Issue

CASE PRESENTATION
A 72-year-old woman presents with frequency (12-15 times per day), urgency, urge incontinence, and nocturia (four times per evening). She has had symptoms for more than five years and has not discussed this with her primary care physician. She had a hysterectomy more than 20 years ago. She is not sexually active because of the embarrassment of incontinence. Physical exam reveals a minimal cysto- urethrocele with pale-appearing atrophic vaginal mucosa. Her urinalysis is negative.

DISCUSSION
Overactive bladder (OAB) describes a range of lower urinary tract symptoms that

Visual impairment is very common in the older adult. Many eye disorders do not exhibit any symptoms until they enter their late stages. Therefore, it is important to schedule an appointment with your ophthalmologist for a medical exam every 2-4 years if you are between the ages of 40 and 64, and every 1-2 years if you are 65 years of age or older. If you are experiencing any changes in vision, schedule an appointment immediately. Although some disorders cannot be cured, there are ways to delay onset or progression. This patient aid outlines the symptoms, risk factors, prevention, and treatment

In reviewing the contents of this issue, I was struck by the theme of subclinical illness, a term that often leads to confusion. Subclinical should not be interpreted to mean that there is no change in physiologic function or well-being and that the problem is insignificant, but rather that conventional measures that have been used to evaluate an individual for the presence of a disease may not detect changes. Dr. Miller’s CME article in this issue clearly describes the effect of both subclinical hyperthyroidism and subclinical hypothyroidism on various health parameters, including the heart

Motor vehicle crashes are the leading cause of injury to adults 65-75 years of age, and the second leading cause of injury to those 75 years of age and older.1 Physicians and other health care professionals can play a critical role in preventing motor vehicle injuries and in helping older patients maintain their mobility through the use of preventive clinical practices. In addition, clinicians can assess health changes of older patients and provide effective medical treatment to address any functional limitations that arise and may inhibit mobility. Finally, if remediation is not possible, cli

Since the first Surgeon General report on smoking was issued in 1964, the smoking rate in the United States has been progressively declining.1 Yet today, cigarette smoking remains the leading cause of preventable death in the United States, and it is associated with significant health and economic burdens to society.2 A vast array of resources have been assigned to address smoking cessation or abstinence programs, almost exclusively aimed at the adult and adolescent populations. Little to no attention has been paid to older smokers. Obstacles to smoking intervention in the elderly include the

CASE PRESENTATION
Ms. G is a 72-year-old, single white female who lives alone and has no children. She was visited by local mental health services at the request of her neighbors, who complained about an intolerable smell and flies coming from her apartment. On observation from the entrance, the apartment was grossly dirty with an offensive odor. The carpets were soaked with urine and moldy feces. Piles of garbage, each about 5 feet high, restricted the living space. There was no furniture in the house, no refrigerator, and among the garbage the only signs of nourishment were cracker wrappers

CME ARTICLE

FULL DISCLOSURE POLICY AFFECTING CME ACTIVITIES
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following: Dr. Miller has indicated that he has not received financial support for consultation, researc

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 “Subclinical Thyroid Disorders,” which appears on pages 38-45 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 provide continuing me