Delirium in Hospitalized Older Patients
- Thu, 12/30/10 - 2:39pm
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- 8685 reads
Delirium, defined as an acute confusional state with change in attention and cognition, is a common condition that results in significant morbidity and mortality among elderly persons. It is characterized by disturbances of consciousness, reduced environmental awareness, and a waxing and waning course. Ten percent to 31% of geriatric patients presenting to an emergency department have delirium and 6% to 56% of older patients develop this complication during hospitalization.
Evaluation and Management of Hearing Loss in Older Adults
- Fri, 10/15/10 - 9:15am
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- 6078 reads
Hearing impairment is an extremely prevalent problem among older adults that can impact all domains of life, including cognitive, social, physical, and emotional. Identification and treatment can improve overall quality of life as well as functional capacity. Primary care providers play an essential role in identifying hearing loss and ensuring that patients are treated appropriately. This article discusses the epidemiology, risk factors, consequences, and etiology of hearing loss in the older patient. Information on screening techniques, hearing evaluation, and treatment options including hearing aids and cochlear implantation is also included.
Pharmacologic Management of Pain in Older Patients
- Wed, 9/15/10 - 9:32am
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- 7761 reads
Introduction
We are all likely to experience pain at some point in our lives. How that pain is best managed depends on its etiology, acuity, and pathophysiology. Coexisting medical conditions and the potential risk for adverse effects play a larger role in treatment choices for older adults. In this article, we present treatment options for both acute and persistent pain. A step-wise approach with rationale for treatment choices is discussed. In addition to a variety of pharmacologic treatment options, physical therapeutics, modalities, and focused interventions are presented.
Treatment of Acute versus Persistent Pain
A Review and Update of Insulins in the Management of Elderly Patients with Diabetes
- Thu, 8/19/10 - 8:36am
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This article is the fourth in a continuing series on diabetes in the elderly. The third article in the series, “Diabetes Agents in the Elderly: An Update of New Therapies and a Review of Established Treatments,” was published in the June issue of the Journal. The remaining articles in the series will discuss such topics as the role of exercise and dietary supplements in the management of diabetes, and microvascular and macrovascular complications of diabetes.
Impact of Trauma-Related Hip Fractures on the Older Adult
- Wed, 6/16/10 - 10:21am
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This article is the sixth and final article in a series on trauma care and the older adult. The series discusses the growing problem of trauma in the elderly, including its causes and possible ways to prevent it, care in the acute stages, and manifestations and treatment strategies when trauma involves the torso, spine, brain, and hip. Authors include skilled experts in the trauma field representing various specialties at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center and the University of Maryland School of Medicine.
Introduction
Shoe Wear Recommendations for the Older Adult
- Thu, 5/20/10 - 8:45am
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- 8276 reads
Introduction
Clinical practice suggests that many older individuals have great difficulty procuring shoes that are comfortable or shoes that successfully address a clinical problem they are experiencing. Clinicians are often faced with the difficult task of recommending shoes to their patients that will address either or both of these requirements. A report published in the Journal of the American Geriatrics Society indicated that only 58% of healthcare providers either provided intervention or made a referral for foot or footwear problems identified in their patients, with providers including Emergency Department physicians, hospital discharge planners, home health agency nurses, and primary care physicians.1 Barriers to effective intervention in these instances could include patient willingness to comply, financial resources, availability of services, and knowledge on the part of the practitioner.
Pathophysiology of Diabetes in the Elderly
- Thu, 4/15/10 - 2:13pm
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- 11246 reads
This article is the first in a continuing series on diabetes in the elderly. The series will discuss such topics as quality improvement efforts, the role of exercise and dietary supplements in the management of diabetes, treatment of diabetes with oral and parenteral agents, as well as microvascular and macrovascular complications of diabetes. The second article in the series, “Quality Improvement in the Diagnosis and Management of Diabetes Mellitus in Older Adults,” will be published in the next issue of the Journal.
Diabetes in the elderly is unique. The pathophysiology of th
Opioid Analgesics for Persistent Pain in the Older Patient: Part I
- Thu, 3/18/10 - 11:26am
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- 6242 reads
Introduction
The opioid analgesics are among the oldest of drugs in use today, with evidence of use dating back thousands of years. These agents mimic the endogenous opioid peptides and act by reducing neuronal excitability (by hyperpolarizing the neuron via enhancement of potassium ion influx) and inhibiting neurotransmitter release (by reducing calcium ion influx). Their effects are mediated by binding to specific receptors in the central and peripheral nervous systems (Table I).1
In this two-part article, some general concepts underlying the use of opioid analgesics
Depression in a Patient with Alzheimer’s Disease
- Fri, 2/12/10 - 3:53pm
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- 3089 reads
Case Presentation
Mrs. D is an 85-year-old widowed woman who resides with her granddaughter, Ms. S. Mrs. D was diagnosed with dementia of the Alzheimer’s type 8 months ago and is currently being treated with donepezil 10 mg daily. She also has hypertension, coronary artery disease, and osteoarthritis. Her other medications include losartan 50 mg daily, aspirin 81 mg daily, and acetaminophen 650 mg 3 times daily. Mrs. D receives 4 hours daily of home attendant services 5 days per week. Ms. S moved in with her 6 months ago to help with her care. Mrs. D raised her granddaughter after
