Flo Grayson – Management- pointers to consider

Neurological disease – Ask Nursing staff if symptoms of parkinson’s disease is worsening.
Discuss referral to dietician to address obesity.
Manage any constipation
Advise nursing staff to encourage caffeine free drinks.

Medical: duloxetine is NO longer recommended for 1st or 2nd line treatment.


MDT: continence advisor referral, pelvic floor exercises.

Management:

  • Lifestyle: reduce fluid intake, especially in the evening (advise no drinks after 8pm), reduce caffeine and alcohol intake, weight reduction, manage constipation.
  • Medical: antimuscarinic drugs. These are the mainstay of treatment. They act on the M3 receptors on the detrusor muscle to reduce contraction. They do have common side effects and need to be used with caution in the elderly (the newer agents are said to be more selective for the M3 receptor and therefore have less CNS side effects). Examples include: oxybutynin, tolteridone, darifenacin, trospium, solifenacin and propiverine.

NICE recommended first line agents are:
Oxybutynin (but not to be used in older adults with frailty or in Parkinson’s Disease)

  • Tolteridone
  • Darifenacin

If a first line agent is not tolerated or does not work, then a second agent should be trialled.

  • Beta-3-adrenoceptor agonists (Mirabegron) If there are contraindications, intolerable side
    effects or poor efficacy to antimuscarinics, a trial of Mirabegron can be considered. Beta-3-
    adrenoceptors cause the bladder to relax, which helps it to fill and also to store urine.

What would you include in your documentation in Flo’s care plan?