Issue

CASE PRESENTATION
Mrs. C is a 79-year-old widowed woman admitted to the hospital after suffering a syncopal episode. She was found to be thin and frail, with a blood pressure of 90/50 mm Hg. Mrs. C is 5’9” tall and weighs 112 lbs. Her protein and albumin levels were low, and she was mildly anemic. She underwent numerous diagnostic tests, including computed tomography studies of the head, chest, and abdomen; magnetic resonance imaging of the brain; transesophageal echocardiogram; and monitoring in the hospital telemetry unit. On the third hospital day, Mrs. C was scheduled for endoscopy, b

Numerous botanical and biological agents are available for use by older persons. Some of these are increasingly being recommended by physicians and used by patients who seek an alternative or complementary way to treat specific medical problems, to produce an anti-aging effect, or to improve their feelings of “well-being.” Concerns continue, however, regarding the effectiveness of many of these products as well as interactions they may have with prescribed medications. The potential benefit must always be weighed against any possible side effect, although few studies have provided much dat

CASE PRESENTATION
A 78-year-old African-American man with diabetes mellitus, hypertension, and hyperlipidemia presented with a three-day history of intermittent chest pain on exertion and at rest with radiation to his left arm. In the morning of admission he was woken up by the same chest pain, which lasted about 15 minutes. He had never experienced any anginal symptoms before. He denied dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, palpitations, or syncope. He had been free of cardiovascular events in the past. The patient is a nonsmoker and does not have any family history

Educational Objectives
1. To appreciate the barriers to optional pain management at the end of life
2. To understand the importance of assessment and reassessment of pain for patients at the end of life
3. To be knowledgeable of the unique approaches to assessment and management of pain in the elderly
4. To be able to utilize the Three-Step Analgesic Ladder approach of the World Health Organization in the management of pain at the end of life

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

March 2005

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 “Pain Management at the End of Life,” which appears on pages 44-52 in this issue of Clinical Geriatrics.

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

Recently, the chairs of the various departments at my hospital were asked to make a presentation to members of our Board of Directors at their annual planning meeting. We were challenged to come up with 10 items that we believed would influence the future of medicine over the next few decades. Clearly, my task was more complicated than most, as internal medicine has so many areas of subspecialization. After careful consideration, the following made my list, including an 11th item I could not exclude:

1. Changing demography
We will witness an increase in the number of older persons and

USE OF COXIBS IS ASSOCIATED WITH HIGH BLOOD PRESSURE
Tai-Juan Aw, MBBS, FRACP, and coauthors found that cyclooxygenase-2 inhibitors (coxibs) are linked to a point-estimate blood pressure (BP) elevation compared with placebo and nonselective non-steroidal anti-inflammatory drugs (NSAIDs). The recent meta-analysis from Archives of Internal Medicine reported that these BP elevations may be significant in relation to increased cardiovascular risk.

Researchers analyzed 19 randomized, controlled trials, which included more than 45,000 participants, and found that coxibs produced a weighted mean

Since the plan for prescription drug coverage for our Medicare patients was announced, we have been confronted with the need to address many questions raised by our patients and their families. Clearly, we are aware that many patients may not be able to easily afford medications we prescribe, and our hope is that these new drug plans will ensure better access to medication. Low-income Medicare beneficiaries may be particularly in need of the new benefit; we should be able to direct our patients appropriately.

For the past year, AGS has been participating in a broad-based coalition led by t