Clinical Geriatrics

Neuropathic pain affects approximately 3.8 million individuals in the United States annually.  Two of the most common forms of neuropathic pain are diabetic peripheral neuropathy (DPN) and postherpetic neuralgia (PHN). In this article, the authors discuss current pharmacotherapy for PHN, with a focus on prevention and combination therapy. In the previous issue of Clinical Geriatrics, the authors discussed pharmacotherapy for DPN. The aim of these two articles is to provide clinicians with a comprehensive overview of pharmacotherapy management so that treatments are properly prescribed and used, thus improving quality of life among elders with neuropathic pain.

An accumulation of fluid within a small chamber but with no epithelial or other membrane lining is called a pseudocyst. When this cyst-like structure develops within the cartilage of the auricle of the ear, it is commonly referred to as an auricular pseudocyst. Because auricular pseudocysts are benign and rare, they are easily overlooked or misdiagnosed by clinicians. The authors present the case of a 74-year-old man with an auricular pseudocyst who was successfully monitored clinically, without any medical or surgical intervention. A literature review of the topic as well as typical therapeutic options and their usual outcomes are also provided.

Receiving adequate nutrition is an essential component of healthy aging, and this includes taking measures to ensure adequate levels of vitamin D, a prohormone that promotes the absorption of calcium. Vitamin D and calcium have long been recognized for their essential role in preserving bone health. More recently, there have been discoveries that have afforded new insights on a diverse array of physiological processes that involve vitamin D. This article, the first in a continuing series on nutrition in the elderly, reviews the importance of vitamin D and calcium in preserving musculoskeletal, cardiometabolic, and cognitive health among older adults, and discusses their potential impact on cancer. The authors also propose clinical guidelines for evaluating and maintaining vitamin D status in the elderly population.

Lewy body disorders (LBDs) represent a spectrum of neurodegenerative disease, of which Parkinson’s disease (PD) with dementia and dementia with Lewy bodies (DLB) are prevalent phenotypes. Patients with PD and DLB often develop autonomic dysfunction. Although not a movement disorder like PD nor associated with dementia, pure autonomic failure (PAF) is increasingly recognized as another phenotype of LBD. PAF shares many features with PD and DLB, particularly urinary, gastrointestinal, and cardiovascular dysfunction disorders. This article, the second installment of a two-part article, examines additional indicators of autonomic failure of the cardiovascular system in patients with LBD, including supine hypertension, postprandial hypotension, carotid sinus syndrome, and rhythm abnormalities. It also discusses how to evaluate patients for these cardiovascular phenomena and reviews management strategies.

Treatment and prevention of urinary tract infections (UTIs) are important aspects of care for patients with dementia, as UTIs frequently result in superimposed delirium that can accelerate cognitive decline in these patients. When UTIs are recurrent, risk of delirium and subsequent cognitive decline is increased, making this scenario particularly problematic. The authors report the case of a patient with advanced dementia complicated by recurrent UTIs resulting in delirium that was successfully managed using a systematic hygiene intervention administered by the family caregiver.