Issue

Over the years, I have had the opportunity to hear numerous patient stories presented to me by colleagues, residents, and students. Although I find each and every one unique and interesting in its own right, occasionally there is a story that stands out as worth sharing. The following case is one such example; not because there is any major new finding or disease entity to present, but because something so simple was missed—and many other medical centers may find themselves with a similar situation.

Mr. J is a 93-year-old gentleman who was active and in his usual state of health until tw

CASE PRESENTATION
An 82-year-old woman was referred for psychiatric evaluation by her primary care physician. Mrs. C was accompanied by her 86-year-old husband. She has suffered from dementia of the Alzheimer’s type for the past six years. Her husband has been her primary caregiver, with some assistance from the couple’s son and daughter-in-law, who live nearby. Mrs. C sat quietly next to her husband in the waiting room, but on observation displayed prominent movements of her lips and jaw, as well as restless and jerky movement in her arms and legs.

Mr. C is a very reliable historian

EXERCISE LOWERS DIASTOLIC BLOOD PRESSURE
According to a study published in a recent issue of Archives of Internal Medicine, improvements in body composition are linked to blood pressure (BP) reductions. These findings could link exercise training to improvements in cardiovascular health in older persons.

This six-month, randomized, controlled trial compared participants (ages 55-75 years) who combined aerobic and resistance training (n = 51) with controls who followed usual care physical activity and diet advice (n = 53). The participants had untreated systolic BP (SBP) of 130-159 mm Hg o

Recently, a highly publicized case in Florida brought the subject of advance directives to the forefront in the United States. Weeks of extraordinary legal wrangling, attempts to obtain various court orders, and family conflict became very public examples of what can happen in the absence of written advance directives. It appears, however, that some good has already come of this very sad situation: increased public awareness of the importance of advance directives and greater understanding of the scope of the powers such documents can afford patients who are chronically ill or dying.

We ar

Osteoporosis is a systemic skeletal disease characterized by compromised bone strength that predisposes affected individuals to an increased risk for fracture.1 In the United States, 20% of postmenopausal white women have osteoporosis. An additional 52% have low bone mass at the hip, placing them at an increased risk for osteoporotic fractures.2 However, osteoporosis is often asymptomatic until fracture occurs. Even after fracture, patients often are not treated. One year after a first hip or wrist fracture, only 4-5% of women 50 years or older were taking medications to reduce the risk of a s

CASE PRESENTATION
A 60-year-old man had a screening prostate-specific antigen that was 7.0 ng/mL. The digital rectal exam was normal. A transrectal ultrasound and prostate biopsy revealed moderately well differentiated adenocarcinoma of the prostate, with a Gleason score of 7 (3 + 4). The bone scan and computed tomography (CT) scan of the abdomen and pelvis were negative for metastatic disease. The patient had a radical retropubic prostatectomy. The regional lymph nodes were negative, and the surgical margins were clear of prostate cancer, T1c disease. The postoperative PSA was undetectable,

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 “Peripheral Arterial Disease and the Older Adult: More Sinister than It Appears,” which appears on pages 47-54 in this issue of Clinical Geriatrics.

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