Issue

CASE PRESENTATION
Mrs. R is an 84-year-old widowed woman with a 3-year history of dementia of the Alzheimer’s type. She lived in her apartment with part-time home care until 1 year ago, when she started wandering at night and was found by the police several times. Mrs. R moved in with her daughter and her husband, Mrs. and Mr. B. Mrs. R remains fairly stable after an initial period of adjustment. She attends a local senior center that offers a dementia care program and is able to use a senior transportation service. She suffers from hypertension treated with losartan 50 mg and hydrochlorot

CASE PRESENTATION
Mrs. H was a pleasant 93-year-old African-American woman who presented to her primary care physician for fatigue, pruritis, and weight loss of 40 pounds over 6-8 months. Her medical history included depression, hypertension, arthritis, stroke, and diverticulitis. At the time of her presentation, her medications included paroxetine, hydrochlorothiazide, and aspirin. Mrs. H’s physician did an extensive work-up that revealed a positive HIV enzyme-linked immunosorbent assay (ELISA) and positive rapid plasma reagin (RPR) and venereal disease research laboratory (VDRL) tests. T

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

I recently was asked to review a case involving a physician’s actions with a patient. I re-reviewed the American Medical Association (AMA) Principles of Medical Ethics (www.ama-assn.org/ama/pub/category/2512.html), often referred to as the “Physician’s Code of Conduct,” and thought it would be valuable to share these with the readers of Clinical Geriatrics. As stated so well in this document, a physician is responsible to his/her patients “first and foremost, as well as to society, to other health professionals, and to self.” The following Principles have been adopted by the AMA as

President Bush’s 2008 budget proposal—released shortly before this issue of Clinical Geriatrics went to press—is a wake-up call for those of us who care for older adults. In numerous ways, the President’s spending plan would undermine efforts to improve both healthcare and access to healthcare for older Americans. Making matters worse, it would do so for years to come.

Consider the President’s proposals for Medicare and Medicaid. All told, they would cut funding for the programs by $101 billion over 5 years. More than one-third of that total would come from limits on annual infla

It’s never been more taxing to be a geriatric healthcare provider than now, what with the aging of the baby boomers demanding more services. At the same time, a greater number of innovative products are becoming available—all in the face of limited available funding.

Not surprisingly, the American College of Physicians Executives’ Physician Morale Survey found physicians suffering from low reimbursement, loss of autonomy, bureaucratic red tape, patient overload, and diminished respect.1 Even more telling was the fact that nearly 60% of physicians who participated in the survey stated

March 2007

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 “Secondary Hyperparathyroidism and Renal Bone Disease: A Growing Problem in the Older Adult,” which appears on pages 39-45 in this issue of Clinical Geriatrics.

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

As we get older, we tend to get wiser in many ways. Thanks to experience, we may be better at making decisions, have bigger vocabularies and be more expert in certain areas than we were when we were younger.

As our brains get older, however, it may be a bit harder for us to learn certain
information or remember things. It may be harder, for instance, to remember your neighbor’s phone number, or your grandson’s birthday.

The good news is that there are lots of things you can do to keep your brain sharp
and working well throughout your life. Researchers call this “cognitive vit