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Current Status of Screening for Colon Cancer in Older Adults
Introduction
Colorectal cancer (CRC) is the third most common type of cancer and second leading cause of cancer death in the United States.1 It primarily affects patients over 50 years of age. While the much publicized death of news anchor Katie Couric’s 42-year-old husband Jay Monahan spawned national interest in CRC screening,2 screening rates in this country remain at only approximately 50%.
Colorectal cancer almost always develops from precursor polyps. Further, colonoscopy with polypectomy can reduce the incidence of this largely preventable cancer by
Sexual Function in the Geriatric Patient
INTRODUCTION
Individuals age 65 years or older numbered nearly 36 million in 2003. By 2030, this age cohort is expected to double to nearly 72 million persons in the United States.1 While sexual activity may decline with age and sexual dysfunction tends to increase, a survey conducted in 1969 reported that 68% of men and 30% of women over the age of 60 were still sexually active.2 A recent study in Australia found that more than 55% of women over the age of 70 are still interested in sexual activity.3 This highlights the importance of sexuality in older patients and clinicians being aware of
Safer Prescribing for Older Adults: Clinical and Business Imperatives Aligned
For the past 6 years, Dr. B had been treating Mr. J for atrial fibrillation. Two years ago, Dr. B’s large multispecialty medical group opened an anticoagulation clinic, and Dr. B referred Mr. J there for ongoing management.
Prior to joining the anticoagulation clinic, roughly 60% of Mr. J’s International Normalized Ratio (INR) results had been within the targeted therapeutic range; for the past 2 years, over 90% of his INRs have been therapeutic. Both Dr. B and Mr. J were pleased with the improved results.
Two months ago, the anticoagulation clinic had an unanticipated staffing sho
Paget’s Disease in the Elderly Patient
CASE PRESENTATION
A 67-year-old bedridden African-American female was brought to the emergency room (ER) by her husband with the acute onset of altered mental status changes and urinary incontinence. From her history it was revealed that 1 week prior to this episode she had been evaluated by the Neurology service as an outpatient for possibly having had syncopal episodes over the previous several months. An electroencephalogram (EEG) done during that visit showed cortical instability with intermittent slowing in both hemispheres, and transient sharp waves consistent with a cerebral infarction
Medicare Part D: Why Doesn’t CMS Understand the LTC Difference?
The Centers for Medicare & Medicaid Services (CMS) has the difficult, if not impossible, task of implementing the laws governing Medicare. CMS’s philosophy in developing the regulations has been to look at the overall well-being of the program. Unfortunately, in doing so, individual patients who exist at the extremes often suffer. Medicare Part D and the effect of this program on nursing home residents is a clear example of this problem.
As is often the case, the needs of long-term care (LTC) residents were not considered in the drafting of Medicare Part D legislation. States had viewed
Can Polypharmacy Reduction Efforts in an Ambulatory Setting Be Successful?
INTRODUCTION
Research has shown that for every dollar spent on pharmaceuticals, another dollar is spent to manage drug-related problems, costing Americans living in the United States approximately $104.2 billion annually.1-3 The elderly account for 12.7% of the U.S. population, but consume 34% of total prescription medication and 40% of all over-the-counter medicine.4-6 Inappropriate medication use may lead to increased health care services, including physician visits, emergency department visits, and hospitalizations.2 Polypharmacy (use of one or more unnecessary medications)7,8 in older adu
Medicare Part D Update: Seeing Through the Political Spin
43 million people are eligible for Medicare Part D. Roughly 20% of the population of the United States.
Lost in the confusion and the difficulties with the implementation of Medicare Part D is the realization that the U.S. government, in its endless bureaucracy and politics, just enrolled 37 million people into a prescription drug benefit that will on average save a typical Medicare beneficiary $1100 per year.1 This was no small feat. It’s easy for pundits and experts to bemoan the barriers and difficulties of such an endeavor—but the reality is that it worked.
There will be no dela
Medicare Part D Update: Avoiding a New Liability for Nursing Homes
As is too often the case, federal legislation has set up a system that did not fully take into account the unique environment that exists in nursing facilities. Medicare Part D is a prime example. In addition to difficulties imposed by the unique and already heavily regulated environment of nursing facilities, these regulations are now in conflict with the new Part D federal legislation.
The basis for this conflict is Medicare Conditions of Participation that requires skilled nursing facilities (SNFs) to provide all of the care and services that are medically necessary to their residents i
Medicare Part D: How to Help Your Patients Choose the “Right” Prescription Drug Plan
May 15, the end of the initial open enrollment period for Medicare Part D, is quickly approaching and, despite all the talk about the dangers of not making a decision, some 20 million Medicare beneficiaries have yet to enroll in a prescription plan. But how do people evaluate, select, and enroll in a prescription plan? The fact is that it is a complex process, but in most cases well worth it because the costs involved in not making a decision are high, and the benefits of joining are much greater. Those costs include a late enrollment penalty, being locked out until January 1, 2007 from any co
Clinical Geriatrics Blogs
Coming in Future Issues of Clinical Geriatrics
Series: Diabetes in the Elderly
Series: Cancer in Older Adults
First Report® Conference Coverage: American Academy of Neurology, American Diabetes Association, 2010 Digestive Disease Week
Assessment and Classification of Pain in the Elderly Patient
Pharmacologic Management of Pain in Older Patients
Miscellaneous Pain Syndromes in Older Adults
Nonhernia Causes of Inguinal Pain in the Elderly
