Clinical Geriatrics

More seniors are unhappy than happy with healthcare reform, according to a recent Gallup poll that also reflects what I’m hearing from older adults. Aware that the new healthcare reform law calls for Medicare cuts, many seniors are concerned that the cuts will chip away at their benefits. But the truth of the matter is that reform legislation will actually enhance Medicare benefits—and the practice of geriatrics.

The new reform law calls for significant future cuts in Medicare outlays, but these cuts focus on inefficiency, waste, and fraud that together cost Medicare billions each year. Basic Medicare benefits are guaranteed by law. And under healthcare reform, greater care coordination and support for care within a broader context of wellness will improve both the quality of care that beneficiaries receive and its cost-effectiveness. By accomplishing the latter, the legislation will make Medicare more sustainable.

I was recently asked to consult on a 93-year-old man, Mr. M, who had fallen and broken his left femur and right humerus. He had underlying dementia and several chronic medical conditions. The patient’s initial liver function tests (LFTs) demonstrated a slightly increased total bilirubin of 2.1 mg/dL, but the rest were all within normal limits: aspartate aminotransferase (AST), 41 IU/L; alkaline phosphatase (ALP), 42 IU/L; and gamma glutamyl transpeptidase (GGT), 14 IU/L. He had a large hematoma in his thigh and upper arm, and a broken left 10th rib. Mr. M was treated acutely for his fracture

This issue of Clinical Geriatrics features articles that I hope you will enjoy reading as much as I have: “Hyperlipidemia in Older Adults,” “Predicting Survival From In-Hospital CPR,” and “Management of End-Stage Renal Disease in the Older Adult.” As I was reading these articles in sequence, however, I kept thinking of the healthcare debate and the cost of providing care to individuals in their last decade or less of life. Whether someone has hyperlipidemia, end-stage renal disease, cancer, or cardiac arrest, the cost of one’s healthcare is not insubstantial.

We recently have

This issue of Clinical Geriatrics focuses on important topics in women’s health. Last month, we published an article that explored screening for depression, an all-too-common problem affecting the older woman. This month we chose three issues also of major significance to the older woman: menopause, osteoporosis, and cardiac disease. While menopause is a natural part of the aging process, it can clearly impact the older woman’s quality of life and deserves proper attention in the physician’s office. Cardiac disease and osteoporosis are best approached through a life-long program of preve

I am pleased that this issue of Clinical Geriatrics contains an article regarding the developmentally disabled elderly.1 I first became personally interested in the special needs of this population over 20 years ago when I noted that persons with developmental disability were often being admitted to long-term care facilities for reasons that at the time I did not understand. Urinary incontinence, mild congestive heart failure, a need to take multiple medications throughout the day, among other reasons, seemed manageable to me with proper support and medical guidance, and should not have result