Answer to Question 1
Ans: B
Decreased estrogen levels cause a loss of tone, strength, and collagen support in the urogenital tissues and can predispose the urinary system to leakage problems; but in older adults, degenerative changes in the cerebral cortex may alter both the sensation of bladder fullness and the ability to empty the bladder completely. The degenerative changes in this 91-year-old woman more directly impact the decision to toilet every 2 hours. Younger adults perceive a sensation of fullness when the bladder is about half full, but this occurs at a later point for older adults. Normal aging does not include the demyelination of parasympathetic nerves. Diminished thirst is not impacted by toileting every 2 hours.
Answer to Question 2
Ans: C
Antimuscarinic agents are used for urge urinary incontinence. Oxybutynin is the medication most commonly associated with cognitive impairment, but all antimuscarinic agents need to be used with caution in older adults with preexisting dementia. These medications have the same adverse effect profile as other anticholinergics, such as dry mouth, constipation, blurred vision, and mental changes. There is no need to toilet before, water is important, but cognition is the priority.
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