November/December 2004
New Options for Successful Outcomes by Nalaka Gooneratne, M.D. Although most physicians agree that sleep problems in the elderly are important, these problems are often overlooked and underdiagnosed. The articles in this Sleep Disorders Special Report offer ways to assist patients while minimizing complications. See Full Story
Assessing and Treating Sleep Disturbances in Patients With Alzheimer's Disease by Clifford Singer, M.D., and Alison Bahr, M.A. Patients with Alzheimer's disease may suffer the same age- and disease-related changes to sleep as their age-matched peers. However, as the dementia progresses, even more severe disturbances develop. This article focuses on long-term, holistic approaches to treatment, including environmental and behavioral interventions to augment sleep medications. See Full Story
Non-Pharmacological Treatment Options by William B. Dollman, BPharm, MAppSc, FSHP For some time now, non-drug strategies have been recommended as the first-line treatment in the management of insomnia. Recent programs in Australia have demonstrated that techniques to manage insomnia without medication can be adapted and successfully used by the general practitioner. See Full Story
September/October 2004
Pneumonia: Predisposing Factors, Prevention and Treatment by Keith C. Meyer, M.D. Why do older individuals have a greatly increased risk of developing pneumonia, increased morbidity and mortality, and prolonged recovery as compared to younger adults? Which prevention strategies will help keep your patients well? See Full Story
West Nile Virus in the Elderly: Transmission, Diagnosis and Treatment by Lara E. Jeha, M.D. West Nile virus has been recently recognized as a major cause of significant mortality and neurological morbidity in the United States. Usually transmitted through mosquito bites, individuals older than 50 have a 10-fold higher risk of developing neurologic symptoms. For those over 80, the risk is 43-fold. See Full Story
July/August 2004
What Physicians Can Do to Help Older Patients with Multiple Sclerosis by Marcia Finlayson, Ph.D., OTR/L Current research shows that adults with MS are expected to have the same life span as their healthy counterparts. How can doctors help these patients to live full and productive lives with increased mobility? See Full Story
Lumbar Spinal Stenosis in the Elderly: Clinical Features and New Trends in Surgical Treatment by Marek Szpalski, M.D., and Robert Gunzburg, M.D., Ph.D. Lumbar spinal stenosis is a common condition in elderly patients and one of the most frequent reasons for spinal surgery. Stenosis leading to radiculopathy or neurogenic claudication can be caused by different factors, a number of which are related to degenerative processes. Surgery for lumbar spinal stenosis is generally accepted when conservative treatment has failed and aims at improving the quality of life through a reduction of symptoms such as neurogenic claudication, restless legs and radiating neurogenic pain. See Full Story
May/June 2004
Complementary and Alternative Medicine Use With Diabetes by Leonard E. Egede, M.D., M.S. Studies show that the complementary and alternative medicine (CAM) therapies most frequently used by individuals with diabetes include nutritional advice, spiritual healing, herbal remedies, meditation and massage therapy. This review article discusses the prevalence, patterns and costs of CAM use by individuals with diabetes. In addition, information is provided on promising CAM agents for diabetes and guidance to health care practitioners on how to approach the issue of CAM use in their patients with diabetes. See Full Story
Differentiating Between Inability to Afford Prescription Medications and 'Noncompliance' by Susanne J. Pavlovich-Danis, R.N., M.S.N., ARNP-C For many seniors, financial issues may dictate medication decisions. How can physicians assist these patients? Patient assistance programs, providing samples, reviewing medications for less expensive alternatives are some of the options discussed. See Full Story
Statin Adverse Effects: Implications for the Elderly by Beatrice A. Golomb, M.D., Ph.D. Adverse effects of statins on cognitive function and muscle function are among the best documented. However, even modest reductions in cognitive and lower extremity function have been shown to be linked to significant harmful effects on disability, independence and mortality among older patients. Randomized trial data fail to show even a suggestion of mortality benefit with statins in elderly individuals, even for those at high cardiovascular risk. Caution should be used in prescribing lipid-lowering treatments to elderly patients, and keen awareness of potential adverse effects should be kept carefully in mind. See Full Story
March/April 2004
The Electronic Medical Record and Improving Geriatric Care by John F. Hurdle, M.D., Ph.D. Electronic medical records have failed historically to offer enough practical benefit to offset the cost required to adapt to and use them. With the advent of Internet Protocol and Web-enabled technologies, and supported by the firm foundation of excellent medical communication and vocabulary standards, the very nature of the electronic medical record is being transformed from that of an e-copy of the paper chart to a far more intelligent, active member of the care team. What are the applications to geriatric care? See Full Story
Nurse and Patient Preferences for Telehealth Home Care by Bonnie J. Wakefield, Ph.D., R.N. Interactive video is being adopted to replace or supplement in-home nursing visits. This study examines nurse and patient preferences for two video platforms. Patients were more willing to use and recommend interactive video as a replacement for in-home nursing visits. Ease of use, clinical appropriateness, and training and support will likely play deciding roles in future growth of home telehealth. See Full Story
January/February 2004
MCI as a Useful Clinical Concept by Ronald J. Petersen, M.D. Mild cognitive impairment is believed to progress to dementia over the course of many years. Amnestic MCI, specifically, progresses to AD at a rate of 10% to 15% per year. What are the criteria for the different subtypes and what are some possible treatments? See Full Story
Legal and Ethical Issues in the Dementias by Myron Weiner, M.D. The management of people with dementia illnesses includes the creation of a formal will. What are the legal and ethical issues surrounding the wishes of patients with dementia? How can the safety of patients be balanced with maintaining their dignity and autonomy? See Full Story
A Galantamine Mechanism Primer by Stephen Deutsch, M.D., Ph.D., Richard B. Rosse, M.D., Lynn H. Deutsch, D.O., and Judy L. Eller The possible contribution of diminished expression of nicotinic acetylcholine receptors to Alzheimer's disease and other neuropsychiatric disorders has encouraged the exploration of nicotinic acetylcholine receptor agonists, such as galantamine, as possible treatments. This primer provides an exploration of galatamine's theoretical mechanism of action and points to future research options. See Full Story
November/December 2003
The Evaluation and Management of Swallowing Disorders in the Elderly by Jo Shapiro, M.D., and Lorraine Downey, M.S., CCC-SLP
Swallowing disorders are prevalent in the elderly population. They can stem from absent or poor dentition or tongue dysfunction. This article details the physiology of swallowing disorders and appropriate methods of management.
See Full Story
Infectious Diarrhea in the Elderly: Case Study by Christine Surawicz, M.D., and Jill Watanabe, M.D., M.P.H.
An elderly, institutionalized woman presents with a two-day history of bloody diarrhea, associated fevers, mild dehydration, and a recent C. difficile infection. What should be included in the differential diagnosis? This discussion will include the diagnostic approach to this elderly patient with bloody diarrhea and the role of empiric therapy.
See Full Story
September/October 2003
Alcoholism and At-Risk Drinking in the Older Population
With the growing number of aging baby-boomers, late-life alcoholism is expected to be a major public health concern. How do we define problem drinking and at-risk drinking, and how can these patients best be screened and treated?
See Full Story
Combined Psychotherapy and Pharmacotherapy for Late-Life Depression
Late-life depression, particularly in combination with other medical illnesses, is studied in this article. Studies have shown that adding psychotherapy to pharmacotherapy can improve both outcome and compliance. See Full Story
July/August 2003
Nerve Damage From Coronary Artery Bypass Surgery Can Affect Arm Functioning
Injury to the brachial plexus nerve can leave patients with shoulder pain and weakness or paralysis following coronary artery bypass surgery. Methods for diagnosing this injury and which factors may predispose surgical patients toward suffering from it are discussed.
See Full Story
Tinnitus: Prevalence, Causes and Treatment Approaches
Tinnitus may be transient or constant, tolerable or cognitively disabling, and may be associated with both normal and abnormal health states. A careful history and physical examination are required to classify the type, identify associated disease, and to organize diagnostic and therapeutic considerations.
See Full
Story
Aging Senses in the News
Learn why balance problems may be to blame for increased fall risk following stroke, which lifestyle changes and supplements may improve outcome in age-related macular degeneration, and more.
See Full
Story
May/June 2003
CVD, Pharmacogenomics and Tailored Medical Therapy
The overall effect of a drug may be influenced by any number of genes. Discover which polymorphisms affect cardiovascular drug responses and the potential application of pharmacogenomics in improving drug safety and efficacy. See Full Story
Pharmacology in the News
Learn about new pharmaceuticals in the pipeline for treating heart disease, which new drug has been shown safe for treating epilepsy in seniors, new guidelines for treating hypertension in African-Americans, and more.
See Full
Story
March/April 2003
Complications of Type 2 Diabetes in the Elderly
Due to physiologic changes associated with aging, the diagnosis and treatment of type 2 diabetes in older patients present unique challenges. Review which symptoms older patients present with most often, which medications are recommended for older patients, and which complications can be expected when treating this population. See Full Story
Overview of Diabetic Gastroenteropathy
Gastroenteropathy occurs in at least one of every four patients with diabetes. It is clinically relevant and can cause sudden blood glucose level fluctuations in patients who are otherwise metabolically stable. Although there are few treatment options, the realization of gut neuroendocrine signal substances as therapeutic agents opens up a new approach for possible therapy.
See Full
Story
Diabetes in the News
Read about combination therapy for glycemic control, the value of patient education, the role of whole grain consumption in reducing diabetes risk, and the link between poor glucose tolerance and old-age memory loss.
See Full Story
January/February 2003
Management of Cardiovascular Risk in Older Women
Recent studies of the effects of hormone replacement therapy on cardiovascular risk factors have raised more questions than they have answered. Other medications may be equally efficacious, and their risk profile may affect which drugs you prescribe. See Full Story
Brain Damage After Surgical and Angiographic Heart Procedures
Some methods of imaging technology can visualize lesions as much as two weeks earlier than others. While technological progress has lowered the cardiological adverse events of heart and coronary artery surgery, the rate of neurological complications has remained stable. The types of neurological complications that result after surgery can be detected earlier if the right technology is used. See Full Story
Cardiovascular Illnesses in the News
The latest news reveals cardiovascular risks in the use of pain killers, the experience of exhaustion and even in tooth decay. How will these findings affect patient education in your office? See Full Story
November/December 2002
Research Initiatives to Improve End-of-Life CareThe science of end-of-life care is developing as research funded by various institutes in the National Institutes of Health is completed. Informed best practices are emerging to prevent suffering and to improve the quality of life at the end of life. See Full Story
Spirituality in Palliative Care
Religion and spirituality have a role to play in a variety of mental and physical health ailments. In the context of palliative care, patients are faced with a challenge to understand the meaning of their illness as well as a lack of control over the course of their illness and their life circumstances. How can addressing religious and spiritual concerns be protective in palliative care? See Full Story
September/October 2002
The Role of B Vitamins, Homocysteine in AD and Vascular DementiaDespite considerable advances in the cellular and molecular pathology of Alzheimer's disease, little progress has been made in understanding its causes. It remains incurable. Is it possible to lower the risk of dementia by nutritional intervention using specific vitamin supplements?
Using Complementary Treatments
Natural products show promise as new treatments for Alzheimer's disease and other dementing illnesses. Thirteen dietary supplements most commonly used for memory impairment are evaluated through looking at the latest scientific evidence.
July/August 2002
Surviving an Aerobic Environment: Aging Under Oxidative Stress
Aging is marked by an inevitable and progressive degeneration of biological functions, but what causes these changes? Prevailing theory points to the effects of cellular exposure to oxidants.
See Full Story
Biomechanics in Disability Research: Gait Dysfunction in the Elderly
People with lower extremity impairments often adapt their walking style to minimize pain and avoid exacerbating their condition, but it is unknown what long-term effects these adaptations may have on the musculoskeletal system and on neuromuscular control of the body. Biomechanical measurements that identify compensatory movement strategies in response to impairments may provide valuable insights into the design of new physical activity-based interventions for improving function. See Full Story
Male Osteoporosis: An Unrecognized Problem
While osteoporosis has traditionally been considered a disease of elderly white women, men are also at risk for both osteoporosis and fragility fractures. How can you better help your patients? See Full Story
Even Frail Patients Can Benefit From Exercise
Despite fears that exercise can lead to injury in the frail elderly, strength and resistance training can improve function, balance and mobility in this population. See Full Story
May/June 2002
Benefits of Insulin Pump Therapy in the Elderly
Insulin pump therapy has been shown to have many advantages over multiple insulin injections. However, there has been reluctance to prescribe this therapy for elderly patients due to worries that these patients may not be able to follow its stringent requirements. Studies of elderly patients with both type 1 and type 2 diabetes are beginning to show these concerns are groundless when the proper criteria for choosing patients for insulin pump therapy are followed. See Full Story
Brittle Diabetes Mellitus in the Elderly
The etiology of brittle diabetes may be due to multiple causes and may not be well-defined in the elderly. A thorough history with observation of patients' self-management techniques and a high suspicion of psychosocial factors impacting brittleness are key components to evaluation. Treatment is aimed at avoiding excessive hyper- and hypoglycemia and alleviation of symptoms. See Full Story
Diabetes Care in the News
Does access to health care affect treatment outcomes? A study showing equal rates of diabetes-related lower extremity amputations for African Carribeans and Europeans, in contrast to the higher rates seen in African Americans as compared to white Americans, seems to suggest that health care distribution does make a difference. Also in diabetes news are the results of a study showing that stress relaxation techniques may have a beneficial effect on glucose levels. See Full Story
March/April 2002
Statins and the Stimulation of Bone
Growth -- Do They or Don't They?
There is strong evidence for and against the argument that the
cholesterol-lowering statins stimulate bone growth and reduce fracturing in
postmenopausal women. How do the statins' osteogenicity and estrogen effect a
statin's mechanism of action? What else could be causing the conflicting
results? See Full Story
Racial Differences in the Increased Use
of Psychotropic Medications
Over the last decade, among adults of all ages, the use of psychotropic
medications has increased, particularly the use of antidepressants. For
community-dwelling elders, is there a difference in psychotropic use between
African Americans and whites? See Full Story
Pharmacology in the
News
Are some of the common medications that your patients are using increasing
their risk for other problems? Are home health care patients at risk for
medication errors similar to those found in inpatients? Another pharmaceutical
company offers a discount prescription program for seniors. See Full Story
Management of Allergic
Rhinitis
Allergic rhinitis has become more prevalent in recent decades, and in older
adults, conditions in the differential diagnosis of allergic rhinitis, such as
cholinergic hyperactivity, medication effects and chronic sinusitis, occur more
frequently. Proper diagnosis and management can relieve much of the morbidity
associated with untreated or undertreated allergic rhinitis. See Full Story
January/February 2002
Adverse Taste Side Effects of
Cardiovascular Medications
Taste side effects, one of the more common complaints for some heart
medications, may interfere with medication compliance, nutrition intake and
quality of life. Consequences for adverse taste effects may be more serious for
those individuals (such as the elderly) with compromised nutritional status.
Six antihypertensive medications and three antiarrhythmia medications were
tested for their effects on taste at the peripheral level. See Full Story
Rehabilitation and Cardiovascular
Disease
Rehabilitation is an effective means of preventing future cardiac illness, but
remains an underutilized component. What are the phases and elements of and the
conditions necessary for successful cardiac rehabilitation? See Full Story
Cardiovascular Diseases in the
News
Does dietary legume consumption decrease the risk of cardiovascular disease?
What interventions are helpful in reducing the onset of depression following
myocardial infarction? Is aggressive treatment for cardiovascular disease in
the elderly worth the risk? See Full Story
November/December 2001
Treating American Indians/Alaskan
Native Elders
With an expanding life expectancy, there has been a corresponding increase in
the number of chronic diseases and rates of disability among AI/AN elders. This
article discusses the epidemiology and implications of these diseases and opens
discussion of the emerging issues of advanced directives and palliative care in
cultures that do not always conform to Western beliefs and traditions. See Full Story
Gender Differences in Alzheimer's
Disease
Although Alzheimer's disease can be characterized by a general clinical
syndrome of gradually progressive dementia with typical cognitive deficits and
behavioral abnormalities, there is heterogeneity in these manifestations among
individual patients. In this article, the authors discuss gender as a discrete
factor contributing to some of the differences seen in cognition and behavior
in AD patients. The potential neurobiological bases for such differences are
also discussed. See Full Story
Challenges of Caring for the Israeli
Elderly Population
Israel is a young nation with an extremely heterogeneous population. With the
enactment of the National Health Insurance Law in 1995, the country has
attempted to provide its citizens with universal health care. These two facts
make Israel a fascinating gerontological laboratory. See Full Story
Diverse Populations in the
News
How do women perform on cognitive tests as compared to men? Does ethnic
background influence a person's risk factors for and treatment of disease? What
is the government's role in supporting the health care of different ethnic
groups? See Full Story
September/October 2001
Herbal Products and
Uses
As more and more Americans are turning to herbal supplements, it behooves
physicians to keep an open mind on these alternative treatments. The uses and
current research for three of the most commonly used supplements are
described. See Full Story
Investigating SAM-e for
Depression
Is dietary supplementation of SAM-e -- a naturally produced, physiologically
necessary compound for living cells -- the new choice for treatment-resistant
depressed patients? While research on this compound has been taking place for
decades around the world, it has only been on the U.S. market since 1999.
Richard P. Brown, M.D., who has been using SAM-e in patients with depression,
offers insight into the pharmacokinetics, efficacy and use of this
compound. See Full Story
Complementary Medicine in the
News
The use of complementary medicine continues to grow. These four articles
discuss options that can enhance medical treatment, such as electrical
stimulation, supplements and diet regulation. See Full Story
July/August 2001
Protecting the Quality of Life of
Older Adults
Life-sustaining medical advances have guaranteed that more older adults are
living a longer life, but what about quality of life? Surveys have shown that
older adults are concerned about what advancing age will bring and are
articulate about their social, economic and end-of-life needs. See Full Story
House Calls for the
Elderly
House calls have not gone away; they have just changed their focus. This
article outlines how a multi-disciplinary, collaborative team can work together
to assess risks and dangers for community-dwelling elderly patients to help
them maintain their independence. See Full Story
Strength Training for Older
Adults
A program of resistive strength training can improve strength, balance,
functional capacity and bone density. It also enables older patients to perform
activities of daily living with greater ease and can counteract the muscle
weakness and frailty found in the very old. How do modality and frequency,
intensity, duration, and progression of workouts impact an exercise program for
older adults? What about safety? See Full Story
May/June 2001
Managing Agitation in Elderly
Patients With Dementia
Agitation and aggression in patients with dementia can be frustrating and
worrisome, and the underlying causes of the agitation and aggression are not
always apparent. Jiska Cohen-Mansfield, Ph.D., outlines suggestions to help
clinicians determine the often unspoken needs of demented patients and make the
appropriate accommodations. See Full Story
Cost Effectiveness of Case Management
Programs for the Elderly
While case-management programs are often instituted to reduce or contain costs,
it does not necessarily follow that just any model will achieve this. Selecting
a case-management program requires careful consideration of the goals of the
program relative to model dynamics. The author evaluates evidence from a study
of case management in an elderly, functionally impaired population and finds
that, although implementing case management may lead to increased costs, as in
this example, there may be substantial benefits that justify this additional
cost. See Full Story
Long-Term Care in the
News
Are your patients taking the full course of antibiotics that you prescribe? Do
they need to? Exactly which kind of medications are geriatric patients taking
on a regular basis? These articles discuss geriatric medications along with a
simple method you can use to keep track of your patients' records. See Full Story
How to Help Families Better Assess
Patients' Pain
In 2001, the Joint Commission on Accreditation of Healthcare Organizations will
require hospitals and long term care facilities to provide comprehensive pain
education and monitoring and treatment programs for both patients and families.
Teaching family members to use standardized instruments and monitoring their
assessments of pain, similar to what institutions do for blood sugar testing,
should lead to better assessments and correlation with other pain
behaviors. See Full Story
March/April 2001
Inappropriate Psychotropic Agents for
the Elderly
Special provisions should be taken when prescribing medications for older
adults. Criteria have been developed to help physicians understand whether or
not the elderly can appropriately consume certain medications. What are the
reasons behind the inappropriateness of some medications, and what are the
safer alternatives to these medications? See Full
Story
The Use of COMT Inhibitors in Older
Patients
Catechol-O-methyltransferase inhibitors, a new class of drugs for use in
patients with Parkinson's disease, are used most often for "wearing off"
phenomenon as an adjunct to levodopa. Appropriate use and the side effects of
the two most widely used COMT inhibitors are reviewed. See Full Story
A Fresh Look at
Diuretics
Historically, diuretics have been used to treat hypertension and edema. When
using them in older adults, there is still a lot more to learn in order to
ensure they are used safely and effectively. Nephrologist, Christian W. Mende,
M.D., provides a brief overview of diuretic methodology, along with a
discussion of the different classes of diuretics, treatment methods, and
recommendations. See Full Story
Janaury/February 2001
Care Teams Provide Model for
Community Care
A collaboration of pharmacist and social worker provides community support for
the elderly and chronically ill that is easily accessible. Each discipline uses
its strengths to create medication management interventions that improve
patient care. See Full Story
November/December 2000
Caregiver Stress Increases Risk of
Homicide-Suicide
Suicide among the elderly is generally portrayed in the media as "mercy
killing." Dr. Cohen presents research findings that show this is far from the
truth. Homicide-suicides are acts of desperation and depression, usually
perpetrated by a male caregiver. Risk factors and interventions for
homicide-suicide are discussed.See Full Story
How Can Health Care Professionals Meet
the Spiritual Needs of Dying Older Patients?
The dying elderly present intense challenges to health care providers, due to
the growing numbers of elderly living long, often very debilitated lives and
their specific physiological and psychosocial developmental needs. Suggestions
are made as to questions practitioners may ask to open the conversation with
the patient about spiritual needs. Emphasis is placed on the concept of
"meaning-making." See Full Story
Hospice and Alzheimer's
Disease
Hospice care, with its focus on palliative rather than preventive care for
terminally ill patients, has previously not been thought of as a solution for
patients with Alzheimer's disease. Now, specially trained health care
professionals offer end-of-life care to these patients and their families. See Full Story
September/October 2000
Alcohol and Drug Dependence in Older
Adults
Identifying substance abuse in the elderly presents unique difficulties. A
speaker at the recent U.S. Geriatric and Long-Term Care Congress outlines these
difficulties, and how physicians can overcome them. See
Full Story
Polypharmacy: Pandora's Medicine
Chest?
Polypharmacy, wherein elderly patients take multiple medications, opens the
door to medical misadventures. Multiple prescriptions, self-prescribed
over-the-counter drugs, natural supplements and lack of continuity of care all
contribute to an estimated 106,000 deaths annually. Education and prevention
strategies are reviewed. See Full Story
July/August 2000
Focusing on the Nutritional Needs of
Older Americans
Older Americans represent a large proportion of the population, but the USDA
makes few references to their special needs in the latest edition of Dietary
Guidelines for Americans. The National Academy of Sciences, however, is
developing new guidelines based on dietary reference intakes that include
separate recommendations for people between the ages of 51 and 70 and for those
over 70. John W. Erdman, Ph.D., and Robert M. Russell, M.D., explain the
thinking behind these new recommendations. See Full
Story
Nutrition Care Alerts Promote
Health and Function
Seniors in both nursing care facilities and home care are at risk of
malnutrition from four major conditions: unintended weight loss, dehydration,
pressure ulcers and feeding tube complications. A coalition of health care
professionals has developed a Nutrition Care Alert that assists caregivers in
recognizing signs of malnutrition associated with these conditions. See Full Story
May/June 2000
Avoiding Medication Mishaps: A
Pharmacist's Perspective
Polymedicine occurs for many reasons, and there are many ways to prevent it.
Evidence of polymedicine is easier to identify when viewed from the perspective
of drug need rather than the number of prescriptions. Physicians and
pharmacists should look carefully at the individual patient when considering
the possible interactions medications may have. See Full
Story
Prescription and Over-the-Counter Drug Misuse Among the Elderly While it is true that the elderly are at risk for adverse events from polypharmacy due to multiple disorders, other issues need to be considered as well. Over-the-counter use, and the use of nutriceuticals and other natural remedies need to be ascertained and monitored by the physician. Additionally, physicians need to make sure prescribed medications are still performing as expected and, indeed, are still necessary. See Full Story
Safe Prescribing: Interdisciplinary
Solutions
Patient age, multiple diseases and disease severity, polypharmacy and physician
lack of training place elderly individuals at risk of developing adverse drug
events. Programs to detect unsafe or ineffective prescriptions are a
significant step toward improving pharmacotherapy among community-based older
adults. See Full Story