a few. The next morning, after handing the patients over to the day staff and updating all the charts, I suddenly recalled that there was a lecture on the topic of incontinence at noon. A few sips of strong coffee and I was on the way to the lecture. The chairman introduced Bernard Isaacs, Professor of Geriatric Medicine at Birmingham University in the UK, as one of the leading geriatricians of this generation. Isaacs had characterized the principal symptoms affecting the elderly as the ‘Geriatric Giants’, these being incontinence, immobility, instability (resulting in falls) and intellectual impairment. He would now enlighten the audience with a talk on one of the Giants – incontinence. Bernard Isaacs, a balding man with an infectious smile, commenced his lecture with the following statement: