Issue

Whenever I evaluate an older person I think of them clinically in three ways. First, I consider what findings relate to normal aging. Whether it is their wrinkling of the skin or their decrease in lung tidal volume, I try to determine whether there is anything out of the ordinary that may either represent an acceleration of the otherwise normal aging process or a disease, perhaps early in its course.

I then consider whether any of the presenting signs and symptoms relate to an age-prevalent illness. Diseases that may not occur commonly during an earlier period of life now need to be conside

Healthcare professionals are generally trained in isolation and continue their practice in much the same way. Geriatrics has historically embraced an interdisciplinary team approach to training and practice. The importance of a well-balanced interdisciplinary team has been shown to be beneficial in the care of the elderly; however, payers and government regulators are attempting to lower one aspect of healthcare cost by making decisions that will directly affect the balance of the care team. Our current geriatric care system is under increasing pressure to find efficient and effective systems

Walking is the most popular form of exercise among older adults and it’s a great choice.
Walking can strengthen muscles; help prevent weight gain; lower risks of heart disease, stroke, diabetes, and osteoporosis; improve balance; and lower the likelihood of falling.

Before older adults plan their first walk, they should check with a health care provider.

Take these steps to walk safely:

Tell your health care provider if you have any pain or problems walking
It’s important to be as healthy as possible before you start to walk, but don’t let a health problem keep you from g

CASE PRESENTATION
Mrs. W is a 65-year-old retired school teacher. Her husband died two years ago in a car accident. Mrs. W’s two daughters are both school teachers who live nearby. She has five grandchildren and often cares for them when her daughters need help. Mrs. W went through a period of grief and mourning following the sudden loss of her husband but continued to teach until 6 months ago after reaching her 65th birthday. She decided to retire and traveled to Europe with some friends. While traveling, Mrs. W started drinking coffee each morning with her friends, and often drank several

CASE PRESENTATION
A 63-year-old woman presented in June complaining of a 1-week history of malaise, headache, generalized body aches, and low-grade fever of 101 degrees F. She denied any upper respiratory, gastrointestinal, or other associated symptoms. Physical examination was generally unremarkable with the exception of a slightly raised, 8 x 6–cm, irregular, ovoid patch with spotty areas of mildly intense-to-faded erythema found on her right anterior thigh (Figure 1). A central papule was noted, consistent with a punctum from a recent tick or insect bite (Figure 2). When the lesion was

INTRODUCTION
Aging is known to be associated with an increased prevalence of diabetes. In 2005, the Centers for Disease Control and Prevention reported an estimated prevalence of diabetes in the United States to be 2% in the 20-39 age group, 10% in the 40-59 age group, and 21% in the 60 or older age group.1

For type 2 diabetes, the mechanisms responsible can be broadly divided into insulin resistance in target tissues and impaired insulin secretion from beta cells in the pancreas. The pathogenesis of type 2 diabetes is multifactorial; however, hyperglycemia does not develop without beta ce

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 i

April 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 “Laxative Use and Abuse in the Older Adult: Part I,” which appears on pages 37-42 in this issue of Clinical Geriatrics.

ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical