Adherence and hypertension in the geriatric patient

Adherence and hypertension in the geriatric patient

Addressing factors that lead to lack of adherence to antihypertensive 
therapy in elderly patients is crucial to improving outcomes.

Menopausal hormone replacement therapy recommendations

Menopausal hormone replacement therapy recommendations

The risks of HRT have received so much attention that its benefits have been largely overlooked.

Antidepressant for neuropathy pain leads to hyponatremia

Antidepressant for neuropathy pain leads to hyponatremia

An older male patient started antidepressants for neuropathy pain but developed hyponatremia as a result.

Consider alternatives to drug therapy for geriatric depression

Consider alternatives to drug therapy for geriatric depression


Geriatric patients who are not responding well to antidepressants may benefit from a combination of pharmacotherapy and psychotherapy.

Managing type 2 diabetes in an outpatient setting

Managing type 2 diabetes in an outpatient setting

How would you help maximize this patient's diabetes therapy, hypertension management, and reduce leg cramps?

B vitamins ineffective in treating cognitive decline

B vitamins ineffective in treating cognitive decline

Most aspects of cognitive function declined during the studies evaluated and vitamin B supplementation reduced circulating homocysteine concentrations, as expected.

The patient who said 'thank you' for years of care

The patient who said 'thank you' for years of care

A patient visited this provider with an important question regarding a procedure, but really wanted to express his thanks for the years of care.

Honoring a fallen solider and son

Honoring a fallen solider and son

A veteran in a hospice unit finally was presented with the American flag to honor his son, a deceased Vietnam veteran.

Moderate activity fends off major disability

Moderate activity fends off major disability

Researchers found that a regular, balanced, and moderate physical activity program reduced the risk of major mobility disability by 18%.

The need for vitamin supplements among older patients

The need for vitamin supplements among older patients

Vitamin D, vitamin B12, vitamin C, and vitamin A have been shown to be beneficial during the aging process.

Midlife activity may stave off dementia

Midlife activity may stave off dementia

Leisure-time physical activity has previously been shown to have a positive impact on health.

Heavy bleeding common during menopause

Heavy bleeding common during menopause

Treating ­hypertension in older patients

Treating ­hypertension in older patients

In those older than age 65 years, high BP heightens risk for various forms of heart disease as well as for chronic kidney disease and diabetes mellitus.

A centarian survives a complicated surgery

A centarian survives a complicated surgery

A geriatric patient undergoes a complex procedure for gastric outlet obstruction and causes a medical team to question their stance on geriatric surgery.

Improving the quality of geriatric cancer survivorship

Improving the quality of geriatric cancer survivorship

A collaborative approach to cancer treatment, incorporating the entire oncology team and the PCP, provides the best outcomes for quality patient care.

Antifungal therapy in the elderly

Antifungal therapy in the elderly

What is the best treatment option for an elderly man with a two-year history of onychomycosis?

Use a laser to get patients walking

Use a laser to get patients walking

A simple technique gets patients with Parkinson disease and dementia to ambulate.

No increased delirium with hydromorphone after hip surgery

No increased delirium with hydromorphone after hip surgery

Hydromorphone for postoperative pain does not appear to increase delirium in elderly patients having hip fracture surgery.

Treating a paranoiac for dementia

Treating a paranoiac for dementia

What is the recommended treatment for patients diagnosed with dementia who are suffering with paranoia and/or hallucinations?

Increasing geriatric care needs prompt credentialing changes

Increasing geriatric care needs prompt credentialing changes

As the healthcare community changes to meet the needs of aging baby boomers, primary care jobs will be in demand.

Controlling geriatric hypertension

Controlling geriatric hypertension

Many older patients take many medications, making contraindications a concern when trying to control hypertension.

When to advise palliative care

When to advise palliative care

When do patients benefit most from palliative care consults?

Diarrhea in an elderly man in an assisted-living facility

Diarrhea in an elderly man in an assisted-living facility

What are the next steps after ruling out Clostridium difficile?

Osteoarthritis and 
Rheumatoid ­Arthritis 2012: Pathophysiology, Diagnosis, 
and Treatment

Osteoarthritis and 
Rheumatoid ­Arthritis 2012: Pathophysiology, Diagnosis, 
and Treatment

This article highlights the differences in the pathophysiology and diagnostic criteria for OA and RA, and also describes current and potentially new treatment options for these conditions.

Sources of comfort for those with dementia

Sources of comfort for those with dementia

A clinician shares gender-specific advice for comforting patients with dementia in moments of confusion.

Vitamin B12 deficiency in older adults

Should testing for vitamin B12 deficiency be part of a standard geriatric workup?

HAART meds: Implications for the older adult patient

HAART meds: Implications for the older adult patient

Patients infected with HIV are living longer, which means they have more age-related comorbidities that require other medications as well.

A new understanding of 
osteoarthritis

A new understanding of 
osteoarthritis

Ongoing research and new developments hold promise for altering 
osteoarthritis and go beyond simply treating the symptoms.

Urine drainage at the end of life

What options are there for a patient with a continent urinary diversion, who is no longer able to self catheterize and has no reliable caregivers?

Decreasing agitation in patients 
with dementia


Distressed elderly patients — especially those with dementia — frequently have a paradoxical reaction to benzodiazepines, causing extremely agitated states.

Elder abuse: Primary care strategies for screening

Elder abuse: Primary care strategies for screening

The primary-care provider may be the only contact homebound elders have outside the abuse situation.

What causes a metallic taste and burning tongue?

What are the differential diagnoses for a woman aged 60 years with a metallic taste in her mouth and the sensation of a burning tongue?

Urinary incontinence in the older female population

Urinary incontinence in the older female population

Despite what clinicians and patients think, accurate evaluation and targeted interventions can relieve symptoms and improve quality of life.

Testing for cold intolerance

An elderly man complains of feeling cold all the time, even though the weather is warm.

Avoiding reflux when stopping PPIs

Can patients be weaned from proton pump inhibitors without causing a reflux flare?

Screening for functional deficits in older adults

Screening for functional deficits in older adults

Assessment of functional impairments in an aging population is one of the most daunting challenges facing primary-care clinicians.

Remember to HALT SLIPS in older patients

A clinician offers a useful mnemonic device to help prevent falls in older patients.

What causes delirium?

Is it possible to have a geriatric patient in serious delirium while all labs and urinalysis are within normal limits?

Are iodine preparations safe for treating pressure sore eschar formations?

The use of povidine-iodine in wound care is controversial. Several experimental studies have demonstrated concerns regarding its safety and effect on wound healing.

Advice for managing insomnia in patients with dementia

Experts are not certain why reversed sleep-wake cycles occur in patients with dementia, but it may be related to late-day confusion, end-of-day exhaustion and reduced lighting, among other factors.

Treatment guidelines for Alzheimer-type dementia

Treatment guidelines for Alzheimer-type dementia

The most common dementia in the elderly, Alzheimer disease places tremendous physical and emotional strain on patient and caregiver alike.

Refusal of care during periods of acute confusion

Clinician seeks advice regarding a patient that refuses chemotherapy for multiple myeloma because of concerns that her hair will fall out.

Working in geriatric nursing

As life expectancy continues to rise in the U.S. and older adults need continuous care for chronic conditions, experts in the field of geriatric nursing say the demand for qualified health workers is surging.

Use fracture risk to predict osteoporosis

Use fracture risk to predict osteoporosis

Be sure to consult guidelines from the National Osteoporosis Foundation for advice on optimizing calcium and vitamin D intake and reducing fall risk.

Vision and balance disturbances initially blamed on aging

Vision and balance disturbances initially blamed on aging

Over a period of three years, the patient's writing worsened, and she had trouble seeing some colors.

Partial limb amputation causes suit

Partial limb amputation causes suit

Undetected vascular disease reaches its apex while a man is vacationing. Is the on-call clinician to blame?

Intermittent ringing in the ear turns constant

Intermittent ringing in the ear turns constant

The patient first suspected wax was the culprit and underwent an MRI to rule out a benign tumor.

Vitamin B12 deficiency in the elderly

B12 levels rose sharply in a previously deficient elderly patient. Is this cause for concern?

Blisters on swollen ankles

A black woman aged 52 years developed large (1.5-2.0 cm wide), fluid-filled blisters on her swollen ankles. There were no other symptoms, and the patient's health history was unremarkable except for anemia. What could be the cause?

Treating giant cell arteritis to avoid complications

Treating giant cell arteritis to avoid complications

Seen primarily in individuals older than age 50 years, this inflammatory disorder is characterized by headache, jaw pain, and vision difficulties.

Falls in older adults: averting a disaster

Falls in older adults: averting a disaster

Falls can lead to hip fracture and head injury and can raise the risk of early death. Fortunately, this public-health problem is largely preventable.

Clearing up pressure sores

Should silver sulfadiazine cream be first-line therapy for pressure sores?

Medicinal lullaby

Treatments for elderly patients who have dementia and sleep disorders.

Primary care provider missed severe uremia

Patient visits her cardiologist complaining of dizziness and lightheadedness.

Akathisia and visual hallucintions in an elderly woman

Akathisia and visual hallucintions in an elderly woman

First diagnosed with Alzheimer's and Parkinson's, the patient could not tolerate antipsychotic meds.

Guide to caring for patients with dementia

Guide to caring for patients with dementia

Given the importance of long-term treatment and management of this population, primary-care clinicians are ideally suited to play a lead role.

Osteoporosis screening in postmenopausal women

Osteoporosis screening in postmenopausal women

New management strategies include the use of Web-based tools, an emphasis on lifestyle approaches, and early pharmaceutical intervention.

Treatment goal for acute myeloid leukemia

Treatment goal for acute myeloid leukemia

Palliation and disease control or aim for curative?

Screening for functional deficits in older adults

Screening for functional deficits in older adults

Assessment of functional impairments in an aging population is one of the most daunting challenges facing primary-care clinicians.

The right thing takes a wrong turn

The right thing takes a wrong turn

Should the clinician have kept silent when asked about the treatment a patient was receiving?

Carbidopa with levodopa does more than minimize nausea

The combination allows increased amounts of levodopa to be available for entry into the central nervous system.

The costs of treating Alzheimer's disease

Any delay in nursing-home placement is well worth the investment in medication.

An alternative to canes

Use hiking poles for patients with balance issues.

Reaction following contrast CT

The swelling was nontender, nonfluctuant, and involved the whole of the submental portion of the upper thyroid.

Alzheimers management from diagnosis to late stage

Alzheimers management from diagnosis to late stage

Caring for a patient with Alzheimers disease involves more than assessment and treatment. Education and legal issues must also be considered.

Bacterial meningitis complicated by seizures and confusion

Bacterial meningitis complicated by seizures and confusion

The seizures began following surgery to repair a cerebrospinal fluid leak.

Cervical adenocarcinoma after hysterectomy

Cervical adenocarcinoma after hysterectomy

What should be done after Pap smears confirmed adenocarcinoma in situ, and two vaginal biopsies were negative?

Repeating the tuberculin skin test in an older patient

What risks are involved?

Mixing NSAIDs with antiplatelet therapy

Mixing NSAIDs with antiplatelet therapy

Combining these agents may compound GI complications. New guidelines help primary-care clinicians identify and protect patients most at risk.

Bell's palsy

Bell's palsy

The most up-to-date evidence on Bell's palsy

Managing UTIs in debilitated patients

Managing UTIs in debilitated patients

A common occurrence among this patient population, urinary tract infection causes significant morbidity and mortality.

Caring for the geriatric patient: The initial visit

Caring for the geriatric patient: The initial visit

Use the first visit to get as much information as possible about the patient's condition, functional status, and social situation.

Shingles can be treated—and now prevented

Shingles can be treated—and now prevented

Older patients are at greatest risk for debilitating postherpetic neuralgia, but antiviral therapies ease the pain, and a new vaccine offers hope of prevention.

New-onset neck and shoulder pain in an arthritis patient

New-onset neck and shoulder pain in an arthritis patient

A UTI triggers complications in a patient with two forms of arthritis.

Determining when men need testosterone

Determining when men need testosterone

Deficiency can lead to sexual dysfunction and osteoporosis. Here are approaches to diagnosis and some factors to consider before treating.

Osteoporosis: No gender gap for therapy

Osteoporosis: No gender gap for therapy

Although commonly considered a disease of women, men can be affected too. New guidelines recommend risk assessment for men and treatment for both sexes.

Vitamin D prophylaxis for osteoporosis?

Shouldn't vitamin D deficiency be considered the primary risk factor?

Getting high blood sugar levels under control

A 70-year-old man with a history of type 2 diabetes takes insulin glargine (Lantus) 100 units every morning and insulin aspart (Novolog) 20 units with each meal. However his blood sugar is still around 250 mg/dL.

Epileptic seizures in older adult patients

Epileptic seizures in older adult patients

The conclusion of this two-part report looks into the management and therapeutic options available to clinicians treating this population.

Epilepsy in the elderly

Epilepsy in the elderly

Seizures in the elderly often mimic other conditions, such as transient ischemic attack or dementia. Don't be fooled into a misdiagnosis.

Aortic stenosis risk

Limit colorectal screening in the elderly?

Limit colorectal screening in the elderly?

The U.S. Preventive Services Task Force (USPSTF) is calling for an end to colorectal cancer (CRC) screening for persons older than 85 years and is recommending against routine screening for those aged 76-85 years.

Progressive symptoms with family ties

Hoarseness and slowed ocular movements were the first signs in a yearlong hunt for a diagnosis.

Combined BP regimen cuts death rates 40%

Supplementing diuretic hypertension therapy with a drug that conserves potassium sharply reduces fatal heart attacks and sudden cardiac death...

Vitamin C may discourage bone loss in men

There's more to nutrition and bone health than just calcium and vitamin D. Vitamin C is an additional important nutrient that may help prevent bone loss.

Short-term antibiotics may be sufficient for elderly women with uncomplicated UTI

Comparing short-course (3-6 days) vs. longer treatments (7-14 days), there were no significant differences in efficacy or clinical outcomes...

Weight loss, fatigue, and troubling laboratory findings

Elevated liver enzymes were the first clue to a grave diagnosis.

Fall prevention's place in primary care

Primary-care clinicians can help reduce fall-related injuries among their elderly patients by making

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