April 5th 2024
More than 1 in 10 older adults were misdiagnosed with community-acquired pneumonia and nearly all were treated with a full course of antibiotics, a new study found.
A Systematic-and Realistic-Approach to Functional Assessment of Elderly Persons
January 1st 2007A 74-year-old man comes to your office because his wife and childrenhave noticed that his memory has become mildly impaired. He continuesto work part time in the family business. Recently, however, his daughter has found thathe is making significant errors with clients. For example, he has failed to show up for appointmentsthat he had scheduled, and has set up appointments with clients whom he has already served.Because of errors he has made in client billing, he has turned over the company’s bookkeepingresponsibilities to his daughter.
Elderly Woman With a Rapidly Enlarging Facial Tumor
December 31st 2006A 101-year-old woman has had an occasionallypruritic and tender growthon her face for about 2 months. Thegrowth has doubled in size over the past2 weeks. She has no personal or familyhistory of cancer or significant dermatologicdisorders.
Flu Vaccine Crisis: How Best to Protect Patients at Risk
December 31st 2006Pandemics attributable to different influenza A virus subtypes occurredat irregular intervals throughout the 20th century. Because the timingof a pandemic cannot be predicted, we must be prepared for such an outbreak.Although influenza is generally viewed as an illness with potentiallydeadly effects primarily for elderly persons, it can lead to significant morbidityand mortality in otherwise healthy infants and toddlers and in other highriskgroups.
The Non-Alzheimer Dementias:An Approach to Evaluation and Management
December 31st 2006A 72-year-old farmer is brought by his daughter for a comprehensivegeriatric assessment. His previous history is unremarkable. The patientreports that he has had vivid visual hallucinations, which he calls "visitors." He becomes frightenedand hostile when these incidents occur; on several occasions, he has exhibited violent behavioras persons around him tried to calm him. Although the patient was able to recall each episode indetail, he felt as if he had watched it from a distance and had not been an active participant.
Weight Loss in an Elderly Colon Cancer Survivor
December 31st 2006A 72-year-old man complains that he has been losing weightfor the last 2 months. Colon cancer was diagnosed 2 yearsearlier, and the lesion was resected; he did not receive anyadditional therapy at that time. Except for hypertension,which is well controlled with propranolol, the remainder ofthe medical history is unremarkable.
Elderly Man With Fatigue and Backache
December 31st 2006A70-year-old African American man, who is a retiredelectrician, presents with increasing fatigue anddull back pain of 4 months’ duration. Although he usuallywalks about 2 miles a day, he now becomes exhaustedafter half a block. He reports exertional dyspnea but noparoxysmal nocturnal dyspnea or orthopnea. Recently, henoticed ankle edema.
Elderly Man With Sudden Back and Abdominal Pain
December 31st 2006An 84-year-old man with back and abdominal pain ofrecent onset arrives at the emergency department(ED) of a small community hospital at 5 AM. Sudden,severe back pain awakened him from sleep 2 hours earlier.The patient has had back pain for 12 hours and intermittentcolicky pain in the suprapubic region for the past2 hours.
Memory Problems in the Elderly: What’s Significant-What’s Normal?
December 31st 2006Q:Recent research has defined mild cognitiveimpairment as a transitional state between thecognitive changes of normal aging and Alzheimerdisease (AD) and other dementing illnesses. Whatcriteria are used to differentiate mild cognitiveimpairment from more innocuous syndromes, such asbenign senescent forgetfulness? Are patients with mildcognitive impairment considered to have incipientclinical AD?
Aging Matters:Strategies for Optimal Care of the Elderly
December 31st 2006This recent headline succinctly summarizes a crisisof major proportions looming in the health carefield. According to the American Geriatrics Society,the fastest growing segment of the Americanpopulation consists of those who are 85 years andolder. Their numbers are expected to reach 19 million by2050. By 2020, more than 53 million Americans will be65 years or older. Many families will contain 2 generationsof geriatric patients.
Near-Syncope in an Elderly Woman
December 31st 2006An 84-year-old woman with hypertension and type 2 diabetes mellitus isbrought to the emergency department (ED) after an episode of nearsyncope.When emergency medical service personnel initially assessed her,blood pressure was 96/60 mm Hg and heart rate was “slow”; however, shehad no symptoms.
Strategies for Optimal Care of the Elderly
December 31st 2006An 84-year-old woman presents with a 3-year history of slowly progressivememory impairment accompanied by functional decline. Thepatient lives alone but has been receiving an increasing amount of support from her 2 daughters,who accompany her to the appointment. The daughters first noticed that their mother was havingtrouble driving. About a year ago, she started forgetting family recipes. She also left food cookingon the stove unattended and burned several pans. Currently, the daughters are providing mealsand transportation, assisting with housework, and doing their mother’s laundry. They have becomeincreasingly alarmed because she takes her medications only sporadically, despite the factthat they fill her pillboxes and call her regularly with reminders. Their chief concern is whether itis safe for their mother to continue to live alone.
Elderly Woman With Severe, Worsening Dyspnea
December 31st 2006An 88-year-old woman is admitted for severe dyspnea thathas worsened over the past month. Dyspnea on exertionis now elicited by everyday activities, even walking acrossthe room. Orthopnea and paroxysmal nocturnal dyspneahave progressed to the point that she has been unable tosleep at all the past several nights. She also tires very easilyand thinks her ankles are more swollen than previously.She denies chest pain or pressure.
Chest “Tightness” in an Elderly Woman
December 31st 2006A 76-year-old woman presents with chest pain-which she describes as“muscle tightness”- that began when she awoke in the morning. Thepain is constant, exacerbated by deep inspiration, and accompanied by asubjective sense of slight dyspnea; she rates its severity as 3 on a scale of1 to 10. She denies pain radiation, nausea, diaphoresis, palpitations, andlight-headedness. Her only cardiac risk factors are hypertension and a distanthistory of smoking.
Sorting Out the Complexities of an Elderly Woman's Fall
December 1st 2006I enjoyed Dr Henry Schneiderman’s “What’s Your Diagnosis?” case of an elderly woman with severe facial ecchymoses from a fall. Would Dr Schneiderman elaborate on several points about that case? This woman did not trip or complain of dizziness before she fell. What caused her to fall?
Drug Therapy in Elderly Patients:
December 1st 2006ABSTRACT: Age-related changes that affect drug distribution, such as increased total body fat, decreased muscle mass, and decreased total body water, necessitate reduction in the dosage of water- and lipid-soluble agents. Because creatinine clearance declines with age, the dosage of agents that are excreted primarily by the kidney must also be lowered to prevent toxicity. Examples include aminoglycosides, fluoroquinolones, penicillins, procainamide, lithium, angiotensin-converting enzyme inhibitors, and digoxin. A good rule of thumb to follow until creatinine clearance can be calculated is to reduce the total dose by half in frail elderly persons or in those with established renal disease. Anticholinergic agents should be used with caution because they are associated with urinary retention, heart block, constipation, dry mouth, blurred vision, sedation, and acute or chronic confusion in elderly patients.
PSA Screening Rates for Elderly Men Found Too High
November 14th 2006SAN FRANCISCO -- Older men with limited life expectancies are getting screened much too often for prostate cancer, given the potential harm that may follow a positive test versus the likelihood of benefit, researchers here reported.
Shoulder Fracture-Dislocation in an Elderly Woman: Would You Operate?
October 1st 2006An 89-year-old woman, who has long lived on the special care (dementia) unit of a nursing home because of advanced Alzheimer disease, is seen to assess possible injuries after a fall. Many prior falls have been ascribed to her lack of safety awareness in negotiating the environment, rather than to neuromuscular, sensory, or cerebellar deficits.