Issue

Recently, I was reminded of an interesting case that illustrates that even with excellent clinical skills and sophisticated testing, we must remain humble and recognize that certain patient problems may remain unsolved despite our best efforts. In addition, physicians must continually keep apprised of new information and be prepared for the ever-changing challenges of modern medicine.

Mr. J is an 82-year-old Chinese-speaking gentleman who reports being in good health his whole life. He walks daily, tends to his own personal needs, and enjoys visits from his children and grandchildren. He h

Geriatric medicine has clearly come of age within the past 20 years. Not only have the research insights, care approaches, and clinical skills been promoted within different practice environments but also very innovative approaches to the care of older persons have been developed. We can point to the increasing prominence of geriatric medicine as a discipline, but our patients, their families, and our colleagues would all benefit from a clearer identification of our potential role in the care of older adults. How many of us have been asked, “What does a geriatrician do?” and “At what poi

ACUTE INFECTIONS ASSOCIATED WITH INCREASED TRANSIENT RISK OF VASCULAR EVENT

Findings of a study published in a recent issue of the New England Journal of Medicine show that acute infections are linked to a transient increase in the risk of vascular events. Nevertheless, Liam Smeeth, PhD, and coauthors discovered that influenza, tetanus, and pneumococcal vaccinations do not produce a detectable increased risk of vascular events.

Researchers tested the hypothesis that acute infection and vaccination increase the short-term risk of vascular events by utilizing data from the United Kingdom

CASE PRESENTATION

ER is a 76-year-old African-American woman with a history of coronary artery disease (CAD), myocardial infarction, stroke, hypertension, diabetes, and chronic renal insufficiency, who had a pacemaker placed for symptomatic bradycardia. The patient was transferred from a nursing home for evaluation of acute shortness of breath and chest tightness that was different from her typical anginal chest pain. She denied fever, chills, cough, nausea, vomiting, palpitations, and near syncope or syncope. The patient had at least two hospital admissions in the past year for decompensat

Complementary and alternative medicine therapies are being used with increasing frequency by mature and elderly persons. In fact, the use of alternative medicine in some form or another is widespread in the United States, with usage rates reported as high as 30%.1 Many complementary and alternative therapies are available, including: mind-body interventions (meditation, hypnosis, dance, music and art therapy, and biofeedback); biologically based therapies (herbal and dietary); manipulative and body-based methods (osteopathy, chiropractic, and massage); and energy therapies (electromagnetic fie

Delirium occurs in 14-56% of elderly hospitalized patients.1 During these times of confusion, traumatic self-removal of an indwelling urinary catheter with the balloon inflated can occur, resulting in urologic consultation. The use of a “decoy” catheter in a patient with dementia has been previously described to prevent repeated catheter removal.2 We believe this is an underutilized, simple alternative to sedatives and restraints that may prevent the confused patient from removing his or her urinary catheter.

CASE PRESENTATION

A 90-year-old male resident in a nursing facility was

CASE PRESENTATION

Dr. M was making rounds in the hospital when he received a call from his office telling him that his patient, Mrs. S, was in the emergency room after being involved in a car accident. Mrs. S is a 67-year-old woman who suffered the loss of her husband one year ago due to lung cancer. She has multiple medical problems including hypertension, congestive heart failure, history of an inferior wall myocardial infarction at age 62, coronary artery disease, and severe osteoarthritis. Her medications include amlodipine 10 mg, atenolol 100 mg, furosemide 40 mg, ramipril 5 mg, and di

ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit th

This continuing medical education activity is sponsored by the Johns Hopkins University School of Medicine, Baltimore, Maryland. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

These examination questions are based on the article “Management of Urinary Incontinence in the Older Female Patient,” which appears on pages 44-54 in this issue of Clinical Geriatrics.

ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical E