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.
Elderly Woman With Facial Edema and Erythema, and Tattoo on Forearm
September 15th 2005An 87-year-old woman who recently moved to an assisted living facility from her home is seen for evaluation of facial edema and erythema after a bee or wasp sting sustained 2 days earlier. Patient denies pain, pruritus, or visual changes. She took one dose of diphenhydramine shortly after the event and has noticed that the edema, which affected primarily the right side of the face, near the sting, has improved.
Ophthalmic Zoster: Common Manifestation in the Elderly
September 14th 2005Periorbital, forehead, and nasal erythema, crusting, and pain typical of herpes zoster affected a 90-year-old woman. Reactivation of the latent varicella zoster is more common in the elderly and is attributed to impaired immunologic mechanisms.
Remitting Seronegative Symmetric Synovitis With Pitting Edema
September 14th 2005Abrupt onset of symmetric inflammatory arthritis and edema, as seen on the dorsum of this 72-year-old man's hand, is characteristic of remitting seronegative symmetric synovitis with pitting edema-or RS3PE. The work-up of this patient was essentially negative for other types of inflammatory arthritides.
Clinical Consultation: Tai Chi for COPD
September 1st 2005Tai Chi (also known as T'ai Chi Chuan, Taijiquan) is a form of mind-body exercise that has its roots in ancient Chinese martial arts. Throughout Asia, it is often practiced for preventive health, especially among the elderly. In recent years, Tai Chi has become popular in the West among all age groups and has been studied as a therapy for various medical conditions.
Myalgia in the Elderly: Arthritis . . . or Something Else?
September 1st 2005An 82-year-old woman complains that for the past 6 months, she has "not felt like herself." Previously, she was very active and energetic; in fact, 9 months earlier, she had vacationed in Hawaii. It now takes all of her energy just to get out of bed.
How Best to Help Bones in a Woman With Osteoporosis and Lower GI Bleeding
August 1st 2005Is it prudent to prescribe an oral bisphosphonate for an elderly woman with osteoporosis who has had acute hemorrhaging from a lower colonic diverticulum, for which a transfusion of 3 units of packed red blood cells was required?
Elderly Woman With Progressive Eyelid Ptosis
August 1st 2005An 84-year-old woman presents with progressive ptosis of her right upper eyelid and blurred vision in the right eye . The eyelid started to droop 1 month earlier. She denies recent ocular injury or diplopia. Her history includes bilateral pseudophakia and a trabeculectomy.
Elderly Man With Elevated PSA Level
July 1st 2005A 79-year-old man has an elevated prostate-specific antigen (PSA) level(11.3 ng/mL). About 1 month earlier, when he was hospitalized for a seriousurinary tract infection (UTI), his PSA level was 13.3 ng/mL. The more recentlevel was obtained after he received antibiotic therapy for the UTI.
Right-Sided Pain and Rash in an Elderly Man
April 15th 2005An 80-year-old man complains of lancinating pain in his right axilla and chest that began 2 days earlier and has kept him awake at night. He has had no fever, cough, sputum production, dyspnea, or symptoms suggestive of congestive heart failure.
Uncomplicated UTIs in Elderly Patients:
December 1st 2004ABSTRACT: The diagnosis of urinary tract infection (UTI) can be difficult in elderly patients, who may present with vague complaints or atypical symptoms. Office-based urine testing is less sensitive and specific in these patients because they are less likely to have pyuria and more likely to have contaminated specimens than younger adults. Antibiotics used to treat uncomplicated UTIs in the elderly include trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, fosfomycin, nitrofurantoin, cephalosporins, carbenicillin, and trimethoprim. When you select an agent, consider the side-effect profile, cost, bacterial resistance, likelihood of compliance, and the patient's renal function. The optimal duration of treatment of uncomplicated UTIs in elderly women is still a matter of debate. Options for prophylaxis in patients who have recurrent uncomplicated UTIs include estrogen replacement therapy (vaginal or oral) and nitrofurantoin.
Urinary Tract Infections in Elderly Patients:How Best to Diagnose and Treat
October 2nd 2004An 83-year-old woman is brought by her daughter for evaluation becauseof increasing confusion during the past few days. The patienthas early Alzheimer dementia, hypertension, and type 2 diabetes. She takes donepezil, 10 mg/d;lisinopril, 5 mg/d; and glipizide, 5 mg bid. She is unable to bathe and dress herself as well as previously,has been crying for no apparent reason, and has lost her appetite.
The 10 Most Common Prescribing Errors: Tips on Avoiding the Pitfalls
February 1st 2004Numerous factors contribute to the medication errors that kill up to 98,000 patients each year. Unnecessarily high dosages can result in increased side effects with only a small therapeutic benefit, especially in elderly patients. Lack of patient information-such as a history of allergies or adverse drug reactions-is another cause of error and injury. Communication failures include the use of ambiguous abbreviations, misinterpretation of verbal orders, and lack of timely response to a patient's medication-related symptoms. Dosing errors are common in children because of variability in dosage expressions in drug references. Remedies for prescribing errors are described in detail here.
Community-Acquired Pneumonia in the Elderly:
May 1st 2003ABSTRACT: In addition to advanced age, factors such as comorbid illness and debility determine the risk of community- acquired pneumonia (CAP). Many elderly persons do not have the classic symptoms of CAP; instead, they may present with confusion, lethargy, tachypnea, anorexia, or abdominal pain. Even with thorough investigation, an infectious pathogen can be identified in only about half of patients. In addition to the causative organisms for pneumonia in younger adults, elderly persons are at risk for infection with organisms such as Haemophilus influenzae, Staphylococcus aureus, enteric gram-negative bacteria, and anaerobes, and for polymicrobial infection. Prompt empiric treatment is essential. Recommended initial therapy choices include a ß-lactam agent with a macrolide, or an antipneumococcal fluoroquinolone.
Thyroid Disease in the Elderly:
November 1st 2002ABSTRACT: Age-related anatomic and physiologic alterations in the thyroid gland have a variety of clinically important effects. Hypothyroidism, which is common in older persons, raises cholesterol and triglyceride levels; hyperthyroidism may be masked by the severity of the cardiac problems it causes. In younger persons, depression may accompany hypothyroidism but not hyperthyroidism; however, in the elderly, it may be a feature of either condition. Papillary carcinoma-the most common type of thyroid cancer-is more aggressive in older persons. All these factors necessitate a cautious and deliberate approach to the management of thyroid disorders in elderly patients.