Geriatrics

No abstract text is available yet for this article.

Osteoarthritis (OA) is the most common form of arthritis and the leading cause of disability in the United States, especially among older adults. Treatment options have primarily focused on alleviating the pain often associated with this condition. Acetaminophen and nonsteroidal anti inflammatory drugs (NSAIDs) are often employed for relief of mild-to moderate pain associated with OA. NSAIDs are typically more effective than acetaminophen; however, because of adverse effects associated with long-term use of NSAIDS, acetaminophen is considered first-line therapy...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Rheumatoid arthritis (RA) in the geriatric population presents a unique challenge to treating clinicians. It can present as preexisting disease that may have been present for years or as a de novo onset of the illness. Diagnosis and management requires a detailed knowledge of the disease, its differential diagnoses, and the therapeutic options. A number of other diseases can mimic the illness and must be thoroughly evaluated to avoid serious consequences. New agents to treat RA are available that have shown promise in clinical trials and practice...

This article reviews and summarizes the American Heart Association/American Stroke Association guideline: Primary Prevention of Ischemic Stroke. It focuses on recommendations applicable to the geriatric population that may decrease patient risk of developing ischemic stroke. An approach focusing on assessing and treating modifiable risk factors is advised.

When faced with difficult-to-control cardiovascular risk factors, clinicians need to address the potential role of patient adherence to medication. Among the elderly in particular, careful consideration must be paid to accurately diagnosing an adherence problem in the context of often worsening atherosclerosis. This process includes moving beyond relying on clinical intuition to ascertain whether a patient has "real" (e.g., identifiable) reasons for suboptimal risk factor control and becoming comfortable using evidence-based questions and other ancillary data, when available, to more objectively identify patients with adherence issues...

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No abstract text is available yet for this article.

Heart failure primarily affects older adults, but these patients are underrepresented in clinical trials. Implantable cardiac defibrillators have been shown in large trials to reduce mortality through primary and secondary prevention of cardiac arrest. It is not clear, however, whether older patients derive the same mortality benefit as younger patients. Cardiac resynchronization therapy improves exercise tolerance and quality of life, and decreases mortality and hospitalizations for younger and older patients with heart failure...

Recent research has suggested that religion/spirituality may be linked to improved physical and emotional health, although the patient's motivation and method of using religious/spiritual beliefs appear to be a key factor in obtaining benefit. Studies have shown that there is a high level of religion/spirituality among older adults in the United States and significant patient-reported desire to include such beliefs in health care settings. This article provides a brief overview of the support for considering religion/spirituality in the health care of older adults and reviews potential drawbacks and methods for providers to assess and use patient beliefs to improve anxiety/depression...

This review of the guideline developed by the Clinical Efficacy Subcommittee of the American College of Physicians and the accompanying systematic review offers clinicians evidence-based recommendations for palliative care. Seriously ill patients should be assessed for pain, dyspnea, and depression. Clinicians should use therapies of proven effectiveness to manage pain, depression, and dyspnea, including opioids in patients with unrelieved dyspnea and oxygen for short-term relief of hypoxemia. Clinicians should ensure that advance care planning, including completion of advance directives, occurs...

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No abstract text is available yet for this article.

Chronic open-angle glaucoma is a leading cause of blindness and visual impairment in older adults. Optic nerve damage and the associated peripheral and subsequent central vision loss are irreversible, but early diagnosis and treatment will give patients the best chance to maintain functional vision and quality of life. Primary care physicians can assist with the diagnosis of glaucoma by making appropriate referrals for routine ophthalmic examinations, especially in patients with risk factors for glaucoma. Medication adherence and persistence may also be enhanced by discussing strategies to improve medication use and efficacy in the primary care setting...

Elder abuse (physical, sexual, or psychological) and neglect (by caretakers or self-neglect) are major public health problems. Most cases are not identified by clinicians and reported to the appropriate government agencies. There are some barriers to clinician identification and reporting of cases of elder abuse or neglect. These barriers mainly result from a lack of clinician education and comfort regarding this topic. We propose that clinician understanding of the phenomenon of elder mistreatment, familiarity with a simple approach to screening and identification of cases, awareness of risk factors and warning signs, and awareness of appropriate interventions will help to eliminate these barriers and result in clinicians properly fulfilling their duty to help protect their most vulnerable elderly patients...

Chronic gastroesophageal reflux disease (GERD) is a risk factor for the development of Barrett's esophagus, the predominant precursor to esophageal adenocarcinoma. It is important for the primary care physician to identify those at greatest risk of developing Barrett's esophagus for referral for appropriate endoscopic screening. Many older patients display atypical symptoms or may be asymptomatic. The primary care physician must maintain a high index of suspicion and refer anyone who may potentially be at risk of Barrett's esophagus to a gastroenterologist...

No abstract text is available yet for this article.

No abstract text is available yet for this article.