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. Thu, 18 Mar 2010 14:28:04 +0100 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 http://www.medworm.com/index.php?rid=2490347&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000068%2Fabstract%3Frss%3Dyes Polypharmacy is highly prevalent in the elderly due to an increased number of co-morbid disease states that accompany aging. Hypertension is one common disease that can be challenging to treat in the elderly due to the body's physiologic changes, potential risks for side effects, medication interactions, and decreased medication adherence. A thorough medication assessment for each patient is essential when determining pharmacotherapeutic options in the elderly. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2490347 Thu, 30 Apr 2009 23:00:00 +0100 2490347 http://www.medworm.com/index.php?rid=2490346&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000044%2Fabstract%3Frss%3Dyes Nonpharmacologic management of hypertension is all too often overlooked in the elderly. The Dietary Approaches to Stop Hypertension (DASH) diet, weight loss, physical activity, moderation of alcohol, and salt restriction, particularly when used in combination, are effective strategies to help control hypertension and reduce overall cardiovascular risk. Behavioral modification should form the cornerstone of hypertension treatment in the elderly. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2490346 Thu, 30 Apr 2009 23:00:00 +0100 2490346 http://www.medworm.com/index.php?rid=2490345&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000056%2Fabstract%3Frss%3Dyes The geriatric population is growing in number and along with it, the prevalence of hypertension (HTN). The elderly have a unique set of characteristics that must be taken into account when treating this condition. Not only is it widespread, but its consequences, mainly cardiovascular and cerebrovascular, are devastating. Because the elderly have multiple comorbid concomitant conditions, the practitioner must be cognizant of polypharmacy and resistant HTN and prescribe in a safe fashion conducive to compliance and efficacy. Treatment in even the oldest old is indicated. Function and quality of life should be the driving principles when managing the elderly, be they in the ambulatory or long-term care setting. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2490345 Thu, 30 Apr 2009 23:00:00 +0100 2490345 http://www.medworm.com/index.php?rid=2490344&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000020%2Fabstract%3Frss%3Dyes The loss of arterial compliance as a result of the aging of human vasculature is thought to contribute to the age dependent rise in isolated systolic hypertension, and is an independent predictor of all cause mortality and cardiovascular outcomes. In this article, the author's we begin by providing a brief historical perspective of the study of the pulse wave. The author's then review the physiology of the normal arterial system, the effects of aging on the arterial system and the different measures of arterial stiffness. Finally, the author's review the different studies that look at arterial stiffness in the elderly, its impact on hypertension and cardiovascular outcome, and what is currently known on how to prevent vascular stiffness. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2490344 Thu, 30 Apr 2009 23:00:00 +0100 2490344 http://www.medworm.com/index.php?rid=2490343&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000032%2Fabstract%3Frss%3Dyes Hypertension is clearly associated with cardiovascular disease (CVD) and death. With age, the incidence of hypertension increases, making it imperative that we understand the pathophysiology and treatment of hypertension, especially in the elderly. Data regarding individuals older than 80 years are emerging, with more attention being given to patterns and treatment of hypertension in the elderly. Thus far, we have done a poor job with treating hypertension; this is due to multiple factors, including a reluctance of physicians to treat hypertension in the elderly because of concern of causing harm. In this article, the author's discuss the history and pathophysiology of hypertension, hypertension population studies, and hypertension treatment studies with a focus on the elderly. The author'... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2490343 Thu, 30 Apr 2009 23:00:00 +0100 2490343 http://www.medworm.com/index.php?rid=2490342&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS074906900900024X%2Fabstract%3Frss%3Dyes Hypertension affects more than 65 million individuals in the United States. Given the aging population, this is particularly challenging in the elderly patient; data from the Framingham study indicate that the lifetime probability of developing hypertension in the elderly is over 90%. Management of hypertension in elderly patients is a part of daily clinical practice for many primary care physicians and geriatric specialists. Therefore, this issue focusing on hypertension in the elderly is timely, and it is intended to provide the practicing clinician with a thorough update in this important area. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2490342 Thu, 30 Apr 2009 23:00:00 +0100 2490342 http://www.medworm.com/index.php?rid=2490341&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000378%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2490341 Thu, 30 Apr 2009 23:00:00 +0100 2490341 http://www.medworm.com/index.php?rid=2490340&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000366%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2490340 Thu, 30 Apr 2009 23:00:00 +0100 2490340 http://www.medworm.com/index.php?rid=2350698&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000159%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350698 Sun, 01 Feb 2009 05:00:00 +0100 2350698 http://www.medworm.com/index.php?rid=2350697&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069008000700%2Fabstract%3Frss%3Dyes This article describes a model of coordinated home-based medical care, called Independence at Home (IAH), which operates on a limited basis in many US communities and in the Veterans Affairs system. IAH-type teams deliver a full range of medical and social services at home to seriously ill elders and thereby reduce overall health care costs. We review the evidence that this approach can lower total costs by 25 percent or more while improving patient satisfaction and outcomes. We discuss funding for the new model, which also produces net savings for Medicare. A Medicare reform bill, called the Independence at Home Act, was introduced in the US House and Senate in 2008 to promote replication of this mobile elder care model. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350697 Sun, 01 Feb 2009 05:00:00 +0100 2350697 http://www.medworm.com/index.php?rid=2350696&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069008000682%2Fabstract%3Frss%3Dyes This article focuses on that program, a home care program that specifically targets individuals with complex chronic disabling disease, with the goal of maximizing the independence of the patient and reducing preventable emergency room visits and hospitalizations. HBPC programs provide comprehensive longitudinal primary care by an interdisciplinary team in the homes of veterans with complex chronic disease, who are not effectively managed by routine clinic-based care. HBPC is very different from and complementary to standard skilled home care services, in population, processes and outcomes. HBPC targets persons with advanced chronic disease, rather than remediable conditions. HBPC provides comprehensive care of multiple co-morbidities, rather than problem-focused care. HBPC is delivered by... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350696 Sun, 01 Feb 2009 05:00:00 +0100 2350696 http://www.medworm.com/index.php?rid=2350695&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069008000712%2Fabstract%3Frss%3Dyes This article reviews models of transitional care intervention that have been tested and shown to be effective including less intensive coaching or guided care approaches, and more intensive case management strategies. Effective transitional care processes, linked with strong home care programs can reduce re-hospitalization by a third in some less intensive models and by half or more in some more intensive models. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350695 Sun, 01 Feb 2009 05:00:00 +0100 2350695 http://www.medworm.com/index.php?rid=2350694&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069008000670%2Fabstract%3Frss%3Dyes This article reviews key findings from the past 2 decades of home care quality improvement research and public policy advances, describes specific examples of local and regional programmatic approaches to quality improvement, and forecasts near-future trends in this vital arena of home health care. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350694 Sun, 01 Feb 2009 05:00:00 +0100 2350694 http://www.medworm.com/index.php?rid=2350693&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069008000645%2Fabstract%3Frss%3Dyes This article discusses workforce development, which is a critical issue for future planning, as recently highlighted by the Institute of Medicine (IOM). Key aspects of recruitment, training, and retention of home care workers are discussed, including those who provide basic support for activities of daily living as well as a variety of skilled professionals: therapists, nurses, pharmacists, and physicians. Although the geriatric workforce shortage affects all care settings, it is especially critical in home health care, in part because we are starting with far too few clinicians to meet the medical needs of homebound elderly. A combination of actions is needed, including educational programs, such as those developed by the American Academy of Home Care Physicians (AAHCP), changes in financ... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350693 Sun, 01 Feb 2009 05:00:00 +0100 2350693 http://www.medworm.com/index.php?rid=2350692&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069008000657%2Fabstract%3Frss%3Dyes Medicare reimbursement for home visits average around $100 without ancillaries, so making 10 home visits to prevent even a single $1,000 ambulance ride is cost-neutral for Medicare. Home medical care is only an added cost if it fails to offset acute care use. The government's demographic and financial pressure suggests a need to press ahead with the enhanced mobile care model, so the explosion in point-of-care devices should continue. The main challenge is to decide which ones provide dispositive value to patients. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350692 Sun, 01 Feb 2009 05:00:00 +0100 2350692 http://www.medworm.com/index.php?rid=2350691&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS074906900800061X%2Fabstract%3Frss%3Dyes Although the acute hospital is the standard venue for treating acute serious illness, it is often a difficult environment for older adults who are highly susceptible to functional decline and other iatrogenic consequences of hospital care. Hospital care is also expensive. Providing acute hospital-level care at home, in lieu of usual institutional care, is viable. As an emerging service model, the definition of hospital at home (HaH) remains unsettled. Data favor HaH models that provide substantial physician inputs and are geared toward substituting for hospital care, provide service that is highly satisfying to patients and their caregivers, are associated with less iatrogenic complications, and are less expensive. Dissemination of HaH in integrated delivery systems is feasible. Widespread... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350691 Sun, 01 Feb 2009 05:00:00 +0100 2350691 http://www.medworm.com/index.php?rid=2350690&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069008000694%2Fabstract%3Frss%3Dyes Assistive technologies are critical to elders maintaining independence in the home. Adequate assessment of the patient's needs, the appropriateness of the device that need, and the patient's motivation to use of a device is required for successful outcomes. A team approach is needed to ensure that devices are correctly prescribed, and the patient is taught how to use it effectively. A wide range of devices is available to support activities of daily living, mobility, home management, and safety. The use of personal computers is significantly expanding the possibility of independent living through support systems, monitoring systems, and information resources. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350690 Sun, 01 Feb 2009 05:00:00 +0100 2350690 http://www.medworm.com/index.php?rid=2350689&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069008000608%2Fabstract%3Frss%3Dyes The prevalence and seriousness of elder abuse and neglect require the collaboration of health care professionals with many other disciplines for adequate assessment and intervention. The home visit provides a unique opportunity for the visitor to evaluate risk factors. Interventions and reporting depend on available resources, expertise and local reporting laws. Possible reasons for low physician and victim self-reporting are reviewed. Domestic violence persists into late life and requires diffferent approaches than dealing with caregiver burnout or self-neglect. Involvement of health professionals in educating others in the community about elder abuse and neglect may allow isolated at-risk elders to be identified. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350689 Sun, 01 Feb 2009 05:00:00 +0100 2350689 http://www.medworm.com/index.php?rid=2350688&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069008000621%2Fabstract%3Frss%3Dyes The focus of this article is paid personal assistant service (PAS) workers in community settings, and the converging current and future trends affecting the need to strengthen and expand the PAS workforce. A number of ways in which the federal and state governments, and the private sector can begin to solve the short and long-term workforce challenges are highlighted. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350688 Sun, 01 Feb 2009 05:00:00 +0100 2350688 http://www.medworm.com/index.php?rid=2350687&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069008000633%2Fabstract%3Frss%3Dyes This article describes: the origin and evolution of house calls; what is uniquely gained from house calls for both patients and providers; key clinical issues managed at home; evidence that house calls improve outcomes; organization of house call practices; and changes in Medicare reimbursement, technology, and interdisciplinary team care that have influenced the delivery of home-based medical care. (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350687 Sun, 01 Feb 2009 05:00:00 +0100 2350687 http://www.medworm.com/index.php?rid=2350686&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069008000724%2Fabstract%3Frss%3Dyes This article reviews the past history of home health agency care from its beginnings to the present day, evidence regarding the effect of recent changes in financing on these services, the state of skilled home health care in 2008, and a discussion of future directions. Home health care serves several million patients per year, many of whom are recuperating from acute illness episodes. Due to illness burden and Medicare funding, a large proportion of care that home health agencies deliver is geriatric care. However, home health care plays an important role for patients of all ages with significant acute and chronic illnesses. Medicare home health care suffered a significant downturn following the 1997 Balanced Budget Act and is recovering under Prospective Payment. Like most sectors of car... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350686 Sun, 01 Feb 2009 05:00:00 +0100 2350686 http://www.medworm.com/index.php?rid=2350685&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069008000736%2Fabstract%3Frss%3Dyes Serving several million people each year in the United States with services ranging from high-touch basic support to high-tech medical therapy, home care helps individuals obtain their best possible function and remain where they prefer to be: at home. This edition of Clinics will review the origins of contemporary home care, beginning with parish nurses and doctors on horseback at the turn of the twentieth century and continuing through present-day care, which includes ventilators the size of a toaster oven, intravenous therapy, “smart houses,” advanced information technology, and more. Each article has current, practical information, references regarding services and coverage, and reviews key evidence regarding impact. The authors articulate the building blocks for a future with full... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350685 Sun, 01 Feb 2009 05:00:00 +0100 2350685 http://www.medworm.com/index.php?rid=2350684&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000147%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350684 Sun, 01 Feb 2009 05:00:00 +0100 2350684 http://www.medworm.com/index.php?rid=2350683&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.geriatric.theclinics.com%2Farticle%2FPIIS0749069009000135%2Fabstract%3Frss%3Dyes (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2350683 Sun, 01 Feb 2009 05:00:00 +0100 2350683 http://www.medworm.com/index.php?rid=2199303&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217488%26dopt%3DAbstract Authors: Boling PA PMID: 19217488 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2199303 Sun, 01 Feb 2009 05:00:00 +0100 2199303 http://www.medworm.com/index.php?rid=2194353&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217488%26dopt%3DAbstract Authors: Boling PA PMID: 19217488 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2194353 Sun, 01 Feb 2009 05:00:00 +0100 2194353 http://www.medworm.com/index.php?rid=2194352&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217489%26dopt%3DAbstract This article reviews the past history of home health agency care from its beginnings to the present day, evidence regarding the effect of recent changes in financing on these services, the state of skilled home health care in 2008, and a discussion of future directions. Home health care serves several million patients per year, many of whom are recuperating from acute illness episodes. Due to illness burden and Medicare funding, a large proportion of care that home health agencies deliver is geriatric care. However, home health care plays an important role for patients of all ages with significant acute and chronic illnesses. Medicare home health care suffered a significant downturn following the 1997 Balanced Budget Act and is recovering under Prospective Payment. Like most sectors of car... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2194352 Sun, 01 Feb 2009 05:00:00 +0100 2194352 http://www.medworm.com/index.php?rid=2194351&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217490%26dopt%3DAbstract This article describes: the origin and evolution of house calls; what is uniquely gained from house calls for both patients and providers; key clinical issues managed at home; evidence that house calls improve outcomes; organization of house call practices; and changes in Medicare reimbursement, technology, and interdisciplinary team care that have influenced the delivery of home-based medical care. PMID: 19217490 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2194351 Sun, 01 Feb 2009 05:00:00 +0100 2194351 http://www.medworm.com/index.php?rid=2194350&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217491%26dopt%3DAbstract Authors: Stone R, Newcomer R The focus of this article is paid personal assistant service (PAS) workers in community settings, and the converging current and future trends affecting the need to strengthen and expand the PAS workforce. A number of ways in which the federal and state governments, and the private sector can begin to solve the short and long-term workforce challenges are highlighted. PMID: 19217491 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2194350 Sun, 01 Feb 2009 05:00:00 +0100 2194350 http://www.medworm.com/index.php?rid=2194349&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217492%26dopt%3DAbstract Authors: Abbey L The prevalence and seriousness of elder abuse and neglect require the collaboration of health care professionals with many other disciplines for adequate assessment and intervention. The home visit provides a unique opportunity for the visitor to evaluate risk factors. Interventions and reporting depend on available resources, expertise and local reporting laws. Possible reasons for low physician and victim self-reporting are reviewed. Domestic violence persists into late life and requires diffferent approaches than dealing with caregiver burnout or self-neglect. Involvement of health professionals in educating others in the community about elder abuse and neglect may allow isolated at-risk elders to be identified. PMID: 19217492 [PubMed - as supplied by publisher]... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2194349 Sun, 01 Feb 2009 05:00:00 +0100 2194349 http://www.medworm.com/index.php?rid=2194348&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217493%26dopt%3DAbstract Authors: Brummel-Smith K, Dangiolo M Assistive technologies are critical to elders maintaining independence in the home. Adequate assessment of the patient's needs, the appropriateness of the device that need, and the patient's motivation to use of a device is required for successful outcomes. A team approach is needed to ensure that devices are correctly prescribed, and the patient is taught how to use it effectively. A wide range of devices is available to support activities of daily living, mobility, home management, and safety. The use of personal computers is significantly expanding the possibility of independent living through support systems, monitoring systems, and information resources. PMID: 19217493 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medici... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2194348 Sun, 01 Feb 2009 05:00:00 +0100 2194348 http://www.medworm.com/index.php?rid=2194347&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217494%26dopt%3DAbstract Authors: Cheng J, Montalto M, Leff B Although the acute hospital is the standard venue for treating acute serious illness, it is often a difficult environment for older adults who are highly susceptible to functional decline and other iatrogenic consequences of hospital care. Hospital care is also expensive. Providing acute hospital-level care at home, in lieu of usual institutional care, is viable. As an emerging service model, the definition of hospital at home (HaH) remains unsettled. Data favor HaH models that provide substantial physician inputs and are geared toward substituting for hospital care, provide service that is highly satisfying to patients and their caregivers, are associated with less iatrogenic complications, and are less expensive. Dissemination of HaH in integrated... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2194347 Sun, 01 Feb 2009 05:00:00 +0100 2194347 http://www.medworm.com/index.php?rid=2194346&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217495%26dopt%3DAbstract Authors: Bayne CG, Boling PA Medicare reimbursement for home visits average around $100 without ancillaries, so making 10 home visits to prevent even a single $1,000 ambulance ride is cost-neutral for Medicare. Home medical care is only an added cost if it fails to offset acute care use. The government's demographic and financial pressure suggests a need to press ahead with the enhanced mobile care model, so the explosion in point-of-care devices should continue. The main challenge is to decide which ones provide dispositive value to patients. PMID: 19217495 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2194346 Sun, 01 Feb 2009 05:00:00 +0100 2194346 http://www.medworm.com/index.php?rid=2194345&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217496%26dopt%3DAbstract This article discusses workforce development, which is a critical issue for future planning, as recently highlighted by the Institute of Medicine (IOM). Key aspects of recruitment, training, and retention of home care workers are discussed, including those who provide basic support for activities of daily living as well as a variety of skilled professionals: therapists, nurses, pharmacists, and physicians. Although the geriatric workforce shortage affects all care settings, it is especially critical in home health care, in part because we are starting with far too few clinicians to meet the medical needs of homebound elderly. A combination of actions is needed, including educational programs, such as those developed by the American Academy of Home Care Physicians (AAHCP), changes in financ... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2194345 Sun, 01 Feb 2009 05:00:00 +0100 2194345 http://www.medworm.com/index.php?rid=2194344&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217497%26dopt%3DAbstract This article reviews key findings from the past 2 decades of home care quality improvement research and public policy advances, describes specific examples of local and regional programmatic approaches to quality improvement, and forecasts near-future trends in this vital arena of home health care. PMID: 19217497 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2194344 Sun, 01 Feb 2009 05:00:00 +0100 2194344 http://www.medworm.com/index.php?rid=2194343&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217498%26dopt%3DAbstract This article reviews models of transitional care intervention that have been tested and shown to be effective including less intensive coaching or guided care approaches, and more intensive case management strategies. Effective transitional care processes, linked with strong home care programs can reduce re-hospitalization by a third in some less intensive models and by half or more in some more intensive models. PMID: 19217498 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2194343 Sun, 01 Feb 2009 05:00:00 +0100 2194343 http://www.medworm.com/index.php?rid=2194342&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217499%26dopt%3DAbstract This article focuses on that program, a home care program that specifically targets individuals with complex chronic disabling disease, with the goal of maximizing the independence of the patient and reducing preventable emergency room visits and hospitalizations. HBPC programs provide comprehensive longitudinal primary care by an interdisciplinary team in the homes of veterans with complex chronic disease, who are not effectively managed by routine clinic-based care. HBPC is very different from and complementary to standard skilled home care services, in population, processes and outcomes. HBPC targets persons with advanced chronic disease, rather than remediable conditions. HBPC provides comprehensive care of multiple co-morbidities, rather than problem-focused care. HBPC is delivered by... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2194342 Sun, 01 Feb 2009 05:00:00 +0100 2194342 http://www.medworm.com/index.php?rid=2194341&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19217500%26dopt%3DAbstract This article describes a model of coordinated home-based medical care, called Independence at Home (IAH), which operates on a limited basis in many US communities and in the Veterans Affairs system. IAH-type teams deliver a full range of medical and social services at home to seriously ill elders and thereby reduce overall health care costs. We review the evidence that this approach can lower total costs by 25 percent or more while improving patient satisfaction and outcomes. We discuss funding for the new model, which also produces net savings for Medicare. A Medicare reform bill, called the Independence at Home Act, was introduced in the US House and Senate in 2008 to promote replication of this mobile elder care model. PMID: 19217500 [PubMed - as supplied by publisher] (Source: Clin... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=2194341 Sun, 01 Feb 2009 05:00:00 +0100 2194341 http://www.medworm.com/index.php?rid=1938027&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18984373%26dopt%3DAbstract Authors: Jaffer AK PMID: 18984373 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1938027 Sat, 01 Nov 2008 04:00:00 +0100 1938027 http://www.medworm.com/index.php?rid=1938026&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18984374%26dopt%3DAbstract Authors: Woolger JM The preoperative evaluation of the geriatric patient is an important time to make a series of assessments. Careful attention is paid to cardiac and pulmonary readiness for the physiologic stress of surgery. It is also a time to focus on the patient's mental capacities and social support system, and nutritional state. Because so many patients take multiple medications and supplements, the preoperative assessment is also a time to carefully review exactly what it being taken. It is a time to assess for drug interactions, and also to adjust medications to prepare the patient for the stress of surgery. PMID: 18984374 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1938026 Sat, 01 Nov 2008 04:00:00 +0100 1938026 http://www.medworm.com/index.php?rid=1938025&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18984375%26dopt%3DAbstract This article reviews the major concepts and recommendations from the ACC guidelines for preoperative cardiac evaluation and perioperative management to reduce risk. Medical management of the major postoperative cardiac complications is also discussed. PMID: 18984375 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1938025 Sat, 01 Nov 2008 04:00:00 +0100 1938025 http://www.medworm.com/index.php?rid=1938024&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18984376%26dopt%3DAbstract Authors: Smetana GW, Conde MV Postoperative pulmonary complications are an important source of surgical morbidity. In this paper, the authors review recent studies that shed light on emerging risk factors, a multifactorial index for respiratory failure, and the value of specific risk reduction strategies. Novel risk factors include advanced age, congestive heart failure, pulmonary hypertension, and obstructive sleep apnea. Important risk reduction strategies include postoperative lung expansion maneuvers, the selective use of nasogastric tubes, epidural analgesia, and inspiratory muscle training. PMID: 18984376 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1938024 Sat, 01 Nov 2008 04:00:00 +0100 1938024 http://www.medworm.com/index.php?rid=1938023&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18984377%26dopt%3DAbstract Authors: Jaffer AK, Brotman DJ Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, is the third leading cause of cardiovascular death after myocardial infarction and stroke in the United States. Recommendations regarding the type and duration of prophylaxis for the various conditions are summarized herein. PMID: 18984377 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1938023 Sat, 01 Nov 2008 04:00:00 +0100 1938023 http://www.medworm.com/index.php?rid=1938022&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18984378%26dopt%3DAbstract Authors: Kumar A, Carson JL Anemia is characterized by less than the normal number of red blood cells (RBCs) (as a result of underproduction, increased loss, or destruction) or decreased quantity of hemoglobin (Hgb) in the blood, thereby reducing the blood's oxygen-carrying capacity. PMID: 18984378 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1938022 Sat, 01 Nov 2008 04:00:00 +0100 1938022 http://www.medworm.com/index.php?rid=1938021&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18984379%26dopt%3DAbstract Authors: Maynard G, O'Malley CW, Kirsh SR The incidence of diabetes in the geriatric population is increasing and the resulting co-morbidities have led to corresponding increases in hospital admissions and surgeries. The weight of the evidence and national guidelines should dissuade us from allowing uncontrolled hyperglycemia in the geriatric perioperative population, but the glycemic target should be modified upwards based on the individual patient characteristics, and in environments that do not have an established track record of reaching more aggressive targets safely. Insulin is the most effective and flexible regimen to achieve inpatient glycemic control, whether by infusion or by subcutaneous basal bolus regimens. Strategies for safe and effective dosing and adjustment of insuli... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1938021 Sat, 01 Nov 2008 04:00:00 +0100 1938021 http://www.medworm.com/index.php?rid=1938020&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18984380%26dopt%3DAbstract Authors: Bagri AS, Rico A, Ruiz JG Geriatric patients are at a high risk for the development of postoperative delirium. By recognizing predisposing and precipitating risk factors, preventive measures can be undertaken to reduce this risk. Accurate and timely diagnosis is essential, and we offer therapeutic strategies to help reduce the high morbidity and mortality of this important condition. PMID: 18984380 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1938020 Sat, 01 Nov 2008 04:00:00 +0100 1938020 http://www.medworm.com/index.php?rid=1938019&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18984381%26dopt%3DAbstract Authors: Gayer S, Zuleta J Eye procedures are considered to be low risk; however, many ophthalmic surgery patients are elderly and are a unique vulnerable group with a myrid of concomitant health issues that put them at greater risk for perioperative medical complications. A trend to shift operative venues from hospitals to ambulatory facilities and more recently to specialty eye-care surgery centers limits the resources available to manage major, and even minor, medical issues that arise on the day of surgery. The role of the internist in the preoperative evaluation and optimization of medical issues before surgery and availability for perioperative consultation and intercession is increasingly essential. PMID: 18984381 [PubMed - as supplied by publisher] (Source: Clinics in Geria... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1938019 Sat, 01 Nov 2008 04:00:00 +0100 1938019 http://www.medworm.com/index.php?rid=1938018&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18984382%26dopt%3DAbstract Authors: Auron-Gomez M, Michota F The United States population at the greatest risk for hip fracture, those aged 65 years and older, is steadily increasing in size. Today, the incidence of hip fracture is approximately 250,000 per year and it is expected to double in the next 30 years. Hip fracture patients are comorbid at baseline, and there are complications inherent to hip fractures that can occur in almost a predictable fashion. Overall, one in four hip fracture patients will die within one year of injury. Medical comanagement of hip fracture patients offers the best chance for successful outcome. PMID: 18984382 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1938018 Sat, 01 Nov 2008 04:00:00 +0100 1938018 http://www.medworm.com/index.php?rid=1938017&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18984383%26dopt%3DAbstract Authors: Noor S, Usmani A Acute renal failure (ARF) or acute kidney injury (AKI) is a common problem occurring in about 1% to 5% of all hospitalized patients. It leads to poor quality of life and increased length of stay (LOS), cost of care, morbidity, and mortality. The survival rate for ARF has not drastically changed over the past 4 decades because of the aging population and presence of multiple comorbid conditions. About 200 patients per million population develop severe ARF each year. Approximately one-third of these patients require ICU care. Recent studies have shown that even milder forms of renal dysfunction are associated with increased LOS and mortality. PMID: 18984383 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1938017 Sat, 01 Nov 2008 04:00:00 +0100 1938017 http://www.medworm.com/index.php?rid=1793788&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18672178%26dopt%3DAbstract Authors: Morley JE PMID: 18672178 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1793788 Fri, 01 Aug 2008 04:00:00 +0100 1793788 http://www.medworm.com/index.php?rid=1676699&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18672178%26dopt%3DAbstract Authors: Morley JE PMID: 18672178 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1676699 Fri, 01 Aug 2008 04:00:00 +0100 1676699 http://www.medworm.com/index.php?rid=1676698&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18672179%26dopt%3DAbstract This article explores the increasing prevalence of diabetes mellitus with aging and how insulin resistance leads to accelerated frailty, disability, hospitalization, institutionalization, and death. PMID: 18672179 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1676698 Fri, 01 Aug 2008 04:00:00 +0100 1676698 http://www.medworm.com/index.php?rid=1676697&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18672180%26dopt%3DAbstract Authors: Vinik AI, Strotmeyer ES, Nakave AA, Patel CV Diabetic neuropathy is a heterogeneous disease with diverse pathology. Recognition of the clinical homolog of these pathologic processes is necessary in achieving appropriate intervention. Treatment should be individualized so the particular manifestation and underlying pathogenesis of each patient's clinical presentation are considered. In older adults, special care should be taken to manage pain while optimizing daily function and mobility, with the fewest adverse medication side effects. Older adults are at great risk for falling and fractures because of instability and weakness, and require strength exercises and coordination training. Ultimately agents that address large fiber dysfunction will be essential to reduce the gross i... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1676697 Fri, 01 Aug 2008 04:00:00 +0100 1676697 http://www.medworm.com/index.php?rid=1676696&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18672181%26dopt%3DAbstract Authors: Mazza AD The incidence of insulin resistance in the geriatric population is growing as this population grows. The management of hyperglycemia and its associated risk factors depends on an expanding understanding of the underlying pathophysiology and progression of disease and of the currently available and future therapeutics, which are continually evolving. There is a major need for studies in the long-term care setting to determine the appropriate standard of care in prevention and treatment of metabolic dysregulation. PMID: 18672181 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1676696 Fri, 01 Aug 2008 04:00:00 +0100 1676696 http://www.medworm.com/index.php?rid=1676695&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18672182%26dopt%3DAbstract Authors: Morley JE Frailty is a pre-disability condition. It now can be defined clinically. The major factors leading to frailty are sarcopenia and a decline in executive function. Stressors precipitate frail individuals into a state of disability. Diabetics develop the conditions necessary for frailty earlier than other aging individuals. Appropriate treatment of diabetes mellitus and frailty precursors can result in a slowing of the aging process. PMID: 18672182 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1676695 Fri, 01 Aug 2008 04:00:00 +0100 1676695 http://www.medworm.com/index.php?rid=1676694&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18672183%26dopt%3DAbstract Authors: Ducharme N, Radhamma R People are now living longer, largely because of a combination of falling rates of fertility and mortality, thus producing a greater proportion of older people in society. Thirty times more centenarians were alive in 2000 than in 1900, and the population growth in the elderly segment of society is expected to continue at an exponential rate. Vascular disease is responsible for more than a quarter of all deaths worldwide. More than 80% of individuals who die of coronary heart disease are older than 65 years. Although a myocardial infarction may be perceived as fatal, heart attacks do not always lead to death but to conditions such as congestive heart failure, ischemic cardiomyopathy, and angina, which greatly impact quality of life. These issues are only ... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1676694 Fri, 01 Aug 2008 04:00:00 +0100 1676694 http://www.medworm.com/index.php?rid=1676693&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18672184%26dopt%3DAbstract This article reviews studies addressing the implications of hypertension and the older diabetic. PMID: 18672184 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1676693 Fri, 01 Aug 2008 04:00:00 +0100 1676693 http://www.medworm.com/index.php?rid=1676692&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18672185%26dopt%3DAbstract Authors: Senkottaiyan N Diabetes mellitus is among the most common and complex chronic diseases that affect approximately 20 million individuals in the United States. An additional 26% of the population has impaired fasting glucose, making diabetes an epidemic. MNT in diabetes addresses not only glycemic control but also other aspects of metabolic status, including hypertension and dyslipidemia, which are major risk factors for cardiovascular disease. MNT is an integral component of diabetes management, which includes the process and system through which nutritional care and specific life style recommendations are provided to diabetic individuals. Cultural and ethnic preferences are taken into account and patients are involved in the decision-making process. PMID: 18672185 [PubMed ... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1676692 Fri, 01 Aug 2008 04:00:00 +0100 1676692 http://www.medworm.com/index.php?rid=1676691&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18672186%26dopt%3DAbstract This article discusses the synergy between these conditions and diabetes. Standards of care that slow the progression of vision loss and exciting new research on new strategies of care that may reverse vision loss are presented. PMID: 18672186 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1676691 Fri, 01 Aug 2008 04:00:00 +0100 1676691 http://www.medworm.com/index.php?rid=1676690&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18672187%26dopt%3DAbstract Authors: Thomas DR Anemia is common in diabetic patients and is associated with increased morbidity and mortality. The observations that diabetes-related chronic kidney disease is more common than chronic kidney disease of other etiologies, that anemia may occur earlier in diabetes-related chronic kidney disease than in other types of chronic kidney disease, and that anemia in diabetes-related kidney disease often is found without measurable renal impairment suggest that the diabetic population may have a predilection to the development of anemia. Anemia is associated with a poorer prognosis in diabetic-associated comorbid conditions, but targeted correction of anemia has improved diabetic patients' quality of life. PMID: 18672187 [PubMed - in process] (Source: Clinics in Geriatric... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1676690 Fri, 01 Aug 2008 04:00:00 +0100 1676690 http://www.medworm.com/index.php?rid=1676689&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18672188%26dopt%3DAbstract This article discusses indications for their usage, along with their beneficial and adverse effects. PMID: 18672188 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1676689 Fri, 01 Aug 2008 04:00:00 +0100 1676689 http://www.medworm.com/index.php?rid=1676688&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18672189%26dopt%3DAbstract Authors: Plummer ES, Albert SG Guidelines for diabetes foot care are available and should be part of the routine care and evaluation of all elderly patients who have diabetes. Those individuals who have good sensation, good vascularity, without foot deformities, and are capable of reaching and seeing their feet may do well with education and reasonable approaches to footwear and foot care. Those who have advanced diabetic complications of neuropathy or vascular insufficiency should be seen by professionals and given intensive education. An experienced team familiar with the progression of illness should follow those who have ulcers. Guidelines are presented for the management of outpatient and inpatient therapy of foot ulcers. PMID: 18672189 [PubMed - in process] (Source: Clinics i... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1676688 Fri, 01 Aug 2008 04:00:00 +0100 1676688 http://www.medworm.com/index.php?rid=1554136&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18387450%26dopt%3DAbstract Authors: Smith HS PMID: 18387450 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1554136 Thu, 01 May 2008 04:00:00 +0100 1554136 http://www.medworm.com/index.php?rid=1352682&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18387450%26dopt%3DAbstract Authors: Smith HS PMID: 18387450 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1352682 Sat, 05 Apr 2008 20:12:06 +0100 1352682 http://www.medworm.com/index.php?rid=1352681&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18387451%26dopt%3DAbstract Authors: Deane G, Smith HS The purpose of this article is to situate the social and demographic context of pain management in older adults. It summarizes representative literature on the age and sex composition of pain among older adults and considers sources of assessment bias that likely lead to the conflicting descriptions of prevalence. It also describes treatment options that are both available and acceptable to older adults. PMID: 18387451 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1352681 Sat, 05 Apr 2008 20:12:03 +0100 1352681 http://www.medworm.com/index.php?rid=1352680&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18387452%26dopt%3DAbstract Authors: McCleane G In the elderly patient, the barriers to effective treatment of pain are substantial. Even the perception of pain may differ from that in those of less advanced years. Of course, many other factors impinge on the presence of, and treatment of, pain in elderly patients. Issues of physical accessibility to treatment, cost of drugs, the presence of coexisting illness, the use of concomitant medication, and even the ability to understand the complaints of the patient who has cognitive impairment are only some of those factors that contribute to the complexity of the situation. PMID: 18387452 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1352680 Sat, 05 Apr 2008 20:12:01 +0100 1352680 http://www.medworm.com/index.php?rid=1352679&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18387453%26dopt%3DAbstract This article provides the clinician with the foundation to perform a successful pain assessment for older adults who are able to communicate by self-report. This provides a comprehensive base on which to build a relevant plan of care. PMID: 18387453 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1352679 Sat, 05 Apr 2008 20:11:58 +0100 1352679 http://www.medworm.com/index.php?rid=1352678&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18387454%26dopt%3DAbstract This article focuses on nonverbal older adult populations with dementia, delirium, and severe critical illness. A comprehensive approach to pain assessment is advocated encompassing multiple sources of information. Selected behavioral tools for nonverbal pain assessment are critiqued. Although there are tools with promise, there is currently no standardized behavioral tool that may be recommended for broad adoption in clinical practice and continued concerted effort to this end is needed. PMID: 18387454 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1352678 Sat, 05 Apr 2008 20:11:55 +0100 1352678 http://www.medworm.com/index.php?rid=1352677&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18387455%26dopt%3DAbstract Authors: Kirsh KL, Smith HS Older patients who have pain present unique challenges for clinicians. On the one hand, care must be taken to treat the pain aggressively while avoiding hampering the patient with excessive side effects, such as drowsiness, nausea and vomiting, and constipation. On the other hand, the clinician must be aware of the growing problem of prescription drug abuse and assess whether or not the patient or his or her family is at risk. Indeed, the concern for assessment is not solely centered on the patient but also extends to the family and extended support network, which may or may not have the patient's best interests at heart when it comes to pain medications. Supposing that addiction and abuse are solely the purview of the young is no longer acceptable, and we h... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1352677 Sat, 05 Apr 2008 20:11:50 +0100 1352677 http://www.medworm.com/index.php?rid=1352676&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18387456%26dopt%3DAbstract This article reviews the pharmacotherapy of pain in older adults, with a focus on salicylates, nonsteroidal anti-inflammatory drugs, and opioids. PMID: 18387456 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1352676 Sat, 05 Apr 2008 20:11:47 +0100 1352676 http://www.medworm.com/index.php?rid=1352675&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18387457%26dopt%3DAbstract Authors: McCleane G Pain processing and transmission are achieved by a complex interaction of pathways and processes. Those parts of the process with peripheral representation may be amenable to therapeutic intervention by systemic administration to achieve a peripheral effect or by local application, including local topical administration to the skin overlying the painful area. Advantages include high level of patient acceptance, ease of administration, avoidance of systemic side effects, and reduced drug-drug interactions. Those drugs with topical analgesic effects include those with specific topical analgesic indication and others in which no such indication exists but that may offer a chance of pain therapy at reduced risk. PMID: 18387457 [PubMed - in process] (Source: Clinics ... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1352675 Sat, 05 Apr 2008 20:11:43 +0100 1352675 http://www.medworm.com/index.php?rid=1352674&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18387458%26dopt%3DAbstract Authors: Schneider H, Cristian A Pain management may play an important role in contributing to optimal quality of life in the elderly population. Pain lowers overall quality of life in part by decreasing function and by amplifying the psychologicic stress of aging. A comprehensive, multidisciplinary approach to pain management, with preservation and restoration of function in older adults, is the cornerstone of an effective pain management program. PMID: 18387458 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1352674 Sat, 05 Apr 2008 20:11:35 +0100 1352674 http://www.medworm.com/index.php?rid=1352673&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18387459%26dopt%3DAbstract Authors: Norelli LJ, Harju SK Pain is a complex phenomenon, influenced by many individual and external factors, and may be experienced differently with age. The detrimental health and social effects of chronic pain are well known. Age-related disorders, such as dementia, may interfere with the communication of pain. Health care provider bias and cultural expectations also may be barriers to the recognition and management of pain in the elderly. A multidisciplinary and multimodal approach in older adults is essential to effective assessment and management. Behavioral approaches to pain should be considered and incorporated into treatment where appropriate. PMID: 18387459 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1352673 Sat, 05 Apr 2008 20:11:32 +0100 1352673 http://www.medworm.com/index.php?rid=1352672&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18387460%26dopt%3DAbstract This article reviews minimally invasive techniques for treating back pain, lumbosacral radicular pain, lumbar spinal stenosis, and compression fractures. PMID: 18387460 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1352672 Sat, 05 Apr 2008 20:11:29 +0100 1352672 http://www.medworm.com/index.php?rid=1352671&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18387461%26dopt%3DAbstract This article aims to characterize the growing unmet need for the treatment of neurogenic intermittent claudication in the elderly population with lumbar spinal stenosis and reviews the current understanding of this condition with an eye toward framing a research agenda for nonsurgical treatments. PMID: 18387461 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1352671 Sat, 05 Apr 2008 20:11:22 +0100 1352671 http://www.medworm.com/index.php?rid=1048201&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035226%26dopt%3DAbstract Authors: Gammack JK PMID: 18035226 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048201 Sun, 25 Nov 2007 01:09:09 +0100 1048201 http://www.medworm.com/index.php?rid=1048200&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035227%26dopt%3DAbstract This article describes the normal changes in sleep physiology in the elderly. PMID: 18035227 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048200 Sun, 25 Nov 2007 01:09:07 +0100 1048200 http://www.medworm.com/index.php?rid=1048199&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035228%26dopt%3DAbstract Authors: Misra S, Malow BA Older patients are at risk for a variety of sleep disorders, ranging from insomnia to circadian rhythm disturbances. The clinical consequence of unremitting sleep disturbances in the elderly population often includes hypersomnolence and may result in disorientation, delirium, impaired intellect, disturbed cognition, psychomotor retardation, or increased risk of accidents and injury. These symptoms may compromise overall quality of life and create social and economic burdens for the health care system, as well as for the caregivers. The clinical assessment of aging patients who have sleep complaints involves an in-depth multidisciplinary approach. PMID: 18035228 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048199 Sun, 25 Nov 2007 01:09:05 +0100 1048199 http://www.medworm.com/index.php?rid=1048198&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035229%26dopt%3DAbstract Authors: Garcia AD Sleep disorders are increasingly common as people age. Along with the numerous physiologic changes that occur with aging, sleep patterns are also altered. Inability to get to sleep, shorter sleep times, and changes in the normal circadian patterns can have an impact on an individual's overall well being. In addition, many common chronic conditions, such as chronic obstructive pulmonary disease, diabetes, dementia, chronic pain, and cancer, that are more common in the elderly, can also have significant effects on sleep and increase the prevalence of insomnia as compared with the general population. This is a result not only of the chronic medical illnesses themselves, but of the psychologic and social factors associated with the disease processes. PMID: 18035229 [... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048198 Sun, 25 Nov 2007 01:09:04 +0100 1048198 http://www.medworm.com/index.php?rid=1048197&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035230%26dopt%3DAbstract Authors: Martin JL, Ancoli-Israel S Nighttime sleep disruption is characteristic of long-term care residents, is typically accompanied by daytime sleepiness, and may be caused by a multitude of factors. Causal factors include medical and psychiatric illness, medications, circadian rhythm abnormalities, sleep disordered breathing and other primary sleep disorders, environmental factors, and lifestyle habits. There is some suggestion that these factors are amenable to treatment; however, further research on the implementation of treatments within the long-term care setting is needed. Additional work is also needed to understand the administrative and policy factors that might lead to systemic changes in how sleep is viewed and sleep problems are addressed in long-term care settings. ... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048197 Sun, 25 Nov 2007 01:09:01 +0100 1048197 http://www.medworm.com/index.php?rid=1048196&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035231%26dopt%3DAbstract Authors: Flaherty JH Among hospitalized older persons, rates of insomnia are alarmingly high, as is evident by the high rates of use of sedative-hypnotic drugs, ranging from 31% to 88%. Insomnia among hospitalized patients may represent undiagnosed sleep disorders, underlying medical problems, and underlying psychiatric problems. Causes of insomnia can be intrinsic or extrinsic. In the intensive care unit, which is one of the most studied areas of the hospital related to insomnia, most studies using polysomnography monitoring have shown that although sleep times seem normal (about 7&8 hours per night), no patients have normal sleep patterns. There is evidence supporting the use of nonpharmacologic interventions, which are preferable to the use of sedating drugs because of the risk ... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048196 Sun, 25 Nov 2007 01:09:00 +0100 1048196 http://www.medworm.com/index.php?rid=1048195&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035232%26dopt%3DAbstract Authors: Paniagua MA, Paniagua EW Elders with dementia experience a high prevalence of disordered sleep that can present as agitation, sleep-disordered breathing, or excessive daytime napping. One must also consider broader contextual issues in the evaluation and treatment of the demented elder with insomnia, such as the caregiver and staff, as well as the setting in which the patient resides. The treatment approach to the demented elder with insomnia is difficult and largely based on clinical experience rather than a broad evidence base. Using a "less is better" approach in attempting nonpharmacologic interventions before initiating a trial of drug therapy is the optimal first step. PMID: 18035232 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048195 Sun, 25 Nov 2007 01:08:58 +0100 1048195 http://www.medworm.com/index.php?rid=1048194&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035233%26dopt%3DAbstract Authors: Hajjar RR Sleep disturbance in palliative medicine is a common and challenging condition that significantly adds to the burden of suffering experienced by patients with advanced stage diseases. Sleep disorders may be primary or, more commonly, a secondary symptom of the advancing disease process. The diverse nature of patients under palliative care makes management of sleep disorders particularly challenging and highly individualized. Multiple pharmacologic and nonpharmacologic interventions have been successfully used for the management of sleep disturbances in palliative medicine. Yet, despite these measures, many patients do not seek medical attention for sleep disturbances, and health care providers tend to under-diagnose this condition and under-treat it when diagnosed, t... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048194 Sun, 25 Nov 2007 01:08:56 +0100 1048194 http://www.medworm.com/index.php?rid=1048193&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035234%26dopt%3DAbstract Authors: Tariq SH, Pulisetty S Hypnotics are commonly use in the treatment of insomnia, and hypnotic use among older adults is more prevalent than with younger adults. Unfortunately, the use of hypnotics is not well studied in the ever-growing geriatric population and the magnitude of the medication benefit is usually not impressive. Insomnia in older adults is usually treated with benzodiazepines, nonbenzodiazepines, and other agents, such as trazodone, valerian, and melatonin. Using appropriately selected agents and therapy initiated with a low dose and careful monitoring of the patient could minimize common unwanted side effects. PMID: 18035234 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048193 Sun, 25 Nov 2007 01:08:54 +0100 1048193 http://www.medworm.com/index.php?rid=1048192&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035235%26dopt%3DAbstract Authors: Joshi S Nonpharmacologic modalities may be used alone or in combination with pharmacologic therapy for effective treatment of insomnia in the elderly. Nondrug treatments involve behavioral, cognitive, and physiologic interventions. Common methods of cognitive behavior therapy for insomnia include: relaxation, stimulus control, sleep restriction, cognitive interventions or therapy, sleep education and sleep hygiene, light therapy, and chronotherapy. Evidence suggests that nonpharmacologic treatments are effective and well suited for the clinical management of insomnia in the elderly. PMID: 18035235 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048192 Sun, 25 Nov 2007 01:08:52 +0100 1048192 http://www.medworm.com/index.php?rid=1048191&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035236%26dopt%3DAbstract Authors: Gooneratne NS Complementary and alternative medicines (CAM) are frequently used for the treatment of sleep disorders, but in many cases patients do not discuss these therapies directly with their health care provider. There is a growing body of well-designed clinical trials using CAM that have shown the following: (1) Melatonin is an effective agent for the treatment of circadian phase disorders that affect sleep; however, the role of melatonin in the treatment of primary or secondary insomnia is less well established. (2) Valerian has shown a benefit in some, but not all clinical trials. (3) Several other modalities, such as Tai Chi, acupuncture, acupressure, yoga, and meditation have improved sleep parameters in a limited number of early trials. Future work examining CAM has... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048191 Sun, 25 Nov 2007 01:08:51 +0100 1048191 http://www.medworm.com/index.php?rid=1048190&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035237%26dopt%3DAbstract Authors: Gammack JK Exposure to bright light suppresses the production of melatonin and contributes to the regulation of the circadian rhythm. Because of environmental and medical conditions, older adults are less likely than younger adults to receive the prolonged, high intensity, daily bright light needed to promote a satisfactory sleep-wake cycle. The best available evidence for bright light therapy is in the management of seasonal affective disorder, which is relatively infrequent in the elderly population. For older adults with chronic insomnia, dementia, and nonseasonal depression, there is no consensus on the optimum treatment protocol for bright light therapy. However, in addition to sleep improvement, bright light therapy may be used to reduce unwanted behavioral and cognitive... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048190 Sun, 25 Nov 2007 01:08:49 +0100 1048190 http://www.medworm.com/index.php?rid=1048189&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035238%26dopt%3DAbstract This article reviews the basic terminology and pathophysiology of sleep-disordered breathing, discusses why OSA may be even more prevalent in older adults than in the middle-aged group, and reviews similarities and differences between the two groups in the manifestations, consequences, and treatments of OSA. PMID: 18035238 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048189 Sun, 25 Nov 2007 01:08:47 +0100 1048189 http://www.medworm.com/index.php?rid=1048188&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18035239%26dopt%3DAbstract Authors: Spiegelhalder K, Hornyak M Restless legs syndrome (RLS) is a common neurological disorder characterized by an urge to move the legs. The symptoms show a strong circadian rhythmicity, with onset or increase in the evening or at night; thus, sleep disturbances are the most frequent reason for patients seeking medical aid. The prevalence of the disorder increases strongly with age, with an estimated 9% to 20% of sufferers being among the elderly. Dopaminergic drugs are the first-line treatment option in RLS; opioids and anticonvulsants can also be used either as add-on or stand alone therapy options. Secondary forms of RLS and possible interaction with other medications require particular consideration in the elderly. PMID: 18035239 [PubMed - in process] (Source: Clinics in G... Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=1048188 Sun, 25 Nov 2007 01:08:45 +0100 1048188 http://www.medworm.com/index.php?rid=941280&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17923333%26dopt%3DAbstract Authors: Tariq SH PMID: 17923333 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=941280 Thu, 11 Oct 2007 00:16:28 +0100 941280 http://www.medworm.com/index.php?rid=941279&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17923334%26dopt%3DAbstract This article summarizes the definitions, epidemiology, clinical presentation, and impact of these common problems in the geriatric patient. PMID: 17923334 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=941279 Thu, 11 Oct 2007 00:16:26 +0100 941279 http://www.medworm.com/index.php?rid=941278&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17923335%26dopt%3DAbstract This article reviews age-related changes to appetite, food intake, and body composition; undernutrition in the elderly; and the factors contributing to physiologic and pathologic anorexia and undernutrition. PMID: 17923335 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=941278 Thu, 11 Oct 2007 00:16:25 +0100 941278 http://www.medworm.com/index.php?rid=941277&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17923336%26dopt%3DAbstract Authors: Morley JE Changes in the physiology of the gastrointestinal tract with aging are less obvious than are seen in other organs, such as the brain. Nevertheless, physiologic changes play a role in the anorexia of aging, postprandial hypotension, aspiration pneumonia, increased Clostridium difficile infections, fecal incontinence, gallstones, and altered drug metabolism. PMID: 17923336 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=941277 Thu, 11 Oct 2007 00:16:24 +0100 941277 http://www.medworm.com/index.php?rid=941276&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17923337%26dopt%3DAbstract This article addresses clinical presentation, etiology, diagnosis, and treatment of upper and lower gastrointestinal bleeding in elderly individuals. PMID: 17923337 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=941276 Thu, 11 Oct 2007 00:16:22 +0100 941276 http://www.medworm.com/index.php?rid=941275&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17923338%26dopt%3DAbstract This article focuses on the interactions between gastric emptying and diabetes, how each is influenced by the process of aging, and the implications for patient management. PMID: 17923338 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=941275 Thu, 11 Oct 2007 00:16:20 +0100 941275 http://www.medworm.com/index.php?rid=941274&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17923339%26dopt%3DAbstract This article examines the diagnosis and management of IBD in the context of recent advances in the understanding of its pathogenesis, and newer therapeutic modalities that have been possible from these advances. PMID: 17923339 [PubMed - in process] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=941274 Thu, 11 Oct 2007 00:16:19 +0100 941274 http://www.medworm.com/index.php?rid=941273&cid=s_33210_18_f&fid=33210&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17923340%26dopt%3DAbstract Authors: Morley JE Constipation and irritable bowel syndrome are very common in older persons. Constipation is over diagnosed and over treated in older persons. Lifestyle changes, osmotic laxatives, and lubiprostone are the approaches of choice for the management of constipation. Irritable bowel syndrome should be considered in the differential diagnosis of abdominal pain, diarrhea and constipation in older persons. PMID: 17923340 [PubMed - as supplied by publisher] (Source: Clinics in Geriatric Medicine) Clinics in Geriatric Medicine journals http://www.medworm.com/rss/comments.php?id=941273 Thu, 11 Oct 2007 00:16:17 +0100 941273