Letter to the Editor

To the Editor:

I read with interest your article in Clinical Geriatrics.1 I am a nephrologist at a suburban Philadelphia hospital, and I also chair the Ethics Committee. My question concerns an 82-year-old woman with chronic renal failure who for two years had refused dialysis and, in fact, told me not to mention the “D” [dialysis] word when she came for office visits. This woman had been a nurse and knew patients on dialysis, which I think influenced her thinking. Also, she had never told her family that she was seeing a nephrologist. She eventually became uremic, and in August...

To the Editor:
This article1 was quite odd. Its title suggests the author will show an example of a “healthcare system” failing to provide necessary services. Instead, we see how ridiculous it can be to attempt to maintain independence at all costs. The 62-year-old man does not even live in the same state as his father, who had had a severe stroke. He was concerned enough to arrange home care, but could

To the Editor:
The article “Wandering in Dementia” by Melinda S. Lantz, MD, from the November 2007 issue of Clinical Geriatrics1 uses a case description that is all too typical, but also an example of several common errors in medicine that are overlooked, not discussed, and were not addressed by the author.

First, a diagnosis of dementia is not sufficient for initiation of treatment with a cholinesterase inhibitor, alt

Using C-Reactive Protein to Predict Cardiovascular Risk

To The Editor:

Dr. Blaine presented an excellent analysis of C-reactive protein usage in the elderly population for cardiovascular risk reduction.1 My question concerns the myeloperoxidase level and its assessment. Should this level be checked, and under what circumstances would it prove useful?

(Dr.) Frank M. Shanley, PA, FACC
Denville, NJ

Reference
1. Blaine JM. Using C-reactive protein to predict cardiovascular risk in older patients. Clinical Geriatrics 2007;15(8):20-25.

________

To the Editor:

Thank you for the excellent article, “The Elderly Concentration Camp Survivor,”1 which highlights a very important aspect of the life of the Holocaust/concentration camp survivor.

While it is true that almost 11,000,000 persons perished as a result of the Nazi regime, not all of the victims were in the camps. Some were murdered while hidden, others tried to resist in the woods, and others were victimized in their homes, streets, and communities. All survivors exhibit needs, as do the camp survivors.

As a final point, for the mental health of the surv...

To the Editor:
I read with interest the article, “Osteoporosis in Elderly Men,”1 written by Neil Baum, MD. The initial background information is pertinent and raises awareness of the growing problem of osteoporosis in men, and a number of preventive and management strategies are suggested. The case presented in the article is a 66-year-old man with a history of prostate cancer that was initially treated with radiation therapy. After a recurrence of cancer, he was treated with luteinizing hormone-releasing hormone agonist and anti-androgen therapy, which is an important risk factor...

To the Editor:

I was delighted to see your Psychiatry Rounds article, “Anxiety, Headaches, Insomnia, Restless Legs, and Hypertension: Multiple Disorders or One Problem?”1 I have long recognized a TRIAD: anxiety, restless legs syndrome (RLS), and labile hypertension. As a psychiatrist, I use small doses of clonazepam in these persons to treat three disorders with one drug. I have never before seen “my TRIAD” in print.

I suspect that a deficiency of cytochrome P4501A2, known to be a factor in anxiety, is the cause. Deficient individuals metabolize methylxanthines* at 2 p...

To the Editor:
Thank you for your Psychiatry Rounds column in Clinical Geriatrics—always thoughtful and thought-provoking. I was especially interested in “Decision-Making Capacity.”1 You made many of the same points as Ganzini et al,2 which are increasingly important to be understood by all practitioners caring for elderly and care-dependent patients.

I would like to ask the following:

1. While the law “presumes legal competence” unless adjudicated otherwise, should clinicians presume clinical capacity in settings with a known prevalence of incapacity exceedi...

To the Editor:
I thoroughly enjoyed the Psychiatry Rounds article “Decision-Making Capacity.”1 I would like to ask the following:

1. Do you personally use the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) (I was thinking of purchasing the interview for our use), or do you prefer another assessment tool?

2. Generally, in what instances, if any, do you feel that the MacCAT-T is not sufficient and neuro-psychiatric testing is warranted?

Thank you,
Paula Bordelon, DO
Geriatric Fellow
Family Practice
Sacred Heart Hospital

• Read more