Cognitive Impairment Among Older Individuals with HIV Infection
Abstract
The introduction of combination antiretroviral therapy (CART) has led to a dramatic increase in the survival of HIV seropositive (HIV+) individuals and an aging HIV+ population with over 50 % of HIV+ persons in the USA now over the age of 50. Cognitive impairment is common across the lifespan in HIV but is twice as common among older HIV+ adults. HIV itself may lead to HIV-associated neurocognitive disorders, but cardiovascular risk factors may also contribute to cognitive impairment in older HIV+ adults. Abnormal amyloid deposition in brains of HIV+ individuals at autopsy may also indicate a ro...
Source: Current Geriatrics Reports - March 31, 2016 Category: Geriatrics Source Type: research
Pulmonary Function Testing and Role of Pulmonary Rehabilitation in the Elderly Population with Pulmonary Diseases
Abstract
With an aging population worldwide, the incidence and prevalence of certain pulmonary conditions such as chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are increasing. Pulmonary function tests (PFTs) are helpful tools to confirm pulmonary disorders. However, in the elderly population, age-associated changes in PFTs increase the risk for over diagnosis of obstructive lung disease. Therefore, an individualized approach to diagnosis of pulmonary disorders is essential for optimal management. For patients with established pulmonary disorders, pulmonary rehabilita...
Source: Current Geriatrics Reports - March 31, 2016 Category: Geriatrics Source Type: research
Role of Palliative Care in Improving the Quality of Life in Elderly with Advanced Lung Disease
Abstract
The traditional “either cure or comfort” approach does not optimize palliative care in elderly with advanced lung disease. Instead, a holistic, patient-centered, “comfort and cure together” approach with palliative and best care practices integrated as needed across the entire illness course will improve quality of life and other outcomes in these patients and their families. Competency in primary palliative care, identification of patient and family vulnerability, care plans formed by patient-centered communication, timely palliative responsiveness, and effective advance care planning ar...
Source: Current Geriatrics Reports - March 29, 2016 Category: Geriatrics Source Type: research
REM Sleep Behavior Disorder: a Prodromal Synucleinopathy
Abstract
Rapid eye movement sleep behavior disorder (RBD) is an abnormal condition that constitutes dream enactment behavior occurring during rapid eye movement (REM) phase sleep with loss of normal muscular atonia. Idiopathic RBD is a recognized risk factor for the development of alpha-synuclein neuropathology, often referred to as Lewy body disorders (LBD) like Parkinson disease, multiple system atrophy and dementia with Lewy bodies, with conversion rates of 80–90 % over a lifetime. In the past decade, studies have described multiple features of idiopathic RBD subjects that resemble patients with alp...
Source: Current Geriatrics Reports - March 28, 2016 Category: Geriatrics Source Type: research
The Wrath of Steroids in Elderly Patients with Pulmonary Diseases
Abstract
Pulmonary diseases such as Chronic Obstructive Pulmonary Disease (COPD) and asthma are common in the elderly population. Corticosteroids, systemic and inhaled, are commonly used in their treatment. There are many adverse effects associated with corticosteroid treatment. These include cataracts, osteoporosis, diabetes mellitus, and delirium, which are more common and more dangerous in the elderly population. (Source: Current Geriatrics Reports)
Source: Current Geriatrics Reports - March 28, 2016 Category: Geriatrics Source Type: research
Chronic Subdural Haematoma in the Elderly: Is It Time for a New Paradigm in Management?
Abstract
Chronic subdural haematoma (CSDH) is a common neurological condition that usually affects the elderly. The optimal treatment strategy remains uncertain, principally because there is a lack of a good evidence base. In this paper, we review the literature concerning the peri-operative and operative care of patients. In particular, we highlight the non-surgical aspects of care that might impact on patient outcomes and CSDH recurrence. We propose that an integrated approach to care in patients with CSDH, similar to care of fragility fractures in the elderly, may be an important strategy to improve pa...
Source: Current Geriatrics Reports - March 22, 2016 Category: Geriatrics Source Type: research
Myasthenia Gravis in the Elderly: Differential Diagnosis and Management
Abstract
Late-life disorders presenting with weakness often have a delay in diagnosis leading to decreased quality of life and impairment of mobility. Myasthenia gravis is an immune disorder affecting the neuromuscular junction resulting in varying levels of weakness in the orbital, bulbar, and limb muscles. The evaluation of weakness in the elderly should be geared toward treatable and reversible causes such as myasthenia gravis. The major treatment options include symptomatic, immunosuppressive, and immunomodulating therapies. (Source: Current Geriatrics Reports)
Source: Current Geriatrics Reports - March 21, 2016 Category: Geriatrics Source Type: research
Venous Thromboembolism in the Elderly
Abstract
Aging is a major risk factor for venous thromboembolism. Compared to the general population, the elderly have a much higher 1-year mortality from venous thromboembolism (VTE). Clinical presentation of VTE in the elderly tends to be different, with atypical symptoms being more common than in the general population. Diagnostic work-up starts with establishing a VTE pretest probability followed by D-dimer testing for patients with low pretest probability and confirmatory testing for patients with high pretest probability of VTE. The age-adjusted D-dimer cutoffs are associated with a higher specifici...
Source: Current Geriatrics Reports - March 8, 2016 Category: Geriatrics Source Type: research
Assessment of physical function in geriatric oncology based on International Classification of Functioning, Disability and Health (ICF) framework
Abstract
Older patients with cancer may have multiple physical impairments, such as limitation in range of motion, muscle weakness, lack of coordination, and balance and gait dysfunction. A patient’s physical function may be further limited by pain, fatigue, depression, and shortness of breath that hasten the deconditioning process and affect their overall quality of life. Understanding the common impairments in cancer would help the therapist to assess and treat them effectively; thus, this article aims to provide an overview of functional limitations associated with cancer and its treatments and the u...
Source: Current Geriatrics Reports - March 1, 2016 Category: Geriatrics Source Type: research
Nuances in the Care of Emergent Splenic Injury in the Elderly Patient
Abstract
The spleen is the most commonly injured abdominal solid organ. Over 39,000 adults are hospitalized each year in the USA with a splenic injury. The management of spleen trauma has evolved over the past three decades, focusing on splenic preservation and non-operative management “Hurtuk et al. (J Trauma Infection Crit Care Burns 61:243–255, 2006).” Over the same time period, the geriatric population of the USA is rapidly increasing and is expected to double to 72 million by 2030 and account for almost 39 % of trauma admissions by 2050 “Pandya et al (J Trauma 70(6):1326–30, 2011).” The g...
Source: Current Geriatrics Reports - February 15, 2016 Category: Geriatrics Source Type: research
Evaluation of Common Fractures of the Hip in the Elderly
Abstract
Hip fractures in the geriatric population are a common injury encountered in the emergency department. The recommendations for preoperative medical workup and management of these patients have recently been evaluated. Although medical therapies have been designed in an attempt to decrease the rate of these fractures, attempts to medically manage osteoporosis has created a new “atypical” fracture pattern that must be recognized and managed appropriately. The current recommendations for preoperative medical evaluation and management of patients with hip fractures will be reviewed. In addition, ...
Source: Current Geriatrics Reports - February 5, 2016 Category: Geriatrics Source Type: research
Asymptomatic Bacteriuria in Older Adults
Abstract
Asymptomatic bacteriuria is a common finding in older populations. The prevalence increases with age in both men and women and is the highest in the most functionally impaired. Subjects with chronic indwelling catheters are always bacteriuric. Current management issues include the continuing need to refine clinical features identifying symptomatic infection and developing effective strategies to minimize inappropriate antimicrobial use for the treatment of asymptomatic bacteriuria. These are particularly relevant for residents of long-term care facilities where this is a high prevalence of bacter...
Source: Current Geriatrics Reports - February 4, 2016 Category: Geriatrics Source Type: research
Antimicrobial Stewardship and Infection Prevention in Long-Term Care Settings: New Strategies to Prevent Resistant Organisms
Abstract
Many studies worldwide confirm that antibiotic use is common in long-term care facilities (LTCFs). Some of that antibiotic use is inappropriate and may contribute to the emergence of antibiotic resistance. Inappropriate use may be characterized as antibiotic treatment of clinical syndromes that are not infectious, infectious conditions that do not respond to antibiotics, and prolonged duration. Additionally, better antibiotic choices should have been made or insufficient clinical evidence was present to start an antibiotic. National and international action plans are under development to curtail ...
Source: Current Geriatrics Reports - February 4, 2016 Category: Geriatrics Source Type: research
Ethics and the Emergency Care of the Seriously Ill and Injured Elderly Patient
Abstract
Ethics in western medicine is governed by four basic principles: nonmaleficence, beneficence, autonomy, and justice. Acutely ill and injured elderly patients often present ethical challenges to the physician as they attempt to balance conflicting ethical priorities. Healthcare decisions in the elderly are made more complex by numerous factors such as advances in surgical care that may lengthen life yet worsen quality of life, allocation of resources, disparities of care, the presence of dementia, and need for surrogate decision makers. Communication is a key factor in providing the best possible ...
Source: Current Geriatrics Reports - February 4, 2016 Category: Geriatrics Source Type: research
Care of the Elderly Patient with Acute Diverticulitis
Abstract
Diverticulitis is frequently encountered in the elderly population. Because elderly patients typically have decreased physiologic reserve and other complicating comorbid conditions, treatment decisions must be carefully made. Like with younger patients, uncomplicated diverticulitis is usually treated successfully with antibiotics alone. Frequent contact with the patient is required so that worsening is promptly detected, and a treatment escalation, if needed, is not missed. Treatment of complicated diverticulitis depends on the specific complication. For perforated diverticulitis, resection with ...
Source: Current Geriatrics Reports - February 4, 2016 Category: Geriatrics Source Type: research
