Issue

CASE PRESENTATION
Mr. A is a 72-year-old married man with two daughters. He is a native of Puerto Rico who came to the United States at age 20. Mr. A owned a grocery store and worked until 5 years ago, when he developed distressing symptoms of tremor and bradykinesia. He was diagnosed with Parkinson’s disease, but did not receive any treatment until 2 years ago, when his gait became too unsteady for him to walk independently. Levodopa-carbidopa 25/100 mg 1/2 tab 3 times a day was prescribed by his neurologist. Mr. A improved enough to move around in his house, but his wife provided assista

For the past 6 years, Dr. B had been treating Mr. J for atrial fibrillation. Two years ago, Dr. B’s large multispecialty medical group opened an anticoagulation clinic, and Dr. B referred Mr. J there for ongoing management.

Prior to joining the anticoagulation clinic, roughly 60% of Mr. J’s International Normalized Ratio (INR) results had been within the targeted therapeutic range; for the past 2 years, over 90% of his INRs have been therapeutic. Both Dr. B and Mr. J were pleased with the improved results.

Two months ago, the anticoagulation clinic had an unanticipated staffing sho

INTRODUCTION
Hypertension has been associated with an increased risk of stroke, vascular dementia, and Alzheimer’s disease.1-10 Cerebral infarcts, lacunae, and white matter changes are implicated in the pathogenesis of vascular dementia, but also may lead to the development of Alzheimer’s disease.11 Microcirculatory disorders and endothelial dysfunction also may cause a deterioration in cognitive function in persons with hypertension.11 The Epidemiology of Vascular Aging study showed that hypertension is a major risk factor for severe white matter hyperin

CASE PRESENTATION
A 70-year-old man was brought to the emergency room by his neighbor, who reported a 10-day history of progressive fatigue, leg pain, and generalized weakness. The patient had suffered an ischemic stroke 7 months before and was dependent on his neighbor for his daily care. His past medical history was significant for hypertension. His caretaker also commented on the patient’s decline in function during the last month, noting some “bloody stools,” shortness of breath, “easy bruising,” leg swelling, and a recent “red rash” on his arms and legs. The patient had no

In this issue, we are pleased to inaugurate a new feature aimed at helping our readers educate their patients about important medical topics that affect them daily: “Tip Sheets for Older Adults” and “The Patient Education Forum” from the American Geriatrics Society Foundation for Health in Aging (FHA) Aging in the Know website. These will appear in this and future issues as convenient informational resources written specifically for the older patient. Topics will include vaccination tips (which appears on pages 9 and 10 in this issue of Clinical Geriatrics), hot weather and winter safe

With flu season upon us, now’s the time to urge our patients and staff members who haven’t yet been vaccinated against influenza to get their flu shots. Although Medicare covers the vaccinations, flu shots remain an underutilized benefit, the Centers for Medicare & Medicaid Services (CMS) reports. This is worrisome news, since the flu kills an estimated 36,000 Americans yearly—and the majority of deaths are among older adults.

To help older people understand which vaccinations they need and when to get them, the American Geriatrics Society Foundation for Health in Aging recently publ

Before the new plan year starts on January 1, marking once again the beginning of the prescription drug benefit cycle, many Medicare beneficiaries will find themselves having a difficult time obtaining their medications because of the gap in coverage. This gap in coverage, commonly referred to as the “donut hole,” is the period in the Medicare Part D benefit when the beneficiaries are completely responsible for the cost of their medications.

While many long-term care (LTC) residents are not subject to the donut hole, a fair number of them unfortunately are. The Kaiser Family Foundation

From the Johns Hopkins University/Sinai Hospital Program in Internal Medicine and Johns Hopkins University School of Medicine, Baltimore, MD.

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 ac

November 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 “Clostridium difficile–Associated Disease: A Rising Epidemic in Our Elderly Population,” which appears on pages 36-45 in this issue of Clinical Geriatrics.

ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Acc

The AGS Foundation for Health in Aging’s

It’s That Time of Year Again: Flu and Other Potentially Life-Saving Shots

As fall approaches, it’s time for seniors to make plans to get that all-important
flu shot. Studies show that older adults are more likely than younger adults to become seriously ill after contracting the flu or other infections. In fact, the flu alone kills more than 20,000 Americans, most of them 65 and older, each year.

According to American Geriatrics Society President Jane F. Potter, MD, healthcare providers and clinics often start offering f lu shots in ea