Geriatrics

All elements of the skin are affected by age. In this 2-part article, I will discuss how the blood vessels, the lymphatics, and the ground substance- which surrounds these vessels-respond to age, and I will show how the aging elements of the vasculature can engender a variety of pathological cutaneous conditions.

A research team led by Frederick Unverzagt, MD, associate professor of psychiatry, Indiana University–Purdue University, Indianapolis, found that older adults with pre-existing mild memory impairment benefit from cognitive training that does not rely on memorization as much as those with normal memory function.

I read with interest Dr Gregory Rutecki’s Top Papers Of The Month feature, “Treat Dementia in Elderly Patients With Caution” (CONSULTANT, January 2009, page 60). Elderly patients who live at home and those in long-term–care facilities often pose management challenges, whether they have evident Alzheimer disease or other diagnoses. While I am not in favor of bad medicine, consideration should be given to treating agitated, violent, and apparently angry and hostile persons with what works. I do not favor quieting noisy patients with drugs.

Alzheimer disease (AD) is more than twice as likely to develop in elderly persons with orthostatic hypotension (OH) as in those without OH, according to a new study presented at the Annual Meeting of the American Academy of Neurology.

An 88-year-old man who had left hip repair after a fracture a few months earlier is now admitted to behavioral hospital because of implacable refusal to take medications, and because of poor food intake and ongoing refusal of rehabilitation. Ambulated with a walker before fracture but now barely ventures out of wheelchair even with rolling walker and therapist guidance.

Elderly persons with essential tremor (ET) are almost twice as likely to have dementia as those without ET, according to a new study from Elan Louis, MD, professor of neurology, and colleagues at Columbia University in New York.

Sleep disorders are common in persons older than 70 years, according to a large community-based study of age-related diseases and cognitive functioning. The most common disorder, sleep-related leg cramps, occurred in 32% of the study participants, according to investigator Jennifer Molano, MD, a behavioral neurology fellow at the Mayo Clinic in Rochester, Minnesota.

A 76-year-old man is seen because of redness below the right eye. Has long-standing “lazy eye” on the left, which is chronically deviated outward. Has lived in nursing home for some years due to self-care deficit from memory loss. No recent eye surgery, conjunctivitis, sinus infection, or periocular trauma.

An 89-year-old woman is seen because of a white area on the tongue. She has been hospitalized on a behavioral health unit for 2 weeks; 1 day ago, enoxaparin was begun for a new left leg deep venous thrombosis. Recent antibiotic therapy for a urinary tract infection; candidal vulvitis followed and was treated with topical clotrimazole. Has penicillin allergy.

The population of elderly nursing home residents who have dementia has been steadily increasing. It is not unusual to be called early in these patients’ course, day or night, and be asked to prescribe something for agitation-triggered by strange new surroundings and people. Nearly 1 in 5 new nursing home residents receives an antipsychotic drug within 100 days of arrival.1 Does this “typical” practice have a downside?

An important study demonstrated the efficacy of chlorthalidone for the treatmentof systolic hypertension in elderly persons,1 and the results have been validatedby other studies.

In plombage therapy for pulmonary TB, polymerized methyl methacrylate, or Lucite, balls were inserted into the chest to collapse the lung and to maintain adequate thoracic expansion.

A 92-year-old woman presents with sharp abdominal pain of 1 day's duration, accompanied by 1 episode of emesis. The pain is neither relieved nor exacerbated by food ingestion.

After a family argument, an 83-year-old woman experienced chest pain, a "racing heart," and a choking sensation and was brought to the emergency department. The chest pain lasted 10 to 15 minutes; was sharp, substernal, and nonradiating; and was associated with dyspnea and a bout of emesis. A sublingual nitroglycerin tablet partially alleviated the pain, but the patient felt syncopal. Her symptoms persisted despite the administration of supplemental oxygen and a second sublingual nitroglycerin tablet. The patient had a history of gastroesophageal reflux disease, allergic rhinitis, and osteoarthritis. Her oral medications included esomeprazole (40 mg/d), aspirin (81 mg/d), and fluticasone nasal spray. She had discontinued valdecoxib 3 weeks earlier.

Dull, intermittent, midepigastric abdominal pain of 1 day's duration prompted a 73-year-old man to seek medical attention. He had no other symptoms.

A 71-year-old man complains of left elbow pain that increases with movement and has worsened over the past 12 hours. He has also had a cough with sputum production for the past several days.

An 81-year-old woman with a history of moderate Alzheimer dementia, depression, coronary artery disease, hypertension, and type 2 diabetes mellitus was accompanied to the office by her son for a routine follow-up appointment.

DUNDEE, Scotland -- A five-month course of the ACE inhibitor perindopril (Aceon) was equivalent to six months of exercise training for elderly patients with mobility problems, researchers here found.

A comatose 82-year-old woman is brought to the emergency department. Her husband reports that after dinner she began to have difficulty in speaking, lost consciousness, and fell to the floor. He tried to rouse her, but was unsuccessful and called for an ambulance.

An 89-year-old man reported that this lesion began developing on his left forearm 11 days earlier. It is a keratoacanthoma, a rapidly growing but benign neoplasm that occurs predominantly on the extensor surfaces of the hands and forearms of white men over age 50.

SALT LAKE CITY -- Forecasts that physician-assisted suicide and euthanasia would be practiced disproportionately on vulnerable groups, such as the poor, the elderly, and women, did not prove accurate, according to researchers here.

One morning, an 83-year-old woman woke up to find a gray-colored spot in the central vision of her right eye. The spot was constant, and she could not see through it. She had a history of dry age-related macular degeneration and cataract surgery in both eyes.

Common eye diseases such as glaucoma, cataract, and age-related macular degeneration (ARMD) (Figure) can have significant systemic ramifications. Recent studies have found that these eye diseases may herald the onset of various types of physical and mental impairment, especially in elderly persons.

A number of factors heighten the risk of parasitic infections in elderly persons, who often live in communal settings (eg, nursing homes), where they are more likely to encounter parasites, such as the scabies mite.

I work with frail, elderly patients who generally have few--if any-- living relatives. During their initial physical evaluation, I always ask them if they have any pets.

BIRMINGHAM, England -- Warfarin's stroke prevention benefits extend to the elderly -- without increasing the risk of major bleeds.

ANN ARBOR, Mich. -- Common complaints of aging such as memory problems, falls, or incontinence may be overlooked by clinicians focused on chronic diseases, found investigators here.

A 77-year-old man complains of deep, aching pain of several months' duration in his left thigh that is exacerbated by both standing and walking.

Drugs may confer serious risks along with substantial therapeutic benefits. The aging of the population and the trend toward increased outpatient drug use-and hence the likely rise in adverse events-underscore the need for ongoing surveillance of outpatient drug safety.

NEW ORLEANS -- Almost two years after Hurricane Katrina ravaged this city, a grand jury here refused to indict Anna M. Pou, M.D., in the deaths of four elderly patients at Memorial Medical Center.