Nonsurgical Management of Urinary Incontinence in Older Women
AbstractPurpose of ReviewUrinary incontinence is highly prevalent and very costly. Proper detection and evaluation of urinary incontinence can facilitate appropriate treatment options for older women. Our goal is to discuss first-line, nonsurgical management of urinary incontinence in older women. We include behavioral, lifestyle, and pharmacologic management options.Recent FindingsBehavioral treatment options represent first-line treatments and have efficacy data for all types of urinary incontinence. Behavioral treatments include pelvic floor muscle exercises, strategies for controlling stress and urgency symptoms, bladd...
Source: Current Geriatrics Reports - May 5, 2017 Category: Geriatrics Source Type: research
The Relationship Between Urinary Incontinence, Mobility Limitations, and Disability in Older Women
AbstractPurpose of ReviewThis paper describes current understanding and the relationship between urinary incontinence (UI), mobility limitations, and disability in older women with pelvic floor disorders.Recent FindingsUI is a prevalent pelvic floor disorder in older women and is considered to be one of the most common geriatric problems. There is no clear classification of UI as a disease versus UI as a geriatric syndrome in the current literature. Since the disability is also prevalent in older women, an evaluation of the relationship between UI and disability may improve our understanding of UI as a disease or a geriatr...
Source: Current Geriatrics Reports - May 5, 2017 Category: Geriatrics Source Type: research
Epidemiology, Pathophysiology and Management of Fecal Incontinence in the Older Woman
AbstractPurpose of ReviewTo review up-to-date management of fecal incontinence in older women, highlighting age-related issues.Recent FindingsFecal incontinence is highly prevalent in older women. The etiology is multifactorial; however, advanced age itself has been found to be an independent risk factor. Understanding age-related physiologic and anatomic changes and unique challenges in the geriatric population is critical in order to offer effective therapy. Evaluation should start with obtaining a thorough history and physical examination, and diagnostic tests should be reserved for refractory symptoms or specific condi...
Source: Current Geriatrics Reports - May 4, 2017 Category: Geriatrics Source Type: research
Non-surgical and Surgical Management of Pelvic Organ Prolapse in the Older Woman
AbstractPurpose of ReviewPelvic organ prolapse (POP) is a common condition that can adversely affect quality of life in older women. With the current trend in longevity, the number of women with this problem will exceed the availability of subspecialists in Female Pelvic Medicine and Reconstructive Surgery. The purpose of this paper is to aid primary care physicians, geriatricians, and general gynecologists in the evaluation, referral, and treatment of women with POP. Women can be quickly evaluated and offered therapy prior to referral to a subspecialist.Recent FindingsNewer trends include emphasis on the use of pelvic mus...
Source: Current Geriatrics Reports - April 29, 2017 Category: Geriatrics Source Type: research
Perioperative Management of Older Women in Urogynecologic Surgery
AbstractPurpose of ReviewPreoperative measurements of frailty and mobility predict surgical outcomes in older patients better than measurements of medical comorbidities or American Society of Anesthesiologists (ASA) status alone. The purpose of this review is to summarize updated evidence for optimal preoperative assessment, perioperative management, and postoperative care for elective gynecologic surgery in older women.Recent FindingsTwo joint best-practice guideline statements from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and the American Geriatrics Society (AGS) focus on...
Source: Current Geriatrics Reports - April 7, 2017 Category: Geriatrics Source Type: research
Norovirus Disease in Older Adults Living in Long-Term Care Facilities: Strategies for Management
AbstractPurpose of ReviewNoroviruses are the most common cause of gastroenteritis outbreaks in long-term care facility (LTCFs). This review summarizes the most up-to-date knowledge on norovirus infection in LTCFs with the aim of identifying potential strategies for management.Recent FindingsLTCF residents are at greater risk of norovirus infection. Early identification of norovirus infection and prompt initiation of appropriate supportive therapy are required to reduce morbidity and mortality. Measures to prevent outbreaks and reduce the risk of norovirus infection in LTCFs include timely diagnosis and implementation of in...
Source: Current Geriatrics Reports - February 23, 2017 Category: Geriatrics Source Type: research
Geriatric Orthopaedics: a New Paradigm for Management of Older Patients
AbstractPurpose of ReviewFragility fractures have become a worldwide epidemic that has necessitated a paradigm shift in how we approach the care for elderly orthopaedic patients. There is a great need for subspecialty trained orthopaedic surgeons to help bridge the gap and help with transition of care in geriatric orthopaedic patients.Recent FindingsNot only are the surgical needs of elderly patients different than younger patients but often the complexity of co-morbidities and bio-psychosocial needs are important considerations for patient care and outcomes.SummaryGeriatric orthopaedic fellowship training is a crucial par...
Source: Current Geriatrics Reports - February 12, 2017 Category: Geriatrics Source Type: research
Herpes Simplex Virus Encephalitis in Geriatric Patients
AbstractPurpose of ReviewHerpes simplex virus encephalitis (HSVE) is a rare, devastating infectious disease of the brain. We reviewed published case series to determine whether epidemiology, clinical characteristics, and prognosis of HSVE differed in geriatric patients.Recent FindingsGeriatric patients have a higher incidence of HSVE and a worse prognosis than the rest of the adult population.SummaryThe gold standard to confirm HSVE diagnosis is to demonstrate HSV DNA in cerebrospinal fluid using polymerase chain reaction. Antiviral treatment with acyclovir prevents HSVE-related morbidity and mortality if started on time. ...
Source: Current Geriatrics Reports - February 12, 2017 Category: Geriatrics Source Type: research
Post-Polio Syndrome, Implications for Geriatric Care
AbstractPurpose of ReviewPost-polio syndrome (PPS) is commonly experienced by geriatric patients with a history of acute paralytic poliomyelitis. The goal of this review is to educate clinicians about the clinical presentation and diagnostic criteria for PPS as well as explore established and experimental treatment options.Recent FindingsOn review of the literature, there is no new research identifying effective interventions for PPS.SummaryThe paucity of recent studies is not surprising since polio patients are diminishing in number. There is some hope that interventions for other similar conditions may cross over and sho...
Source: Current Geriatrics Reports - February 12, 2017 Category: Geriatrics Source Type: research
A Review of Total Hip Replacement Following Acetabular Fractures
AbstractPurpose of ReviewThe incidence of geriatric acetabular fractures is increasing with our aging population. Geriatric acetabular fractures offer unique challenges to treating physicians due to the complexity of fracture patterns, osteoporotic bone, and pre-existing joint arthritis. Controversy remains regarding the optimal reconstructive treatment of these injuries, and both acute and delayed total hip arthroplasty options exist in appropriate settings for these patients.Recent FindingsWhile early experience with acute THA led to poor clinical outcomes, several newer studies report improvements in survivorship and in...
Source: Current Geriatrics Reports - February 6, 2017 Category: Geriatrics Source Type: research
Management of Osteoporotic and Neuropathic Ankle Fractures in the Elderly
AbstractPurpose of ReviewTreatment of osteoporotic and neuropathic ankle fractures in the elderly is challenging. The purpose of this paper is to review recent publications on this topic and to identify the optimal treatment for these fractures.Recent FindingsTreatment consists of a variety of conservative or operative options all with advantages and disadvantages as described in this review. Little research has been published that specifically focuses on elderly patients with ankle fractures. Operative treatment has a high complication rate. Multiple comorbidities are predictors for complications.SummaryAn optimal treatme...
Source: Current Geriatrics Reports - February 2, 2017 Category: Geriatrics Source Type: research
Overview and Update in Geriatric Dermatology
AbstractCurrent literature regarding elderly patient care in dermatology continues to advance and expand due to the increase in population, treatment options, and the associated morbidities. Medical literature in dermatology now includes more topics that focus on treatment of the elderly population in regard to cutaneous and systemic pathologies. Such topics include holistic patient care, integrative medicine, chronic pruritus, autoimmunity, carcinogenic prevention and treatment, and nursing home dermatology. The elderly patients consume a large percentage of pharmaceuticals and experience more comorbidities than other age...
Source: Current Geriatrics Reports - November 10, 2016 Category: Geriatrics Source Type: research
Treatment-Resistant Depression in the Elderly: Diagnostic and Treatment Approaches
AbstractDepression is a common illness in the geriatric primary care population. Risk factors including serious medical illness and functional disability, as well as neurodegeneration and cardiovascular risk factors, can make treatment particularly difficult in late-life depression. There is a paucity of well-validated evidence to guide the geriatric clinician ’s diagnosis and management of treatment-resistant late-life depression (TRLLD). In this article, I provide clinical recommendations for the evaluation and diagnosis of late-life depression appropriate for the geriatric primary care provider. With an accurate diagn...
Source: Current Geriatrics Reports - October 24, 2016 Category: Geriatrics Source Type: research
Oxygen Therapy in the Elderly: When Nasal Cannula Is Not Enough
AbstractRespiratory disease impacts significantly on health economics, and the burden of disease increases with age. A significant proportion of patients will present to acute hospital services with respiratory failure that requires prompt and appropriate management. Multiple options are available to deliver supplemental oxygenation from simple nasal prongs to non-invasive ventilation. The development of high-flow humidified oxygen systems and non-invasive ventilation has had a significant positive impact on the care of patients in respiratory failure. However, it is of crucial importance that individual patients are taken...
Source: Current Geriatrics Reports - October 23, 2016 Category: Geriatrics Source Type: research
Utility of Neuropsychological Evaluations in the Clinical Management of Geriatric Patients
This article provides an introduction to what these assessments entail (i.e., length of assessment, insurance coverage) and the domains that are typically covered (i.e., attention, language, memory, psychiatric symptoms). Examples are provided as to the types of referral questions that can be addressed. We also discuss how information gleaned from these evaluations can aid in differential diagnosis. Specifically, pattern of test performance may be suggestive of a particular disorder. Assessment results can also aid in the treatment, management, and dispositional planning for aging patients. Case examples, relevant to geria...
Source: Current Geriatrics Reports - October 21, 2016 Category: Geriatrics Source Type: research
