Issue

Irritable bowel syndrome (IBS) is a widely prevalent yet poorly understood disorder. Despite advances in modern medicine, it remains a symptom-based diagnosis. It is a functional disorder of the gastrointestinal (GI) tract that affects hundreds of millions of persons throughout the world. Estimates of prevalence range from 10-20% of the adult U.S. population.1-5 Symptoms consistent with the disease account for 2.4-3.5 million physician visits annually, resulting in 2.2 million prescriptions written each year to treat this disorder.6-9 However, the epidemiology and clinical presentations of I

CASE PRESENTATION
Mr. V is an 83-year-old married man with a history of vascular dementia for the past five years. He is cared for by his 72-year-old wife, with four hours of paid assistance twice per week. Mrs. V attends a caregiver support group at a local senior center and is active in her local Alzheimer’s Association. Mr. V suffered his first stroke five years ago, with right-sided weakness, difficulty with word finding, and cognitive loss. After a period of rehabilitation he was able to return home, using a cane for ambulation. One year later he suffered another stroke, affecting the

In psychiatric literature, several terms including sundowning, sundowning syndrome, and nocturnal delirium have been used interchangeably to describe the same observations. The reason for this confusion is the lack of a clear and precise definition for the observed phenomenon along with indefinite sources of etiology. Sundowning is a descriptive term rather than a psychiatric diagnosis as defined in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition-text revision (DSM-IV-TR). This article reviews past investigations to characterize the observed phenomenon of sundowning.

CASE PRESENTATION
Mr. R started jogging in his early 30s, and typically ran 31/2 miles per day three times a week at an 11 min/mile pace. In his early 40s, he increased his distance to 5 miles per day three times weekly. Over the next decade, his exercise regimen varied but he continued to be a recreational jogger running 12-15 miles per week at a reduced pace. At age 56, he volunteered for a high-intensity exercise research study in our laboratory for the purpose of improving his running pace and health. After the 9-month training period, his maximal aerobic capacity (VO2max) increased from

Educational Objectives
1. To identify risk factors associated with the development of UTI in older women
2. To understand the management of asymptomatic bacteriuria
3. To be able to recommend antimicrobial treatment for UTI in older women
4. To understand the major side effects and drug interactions associated with antimicrobials used to treat UTI

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 Medic

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 “Diagnosis and Management of Urinary Tract Infections in Older Women,” which appears on pages 47-53 in this issue of Clinical Geriatrics.

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

I just returned from rounds and cannot forget the 96-year-old severely cachectic woman I saw who had left the ICU to continue to recover from a bout of pneumonia. Her family surrounded her, and they all seemed to enjoy the moment. They told me when I entered the room that they were reminiscing about the past. “Mom was a practicing physician and always healed herself,” they said. I could see how strong their relationship was with her. I knew that they would be a key factor if she was to regain her strength. The food at the bedside remained from earlier that day, and we spoke of ways to impr

To the Editor:

You do not know me, but I am your biggest fan. I am 50 years old and have MS. After living with incontinence for the past 5 years, I just yesterday got an indwelling catheter. Last night was pretty rough for me emotionally. Every time you need a new “help” it takes awhile to adjust mentally to it.

I went on the Internet this morning and typed in “living with an indwelling catheter,” and I happened upon your article, “Urinary Catheter Management for the Older Adult Patient.”1 I just wanted you to know what a difference reading your article has made to me. I feel

Parkinson’s disease (PD) usually affects persons over age 50, and is the result of the loss of dopamine-producing brain cells. The main symptoms of PD are tremor (trembling), rigidity (stiffness of limbs and trunk), bradykinesia (slowness of movement), and postural instability (impaired balance and coordination). Other symptoms may include emotional changes such as depression; difficulty swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions. Symptom severity occurs gradually, increasing more rapidly in some persons than in others. As PD pro