Clinical Geriatrics

This issue of Clinical Geriatrics has several articles devoted to the problem of pain in the older person. Pain is the most common reason for physician consultation in the United States and is a major symptom in many medical conditions. It significantly interferes with not only function, but also quality of life. The International Association for the Study of Pain (www.iasp-pain.org) has a classification system to describe pain according to five categories: duration and severity; anatomical location; body system involved; cause; and temporal characteristics.

However one describes it, pain is a very subjective problem with varying thresholds and complaints based on a wide variety of factors. These include person-to-person variability in pain perception, as well as cultural barriers that keep a person from telling someone that he/she is in pain, religious beliefs preventing one from seeking help for pain, and cultural and social expectations as to what is acceptable.

While a certain amount of sodium is essential for life, consuming an excessive amount can lead to bad outcomes. It has been estimated that the body requires between 250 mg and 500 mg each day for basic physiological functions (eg, to transport nutrients, transmit nerve impulses, contract muscles). We maintain a careful balance under hormonal control. Under certain circumstances when our bodies sense that we need more sodium, most individuals will crave sweet and salty foods. Our hormones and taste buds (sweet, salty, bitter, sour, and savory) not only provide us with pleasure, but also are nature’s way of keeping us in metabolic balance when necessary. As we age, however, data have suggested that we preferentially lose our taste buds for sweet and salty flavors, and our hormonal system also undergoes changes that favor hyponatremia. Food preferences, habits, cultural norms, and food availability also influence what types of food we eat and how much sodium is consumed.

Primum non nocere…first, do no harm. These words frequently echo in my mind as I hear about various patients. Physicians are often faced with a dilemma; a patient presents with one problem, and in 15 minutes, a decision must be made regarding what the likely cause is and how best to treat it. While this may work when caring for the younger, healthier person in whom “economy of diagnosis” is usually the case and one problem can explain the presenting signs and symptoms, it is a major flaw in the care of the older person whose medical history and medical conditions are frequently more comp

As we start the New Year, it is important that we all consider planning ahead. This is particularly true if you are an older person facing what is not only the coldest but also often the loneliest and most difficult time of the year. Winter can be a wonderful time of beautiful fields covered with snow, sleigh bells in the air, snow squishing under our feet, and indoor gatherings of family and friends. It can also be a time when some find themselves isolated, unable to go outside due to the risk of falling on snow or ice, cold beyond endurance, and heating bills that can numb the senses and

Ms. J is a 62-year-old woman with a long and difficult medical history. Suffering from diabetes mellitus for most of her life, she underwent renal transplantation 16 years ago, at the same time she had a pancreatic transplant. She took insulin daily as well as a number of immunomodifying medications, including steroids. In the past few years, she was diagnosed with congestive heart failure (CHF) for which she also took a myriad of medications, including an anticoagulant. One night, Ms. J awoke complaining of “pain” and was brought to the ER by her concerned family.

The ER