Issue

This issue of Clinical Geriatrics includes a CME article on “Oral Infections in the Elderly,” the second part of a series written by Kenneth Shay, DDS, MS. Primary care physicians caring for the older person must take responsibility for the “whole” patient, and this includes an appropriate history and thorough exami
nation of the oral cavity. Few medical schools include a significant curriculum regarding the oral environment; most physicians believe that this area of the body is better left to the dental expert. While specific problems that are identified may indeed require a dental

CASE PRESENTATION
A 91-year-old widowed woman was under the care of a home health agency’s long-term program for skilled nursing care, physical therapy, and home attendant services. She was a native of Puerto Rico and spoke both English and Spanish. After several months of home care, the patient’s primary nurse became concerned about persistent depression, and referred the patient to the behavioral health division of the agency for evaluation.

A social worker saw the patient in her home and agreed that she appeared depressed and withdrawn. A psychiatric consultation was requested thr

An orthosis is an orthopedic appliance or apparatus used to support, align, prevent, or correct deformities, or to improve the function of movable parts of the body.1 (In contrast, an assistive device is more specifically a device like a walker, wheelchair, cane, or crutches used to compensate for a physical limitation.2) With improvements in trauma care, more victims of catastrophic events are surviving to live with disabilities.3 Life expectancy is increasing, so increasing numbers of older adults are facing their later years with disabling sequelae of disease or trauma. Along with this rise

INTRODUCTION
Similar to most other health care providers, surgeons are seeing an increasing proportion of elderly patients in their practices. Furthermore, this patient population is more likely to require operations. Patients age 65 and older currently account for approximately 60% of the average general surgeon’s work.1 The growth in general surgery over the next decade is expected to outpace the population growth due to a large increase in the number of older Americans. In specialties that care for a greater proportion of elderly patients, such as ophthalmology, urology, and cardiothorac

INTRODUCTION
Research has shown that for every dollar spent on pharmaceuticals, another dollar is spent to manage drug-related problems, costing Americans living in the United States approximately $104.2 billion annually.1-3 The elderly account for 12.7% of the U.S. population, but consume 34% of total prescription medication and 40% of all over-the-counter medicine.4-6 Inappropriate medication use may lead to increased health care services, including physician visits, emergency department visits, and hospitalizations.2 Polypharmacy (use of one or more unnecessary medications)7,8 in older adu

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

The more older adults, and their caregivers, know about their health, the better they fare. Studies have found, for example, that well-informed patients are more likely to follow their healthcare providers’ recommendations and are better able to manage chronic health problems.

Increasingly, older adults and their caregivers are turning to the Internet for health information. According to a nationwide Pew Internet & American Life Project survey, the number of Americans age 65 and older using the Internet jumped 47% between 2000 and 2004—when nearly 1 in 4 was going online. Among Web use

The Centers for Medicare & Medicaid Services (CMS) has the difficult, if not impossible, task of implementing the laws governing Medicare. CMS’s philosophy in developing the regulations has been to look at the overall well-being of the program. Unfortunately, in doing so, individual patients who exist at the extremes often suffer. Medicare Part D and the effect of this program on nursing home residents is a clear example of this problem.

As is often the case, the needs of long-term care (LTC) residents were not considered in the drafting of Medicare Part D legislation. States had viewed

July 2006
Oral Health

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 “Oral Infections in the Elderly—Part II: Fungal and Viral Infections; Systemic Impact of Oral Bacterial Infections,” which appears on pages 37-45 in this issue of Clinical Geriatrics.

ACCREDITATION
The Johns Hopkins University School