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.
Heart Failure: Part 1, Diagnosis and Staging
July 1st 2007Heart failure is prevalent in both primary care and cardiology practices. It develops in about 1 in 5 persons during their lifetime and in about 1 in 8 of those who have not sustained a myocardial infarction (MI). Heart failure is also the leading cause of hospitalization in the elderly.
Penile Cancer: Squamous Cell Carcinoma In Situ
July 1st 2007An 82-year-old man is seen for annual physical examination in the nursing home. He has resided there for 1 year because of the aggregate impact of multiple medical problems including, most prominently, laryngeal swallowing dysfunction associated with vocal cord paralysis.
Candidiasis, Onychomycosis, and Tinea
June 1st 2007Maceration or scale between isolated web spaces of the fingers suggests erosio interdigitalis blastomycetica (interdigital candidiasis). It most often occurs in the web space between the middle and ring fingers; sometimes the toes are affected. Erosio can spread and can be painful.
Elderly Drivers: When Is It Time to Take the Keys Away?
January 1st 2007A 78-year-old widower with hypertension, type 2 diabetes, and hyperlipidemiais referred for a comprehensive geriatric assessment.His daughter is concerned about her father’s decline following her mother’s death a year ago.His memory seems to be deteriorating. His desk is cluttered with bills, but he refuses to lethis daughter help him or even look at his checkbook.
Malnourished Elderly Woman With Worsening Anemia
January 1st 2007An 83-year-old woman is hospitalized for treatment of deep venous thrombosisin her left leg. She underwent left hip replacement surgery 2 months earlier.At that time, mild anemia (hemoglobin level, 10 g/dL) was noted, and iron therapywas initiated. An iron panel obtained shortly after the hip surgery revealeda serum iron level of 80 μg/dL, a transferrin level of 360 mg/dL, and a ferritinlevel of 50 ng/mL.
What Kind of Exercise Is Good -- or Bad -- for Patients With Hypertension?
January 1st 2007Q:Should hypertensive patients be discouraged from participating inmoderate to vigorous exercise?A:On the contrary, most patients with sustained hypertension should bestrongly encouraged to exercise regularly at moderate to vigorous levels.Randomized controlled clinical trials have demonstrated that increasedphysical activity can lower blood pressure (BP) and delay or prevent the developmentof hypertension and thus the need for antihypertensive medication.1In addition, physical activity can help reduce cardiovascular risk factors by improvinglipid profiles and reducing weight and blood glucose levels. In elderlypersons, exercise is associated with improvements in osteoporosis, depression,and physical functioning, as well as an enhanced sense of well-being.
Cataracts:The Case for Earlier Surgery
January 1st 2007Cataracts areone of themost importantcauses ofreversibleblindness in elderly persons.1 A recent report thatpredicts a surge in cataractincidence has heightenedawareness of the importanceof proper timing andtechniques for cataract extraction.The study, authoredby the Eye DiseasesPrevalence ResearchGroup, estimated that thenumber of Americans withcataracts will increase byapproximately 50% in thenext 20 years as the populationages.2 Cataracts werethe leading cause of low vision(less than 20/40 bestcorrected visual acuity inthe better-seeing eye)among whites, blacks, andHispanics.
How to Boost the Accuracy of TB Testing in the Elderly
January 1st 2007It struck me when reading Dr Thomas Petty’s “PulmonaryQ&A” on when to treat latent tuberculosis (TB) infections(CONSULTANT, January 2003, page 48) that it is importantto remind clinicians how misleading tuberculin testingin the elderly can be if the 2-step testing procedure is notfollowed.
Updated Criteria for Inappropriate Medication Use in Elderly Persons
January 1st 2007A consensus panel of experts recently updated the Beerscriteria, one of the most widely used guidelines for medicationuse in older adults.1 Listed in the Table are medicationsthat should generally be avoided in persons aged 65and older-regardless of diagnosis or condition-eitherbecause the agents are ineffective in these patients or becausethey pose unnecessarily high risks.
Cholesterol Lowering and Cancer: A Connection?
January 1st 2007In his "Consultations & Comments" response to a reader’scomments about statins and cancer risk in elderly patients(CONSULTANT, October 2003, page 1389), Dr David Nashnotes that the increased number of deaths from cancer thatoccurred in the second year of the Pravastatin in Elderly Individualsat Risk of Vascular Disease (PROSPER) study canprobably be attributed to disease that was already present beforethe start of the trial.