Geriatrics

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Dry eye is the most common cause for chronic eye irritation in the patient over age 50 years and is multifactorial in etiology. Whatever the etiology, the final common pathway is loss of water from the tear film, with an increase in tear film osmolarity. Patients with dry eye experience sandy-gritty irritation, dryness, burning, or increased awareness of their eyes that gets worse as the day goes on. These patients need to be distinguished from patients with posterior blepharitis, or meibomitis, in which similar symptoms are worse on eye opening...

Hyperglycemia is commonly noted yet undertreated among hospitalized patients. Older adults are particularly susceptible to the adverse effects of elevated glucose because of hyperglycemia-induced immune defects coupled with age-associated immune senescence. Although the American Diabetes Association (ADA) recommends maintaining fasting blood glucose (FBG) levels below 126 mg/dL and random glucose levels below 200 mg/dL in patients on general medical wards, there is limited evidence to support these targets since the recommendations are not based on randomized, controlled trials...

Diabetes is a complex chronic disease that affects approximately 25% of people above the age of 60 in the United States. This poses a significant challenge to primary care physicians to provide optimal treatment plans to improve metabolic control and to minimize debilitating complications. This article provides a summary of the recent guideline published by the Institute for Clinical Systems Improvement (ICSI) for the Diagnosis and Management of Type 2 Diabetes Mellitus in Adults. The purpose of this guideline is to provide a comprehensive approach to the diagnosis and management of prediabetes and type 2 diabetes in adults...

As the enormous task of finding good and affordable care for the aging population looms in our society's immediate future, home-health and medical-care-at-home research may help to allocate resources for the elderly and the disabled. Home health care continues to be one of Medicare's most popular services. Study results support that home health care services preserve function for homebound patients with disabilities. When clinicians join the traditional home health care team, "medical care at home" is created...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Cataract surgery with intraocular lens implantation is the most frequently performed operation in the Medicare Part B population. Such patients will seek the advice of their primary care practitioner, and the safety of the procedure may depend on the information the practitioner provides to the surgeon and anesthesia team. This article reviews pertinent issues surrounding the decision to operate; how various intraocular lens implants are selected; how surgery is now performed; postoperative complications, activities, and care; the role of the primary care physician; and the issue of medical clearance for this procedure...

Antipsychotic medications have a modest effect on the neuropsychiatric symptoms of dementia, but product labels warn of the excess risk of death and morbidity associated with their use in older patients. As such, these agents should not be the first choice for the treatment of behavioral and psychotic symptoms of dementia. Nevertheless, a trial of these agents may be indicated in instances in which the severity of symptoms is extreme, or symptoms do not respond to nonpharmacologic methods or other medications...

There are many factors that can reduce the rates of rehospitalization, including transition or discharge coaches who work with the patient before, during, and after the discharge; better collaboration between hospitals and physicians to improve promptness and reliability of follow-up care; and earlier medical follow-up after surgical procedures.

The neuropsychiatric symptoms of dementia can lead to a decreased quality of life, rapid cognitive decline, early patient institutionalization, tremendous caregiver burden, and increased cost of care. A thorough assessment to evaluate and treat any underlying causes of symptoms is essential. With the lack of an approved drug to treat the neuropsychiatric symptoms of dementia, nonpharmacologic interventions take on added importance. Behavioral management, cognitive stimulation therapy, and caregiver and health care staff education have shown the most promise to reduce symptom burden over the long term...

The eyelids, essential to protecting and cleansing the eye, are a common site for a range of disorders affecting older adults. Some of these are benign and some serious, with the most clinically important being suspicious lid lesions that may harbor malignancy and neurologic disorders, as well as structural malpositions that cause poor lid function and may lead to globe damage and visual impairment. The ability to recognize eyelid problems is important, as they often present first to the primary care physician...

A representative case is presented to provide a forum for a brief review of electroconvulsive therapy (ECT), a treatment that remains safe and effective in treating several psychiatric and neuropsychiatric conditions. The history, indications, efficacy, adverse events, treatment course, and aftercare are discussed in order to provide the reader a general introduction to this useful procedure.

Electroconvulsive therapy (ECT) can be both a life-enhancing and life-saving procedure in the elderly. Don't forget to think about recommending ECT in an elderly depressed patient who is suicidal or has failed multiple courses of antidepressants and is doing poorly.

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No abstract text is available yet for this article.

Alzheimer's disease is by far the most common degenerative dementia, followed by dementia caused by cerebrovascular disease, Lewy body dementia, and frontotemporal dementia. These dementia subtypes have more overlapping signs and symptoms than defining ones. However, accurate diagnosis is important as each subtype has unique prognostic and treatment considerations. Key elements of the history, physical exam and diagnostic tests useful in deferential diagnosis of dementia sub-types are reviewed here.

Age-related macular degeneration (ARMD) is the leading cause of legal blindness of Americans over age 65 years. Severe loss of vision is usually due to exudative ARMD, of which there are about 200,000 new cases in the United States annually. Until recently, only a small fraction of patients benefited from treatment, but advances in the early diagnosis of the disease and major developments in therapy have substantially improved the prognosis of patients with ARMD. Because visual loss substantially reduces quality of life, effective management of ARMD will have increasing public health importance as the population ages...

Although falling may seem like a simple event, in reality it is a complex medical issue leading to serious injuries including fractures, lacerations, soft tissue and traumatic brain injuries, and even death. The Nurses Improving Care for Health System Elders (NICHE) guideline for falls prevention in acute care unit was formulated by incorporating recommendations from systematic reviews of the literature and advice from expert consensus. Recommendations include pre-fall risk assessment, utilization of a post-fall assessment tool, follow-up monitoring for 48 hours, and implementation of an individualized, multidisciplinary plan of care to address treatable problems that contributed to the fall and to prevent future falls...

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