Issue

CASE PRESENTATION
Mr. P is a 69-year-old male with a 7-8-year history of parkinsonian motor symptoms and visual hallucinations. He was first referred to a local mental health clinic 3 years ago, and at that time described seeing transparent human figures walking around his house. He said that these visual hallucinations have become more vivid and now occur on a daily basis. The patient also complained of some difficulty with his memory. Cognitive impairment was noted at his initial presentation. He was unable to draw a clock face, complete a serial 7’s task, or perform simple calculations.

CASE PRESENTATION
A 75-year-old Haitian man presented to the emergency department (ED) with altered mental status (disoriented to time and place). Although a poor historian, he did report progressive worsening of vision in his eyes bilaterally over an approximate 2-week period. Past medical history included type 2 diabetes mellitus for approximately 6 years and hypertension. He was not compliant with medications for these chronic conditions as prescribed by his primary care physician and was taking no medications at the time of assessment in the ED. Social history was significant for alcohol

INTRODUCTION
Although eating is an activity everyone should know a great deal about, many persons fail to eat a nutritionally balanced diet and do not take advantage of the many natural food sources that not only can provide necessary nutrients, but can also help maintain health and promote a more successful aging process. Many persons eat to excess or fail to consume basic requirements necessary for health. Malnutrition is not something observed only in third-world countries. In addition to a necessary amount of proteins, carbohydrates, and fats, we must ensure an adequate intake of vitamin

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

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 “Neuroleptic Malignant Syndrome in the Elderly: Diagnostic Criteria, Incidence, Risk Factors, Pathophysiology, and Treatment,” which appears on pages 39-46 in this issue of Clinical Geriatrics.

ACCREDITATION
The Johns Hopkins University School of Medicine is acc

Ms. J was a very healthy, 63-year-old woman in the prime of her life until 2 days prior to admission, when she developed a sharp pleuritic chest pain on the left side. She denied any shortness of breath or upper respiratory symptoms, and had no pain or swelling in her lower extremities. She had traveled to Las Vegas, a 3-hour plane trip, 3 weeks earlier and had what appeared to be a viral illness at that time that improved within a few days. She was not taking any medications, and reported no other changes in her daily routine or abilities.

Thinking that there must be some acute problem, s

As all of us in clinical care know well, what happens in Washington profoundly affects the practice of geriatrics. Legislative decisions regarding Medicare fee schedules and funding for geriatrics education, training programs, and research affect both our day-to-day practice and the future of geriatrics care. Media and public perceptions of geriatrics also have tremendous impact; among other things, they influence lawmakers.

In light of this, the American Geriatrics Society (AGS) has created three new Web-based resources to help geriatrics health care providers advocate for initiatives and

As is too often the case, federal legislation has set up a system that did not fully take into account the unique environment that exists in nursing facilities. Medicare Part D is a prime example. In addition to difficulties imposed by the unique and already heavily regulated environment of nursing facilities, these regulations are now in conflict with the new Part D federal legislation.

The basis for this conflict is Medicare Conditions of Participation that requires skilled nursing facilities (SNFs) to provide all of the care and services that are medically necessary to their residents i

To the Editor:
I thoroughly enjoyed the Psychiatry Rounds article “Decision-Making Capacity.”1 I would like to ask the following:

1. Do you personally use the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) (I was thinking of purchasing the interview for our use), or do you prefer another assessment tool?

2. Generally, in what instances, if any, do you feel that the MacCAT-T is not sufficient and neuro-psychiatric testing is warranted?

Thank you,
Paula Bordelon, DO
Geriatric Fellow
Family Practice
Sacred Heart Hospital
Allentown, PA

REFERENCE
1. Lan