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By Marianne De Nobel i'm a physician in the elderly care at an Hospice and in a nursing home, with people with dementia and /or chronic diseases also i'm working in the primary care
Hilaire J Thompson, Wayne C McCormick, Sarah H Kagan
Traumatic brain injury (TBI) is a significant problem in older adults. In persons aged 65 and older, TBI is responsible for more than 80,000 emergency department visits each year; three-quarters of these visits result in hospitalization as a result of the injury. Adults aged 75 and older have the highest rates of TBI-related hospitalization and death. Falls are the leading cause of TBI for older adults (51%), and motor vehicle traffic crashes are second (9%). Older age is known to negatively influence outcome after TBI...
October 2006: Journal of the American Geriatrics Society
Calvin H K Mak, Stephen K H Wong, George K Wong, Stephanie Ng, Kevin K W Wang, Ping Kuen Lam, Wai Sang Poon
Traumatic brain injury in elderly patients is a neglected global disease burden. The main cause is fall, followed by motor vehicle accidents. This review article summarizes different aspects of geriatric traumatic brain injury, including epidemiology, pathology, and effects of comorbidities and pre-injury medications such as antiplatelets and anticoagulants. Functional outcome with or without surgical intervention, cognitive outcome, and psychiatric complications are discussed. Animal models are also reviewed in attempt to explain the relationship of aging and outcome, together with advances in stem cell research...
2012: Current Translational Geriatrics and Experimental Gerontology Reports
Anat Mirelman, Lynn Rochester, Inbal Maidan, Silvia Del Din, Lisa Alcock, Freek Nieuwhof, Marcel Olde Rikkert, Bastiaan R Bloem, Elisa Pelosin, Laura Avanzino, Giovanni Abbruzzese, Kim Dockx, Esther Bekkers, Nir Giladi, Alice Nieuwboer, Jeffrey M Hausdorff
BACKGROUND: Age-associated motor and cognitive deficits increase the risk of falls, a major cause of morbidity and mortality. Because of the significant ramifications of falls, many interventions have been proposed, but few have aimed to prevent falls via an integrated approach targeting both motor and cognitive function. We aimed to test the hypothesis that an intervention combining treadmill training with non-immersive virtual reality (VR) to target both cognitive aspects of safe ambulation and mobility would lead to fewer falls than would treadmill training alone...
September 17, 2016: Lancet
Thomas N Robinson, Jeremy D Walston, Nathan E Brummel, Stacie Deiner, Charles H Brown, Maura Kennedy, Arti Hurria
No abstract text is available yet for this article.
December 2015: Journal of the American College of Surgeons
Judith S L Partridge, Danielle Harari, Jugdeep K Dhesi
The rate of surgical procedures in the older population is rising. Despite surgical, anaesthetic and medical advances, older surgical patients continue to suffer from adverse postoperative outcomes. Comorbidities and reduction in physiological reserve are consistently identified as major predictors of poor postoperative outcome in this population. Frailty can be defined as a lack of physiological reserve seen across multiple organ systems and is an independent predictor of mortality, morbidity and institutionalisation after surgery...
March 2012: Age and Ageing
Frank Buttgereit, Christian Dejaco, Eric L Matteson, Bhaskar Dasgupta
IMPORTANCE: Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are related inflammatory disorders occurring in persons aged 50 years and older. Diagnostic and therapeutic approaches are heterogeneous in clinical practice. OBJECTIVE: To summarize current evidence regarding optimal methods for diagnosing and treating PMR and GCA. EVIDENCE REVIEW: MEDLINE, EMBASE, and Cochrane databases were searched from their inception dates to March 30, 2016...
June 14, 2016: JAMA: the Journal of the American Medical Association
Gary J Kennedy, Jack Castro, Mason Chang, Jaimini Chauhan-James, Manuel Fishman
The mental health needs of older primary care patients are now widely recognized if not widely addressed. The range of behavioral health approaches including co-locating psychiatrists and integrating mental health professionals as care managers into primary care sites is extensive and growing. Nonetheless the primary care provider remains the first line of defense against mental disorders, most commonly depression and anxiety that accompany and exacerbate common physical conditions. The excess, potentially avoidable disability that results from comorbidity makes it imperative that early recognition and evidence based intervention occur...
July 2016: Current Psychiatry Reports
Mark R Jones, Ken P Ehrhardt, Juan G Ripoll, Bharat Sharma, Ira W Padnos, Rachel J Kaye, Alan D Kaye
Pain management in the elderly has increasingly become problematic in the USA as the aged population grows. The proportion of the population over 65 continues to climb and may eclipse 20 % in the next decade. In order to effectively diagnosis and treat these patients, a proper history and physical exam remain essential; pain assessment scales such as the Verbal Descriptor Scales (VDS), the Numerical Rating Scales (NRS), and the Visual Analogue Scales (VAS) often but not always prove beneficial. The conditions most frequently afflicting this population include osteoarthritis, diabetic neuropathy, post-herpetic neuralgia, and lower back pain which include spondylosis and radiculopathies...
April 2016: Current Pain and Headache Reports
Leslie P Scheunemann, Robert M Arnold, Douglas B White
Many patients who develop incapacitating illness have not expressed clear treatment preferences. Therefore, surrogate decision makers are asked to make judgments about what treatment pathway is most consistent with the patient's values. Surrogates often struggle with such decisions. The difficulty arises because answering the seemingly straightforward question, "What do you think the patient would choose?" is emotionally, cognitively, and morally complex. There is little guidance for clinicians to assist families in constructing an authentic picture of the patient's values and applying them to medical decisions, in part because current models of medical decision making treat the surrogate as the expert on the patient's values and the physician as the expert on technical medical considerations...
September 15, 2012: American Journal of Respiratory and Critical Care Medicine
Jodi Halpern, Robert M Arnold
Patients facing medical decisions that will impact quality of life make assumptions about how they will adjust emotionally to living with health declines and disability. Despite abundant research on decision-making, we have no direct research on how accurately patients envision their future well-being and how this influences their decisions. Outside medicine, psychological research on "affective forecasting" consistently shows that people poorly predict their future ability to adapt to adversity. This finding is important for medicine, since many serious health decisions hinge on quality-of-life judgments...
October 2008: Journal of General Internal Medicine
Rebecca L Sudore, Terri R Fried
The traditional objective of advance care planning has been to have patients make treatment decisions in advance so that clinicians can attempt to provide care consistent with their goals. The authors contend that the objective for advance care planning ought to be the preparation of patients and surrogates to participate with clinicians in making the best possible in-the-moment medical decisions. They provide practical steps for clinicians to help patients and surrogate decision makers achieve this objective in the outpatient setting...
August 17, 2010: Annals of Internal Medicine
Yael Schenker, Douglas B White, Robert M Arnold
No abstract text is available yet for this article.
July 2014: JAMA Internal Medicine
R C Oude Voshaar
Benzodiazepines are frequently prescribed for a longer period of time for anxiety disorders and insomnia in spite of the many guidelines to prescribe these drugs only short-term. These guidelines are based on the risk-benefit balance between long-term effectiveness and side effects like addiction, anterograde amnesia, and increased risk on falling (resulting in hip fractures), traffic accidents and even mortality. Also low-dose benzodiazepine use can lead to benzodiazepine dependence. Although initially most attention has been paid to the physical withdrawal syndrome, psychological aspects of benzodiazepine dependence have received more and more attention in the past decades...
June 2012: Tijdschrift Voor Gerontologie en Geriatrie
Craig M Alpert, Michael A Smith, Scott L Hummel, Ellen K Hummel
Evidence-based management has improved long-term survival in patients with heart failure (HF). However, an unintended consequence of increased longevity is that patients with HF are exposed to a greater symptom burden over time. In addition to classic symptoms such as dyspnea and edema, patients with HF frequently suffer additional symptoms such as pain, depression, gastrointestinal distress, and fatigue. In addition to obvious effects on quality of life, untreated symptoms increase clinical events including emergency department visits, hospitalizations, and long-term mortality in a dose-dependent fashion...
September 3, 2016: Heart Failure Reviews
Hylton B Menz, Maria Auhl, Shannon E Munteanu
BACKGROUND: Footwear worn indoors is generally less supportive than outdoor footwear and may increase the risk of falls. OBJECTIVE: To evaluate balance ability and gait patterns in older women while wearing different styles of indoor footwear: a backless slipper and an enclosed slipper designed to optimise balance. METHODS: Older women (n = 30) aged 65-83 years (mean 74.4, SD 5.6) performed a series of laboratory tests of balance ability (postural sway, limits of stability, and tandem walking, measured with the NeuroCom® Balance Master) and gait patterns (walking speed, cadence, and step length, measured with the GAITRite® walkway) while wearing (1) socks, (2) backless slippers with a soft sole, and (3) enclosed slippers with a firm sole and Velcro® fastening...
September 3, 2016: Gerontology
Asim A Shah, Awais Aftab, John Coverdale
Whether or not QTc interval should be routinely monitored in patients receiving antipsychotics is a controversial issue, given logistic and fiscal dilemmas. There is a link between antipsychotic medications and prolongation of QTc interval, which is associated with an increased risk of torsade de pointes (TdP). Our goal is to provide clinically practical guidelines for monitoring QTc intervals in patients being treated with antipsychotics. We provide an overview of the pathophysiology of the QT interval, its relationship to TdP, and a discussion of the QT prolonging effects of antipsychotics...
May 2014: Journal of Psychiatric Practice
John C Woolcott, Kathryn J Richardson, Matthew O Wiens, Bhavini Patel, Judith Marin, Karim M Khan, Carlo A Marra
BACKGROUND: There is increasing recognition that the use of certain medications contributes to falls in seniors. Our objective was to update a previously completed meta-analysis looking at the association of medication use and falling to include relevant drug classes and new studies that have been completed since a previous meta-analysis. METHODS: Studies were identified through a systematic search of English-language articles published from 1996 to 2007. We identified studies that were completed on patients older than 60 years, looking at the association between medication use and falling...
November 23, 2009: Archives of Internal Medicine
Maria Rosaria Muscatello, Edoardo Spina, Borwin Bandelow, David S Baldwin
OBJECTIVE: Certain drugs used in the treatment of patients with anxiety disorders can interact with other psychotropic drugs and with pharmacological treatments for physical illnesses. There is a need for an updated comparative review of clinically relevant drug interactions in this area. DESIGN: Relevant literature on drug interactions with medications used in the treatment of anxiety disorders was identified through a search in MEDLINE and EMBASE. RESULTS: Drug interactions involving medications used to treat anxiety disorders may be pharmacokinetic, such as enzyme inhibition or induction in the cytochrome P450 system and transporter-mediated drug interactions, or pharmacodynamic, such as additive effects in causing drowsiness or additive effects at neurotransmitter receptors...
May 2012: Human Psychopharmacology
Andrew I Geller, Wilawan Nopkhun, Marly N Dows-Martinez, Dale C Strasser
Polypharmacy and inappropriate prescribing practices lead to higher rates of mortality and morbidity, particularly in vulnerable populations, such as the elderly and those with complex medical conditions. Physical medicine and physiatrists face particular challenges given the array of symptoms treated across a spectrum of conditions. This clinical review focuses on polypharmacy and the associated issue of potentially inappropriate prescribing. The article begins with a review of polypharmacy along with relevant aspects of pharmacokinetics and pharmacodynamics in the elderly...
March 2012: PM & R: the Journal of Injury, Function, and Rehabilitation
Cathleen S Colón-Emeric, Heather E Whitson, Juliessa Pavon, Helen Hoenig
Functional disability is common in older adults. It is often episodic and is associated with a high risk of subsequent health decline. The severity of disability is determined by physical impairments caused by underlying medical conditions, and by external factors such as social support, financial support, and the environment. When multiple health conditions are present, they often result in greater disability than expected because the patient's ability to compensate for one problem may be affected by comorbid conditions...
September 15, 2013: American Family Physician
2016-09-29 10:07:17
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