Issue

People with developmental disabilities are living longer than ever before, and physicians caring for the mature and aged person need to be aware of their special needs. A developmentally disabled person is one who has a diagnosis of mental retardation, epilepsy, cerebral palsy, autism, or similar neurological condition that originated before adulthood. Perhaps the biggest advance in lifespan for individuals with a developmental disability are those people with Down syndrome. In a study published in 2002 of 1332 people with Down syndrome born after 1902, the average life expectancy was 58.6 yea

To the Editor:
I read with interest the article, “Osteoporosis in Elderly Men,”1 written by Neil Baum, MD. The initial background information is pertinent and raises awareness of the growing problem of osteoporosis in men, and a number of preventive and management strategies are suggested. The case presented in the article is a 66-year-old man with a history of prostate cancer that was initially treated with radiation therapy. After a recurrence of cancer, he was treated with luteinizing hormone-releasing hormone agonist and anti-androgen therapy, which is an important risk factor

Public policy has the potential to profoundly affect clinical care, especially care for older Americans—the majority of whom have healthcare coverage through Medicare. Consider the findings of a recent American Medical Association (AMA) survey of 9000 physicians. Nearly half (45%) said a 10% cut in Medicare payments to healthcare providers that’s mandated for 2008 would force them to see fewer, or stop seeing any, new Medicare patients.

As we know too well, the formula Medicare uses to determine payments to providers is seriously flawed. Known as the Sustainable Growth Rate formula, or

Introduction
Reducing Medicare costs will be an important enterprise in the future as the baby boom generation retires. In the Medicare Prescription Drug Improvement and Modernization Act of 2003, Congressional debate was as much about “limiting government’s future exposure to cost increases”1 as it was about creating a new prescription drug benefit for Medicare. Grassroots efforts to reduce costs through incentives to physicians have been attempted, but without much success. An actuarial team from the Centers for Medicare & Medicaid Services (CMS) reported in 1998 that when face

Case Presentation
The patient is an 84-year-old married woman who was referred for psychiatric evaluation by a plastic and reconstructive surgeon. Mrs. V is a survivor of the Holocaust and spent more than three years in a concentration camp before being liberated at the end of World War II. She went to see Dr. S because he participated in a volunteer program to remove the tattoo ID numbers placed on the victims. Initially, Mrs. V was quite pleasant and cooperative, but when the laser removal process was about to begin she became extremely upset, and started crying and hyperventilating.

Introduction
Adults with developmental disabilities are becoming more commonplace in society, particularly those who have lived with a disability their entire lives. Survival rates have vastly improved for children with chronic disabilities affecting physical function, such as cerebral palsy (CP)1 and spina bifida (SB).2 Current predictions suggest that many individuals with developmental disabilities will live into adulthood and age much like the general population; however, little is known about the natural history of these disorders over the lifespan.1 S

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 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 participa

July 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 “Heat-Related Illness in the Elderly,” which appears on pages 37-45 in this issue of Clinical Geriatrics

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