Older patients and polypharmacy

Special considerations

• Age-related decline in kidney function requires adjustment of drug doses.
• Polypharmacy carries a high risk of drug interactions.
• Atypical presentation (infection without fever, less pronounced pain).
• High risk of complications (falls, delirium, infections).

Common emergencies

• Acute urinary retention (BPH, neurogenic bladder, medications).
• Urinary tract infections (asymptomatic bacteriuria versus clinical infection).
• Clot retention associated with anticoagulants.
• Postrenal AKI (obstruction).

Diagnosis

• Assess kidney function (creatinine, GFR).
• Ultrasonography for obstruction and residual urine.
• Urine cultures if infection is suspected.
• Medication history, particularly anticoagulants, anticholinergics, and diuretics.

Emergency management

• Catheterization for retention.
• Antibiotics for infection, accounting for kidney function and drug interactions.
• Review polypharmacy and discontinue drugs causing retention.
• Monitor urine output and electrolytes.
• Prevent falls and delirium during hospitalization.

Algorithm