Issue

There have been many changes in medicine since I was a medical student in training; fortunately, medical education has done its best to prioritize what students need to learn. Diseases that were newly recognized years ago and were challenges to the medical establishment have been replaced with other more challenging problems. Our diagnostic tools have become more technological, and there appears to be less reliance on a physician’s own judgment and clinical skills. In many ways, we have improved our ability to practice medicine and to diagnose problems earlier and with more certainty. The

INTRODUCTION
The average age of onset of menopause in the U.S. population is 51 years.1 Vasomotor instability and hot flashes are among the first symptoms of decline of endogenous estrogen levels. Hormone replacement therapy (HRT), estrogen or estrogen plus progesterone, has been used to alleviate these symptoms. Important to note are the long-term effects of menopause as a risk factor for osteoporosis. One of the documented side effects of HRT is an increased risk of calculous gallbladder disease,2-4 the subject of this review.

EPIDEMIOLOGY
Cholelithiasis is the pathologic state of sto

CASE PRESENTATION
Mr. M is a 70-year-old retired typesetter and father of two who was admitted to a psychiatric facility after an attempt to strangle his wife of 50 years. He is a devout Catholic and explained that a message from God convinced him that his wife intended to kill their granddaughter. In the past weeks, he had cluttered the home with religious shrines of candles, flowers, and photographs of religious figures. His wife’s protests only resulted in his mounting anger and accusations that her attention to his needs—both culinary and sexual—was flagging. He had been preoccupied

Iodine-induced hyperthyroidism, or Jod-Basedow phenomenon, a thyrotoxic condition caused by exposure to increased amounts of iodine, has historically been reported in regions deficient in iodine.1 However, with advances in contrast imaging, this hyperthyroidism has more recently been reported in patients following studies that require administration of iodine-containing contrast media,2-5 but has received little attention in the elderly,6,7 who frequently undergo such studies. The increasing application of these imaging techniques to evaluate and prognosticate diseases of advanced age, in comb

Many senior patients remain confused about and unable to make a decision regarding participation in the Medicare prescription drug program. Like a deer caught in headlights, they are likely to feel the pain of their indecision. This “pain” will come in three forms: a late enrollment penalty, being locked out of any plan until an open enrollment period, and the lost opportunity that comes with having prescription insurance that can lower one’s out-of-pocket expenditures. The lowering of one’s out-of-pocket expenditures is most significant for those 9 million persons eligible for the low

Sleep disturbances are very common in the context of psychological distress.1,2 Studies of individuals with insomnia have found rates of comorbid psychiatric disorders as high as 62%.3 A substantial amount of research has been conducted investigating insomnia in the context of depression in later life, but relatively little research has been conducted investigating sleep disturbances in the context of anxiety symptoms experienced by the elderly. This is surprising, given that complaints about anxiety and sleep disturbances are among the most common that the elderly express to their physicians.

The recent White House Conference on Aging (WHCoA), which convened in Washington, DC in mid-December, highlighted an agenda that many of us in clinical geriatrics share.

The 1200 delegates to the conference—which meets roughly once a decade to help shape national policy on aging—wrapped up the four-day session by adopting a slate of 50 resolutions to send to the President and to Congress. Among the top 10 were measures calling for greater efforts in:

• Addressing the growing shortage of geriatrics health care workers by supporting geriatric education and training for physicians,

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 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the

March 2006
This continuing medical education activity is presented 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 in the Older Patient,” which appears on pages 40-46 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