Supplements & Special Projects
Physician's Perspective
Hypocalcemia: An Underrecognized Problem in Older Adults
This past week, I have had several patients with abnormal serum calcium levels, both high and low, and thought it would be a good idea to remind others about the problem of hypocalcemia. While hypercalcemia is not an infrequent finding in the older person, few physicians expect to see low calcium values. If they are noted on the laboratory results, they usually assume that they are due to low protein binding; total calcium levels are usually what have been measured. Patients with true hypocalcemia are not uncommon if one looks hard enough or sees patients in the setting of acute illness. In fact, one study reported that 70% of patients in a medical Intensive Care Unit had a low serum calcium level at some time during their admission.1 Of note, the exact cause of the hypocalcemia could be identified in only 45% of these cases.
Reducing Sodium Intake—Good for Society, But Not for Everyone!
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.
Healthcare Reform: A Time to Embrace Change!
At long last, the United States has agreed to a plan for “comprehensive” healthcare coverage…or has it? While there are still those who lobby for or against the approved changes, many are still unsure of what to expect with the new legislation. The following is an attempt to summarize some of the major provisions in the legislation that was passed on March 21, 2010, with a House vote of 219-212 to pass the Senate-passed reform bill, the Patient Protection and Affordable Care Act (H.R. 3590). The Reconciliation Act of 2010 (H.R. 4872) was later voted upon and approved 220-211 to reflect changes sought by the House. These Bills extend healthcare coverage to 32 million Americans representing 95% of legal residents and 92% of all U.S. residents at a cost of $940 billion over 10 years.
Primum Non Nocere…First, Do No Harm
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
Weighing the Benefits and Risks of Searching for the Fountain of Youth
“Healthy aging,” “life extension,” “successful aging.” These phrases are frequently used to promote a special lifestyle, diet, medication regimen, or treatment. While the eternal search for the Fountain of Youth remains elusive, it is easy to see how normal aging and age-associated illness can bring thoughts of vulnerability and the need to do something “different.” While some are searching for a prolongation of the lifespan itself, others are merely trying to live healthier and more productive lives for as long as possible.
This issue of Clinical Geriatrics features two ar
Helping Older Patients Thrive Through the Winter Months
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
Finding the Right Way to Share Life-Changing Information with Patients
I have not been able to get Ms. K out of my mind ever since making teaching rounds with a resident team earlier this week. Ms. K is a 63-year-old woman who came to the hospital because of “odor coming from my left breast.” Upon further questioning, it became apparent that she had first noted a mass in her breast approximately 18 months ago but chose not to seek help from a physician. She had not gone regularly for medical care and told us she could not remember when her last mammogram was. “I put myself in God’s hands,” was her reply to us when we asked her questions; she only wan
The Answer Is Often Right Before Our Eyes
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
August: A Month of Important Births and Other Events
August has always been a special month to me (and not just because it contains my birthday). I thought I would share some facts with you about August events, and end with one that forever changed the way people function in their daily lives—a phenomenon that has opened new horizons to the practice of medicine and so much more.
Some key events that occurred in August:
• August 1846: The Smithsonian Institution was founded in Washington, DC
• August 1884: The cornerstone was placed for the Statue of Liberty in New York Harbor
•
Treatment Algorithms and Management Options for Psoriasis and Psoriatic Arthritis
Psoriasis affects approximately 2.1% of U.S. adults,
up to 7.5 million people, of whom about 30% will develop psoriatic arthritis.
Click here for the latest clinical information on treating your patients with psoriasis.
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
