MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Clinics in Geriatric Medicine' source. Sat, 31 Dec 2011 14:48:57 +0100 http://www.medworm.com/index.php?rid=5388629&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000735%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388629 Tue, 01 Nov 2011 04:00:00 +0100 5388629 http://www.medworm.com/index.php?rid=5388627&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000498%2Fabstract%3Frss%3Dyes Because fatigue is so prevalent in the elderly (>70%), it is included as a specific topic in this publication on successful aging. It is presented so that the primary care physician may help optimize elderly patients' lives, to maximize their level of function and engagement with life. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388627 Tue, 01 Nov 2011 04:00:00 +0100 5388627 http://www.medworm.com/index.php?rid=5388624&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000462%2Fabstract%3Frss%3Dyes This article explores what is known about how the brain changes in normal aging and discuss more fully 2 important neurodegenerative diseases, Parkinson's disease (PD) and Alzheimer's disease (AD), seen in this aging brain setting. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388624 Tue, 01 Nov 2011 04:00:00 +0100 5388624 http://www.medworm.com/index.php?rid=5388623&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000450%2Fabstract%3Frss%3Dyes Aging is a complex phenomenon, with the interaction of genetics, disease, and environmental exposures. It is a challenge at times to separate the effects of the 3 on the process of aging. However, select epidemiologic studies and a review of aging processes shed light onto environmental toxins as a contributory factor to aging. A good example is the well-known effect of sun-related damage to the skin and premature aging with excessive exposure. Other toxins are ubiquitous in our environment and have shown harmful effects for the aging population in particular. This is owing to toxin damage to the various organ systems which are already in the process of decline owing to physiologic changes of aging. It is not surprising to note that some of the most dangerous toxins are prescription and ov... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388623 Tue, 01 Nov 2011 04:00:00 +0100 5388623 http://www.medworm.com/index.php?rid=5388622&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000449%2Fabstract%3Frss%3Dyes Adult supplement use increases with age, such that nearly half of older adults use some form of vitamin supplement. Energy expenditure falls by 33% between the third and ninth decades of life, and because a lower food consumption invariably is accompanied by lower micronutrient consumption, it makes sense to empirically recommend a daily multivitamin to older persons. However, it is generally only the malnourished elderly patient who benefit from a daily multivitamin supplement. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388622 Tue, 01 Nov 2011 04:00:00 +0100 5388622 http://www.medworm.com/index.php?rid=5388621&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000437%2Fabstract%3Frss%3Dyes Aging is the accumulation of biological changes over time leading to decreased biological functioning and impaired ability to adapt to stressors. Evolving theories on the aging process have been reviewed extensively in the literature and it is well established that the rate of aging is determined by a combination of genetic and environmental factors. It is theorized that chronic disease contributes to the aging process by speeding the rate and accumulation of damaging biological changes. Many interventions that slow the progression of age-related illness also slow the rate of aging. The significant age-related illnesses are cardiovascular disease (CVD), cerebrovascular disease, cancer, age-associated cognitive decline, and musculoskeletal degeneration owing to sarcopenia and osteoporosis. ... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388621 Tue, 01 Nov 2011 04:00:00 +0100 5388621 http://www.medworm.com/index.php?rid=5388620&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000425%2Fabstract%3Frss%3Dyes The first modern description of the effects of testosterone on men was by Dr Charles Brown-Sequard, in 1889 when, upon self-injection of testicular extracts from different animals, he reported increased energy, muscular strength, stamina, and mental agility. Since that time, hundreds of studies have described testosterone's physiologic effects, the declining testosterone levels that occur normally with aging and the physiologic and psychological effects of replacement therapy. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388620 Tue, 01 Nov 2011 04:00:00 +0100 5388620 http://www.medworm.com/index.php?rid=5388619&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000516%2Fabstract%3Frss%3Dyes Geriatric medicine historically has been the domain of sick, frail, old, and aging populations of patients. Therapies for aging patients focus primarily on prolonging life, often at very high emotional and financial cost with little focus on the quality of life the patient experiences. As the proportion of aging people continues to rise, reducing the burden of age-related conditions becomes increasingly important in geriatric care. In addition, as the life expectancy of the population increases, years of disability follow unless comprehensive prevention and treatment of age-related diseases and frailty are addressed. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388619 Tue, 01 Nov 2011 04:00:00 +0100 5388619 http://www.medworm.com/index.php?rid=5388617&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000401%2Fabstract%3Frss%3Dyes A text on successful aging would be incomplete without a discussion of what may, or potentially will, be done to retard, delay and, in general, avoid the pitfalls of aging. This has been a universal human pursuit as far back as we have been sentient and, at this time, science may actually be making some reasoned progress in this direction. Research is now offering real hope in extending lifespan in both qualitative and quantitative terms. Scientific inquiry in aging is growing almost exponentially. For example, a Pubmed search for resveratrol returns 3,751 different papers, while a search for anti-aging medicine returns 1,989 results. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388617 Tue, 01 Nov 2011 04:00:00 +0100 5388617 http://www.medworm.com/index.php?rid=5388615&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000632%2Fabstract%3Frss%3Dyes Research in the field of “successful aging” has increased dramatically in the last few decades. As a result, the public's awareness and interest in this area have been heightened. Today, more than ever, our patients are looking to us to serve as information analysts—to help them wade through the ever-rising sea of health information and misinformation that is widely distributed on the internet and available via the lay press. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388615 Tue, 01 Nov 2011 04:00:00 +0100 5388615 http://www.medworm.com/index.php?rid=5388614&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000723%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388614 Tue, 01 Nov 2011 04:00:00 +0100 5388614 http://www.medworm.com/index.php?rid=5388613&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000711%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388613 Tue, 01 Nov 2011 04:00:00 +0100 5388613 http://www.medworm.com/index.php?rid=5388612&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS074906901100070X%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388612 Tue, 01 Nov 2011 04:00:00 +0100 5388612 http://www.medworm.com/index.php?rid=5388625&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000474%2Fabstract%3Frss%3Dyes How old would you be if you didn't know how old you were?—Satchel Paige Aging is often portrayed as a decline into physical limitation and psychological misery. Although aging presents challenges, advances in biopsychosocial care are extending the active and vital portion of the lifespan. Individual physical, social, and psychological factors impact the rate at which “old age” is “felt,” leaving age alone as a largely nonspecific indicator of a person's physical, cognitive, and psychological status. On the one hand, for individuals who age with good health, the “young” old period, which is defined from the late-50s to mid-70s is, in large part, an extension of psychological middle age. Frailty/poor health in this age group is, on the other hand, associated with significant d... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388625 Mon, 26 Sep 2011 04:00:00 +0100 5388625 http://www.medworm.com/index.php?rid=5388618&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000413%2Fabstract%3Frss%3Dyes The geriatric population in the United States, defined as individuals ≥65 years of age, is increasing in size. Between 1989 and 2010, it rose from 25 to 40 million. It is expected to grow to almost 90 million in 2050. The leading causes of death among this population include cardiovascular disease, cancer, diabetes, vaccine-preventable diseases, and unintentional injury. Morbidity and mortality from these causes can be improved by primary, secondary, and tertiary prevention efforts. As such, this article presents an evidence-based review of prevention modalities for common diseases in the elderly. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388618 Fri, 23 Sep 2011 04:00:00 +0100 5388618 http://www.medworm.com/index.php?rid=5388616&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000395%2Fabstract%3Frss%3Dyes Several theories may explain the normal aging process, either alone or in combination with other theories (). These theories can be generally classified into evolutionary, involving historical and evolutionary aspects of aging, and physiologic or structural and functional changes. Processes that may explain these theories at a cellular level include intrinsic timing mechanisms and signals, accidental chance events, programmed genetic signals making an organism more susceptible to accidental events, nuclear or mitochondrial DNA mutations or damage, damaged and abnormal proteins, cross-linkage, glycation, waste accumulation, general molecular wear and tear, free radical formation, and specific cellular components such as gene, chromosome, mitochondria, or telomeres. Physiologic processes tha... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388616 Fri, 23 Sep 2011 04:00:00 +0100 5388616 http://www.medworm.com/index.php?rid=5388628&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000504%2Fabstract%3Frss%3Dyes Now that the definitions and treatments of recent, prolonged, chronic, and idiopathic fatigue have been presented, one must ask how useful these definitions are in clinical practice. Although it is important to know the data and definitions as presented, the arbitrary time frames of the definitions (1 month for recent fatigue, less than 6 months for prolonged fatigue, greater than 6 months for chronic fatigue) are less useful in the initial clinical setting. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388628 Mon, 12 Sep 2011 04:00:00 +0100 5388628 http://www.medworm.com/index.php?rid=5388626&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000486%2Fabstract%3Frss%3Dyes Aging is a complex process that involves the interaction of both physiologic and behavioral factors. Generally, as people grow older, the basal metabolic rate slows; blood pressure increases; and there is a decrease in maximum heart rate, cardiac output, maximal oxygen consumption, and overall muscle mass. Other changes that can occur include a decline in cognitive function, reduced lung compliance, and decreased bone mass. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5388626 Mon, 12 Sep 2011 04:00:00 +0100 5388626 http://www.medworm.com/index.php?rid=5110528&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000590%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110528 Sun, 31 Jul 2011 23:00:00 +0100 5110528 http://www.medworm.com/index.php?rid=5110524&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000206%2Fabstract%3Frss%3Dyes Four body composition phenotypes exist in older adults: normal, sarcopenic, obese, and a combination of sarcopenic and obese. There is no consensus, however, on the definitions and classifications of these phenotypes and their etiology and consequences continue to be debated. The lack of standard definitions, particularly for sarcopenia and sarcopenic obesity, creates challenges for determining prevalence across different populations. The etiology of these phenotypes is multifactorial with complex covariate relationships. This review focuses on the current literature addressing the classification, prevalence, etiology, and correlates of sarcopenia, obesity, and the combination of sarcopenia and obesity, referred to as sarcopenic obesity. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110524 Sun, 31 Jul 2011 23:00:00 +0100 5110524 http://www.medworm.com/index.php?rid=5110522&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000188%2Fabstract%3Frss%3Dyes The etiology of sarcopenia is multifactorial but still poorly understood, and the sequelae of this phenomenon represent a major public health issue. Age-related loss of muscle mass can be counteracted by adequate metabolic interventions including nutritional intake and exercise training. Other strategies including changes in daily protein pattern, the speed of protein digestion, or specific amino acid supplementation may be beneficial to improve short-term muscle anabolic response in elderly people. A multimodal approach combining nutrition, exercise, hormones, and specific anabolic drugs may be an innovative treatment for limiting the development of sarcopenia with aging. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110522 Sun, 31 Jul 2011 23:00:00 +0100 5110522 http://www.medworm.com/index.php?rid=5110517&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000589%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110517 Sun, 31 Jul 2011 23:00:00 +0100 5110517 http://www.medworm.com/index.php?rid=5110516&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000577%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110516 Sun, 31 Jul 2011 23:00:00 +0100 5110516 http://www.medworm.com/index.php?rid=5110515&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000565%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110515 Sun, 31 Jul 2011 23:00:00 +0100 5110515 http://www.medworm.com/index.php?rid=5110527&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000231%2Fabstract%3Frss%3Dyes This article further develops issues on sarcopenia definition, target population, primary and secondary end points, duration of the trials, muscle mass assessment, strength and physical performance assessment, and control of possible confounders. The challenges to conduct phase 3 trials in the elderly should not offset the opportunities for the development of new strategies to counteract sarcopenia and prevent late-life disability. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110527 Sun, 05 Jun 2011 23:00:00 +0100 5110527 http://www.medworm.com/index.php?rid=5110520&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000255%2Fabstract%3Frss%3Dyes The definition of sarcopenia has been thoroughly discussed by scientific stakeholders and industry representatives to increase the clinical applicability of the concept. The pooled consensus from 3 of 5 recent and parallel processes, of which 2 are pending, is that sarcopenia is mainly, but not only, an age-related condition defined by the combined presence of reduced muscle mass and muscle function. Contributing factors to sarcopenia are senescence, chronic disease, physical inactivity, and poor food intake. Cachexia may be considered as one etiologic pathway of an accelerated sarcopenia. The adjusted and extended definitions of sarcopenia promote the clinical use of the concept. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110520 Sun, 05 Jun 2011 23:00:00 +0100 5110520 http://www.medworm.com/index.php?rid=5110519&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000164%2Fabstract%3Frss%3Dyes To a considerable extent, the advent of the term sarcopenia has contributed to the focus on this important condition and its effects on the quality of life and care of older persons. It is hoped that the advances in our understanding of the etiology and treatment of sarcopenia will further contribute to placing this diagnosis and treatment at a higher priority in the management of older persons and prevention of disability. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110519 Sun, 05 Jun 2011 23:00:00 +0100 5110519 http://www.medworm.com/index.php?rid=5110518&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000371%2Fabstract%3Frss%3Dyes Sarcopenia, a progressive reduction in skeletal muscle mass, strength, and quality, is often observed with aging. This condition is one of the main factors that contribute to frailty in older adults. During the past 10 years, sarcopenia has received growing attention by both clinicians and researchers. Indeed, it results in poor physical performances, decreased endurance and resistance capacity, and increased risk of falls and fractures that all contribute to the loss of independence. Sarcopenia also has a deleterious effect on metabolism related to the changes in body composition. Compared to other changes of body composition observed during aging, such as obesity or osteoporosis, sarcopenia was only recently defined but has now emerged as a major public health problem. (Source: Clinics i... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110518 Sun, 05 Jun 2011 23:00:00 +0100 5110518 http://www.medworm.com/index.php?rid=5110526&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS074906901100022X%2Fabstract%3Frss%3Dyes This article presents an overview of current knowledge of the effects of physical training on muscle function and the physical activity recommended for sarcopenic patients. So that this countermeasure strategy can be applied in practice, the authors propose a standardized protocol for prescribing physical activity in chronic diseases such as sarcopenia. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110526 Sun, 15 May 2011 23:00:00 +0100 5110526 http://www.medworm.com/index.php?rid=5110525&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000218%2Fabstract%3Frss%3Dyes This article reviews the new pharmacologic agents currently being assessed for treating sarcopenia. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110525 Sun, 15 May 2011 23:00:00 +0100 5110525 http://www.medworm.com/index.php?rid=5110523&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS074906901100019X%2Fabstract%3Frss%3Dyes This article describes the relationship of sarcopenia and dynapenia with three important outcomes in aging research: functional status, falls, and mortality. The data from epidemiologic studies conducted in large samples of older men and women suggest that muscle functioning, as indicated by muscle strength or muscle power, has a strong impact on functional status, falls, and mortality. Furthermore, there is evidence that the relationship between poor muscle strength and these three different outcomes is not influenced by muscle size. For the prevention of functional decline, falls, and early mortality in older men and women a major focus on maintaining or increasing muscle strength instead of muscle size seems warranted. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110523 Sun, 15 May 2011 23:00:00 +0100 5110523 http://www.medworm.com/index.php?rid=5110521&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000176%2Fabstract%3Frss%3Dyes The term sarcopenia was coined in 1989 and refers to the age-related loss in skeletal muscle mass. Operational definitions of sarcopenia have been used in research studies to identify older persons with healthy muscle mass values (normal) and older adults with unacceptably low muscle mass values (sarcopenic). Despite the enormous research on sarcopenia that has been completed in the past 20 years, sarcopenia currently receives little attention in the clinical setting. To address this issue, the European Working Group on Sarcopenia in Older People recently developed a consensus definition of sarcopenia. The availability of a consensus definition may assist with the integration of sarcopenia into mainstream geriatric assessment. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=5110521 Sun, 15 May 2011 23:00:00 +0100 5110521 http://www.medworm.com/index.php?rid=4914579&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000334%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914579 Sat, 30 Apr 2011 23:00:00 +0100 4914579 http://www.medworm.com/index.php?rid=4914578&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000243%2Fabstract%3Frss%3Dyes This article describes the range of cancer patients in longterm care and provides a framework for clinical decision making. The benefits and burdens of providing standard therapy to a vulnerable population are discussed. To give more specific guidelines for advocates of treatment, skeptics, and others, the authors present best estimates of the current burden of cancer in the long-term care population and current screening guidelines that apply to the elderly under long-term care. Experience-based suggestions are offered for oncologists and clinicians involved in long-term care to help them respond to patient and family concerns about limitations of cancer care. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914578 Sat, 30 Apr 2011 23:00:00 +0100 4914578 http://www.medworm.com/index.php?rid=4914577&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000127%2Fabstract%3Frss%3Dyes This article conveys the need to prepare for the inclusion of the growing aging population with I/DD into long-term care with the general elderly population in the near future. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914577 Sat, 30 Apr 2011 23:00:00 +0100 4914577 http://www.medworm.com/index.php?rid=4914574&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000103%2Fabstract%3Frss%3Dyes This article reviews the significance, risk factors, pathophysiology, prevention, diagnosis, and management of pressure ulcers in long-term care. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914574 Sat, 30 Apr 2011 23:00:00 +0100 4914574 http://www.medworm.com/index.php?rid=4914568&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000036%2Fabstract%3Frss%3Dyes This article addresses the following topics on palliative care for patients with dementia in long-term care: (1) transitions of care, (2) infections, other comorbidities, and decisions on hospitalization, (3) prognostication, (4) the evidence for and against tube feeding, (5) discussing goals of care with families/surrogate decision makers, (6) types of palliative care programs, (7) pain assessment and management, and (8) optimizing function and quality of life for residents with advanced dementia. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914568 Sat, 30 Apr 2011 23:00:00 +0100 4914568 http://www.medworm.com/index.php?rid=4914566&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000097%2Fabstract%3Frss%3Dyes This article provides an overview of the epidemiology, pathophysiology, diagnostic challenges, and management recommendations for pneumonia in this setting. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914566 Sat, 30 Apr 2011 23:00:00 +0100 4914566 http://www.medworm.com/index.php?rid=4914564&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000322%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914564 Sat, 30 Apr 2011 23:00:00 +0100 4914564 http://www.medworm.com/index.php?rid=4914563&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000310%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914563 Sat, 30 Apr 2011 23:00:00 +0100 4914563 http://www.medworm.com/index.php?rid=4914562&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000309%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914562 Sat, 30 Apr 2011 23:00:00 +0100 4914562 http://www.medworm.com/index.php?rid=4914576&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000115%2Fabstract%3Frss%3Dyes This article reveals the deleterious impact that cultural assumptions about dementia have on the care provided, and, through an exploration of anthropological theories of personhood, suggests strategies for seeking improved quality of life through personhood-centered care. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914576 Sun, 17 Apr 2011 23:00:00 +0100 4914576 http://www.medworm.com/index.php?rid=4914575&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000139%2Fabstract%3Frss%3Dyes This article reviews the literature on transitional care to and from the LTC environment, highlighting strategies to improve the quality of care transitions. Several factors are vital in the improvement of systems of care dealing with transitions. Key factors include communication with and among health care providers, effective medication reconciliation, advanced discharge planning, and timely use of palliative care. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914575 Wed, 13 Apr 2011 23:00:00 +0100 4914575 http://www.medworm.com/index.php?rid=4914573&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000085%2Fabstract%3Frss%3Dyes Urinary tract infection (UTI) is common in long-term care (LTC) residents; however, most infections are asymptomatic and do not require treatment. Differentiating asymptomatic from symptomatic UTI is challenging, because LTC residents typically have chronic genitourinary complaints, multiple comorbid illnesses, and communication barriers. Although consensus guidelines have been proposed to improve the accuracy of identifying symptomatic UTIs and minimize treatment of asymptomatic UTIs, diagnostic accuracy is not yet optimized. Strategies for prevention of UTI are unsatisfactory and require further study; nevertheless, there is some evidence for the efficacy of cranberry products and vaginal estrogen to prevent recurrent UTI in women. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914573 Sun, 03 Apr 2011 23:00:00 +0100 4914573 http://www.medworm.com/index.php?rid=4914567&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000024%2Fabstract%3Frss%3Dyes This article covers the following topics on caring for patients with dementia in long-term care: (1) the efficacy of cholinesterase inhibitors and memantine, (2) the optimal environment for maintenance of function in moderate dementia, (3) the treatment of depression and agitation, and (4) the evaluation and management of eating problems. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914567 Sun, 03 Apr 2011 23:00:00 +0100 4914567 http://www.medworm.com/index.php?rid=4914571&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000061%2Fabstract%3Frss%3Dyes Since the advent of the teaching nursing home, made formal in the 1980s, long-term care has been used to teach geriatric medicine. Despite this, national surveys have indicated a need for more training during residency to facilitate the appropriate care for the frail long-term care patient population. In addition to medical knowledge, the long-term care site is appropriate for teaching the Accreditation Council of Graduate Medical Education’s core competencies of “practice-based learning and improvement,” “interpersonal and communication skills,” and “systems-based practice.” Program planners should emphasize opportunities for students to demonstrate their skill in one of these competencies. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914571 Sun, 27 Mar 2011 23:00:00 +0100 4914571 http://www.medworm.com/index.php?rid=4914570&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS074906901100005X%2Fabstract%3Frss%3Dyes This article briefly introduces the concept of EBM; addresses some potential benefits, harms, and challenges of practicing EBM in long-term care settings; and promotes EBM and its appropriate use among long-term care providers. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914570 Sun, 27 Mar 2011 23:00:00 +0100 4914570 http://www.medworm.com/index.php?rid=4914569&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000048%2Fabstract%3Frss%3Dyes This article describes the increasing awareness of potentially inappropriate prescribing in the long-term care setting and reviews the rationale for why various types of medications are deemed inappropriate, with a focus on agents that affect central nervous system functioning. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914569 Sun, 27 Mar 2011 23:00:00 +0100 4914569 http://www.medworm.com/index.php?rid=4914565&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000152%2Fabstract%3Frss%3Dyes The word “doctor” has its origins in the Latin doctoris, which means teacher. Within the specialty of Geriatric Medicine, we are fortunate to have a means to specifically foster and support the careers of teachers who also care for one of our most vulnerable populations. In this issue of Clinics in Geriatric Medicine, we have deliberately sought out those teachers whose passions lie in the care of the frailest elders, and who have a shared passion to teach the next generation of health care professionals to do the same. Many of the authors in this issue of Clinics in Geriatric Medicine are, or have been in the past, recipients of Geriatric Academic Career Awards (GACA), which are administered by the US Department of Health and Human Services, Health Resources, and Services Administra... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914565 Fri, 25 Mar 2011 00:00:00 +0100 4914565 http://www.medworm.com/index.php?rid=4914572&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069011000073%2Fabstract%3Frss%3Dyes This article reviews the frequency and management of nonpain symptoms in the long-term care setting, particularly focusing on patients at the end of life. Although the long-term care setting presents challenges to effective management, an approach for addressing these challenges is discussed and applied to 3 commonly encountered nonpain symptoms. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4914572 Wed, 16 Mar 2011 00:00:00 +0100 4914572 http://www.medworm.com/index.php?rid=4184524&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010001059%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184524 Sat, 20 Nov 2010 06:15:49 +0100 4184524 http://www.medworm.com/index.php?rid=4184523&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000753%2Fabstract%3Frss%3Dyes This article reviews the literature investigating the utility of aerobic and resistance exercise training as an intervention for frailty in older adults. In addition, areas of future research are addressed, including concerns related to the dissemination of exercise interventions on a widespread scale. Guidelines for an “exercise prescription” for frail older adults are briefly outlined. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184523 Sat, 20 Nov 2010 06:15:48 +0100 4184523 http://www.medworm.com/index.php?rid=4184522&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000819%2Fabstract%3Frss%3Dyes This article reviews the clinical spectrum of frailty in older adults, its biologic etiology, and potential clinical interventions. Several operational definitions of frailty and the associated clinical signs, symptoms, and outcomes are outlined. The biologic mechanisms hypothesized to underlie frailty are explored, particularly in the musculoskeletal, endocrine, and immune systems. Treatment options for frail, older adults are discussed, including physiologic system-targeted interventions and geriatric models of care. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184522 Sat, 20 Nov 2010 06:15:48 +0100 4184522 http://www.medworm.com/index.php?rid=4184521&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000765%2Fabstract%3Frss%3Dyes Frailty is an important geriatric syndrome characterized by multisystem dysregulation. Substantial evidence suggests heightened inflammatory state and significant immune system alterations in frailty. A heightened inflammatory state is marked by increases in levels of inflammatory molecules (interleukin 6 and C-reactive protein) and counts of white blood cell and its subpopulations, which may play an important role in the pathogenesis of frailty, directly or through its detrimental influence on other physiologic systems. Alterations in the innate immune system include decreased proliferation of the peripheral blood mononuclear cells and upregulated monocytic expression of specific stress-responsive inflammatory pathway genes. In the adaptive immune system, although little information is av... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184521 Sat, 20 Nov 2010 06:15:48 +0100 4184521 http://www.medworm.com/index.php?rid=4184520&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000790%2Fabstract%3Frss%3Dyes This article reviews the problem of anemia in older adults, with a particular emphasis on the frail elderly. The gaps in the evidence base for the treatment of anemia in older adults are reviewed and the options for advancing the field are assessed. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184520 Sat, 20 Nov 2010 06:15:48 +0100 4184520 http://www.medworm.com/index.php?rid=4184519&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000789%2Fabstract%3Frss%3Dyes Over the last few decades, the understanding of the renin-angiotensin system (RAS) has advanced dramatically. RAS is now thought to play a crucial role in physiologic and pathophysiologic mechanisms in almost every organ system and is a key regulator of hypertension, cardiovascular disease, and renal function. Angiotensin II (Ang II) promotes inflammation and the generation of reactive oxygen species and governs onset and progression of vascular senescence, which are all associated with functional and structural changes, contributing to age-related diseases. Although the vast majority of the actions of Ang II, including vascular senescence, are mediated by the Ang II type 1 receptor (AT1R), the identification, characterization, and cloning of the angiotensin type 2 receptor has focused att... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184519 Sat, 20 Nov 2010 06:15:48 +0100 4184519 http://www.medworm.com/index.php?rid=4184518&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000777%2Fabstract%3Frss%3Dyes This article describes known associations among frailty and chronic diseases and introduces punished inefficiency as an explanatory framework for frailty. Punished inefficiency proposes that having several physiologic impairments leads to physiologic inefficiencies. These inefficiencies may become manifest as frailty, often in the presence of disease. Therefore, frail older adults perform less external work because they must spend more on an absolute scale out of a smaller pool of internal resources. Stress imposed on frail older adults strengthens this negative feedback to activity, leading to disuse. This article discusses how people with frailty and chronic diseases may experience a malignant course and thereby intends to improve the ability to identify beneficial biologic and health ca... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184518 Sat, 20 Nov 2010 06:15:46 +0100 4184518 http://www.medworm.com/index.php?rid=4184517&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000807%2Fabstract%3Frss%3Dyes In developing and validating the concept of frailty as a geriatric syndrome, it has been necessary to distinguish the clinical expression of frailty from normal age-related changes and other age-related disease pathologies. A framework for excluding potentially confounding disease and a working clinical tool to diagnose frailty have been provided. The associations between frailty and other pathophysiologies has also been shown. However, investigating the underlying biologic basis for the geriatric syndrome of frailty by studying basic homeostatic pathways and mechanisms has not proceeded at the same rate. The following article provides an overview of the homeostatic pathways emphasized in research on aging and explains how this science may help to stimulate frailty research. (Source: Clini... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184517 Sat, 20 Nov 2010 06:15:46 +0100 4184517 http://www.medworm.com/index.php?rid=4184516&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000820%2Fabstract%3Frss%3Dyes As nonreplicative cells age, they commonly accumulate subcellular deficits that can compromise function. As people age, they too experience problems that can accumulate. As deficits (symptoms, signs, illnesses, disabilities) accumulate, people become more susceptible to adverse health outcomes, including worse health and even death. This state of increased risk of adverse health outcomes is indistinguishable from the idea of frailty, so deficit accumulation represents another way to define frailty. Counting deficits not only allows grades of frailty to be discerned but also provides insights into the complex problems of older adults. This process is potentially useful to geriatricians who need to be experts in managing complexity. A key to managing complexity is through instruments such as... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184516 Sat, 20 Nov 2010 06:15:46 +0100 4184516 http://www.medworm.com/index.php?rid=4184515&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000832%2Fabstract%3Frss%3Dyes This article reviews the current state of knowledge regarding the epidemiology of frailty by focusing on 6 specific areas: (1) clinical definitions of frailty, (2) evidence of frailty as a medical syndrome, (3) prevalence and incidence of frailty by age, gender, race, and ethnicity, (4) transitions between discrete frailty states, (5) natural history of manifestations of frailty criteria, and (6) behavior modifications as precursors to the development of clinical frailty. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184515 Sat, 20 Nov 2010 06:15:46 +0100 4184515 http://www.medworm.com/index.php?rid=4184514&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000844%2Fabstract%3Frss%3Dyes As the population ages and more individuals are living well past age 80, maintaining a functional, independent, and high-quality life in the community will be an increasingly important goal for older adults and for society in general. Frailty is a syndrome of late-life decline and vulnerability that serves as a warning sign for adverse health outcomes and for mortality. The identification of vulnerable, frail, adults may allow for the development of preventive interventions that help to maintain good health and high quality of life well into the 8th and 9th decade of life. Over the past several years, investigators from across the country have been attempting to better define frailty through describing its clinical and biological characteristics. A number of clinical screening tools have b... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184514 Sat, 20 Nov 2010 06:15:46 +0100 4184514 http://www.medworm.com/index.php?rid=4184513&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010001047%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184513 Sat, 20 Nov 2010 06:15:46 +0100 4184513 http://www.medworm.com/index.php?rid=4184512&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010001035%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184512 Sat, 20 Nov 2010 06:15:46 +0100 4184512 http://www.medworm.com/index.php?rid=4184511&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010001023%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=4184511 Sat, 20 Nov 2010 06:15:46 +0100 4184511 http://www.medworm.com/index.php?rid=3846568&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000637%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846568 Sat, 31 Jul 2010 23:00:00 +0100 3846568 http://www.medworm.com/index.php?rid=3846567&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000352%2Fabstract%3Frss%3Dyes Osteoarthritis of the hip and knee is extremely common in the growing elderly population. Total joint replacement (TJR) of the hip and knee are extremely effective procedures, resulting in decreased pain and improved function and quality of life in patients of all age groups including the elderly. The prevalence and use of TJR is increasing at a significant rate, therefore increased awareness of perioperative issues following TJR among health care providers is of paramount importance. Although elderly patients may be slightly more susceptible to perioperative complications, long-term success rates remain high, and careful perioperative monitoring and preventative measures have resulted in high rates of patient safety and few adverse outcomes in the elderly. (Source: Clinics in Geriatric Me... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846567 Sat, 31 Jul 2010 23:00:00 +0100 3846567 http://www.medworm.com/index.php?rid=3846566&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000339%2Fabstract%3Frss%3Dyes The management of osteoarthritis requires a careful combination of pharmacologic and nonpharmacologic therapies to effect improvements in pain and function. When choosing pharmacologic therapy, the potential toxicities must be considered relative to potential benefits. This review highlights commonly used medications and presents the evidence for their effectiveness as well as their toxicities. Acetaminophen and nonsteroidal antiinflammatory drugs are the mainstay of pharmacologic therapy, but there are numerous adjunctive or alternative medications that may provide some benefit to patients with osteoarthritis. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846566 Sat, 31 Jul 2010 23:00:00 +0100 3846566 http://www.medworm.com/index.php?rid=3846565&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000327%2Fabstract%3Frss%3Dyes With too few conservative options in the current medical system, increasing numbers of osteoarthritis (OA) sufferers are using untested folk remedies and self-prescribed dietary supplements. There is enormous popular demand for noninvasive and nonpharmacologic therapies for OA, and there is a pressing need for clinicians to respond to this demand by updating their practice. This review introduces clinicians to the most important noninvasive devices used in the conservative management of knee OA. Because the shared goal of these devices is to favorably alter lower limb biomechanics, each section of the review considers evidence of biomechanical and clinical efficacy. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846565 Sat, 31 Jul 2010 23:00:00 +0100 3846565 http://www.medworm.com/index.php?rid=3846564&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000479%2Fabstract%3Frss%3Dyes This article reviews the physiologic and mechanical consequences of obesity and exercise on older adults with knee OA, the effects of long-term weight loss and exercise interventions, and the utility and feasibility of translating these results to clinical practice. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846564 Sat, 31 Jul 2010 23:00:00 +0100 3846564 http://www.medworm.com/index.php?rid=3846563&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000315%2Fabstract%3Frss%3Dyes This review summarizes the findings of randomized controlled trials of progressive resistance training (PRT) by older people with osteoarthritis (OA). A significant benefit was found in lower-extremity extensor strength, function, and pain reduction. Across all 3 outcomes, the estimated effect size was moderate, which contrasted with trials of PRT in non–OA-specific groups of older adults where a large effect was found in strength but a small effect on function. This suggests that strength training has strong functional benefits for older adults with OA. Older adults with OA benefit from a strength-training program that provides progressive overload to maintain intensity throughout an exercise program. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846563 Sat, 31 Jul 2010 23:00:00 +0100 3846563 http://www.medworm.com/index.php?rid=3846562&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000303%2Fabstract%3Frss%3Dyes This article describes the dysfunctional delivery of existing conservative care practices in the treatment of osteoarthritis (OA) within the context of a dynamic environment of health reform. It is written from the patient perspective of one of the authors who is afflicted with OA and with the added clinical view of a rheumatologist. The authors envision benefits of more cost-effective care, a decrease in the impact of chronic illness on the financial viability of the United States, and an improvement in the quality of care provided to patients. These benefits can be achieved with tested innovations organized within the integrated delivery system described in this article. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846562 Sat, 31 Jul 2010 23:00:00 +0100 3846562 http://www.medworm.com/index.php?rid=3846561&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000297%2Fabstract%3Frss%3Dyes Osteoarthritis (OA) is not an easy condition to manage. It is very heterogeneous, has an unpredictable natural history, and has variable effects on health status. A wide range of management options is available to OA patients and their health care advisors. Guidelines help the clinician through this complexity. There are many similarities in the advice offered by different guidelines, suggesting a good deal of consensus on what should and should not be offered to patients with OA. Several authoritative international guidelines on OA management have appeared in recent years. In this article the authors evaluate the United Kingdom National Institute for Clinical Excellence guidelines as a contemporary tool to assess the context within which care is delivered and as the basis for discussion o... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846561 Sat, 31 Jul 2010 23:00:00 +0100 3846561 http://www.medworm.com/index.php?rid=3846560&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000285%2Fabstract%3Frss%3Dyes Evidence-based guidelines have the potential to improve the quality of health care by promoting interventions of proven benefit and discouraging unnecessary, ineffective, or harmful interventions. Recent years have seen the development of several evidence-based guidelines developed for osteoarthritis (OA) management. There is some consistency in the numerous guidelines that are available for OA management, yet despite some dissemination attempts, clinical practice does not reflect these recommendations. Current clinical practice reflects a multitude of factors, including clinician and patient preference and health care system support. Similarly, guidelines are frequently prescribed independent of context and thus implementation can be challenging. Future efforts to guide management of OA o... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846560 Sat, 31 Jul 2010 23:00:00 +0100 3846560 http://www.medworm.com/index.php?rid=3846559&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000340%2Fabstract%3Frss%3Dyes This article uses the Disablement Model conceptual framework to guide an analysis of the importance of osteoarthritis (OA) in the development of disability. The Disablement Model describes the development and progression of disablement from impairments to specific functional limitations and disability, and the hypothesized role of predisposing risk factors, extra-individual factors, and intra-individual factors. A wide range of population and clinical studies have characterized the unequivocal contribution of arthritis to the development of functional limitations and disability. Evidence overwhelmingly supports a significant, moderate independent contribution of arthritis to the onset and progression of functional limitations and disability. With respect to important risk factors for the d... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846559 Sat, 31 Jul 2010 23:00:00 +0100 3846559 http://www.medworm.com/index.php?rid=3846558&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000273%2Fabstract%3Frss%3Dyes Osteoarthritis (OA) is the most common cause of chronic disability in older adults. Although classically considered a “wear and tear” degenerative condition of articular joints, recent studies have demonstrated an inflammatory component to OA that includes increased activity of several cytokines and chemokines in joint tissues that drive production of matrix-degrading enzymes. Rather than directly causing OA, aging changes in the musculoskeletal system contribute to the development of OA by making the joint more susceptible to the effects of other OA risk factors that include abnormal biomechanics, joint injury, genetics, and obesity. Age-related sarcopenia and increased bone turnover may also contribute to the development of OA. Understanding the basic mechanisms by which aging affect... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846558 Sat, 31 Jul 2010 23:00:00 +0100 3846558 http://www.medworm.com/index.php?rid=3846557&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000261%2Fabstract%3Frss%3Dyes Osteoarthritis (OA) is the most common joint disorder in the United States. Symptomatic knee OA occurs in 10% men and 13% in women aged 60 years or older. The number of people affected with symptomatic OA is likely to increase due to the aging of the population and the obesity epidemic. OA has a multifactorial etiology, and can be considered the product of an interplay between systemic and local factors. Old age, female gender, overweight and obesity, knee injury, repetitive use of joints, bone density, muscle weakness, and joint laxity all play roles in the development of joint OA, particularly in the weight-bearing joints. Modifying these factors may reduce the risk of OA and prevent subsequent pain and disability. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846557 Sat, 31 Jul 2010 23:00:00 +0100 3846557 http://www.medworm.com/index.php?rid=3846556&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000492%2Fabstract%3Frss%3Dyes Osteoarthritis (OA) is the leading cause of disability among older adults. It is already an incredibly prevalent condition and one that is becoming even more prevalent with the combined effects of an aging and increasingly obese society. In this context, this issue of Clinics in Geriatric Medicine is timely, as we envision this increasingly prevalent disabling condition in an era when health care expenditure is increasingly scrutinized. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846556 Sat, 31 Jul 2010 23:00:00 +0100 3846556 http://www.medworm.com/index.php?rid=3846555&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000625%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846555 Sat, 31 Jul 2010 23:00:00 +0100 3846555 http://www.medworm.com/index.php?rid=3846554&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000613%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846554 Sat, 31 Jul 2010 23:00:00 +0100 3846554 http://www.medworm.com/index.php?rid=3846553&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000601%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3846553 Sat, 31 Jul 2010 23:00:00 +0100 3846553 http://www.medworm.com/index.php?rid=3597088&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000431%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597088 Fri, 30 Apr 2010 23:00:00 +0100 3597088 http://www.medworm.com/index.php?rid=3597087&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000248%2Fabstract%3Frss%3Dyes The definition of sarcopenia continues to evolve, from an observational phenomenon to a differential diagnostic approach. Clinical relevance for sarcopenia is defined by a loss in lean muscle mass and impairment of functional status. A therapeutic approach to the loss of skeletal muscle mass and strength in older persons depends on correct classification. The term sarcopenia is reserved for age-related decline in muscle mass not attributable to the presence of proinflammatory cytokines. For persons with sarcopenia, the primary intervention should include resistance exercise. An improvement in muscle mass and strength has been demonstrated with resistance exercise, even in the very old. Targeting the hormonal changes with aging is an attractive intervention. However, testosterone replacemen... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597087 Fri, 30 Apr 2010 23:00:00 +0100 3597087 http://www.medworm.com/index.php?rid=3597086&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000133%2Fabstract%3Frss%3Dyes Hip fractures in elderly men present many significant challenges and are a leading cause of morbidity and mortality in this age group. A multidisciplinary team approach before surgical intervention is the most efficient way to manage this patient group and achieve the best possible outcome while attempting to return patients to their previous level of function. Timely surgical intervention allows the patient's early mobilization and decreases the risk of potential complications in the postoperative period. Patient education and close follow-up are necessary to ensure compliance with the rehabilitation protocol as well as the prevention of future fractures. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597086 Fri, 30 Apr 2010 23:00:00 +0100 3597086 http://www.medworm.com/index.php?rid=3597085&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000170%2Fabstract%3Frss%3Dyes Osteoporosis develops in males approximately 10 years later than in females. Low vitamin D is a common problem. Decline in testosterone represents a major cause for osteoporosis in men. Bisphosphonates are the treatment of choice for osteoporosis in older males. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597085 Fri, 30 Apr 2010 23:00:00 +0100 3597085 http://www.medworm.com/index.php?rid=3597084&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000200%2Fabstract%3Frss%3Dyes This article examines some key nutritional factors involved in successful aging and highlights different needs between men and women. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597084 Fri, 30 Apr 2010 23:00:00 +0100 3597084 http://www.medworm.com/index.php?rid=3597083&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000145%2Fabstract%3Frss%3Dyes No clear consensual definition regarding frailty seems to emerge from the literature after 30 years of research in the topic, and a large array of models and criteria has been proposed to define the syndrome. Controversy continues to exist on the choice of the components to be included in the frailty definition. Two main definitions based on clusters of components are found in literature: a physical phenotype of frailty, operationalized in 2001 by providing a list of 5 measurable items of functional impairments, which coexists with a multidomain phenotype, based on a frailty index constructed on the accumulation of identified deficits based on comprehensive geriatric assessment. The physical phenotype considers disability and comorbidities such as dementia as distinct entities and therefor... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597083 Fri, 30 Apr 2010 23:00:00 +0100 3597083 http://www.medworm.com/index.php?rid=3597082&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000236%2Fabstract%3Frss%3Dyes The metabolic syndrome is one of several patterns of risk for atherosclerotic cardiovascular disease. Although the concept of the metabolic syndrome has been known for 2 centuries or more, it is only recently that its individual components have been proposed. Visceral obesity is a central component but other major facets such as hypertension, dyslipidemia, or dysglycemia are often present. These components are well-established cardiovascular risk factors and therefore grouping them under a single entity, namely the metabolic syndrome, has questioned its clinical usefulness and its ability to predict cardiovascular disease. Depending on what criteria are used, the prevalence of this syndrome may be as much as 40% in those aged 60 years and older. Heredity, environmental factors, personal li... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597082 Fri, 30 Apr 2010 23:00:00 +0100 3597082 http://www.medworm.com/index.php?rid=3597081&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000182%2Fabstract%3Frss%3Dyes Lower urinary tract symptoms (LUTS) occur commonly in older men and can have a significant effect on quality of life. Symptoms can be categorized as voiding, storage, or postvoiding in nature. A variety of symptom screening scales are available to categorize the nature and severity of the urinary symptoms. Erectile dysfunction (ED) symptoms frequently overlap with LUTS and treatment must address both conditions. Initial evaluation for LUTS and ED includes extensive questioning about symptoms, medication use, and medical history, followed by a targeted physical examination and basic laboratory testing. Treatment is focused on the origin of symptoms, which are frequently bladder hyperactivity, urinary retention, or prostatic hypertrophy. Common medication classes used to treat LUTS and ED in... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597081 Fri, 30 Apr 2010 23:00:00 +0100 3597081 http://www.medworm.com/index.php?rid=3597080&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000169%2Fabstract%3Frss%3Dyes As overall life expectancy grows, clinicians will be confronted more often with diseases that although devastating in the young individual, will not affect survival and possibly even quality of life for those in the older age groups. Prostate cancer is an example of this. The challenge for the physician caring for these patients is to distinguish who is at risk and how much risk so that decisions can be made regarding the propriety of prostate cancer detection and treatment of each individual. In this article, these issues are discussed in a way that helps the clinician guide older men to better decisions regarding prostate cancer detection and therapy. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597080 Fri, 30 Apr 2010 23:00:00 +0100 3597080 http://www.medworm.com/index.php?rid=3597079&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000224%2Fabstract%3Frss%3Dyes This article reviews the epidemiology of benign prostatic hyperplasia (BPH), evaluation of patients with lower urinary tract symptomatology (LUTS), and management of patients with BPH and LUTS. The evaluation includes history and physical examination, laboratory testing, and specialized studies. The management includes medical and surgical options. Medical options include alpha-1-adrenergic receptor blockers, 5alpha-reductase inhibitors, and combinations of these and other medications. Surgical options include endoscopic procedures, open procedures, and laser procedures. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597079 Fri, 30 Apr 2010 23:00:00 +0100 3597079 http://www.medworm.com/index.php?rid=3597078&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000157%2Fabstract%3Frss%3Dyes Increased longevity and population aging will increase the number of men with late-onset hypogonadism, a common condition that is often under diagnosed and under treated. The indication of testosterone replacement therapy (TRT) treatment requires the presence of low testosterone level and symptoms and signs of hypogonadism. Although there is a lack of large-scale, long-term studies assessing the benefits and risks of TRT in men with hypogonadism, reports indicate that TRT may produce a wide range of benefits that include improvement in libido and sexual function, bone density, muscle mass, body composition, mood, erythropoiesis, cognition, quality of life, and cardiovascular disease. Perhaps the most controversial area is the issue of risk, especially the possible stimulation of prostate c... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597078 Fri, 30 Apr 2010 23:00:00 +0100 3597078 http://www.medworm.com/index.php?rid=3597077&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000194%2Fabstract%3Frss%3Dyes It should be recognized that sexuality in the aging male is of such import that a complete sexual history must be performed. By taking a complete sexual history, facts can be obtained that will allow for appropriate focus relating to a holistic evaluation and will enable us to dispel antiquated sexual myths pertaining to the aging male. If initiated by the history taker, questions concerning sexuality may be discussed more comfortably by the patient. Erectile dysfunction, male sexual response cycle, testosterone, sexually transmitted diseases, human immunodeficiency virus, long-term illness, along with religion and culture are explored in this article with the aim of improving one's knowledge base, self reflection, and awareness of the importance of male sexuality. A complete understanding... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597077 Fri, 30 Apr 2010 23:00:00 +0100 3597077 http://www.medworm.com/index.php?rid=3597076&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000212%2Fabstract%3Frss%3Dyes This article briefly reviews these unique challenges. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597076 Fri, 30 Apr 2010 23:00:00 +0100 3597076 http://www.medworm.com/index.php?rid=3597075&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS074906901000025X%2Fabstract%3Frss%3Dyes Men live less long than women. Despite this, they have less disability and more quality life years. Men lose strength and muscle mass at the rate of 1% per year during their lifespan. This is closely related to the loss of testosterone. Low testosterone level is a major factor in the development of frailty. Another reversal factor in the pathogenesis of frailty is low vitamin D level. Men have an increased physiologic anorexia of aging, further putting them at risk for developing frailty. Osteoporosis occurs in men approximately 10 years later than in women. Men who fracture their hip are more likely to die than women who fracture their hip. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597075 Fri, 30 Apr 2010 23:00:00 +0100 3597075 http://www.medworm.com/index.php?rid=3597074&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS074906901000042X%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597074 Fri, 30 Apr 2010 23:00:00 +0100 3597074 http://www.medworm.com/index.php?rid=3597073&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000418%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597073 Fri, 30 Apr 2010 23:00:00 +0100 3597073 http://www.medworm.com/index.php?rid=3597072&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000406%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3597072 Fri, 30 Apr 2010 23:00:00 +0100 3597072 http://www.medworm.com/index.php?rid=3296057&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000091%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296057 Mon, 01 Feb 2010 00:00:00 +0100 3296057 http://www.medworm.com/index.php?rid=3296056&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000925%2Fabstract%3Frss%3Dyes Creative engagement, as an expression of and a support for resilience, may have a neuroprotective effect among older adults, contributing to retention of cognitive capacity. Recent research on creative activities shows that they strengthen social networks and give persons a sense of control; both outcomes have been associated with brain health. The authors cite evidence suggesting that positive social interactions can nurture resilience and creative engagement among older persons, including those living with dementia. The motivational, attentional, affective, and social components of creative activities combine to offer older persons meaningful opportunities to express and strengthen their resilience, regardless of their cognitive status, despite the biopsychosocial challenges of aging. Th... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296056 Mon, 01 Feb 2010 00:00:00 +0100 3296056 http://www.medworm.com/index.php?rid=3296055&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000974%2Fabstract%3Frss%3Dyes The cellular mechanisms underlying neuronal loss and neurodegeneration have been an area of interest in the last decade. Although neurodegenerative diseases such as Alzheimer disease, Parkinson disease, and Huntington disease each have distinct clinical symptoms and pathologies, they all share common mechanisms such as protein aggregation, oxidative injury, inflammation, apoptosis, and mitochondrial injury that contribute to neuronal loss. Although cerebrovascular disease has different causes from the neurodegenerative disorders, many of the same common disease mechanisms come into play following a stroke. Novel therapies that target each of these mechanisms may be effective in decreasing the risk of disease, abating symptoms, or slowing down their progression. Although most of these thera... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296055 Mon, 01 Feb 2010 00:00:00 +0100 3296055 http://www.medworm.com/index.php?rid=3296054&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000950%2Fabstract%3Frss%3Dyes This article reviews potential risk factors and protective factors for the development of dementia, and in particular Alzheimer disease, and discusses the challenges in developing a dementia risk index. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296054 Mon, 01 Feb 2010 00:00:00 +0100 3296054 http://www.medworm.com/index.php?rid=3296053&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000913%2Fabstract%3Frss%3Dyes Current knowledge about the roles of cognitively stimulating lifestyles and cognitive training interventions in preserving cognitive function in later life is reviewed. Potential mechanisms for beneficial effects of cognitive stimulation and training are discussed, and key gaps in research identified. Suggestions are provided for advising patients about brain-healthy lifestyles, acknowledging that much remains to be learned in this area of research. More randomized controlled trials, using challenging regimes of training and stimulation and long-term follow-up, are needed, measuring cognitive trajectories in normal aging and relative risk of Alzheimer disease as outcomes. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296053 Mon, 01 Feb 2010 00:00:00 +0100 3296053 http://www.medworm.com/index.php?rid=3296052&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000949%2Fabstract%3Frss%3Dyes Severe nutritional deficiencies, such as protein energy malnutrition and deficiency of nicotinamide, vitamin B12, folate, and thiamine, have long been recognized to cause severe confusion. Lesser vitamin deficiencies have been linked to the pathogenesis of delirium. Hypo- and hyperglycemia and hypertriglyceridemia can cause cognitive deficits. Epidemiologic and animal studies have linked several other nutrients (omega-3 fatty acids, lutein, alpha-lipoic acid, and the Mediterranean diet) to cognitive performance and the prevention of dementia. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296052 Mon, 01 Feb 2010 00:00:00 +0100 3296052 http://www.medworm.com/index.php?rid=3296051&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000901%2Fabstract%3Frss%3Dyes There is increasing evidence to suggest that physical activity has a protective effect on brain functioning in older people. To date, no randomized controlled trial (RCT) has shown that regular physical activity prevents dementia, but recent RCTs suggests an improvement of cognitive functioning in persons involved in aerobic programs, and evidence is accumulating from basic research. Future prevention of Alzheimer disease may depend on lifestyle habits such as physical activity. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296051 Mon, 01 Feb 2010 00:00:00 +0100 3296051 http://www.medworm.com/index.php?rid=3296050&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000986%2Fabstract%3Frss%3Dyes This article highlights the hormonal changes that occur with aging and the effects of these hormonal changes on the brain, concentrating not on the well-known psychiatric manifestations of endocrine diseases, but on the more subtle effects of hormones and metabolic alteration seen in many older persons. The article focuses predominately on the role of hormones in cognition, as dementia and mild cognitive impairment are major problems in the older individual. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296050 Mon, 01 Feb 2010 00:00:00 +0100 3296050 http://www.medworm.com/index.php?rid=3296049&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000895%2Fabstract%3Frss%3Dyes Sleep plays an important role in learning, memory encoding, and cognition. Insufficient quantity or quality of sleep leads not only to short-term neurocognitive dysfunction but also to permanent changes to the central nervous system. Sleep disorders are common in the geriatric population. The hypoxemia and sleep fragmentation resulting from obstructive sleep apnea are the most likely pathophysiology responsible for damage to the brain. Because treatment of these sleep disorders can lead to improved cognitive function, it is becoming increasingly important for physicians to be able to correctly recognize and treat these disorders in patients presenting with memory or cognitive complaints. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296049 Mon, 01 Feb 2010 00:00:00 +0100 3296049 http://www.medworm.com/index.php?rid=3296048&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009001001%2Fabstract%3Frss%3Dyes Head injury has been recognized as an increasingly important determinant of late-life cognitive function. Despite a large number of research and clinical studies, no direct link has been established between minor head trauma with or without loss of consciousness and the development of dementia of the Alzheimer type. Similarly for alcohol, low doses have been found to be somewhat protective against dementia, whereas large doses increased the risk of late-life cognitive dysfunction. Among the many environmental toxins suspected of causing cognitive dysfunction, lead intoxication has the strongest evidence to support a link. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296048 Mon, 01 Feb 2010 00:00:00 +0100 3296048 http://www.medworm.com/index.php?rid=3296047&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000998%2Fabstract%3Frss%3Dyes Cardiovascular risk factors have been associated with 2 common manifestation of unhealthy brain in older people, cognitive impairment and depression. The evidence for these effects is almost entirely observational, but links hypertension, smoking, hypercholesterolemia, diabetes mellitus, and hyperhomocysteinemia with cognitive impairment and depression. Unfortunately randomized trials evaluating interventions for these risk factors on the outcomes of cognition or mood have either been inconclusive or negative. However, as there are considerable other health benefits from targeting cardiovascular risk factors, these interventions should be more widely adopted, which would also probably result in positive outcomes for the brain. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296047 Mon, 01 Feb 2010 00:00:00 +0100 3296047 http://www.medworm.com/index.php?rid=3296046&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000962%2Fabstract%3Frss%3Dyes Optimal cognitive function is vital to independence, productivity, and quality of life, and the debilitation associated with dementias makes them the most feared of conditions related to aging. Effective preventive measures are key components of any response to the potentially overwhelming problem of dementias. Increasing evidence points to the potential risk roles of vascular factors and disorders (eg, midlife obesity, dyslipidemia, diabetes, high blood pressure, cigarette smoking, and cerebrovascular lesions) and the potential protective roles of psychosocial factors (eg, higher education, regular exercise, healthy diet, intellectually challenging leisure activities, and active socially integrated lifestyle) in the pathogenic process and clinical manifestation of dementing disorders. Opt... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296046 Mon, 01 Feb 2010 00:00:00 +0100 3296046 http://www.medworm.com/index.php?rid=3296045&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009001013%2Fabstract%3Frss%3Dyes This special issue of Clinics in Geriatric Medicine: “Healthy Brain Aging: Evidence Based Methods to Preserve Brain Function and Prevent Dementia,” is devoted to cognitive health, a major factor in ensuring good quality of life and preserving independence in middle aged and older adults. As the readers of Clinics in Geriatric Medicine are well aware, the United States population as a whole is aging at an unprecedented rate. With that comes an increasing incidence of disabling cognitive decline due to a variety of conditions (especially Alzheimer disease and other dementias). The articles in this special issue describe the results of research in the last 2 decades regarding risk and protective factors for late-life cognitive decline and potential implications of these results on clinica... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296045 Mon, 01 Feb 2010 00:00:00 +0100 3296045 http://www.medworm.com/index.php?rid=3296044&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS074906901000008X%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296044 Mon, 01 Feb 2010 00:00:00 +0100 3296044 http://www.medworm.com/index.php?rid=3296043&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000078%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296043 Mon, 01 Feb 2010 00:00:00 +0100 3296043 http://www.medworm.com/index.php?rid=3296042&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069010000066%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3296042 Mon, 01 Feb 2010 00:00:00 +0100 3296042 http://www.medworm.com/index.php?rid=3035112&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000846%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035112 Sun, 01 Nov 2009 00:00:00 +0100 3035112 http://www.medworm.com/index.php?rid=3035111&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000585%2Fabstract%3Frss%3Dyes This article reviews cardiovascular disease (CVD) prevention in older patients, highlighting results from recent clinical studies related to primary and secondary prevention. Many of these studies demonstrated greater absolute reductions in major cardiovascular events among older, higher-risk populations compared with younger patients. Guideline recommendations for CVD risk factor modification are also reviewed with emphasis on issues pertaining to the older adult population. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035111 Sun, 01 Nov 2009 00:00:00 +0100 3035111 http://www.medworm.com/index.php?rid=3035110&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000573%2Fabstract%3Frss%3Dyes This article reviews evidence that CR in nonhuman primates and people has a positive effect on risk factors for CVD. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035110 Sun, 01 Nov 2009 00:00:00 +0100 3035110 http://www.medworm.com/index.php?rid=3035109&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000561%2Fabstract%3Frss%3Dyes Evidence from animal models and preliminary studies in humans indicates that calorie restriction (CR) delays cardiac aging and can prevent cardiovascular disease. These effects are mediated by a wide spectrum of biochemical and cellular adaptations, including redox homeostasis, mitochondrial function, inflammation, apoptosis, and autophagy. Despite the beneficial effects of CR, its large-scale implementation is challenged by applicability issues as well as health concerns. However, preclinical studies indicate that specific compounds, such as resveratrol, may mimic many of the effects of CR, thus potentially obviating the need for drastic food intake reductions. Results from ongoing clinical trials will reveal whether the intriguing alternative of CR mimetics represents a safe and effectiv... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035109 Sun, 01 Nov 2009 00:00:00 +0100 3035109 http://www.medworm.com/index.php?rid=3035108&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS074906900900055X%2Fabstract%3Frss%3Dyes This article reviews the physiologic response to resistance training in older adults and discusses the impact of resistance exercise training on cardiovascular risk factors. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035108 Sun, 01 Nov 2009 00:00:00 +0100 3035108 http://www.medworm.com/index.php?rid=3035107&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000548%2Fabstract%3Frss%3Dyes Aging is associated with a cascade of morphologic and physiologic changes that naturally predispose older adults to progressive weakening, functional decline, morbidity, disability, poor quality of life, and increased mortality. Physical activity moderates such insidious aging patterns and is a vital preventive and therapeutic strategy to optimize health throughout the aging process. Regular exercise provides many physiologic benefits, reduces risk of disease outcomes, and triggers important psychological gains. Advanced age presents distinctive obstacles to maintaining a physically active lifestyle. Individualized exercise strategies and regimens make it possible, however, for every elderly adult to benefit from physical activity. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035107 Sun, 01 Nov 2009 00:00:00 +0100 3035107 http://www.medworm.com/index.php?rid=3035106&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000718%2Fabstract%3Frss%3Dyes There is strong evidence that regular physical activity reduces risk of cardiovascular disease. Building on the evidence review for the 2008 Physical Activity Guidelines for Americans, this article summarizes the recommended amounts and types of physical activity for the primary prevention of cardiovascular disease in older adults. Key guidelines are largely based on current understanding of the dose-response relationship between amount of physical activity and risk of chronic disease. In part due to the preventive effects on cardiovascular disease, physical activity has beneficial effects on functional limitations and health-related quality of life in older adults. Gaps in research on physical activity and cardiovascular health are discussed, with an emphasis on the need for research on h... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035106 Sun, 01 Nov 2009 00:00:00 +0100 3035106 http://www.medworm.com/index.php?rid=3035105&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000536%2Fabstract%3Frss%3Dyes This article examines the evidence on these controversial issues, explores potential explanations for these findings, discusses the clinical implications, and provides recommendations for further research in this area. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035105 Sun, 01 Nov 2009 00:00:00 +0100 3035105 http://www.medworm.com/index.php?rid=3035104&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000743%2Fabstract%3Frss%3Dyes Cardiovascular disease is the major cause of death as well as a leading cause of disability and impaired quality of life in older adults with diabetes. Therefore, preventing cardiovascular events in this population is an important goal of care. Available evidence supports the use of lipid-lowering agents and treatment of hypertension as effective measures to reduce cardiovascular risk in older adults with diabetes. Glucose control, smoking cessation, weight control, regular physical activity, and a prudent diet are also recommended, although data supporting the efficacy of these interventions are limited. While reducing cardiovascular morbidity and mortality remains a primary objective of preventive cardiology in older adults with diabetes, the impact of these interventions on functional w... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035104 Sun, 01 Nov 2009 00:00:00 +0100 3035104 http://www.medworm.com/index.php?rid=3035103&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS074906900900072X%2Fabstract%3Frss%3Dyes This article summarizes current data on lipid-lowering therapy in older adults and the management of hyperlipidemia in elderly patients. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035103 Sun, 01 Nov 2009 00:00:00 +0100 3035103 http://www.medworm.com/index.php?rid=3035102&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000524%2Fabstract%3Frss%3Dyes This article highlights the unique challenges in treating this population. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035102 Sun, 01 Nov 2009 00:00:00 +0100 3035102 http://www.medworm.com/index.php?rid=3035101&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000512%2Fabstract%3Frss%3Dyes This article provides an overview of the epidemiology of CVD in older adults, including an assessment of the impact of CVD on mortality, morbidity, and health care costs. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035101 Sun, 01 Nov 2009 00:00:00 +0100 3035101 http://www.medworm.com/index.php?rid=3035100&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000731%2Fabstract%3Frss%3Dyes The objective of this issue of the Clinics is to provide a concise overview of current strategies for CVD prevention in our burgeoning elderly population. Articles in this issue were derived in part from a symposium on preventive cardiology in the elderly held on November 8, 2008, in New Orleans, Louisiana, cosponsored by the Society of Geriatric Cardiology and the Society for Preventive Cardiology, and supported by a grant from the National Institute on Aging. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035100 Sun, 01 Nov 2009 00:00:00 +0100 3035100 http://www.medworm.com/index.php?rid=3035099&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000834%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035099 Sun, 01 Nov 2009 00:00:00 +0100 3035099 http://www.medworm.com/index.php?rid=3035098&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000822%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=3035098 Sun, 01 Nov 2009 00:00:00 +0100 3035098 http://www.medworm.com/index.php?rid=2802160&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000676%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802160 Fri, 31 Jul 2009 23:00:00 +0100 2802160 http://www.medworm.com/index.php?rid=2802159&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000305%2Fabstract%3Frss%3Dyes Despite the many technical advances in medical care and dialysis delivery, mortality and morbidity remain high in patients with end-stage renal disease. This is particularly true in older patients, who often have a great number of coexisting diseases. In this population, life expectancy and quality of life may be rather poor, raising a number of ethical issues about the decision of starting start or withdrawing renal replacement therapy. Unfortunately, clear behavior guidelines on these critical issues are still insufficient. Reasons for not starting dialysis include old age, neurologic impairment, end-stage organ failure other than the kidneys, metastatic cancer, multiple comorbidities, and patient or family refusal. Similar reasons often underlie dialysis withdrawal of dialysis. Often th... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802159 Fri, 31 Jul 2009 23:00:00 +0100 2802159 http://www.medworm.com/index.php?rid=2802158&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000275%2Fabstract%3Frss%3Dyes This article discusses issues specific to the geriatric dialysis population. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802158 Fri, 31 Jul 2009 23:00:00 +0100 2802158 http://www.medworm.com/index.php?rid=2802157&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000263%2Fabstract%3Frss%3Dyes Chronic kidney disease is a common disorder that affects many patients with a prevalence approaching 19 million people in the United States. Kidney failure and renal impairment is a common occurrence in the geriatric population. Most types of kidney diseases are chronic conditions and frequently manifest at the late stages of life. Epidemiologic studies suggest that older patients are at a greater risk for renal failure if the kidney experiences insults from ischemia or exposure to pharmacologic and diagnostic nephrotoxins. Pharmacologic management of most common diseases in elderly individuals is a difficult task, particularly in older individuals with chronic kidney disease. Thus, primary care providers must proceed with caution when prescribing drugs for elderly patients with kidney dis... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802157 Fri, 31 Jul 2009 23:00:00 +0100 2802157 http://www.medworm.com/index.php?rid=2802156&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000469%2Fabstract%3Frss%3Dyes Urinary incontinence is a common clinical problem in the elderly population, and can affect men and women. Chronic incontinence can lead to impairments in overall functional status and is associated with significant negative effects on both overall and health-related quality of life. Careful clinical evaluation can be useful to differentiate among the various types of urinary incontinence, and can help to identify the potential cause of the condition. A wide variety of behavioral, pharmacologic, and surgical therapies are available to treat urinary incontinence, and these may be used alone or in combination. Treatment can help to improve or eliminate symptoms for many patients, leading to enhanced quality of life and improved functional status. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802156 Fri, 31 Jul 2009 23:00:00 +0100 2802156 http://www.medworm.com/index.php?rid=2802155&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000457%2Fabstract%3Frss%3Dyes Obstructive uropathy is a relatively common condition in which an anatomic or functional problem causes obstruction to normal urinary flow. Obstructive uropathy becomes more prevalent with increasing age and is most frequent as a result of benign prostatic hyperplasia or neurogenic bladder. The clinical manifestations of obstructive uropathy range from little or no symptoms to acute renal failure. Because its prevalence increases with increasing age, the diagnosis and management of obstructive uropathy is particularly relevant to the geriatric population. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802155 Fri, 31 Jul 2009 23:00:00 +0100 2802155 http://www.medworm.com/index.php?rid=2802154&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000299%2Fabstract%3Frss%3Dyes Urinary infection is the most common infection in elderly populations. There is a high prevalence of asymptomatic bacteriuria, but this is benign and does not require treatment. A urine specimen for culture should be obtained before initiating antimicrobial therapy for symptomatic infection. Antimicrobial treatment regimens in the elderly are similar to other populations. Chronic indwelling catheters are associated with increased morbidity from urinary tract infection. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802154 Fri, 31 Jul 2009 23:00:00 +0100 2802154 http://www.medworm.com/index.php?rid=2802153&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000470%2Fabstract%3Frss%3Dyes This article briefly outlines the common presentations of glomerular disease in the elderly and discusses the clinical features, prognosis, and management of the primary and secondary glomerular diseases in this population of patients. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802153 Fri, 31 Jul 2009 23:00:00 +0100 2802153 http://www.medworm.com/index.php?rid=2802152&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000421%2Fabstract%3Frss%3Dyes Hypertension is an important risk factor for cardiovascular morbidity and mortality, particularly in the elderly. Blood pressure elevation in the elderly is due to structural and functional changes that occur with aging. Treatment of hypertension reduces the risk of stroke, heart failure, myocardial infarction, all-cause mortality, cognitive impairment, and dementia in elderly patients with hypertension. A healthy lifestyle helps hypertension management, with benefits extending beyond lowering of blood pressure. Several classes of antihypertensive drugs are effective in preventing cardiovascular events. Treatment decisions should be guided by the presence of compelling indications such as diabetes or heart failure and by the tolerability of individual drugs or drug combinations in individu... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802152 Fri, 31 Jul 2009 23:00:00 +0100 2802152 http://www.medworm.com/index.php?rid=2802151&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000445%2Fabstract%3Frss%3Dyes Although diabetes is clearly linked to macro- and microvasculopathy in multiple organs resulting in cardiovascular and cerebrovascular catastrophic diseases, blindness, and limb amputations, it is the relentless progression of diabetic nephropathy toward becoming the major cause of end-stage renal disease (ESRD) that now challenges budgets and treatment facilities providing hemodialysis, peritoneal dialysis, and kidney transplantation. Nephrology, as a specialty, is now dominated by the necessity to address geriatrics and endocrinology to cope with the tidal wave of elderly ESRD patients suffering from uremia caused by diabetes. On the brighter side, emergence of effective renoprotective regimens now slow the incidence rate of ESRD in those with diagnosed diabetes. There is bona fide reaso... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802151 Fri, 31 Jul 2009 23:00:00 +0100 2802151 http://www.medworm.com/index.php?rid=2802150&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000433%2Fabstract%3Frss%3Dyes Chronic kidney disease is increasingly being recognized in elderly individuals across the world. An understanding of the methods used to estimate or to measure kidney function, the likelihood and factors associated with progressive decline in renal function, and the clinical syndromes associated with poor renal function are key topics for individuals working across many medical disciplines. This review addresses some of the important aspects of chronic kidney disease, and summarizes some of the clinical and laboratory features associated with progressive disease. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802150 Fri, 31 Jul 2009 23:00:00 +0100 2802150 http://www.medworm.com/index.php?rid=2802149&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000251%2Fabstract%3Frss%3Dyes This article reviews these changes and discusses the diagnoses frequently encountered in the elderly patient with acute kidney injury. The incidence, staging, evaluation, management, and prognosis of acute kidney injury are also examined with special focus given to older adults. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802149 Fri, 31 Jul 2009 23:00:00 +0100 2802149 http://www.medworm.com/index.php?rid=2802148&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000500%2Fabstract%3Frss%3Dyes Aging is a degenerative biologic process that affects the kidneys. It is known to be associated with a decline in kidney function coincident with a progressive decrease in the number of functioning nephrons and with glomerular and tubulointerstitial scarring. These changes affect glomerular and tubular function, systemic hemodynamics, and, as a whole, body homeostasis. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802148 Fri, 31 Jul 2009 23:00:00 +0100 2802148 http://www.medworm.com/index.php?rid=2802147&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000287%2Fabstract%3Frss%3Dyes This article examines the areas of research that encompass geriatric nephrology and clinic observations applicable to the care of the geriatric population. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802147 Fri, 31 Jul 2009 23:00:00 +0100 2802147 http://www.medworm.com/index.php?rid=2802146&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000597%2Fabstract%3Frss%3Dyes In the United States, the average life expectancy in 2004 was 75.2 years for men and 80.4 years for women; by 2015, it is expected to be 76.2 and 82.2 years, respectively, and to continue to grow. During the 1990s, the population older than 85 years was the fastest growing group at 38% growth. This older age group is the largest consumer of health care services. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802146 Fri, 31 Jul 2009 23:00:00 +0100 2802146 http://www.medworm.com/index.php?rid=2802145&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000664%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802145 Fri, 31 Jul 2009 23:00:00 +0100 2802145 http://www.medworm.com/index.php?rid=2802144&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000652%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2802144 Fri, 31 Jul 2009 23:00:00 +0100 2802144 http://www.medworm.com/index.php?rid=2490352&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS074906900900038X%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2490352 Thu, 30 Apr 2009 23:00:00 +0100 2490352 http://www.medworm.com/index.php?rid=2490351&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS074906900900007X%2Fabstract%3Frss%3Dyes Resistant hypertension is more prevalent in the elderly population. Current data clearly shows the benefit of blood pressure control in older individuals. It is important to first differentiate pseudoresistance from true resistant and institute appropriate therapy. In those patients with resistant hypertension without an identifiable cause, non invasive measurement of hemodynamic profile is an important option to achieve meet blood pressure goals. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2490351 Thu, 30 Apr 2009 23:00:00 +0100 2490351 http://www.medworm.com/index.php?rid=2490350&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000238%2Fabstract%3Frss%3Dyes Cumulative evidence implicates hypertension in the pathogenesis of Alzheimer disease. Although it may not presently be possible to completely differentiate the effects of treatment and control of hypertension itself from those of the medication used to achieve such treatment goals, efforts directed at the treatment and control of hypertension can have significant public health impact. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2490350 Thu, 30 Apr 2009 23:00:00 +0100 2490350 http://www.medworm.com/index.php?rid=2490349&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000196%2Fabstract%3Frss%3Dyes The efficacy and safety of rennin angiotensin system (RAS) inhibition for lowering blood pressure in older populations has been demonstrated in a number of clinical trials. Whether a patient's age influences the overall ability of these drugs to lower blood pressure and protect against progress of cardiovascular and kidney disease has been the focus of few clinical trials. Herein, the author's review the mechanism of action of the renin angiotensin cascade and then discuss the clinical evidence surrounding the use of RAS-blocking drugs in the older population. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2490349 Thu, 30 Apr 2009 23:00:00 +0100 2490349 http://www.medworm.com/index.php?rid=2490348&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000226%2Fabstract%3Frss%3Dyes This article reviews the evidence for drug treatment in this population. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2490348 Thu, 30 Apr 2009 23:00:00 +0100 2490348