Subtleties in the Emergency Care of Elderly Patients with Biliary Disease
Abstract
The management of acute biliary disease in the elderly population can be a challenging endeavor. Older patients often present with atypical symptoms or advanced disease, which can further complicate the treatment options. A treating physician must have a high index of suspicion for biliary disease as a cause of acute intra-abdominal emergencies in the elderly patient that presents with vague abdominal complaints. While the initial workup of these patients is similar to their younger counterparts, the utilization of advanced imaging modalities can often assist in clarifying the diagnosis. The succ...
Source: Current Geriatrics Reports - February 3, 2016 Category: Geriatrics Source Type: research
Management and Complications of Rib Fractures in Older Adults
Abstract
Thoracic injury is the second-leading cause of trauma-related death. The growing elderly population is at high risk for injury to the thorax as a result of falling from standing and sustaining rib fractures and associated pneumothorax and hemothorax. The elderly patients with rib fractures are challenging therapeutic dilemmas for the trauma surgeon. We provide a summary of the current literature surrounding thoracic trauma in the elderly population. Further, we describe best practices for selection of patients for hospital admission, pain control, and surgical repair. Finally, we describe program...
Source: Current Geriatrics Reports - February 3, 2016 Category: Geriatrics Source Type: research
Herpes Zoster and Post-herpetic Neuralgia
Abstract
Herpes zoster (HZ), which is commonly referred to as shingles, is a syndrome of pain and skin rash that is caused by reactivation of varicella zoster virus (VZV). After primary varicella infection (chicken pox), the virus goes into latency in the spinal cord ganglia. The virus is reactivated when immunity to VZV declines as happens with aging or immunosuppression. The risk of zoster increases steeply after the age of 50 years. Post-herpetic neuralgia (PHN), defined as pain persisting more than 3 months after the skin rash has healed, is a serious consequence of HZ that is difficult to treat and...
Source: Current Geriatrics Reports - January 28, 2016 Category: Geriatrics Source Type: research
Relationship Between Accelerometer-Measured Activity and Self-Reported or Performance-Based Function in Older Adults with Severe Aortic Stenosis
Abstract
In older adults with aortic stenosis, we evaluated whether accelerometer-measured physical activity provides distinct clinical information apart from self-reported surveys or performance-based function tests. We employed wrist-mounted accelerometry in 52 subjects with severe aortic stenosis prior to transcatheter aortic valve replacement (TAVR). Daily daytime activity was estimated using the maximum 10 h of daily accelerometer-measured activity (M10) reported in activity counts. Subjects completed baseline surveys (New York Heart Association (NYHA), Short Form 12 (SF12), Kansas City Cardiomyopat...
Source: Current Geriatrics Reports - October 14, 2015 Category: Geriatrics Source Type: research
A Decision-Making Framework for Objective Risk Assessment in Older Adults with Severe Symptomatic Aortic Stenosis
Abstract
The increasing prevalence of severe symptomatic aortic stenosis (AS) in older adults is now considered a major public health concern. Since medical therapy has not been shown to improve prognosis, surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are the best options currently available, yet not all patients benefit. Objective assessment of risk versus benefit for SAVR and TAVR is essential. Clinical prediction models (CPM) have been created to augment subjective physician estimates of risk and have been shown to improve the accuracy of risk predictions. T...
Source: Current Geriatrics Reports - October 8, 2015 Category: Geriatrics Source Type: research
Recent Advances in Neuromodulatory Therapies in Psychogeriatrics: From TMS to ECT to VNS to Both Surgical and Magnetic DBS
Abstract
Neuromodulation therapies also known as brain stimulation therapies or techniques are used to treat various neuropsychiatric illnesses in adult and geriatric patients. Electroconvulsive therapy (ECT) was the first such treatment availed to be used for mood disorders and psychotic disorders. Since then, transcranial magnetic stimulation (rTMS) was also found to be effective with fewer side effects than ECT. Similarly, vagal nerve stimulation (VNS) and deep brain stimulation (DBS), used for seizure and movement disorders, respectively, have been found useful in the treatment of depression and other...
Source: Current Geriatrics Reports - September 30, 2015 Category: Geriatrics Source Type: research
Heart Failure Among Older Adults in Skilled Nursing Facilities: More of a Dilemma Than Many Now Realize
Abstract
Post-acute care, encompassing long-term care hospitals, home health, inpatient rehabilitation, and skilled nursing facilities, is increasingly employed as an integral part of management for more complicated patients, particularly as hospitals seek to maintain costs and decrease length of stay. Skilled nursing facilities (SNFs) in particular are progressively utilized for patients with complex medical processes, including today’s growing population of older hospitalized heart failure (HF) patients who pose a prominent challenge due to their high risks of mortality, 30-day readmissions, and subst...
Source: Current Geriatrics Reports - September 29, 2015 Category: Geriatrics Source Type: research
Current Concepts in the Diagnosis and Treatment of Schizophrenia in Later Life
Abstract
Caring for patients with schizophrenia in later life is emerging as a major concern as well as a challenge for practicing psychiatrists. The clinical presentation and course of this disorder in older patients differ from that of younger patients with unresolved cognitive and social issues often being prominent. It is hard to establish a definite age of onset for schizophrenia in later life. However, based on research evidence, symptomatology, brain imaging studies, family history, and cognitive issues observed in older patients with schizophrenia, the International Late-Onset Schizophrenia Group ...
Source: Current Geriatrics Reports - September 28, 2015 Category: Geriatrics Source Type: research
The Crossroads of Geriatric Cardiology and Cardio-Oncology
Abstract
Cancer and cardiovascular disease (CVD) are two major causes of mortality in older adults. With improved survival and outcomes from cancer and CVD, the role of the geriatrician is evolving. Geriatricians provide key skills to facilitate patient-centered and value-based care in the growing older population of cancer patients (and survivors). Cancer treatment in older adults is particularly injurious with respect to complications stemming from cancer therapy and as well as to CVD related to cancer therapy in the context of physiologic aging. To best meet their natural potential as caregiving leader...
Source: Current Geriatrics Reports - September 16, 2015 Category: Geriatrics Source Type: research
The Implications and Assessment of Myocardial Fibrosis in Older Cardiovascular Patients
Abstract
Myocardial fibrosis (MF) may play a role in homeostenosis—the decreasing ability of the aging heart to tolerate stressors and cardiac insults—since MF distorts myocardial architecture, impairs mechanical, electrical, and vasomotor function, and culminates in vulnerability to adverse outcomes. While MF is prevalent in many cardiac disorders found in older people, most MF is not attributable to age. MF is a dynamic process whereby synthesis predominates over degradation. Importantly, MF is reversible which likely leads to regression of mechanical and vasomotor abnormalities and survival benefit...
Source: Current Geriatrics Reports - September 11, 2015 Category: Geriatrics Source Type: research
The Role of Mobile Health in Elderly Populations
Abstract
“Gerontechnology” is defined as the application of mobile health (mHealth) technologies to elderly populations. It has conceptual value as a means to enhance preventative or therapeutic approaches to care and has therefore emerged as a key consideration in innovative healthcare approaches for today’s rapidly growing older population. In this review, we consider our pertinent experiences developing and deploying technology in clinical studies facilitated by Wellframe in 2014 and 2015, specifically in orientation to cardiac rehabilitation and care of patients with chronic psychiatric disorder...
Source: Current Geriatrics Reports - August 21, 2015 Category: Geriatrics Source Type: research
Conundrums for Atrial Fibrillation Management in Older Adults
Abstract
Atrial fibrillation (AF) afflicts over 33 million people worldwide, the large majority of them older than 65, and increases embolic stroke risk fourfold to fivefold. This stroke risk can be reduced by two thirds or more with anticoagulation, although this benefit is balanced by an increased risk of bleeding. Guidelines recommend use of the CHA2DS2-VASc risk score to estimate annual stroke risk and inform shared decision making between patients and providers. Although the net clinical benefit of anticoagulation for stroke prophylaxis in AF is well established in patients with CHA2DS2-VASc scores ...
Source: Current Geriatrics Reports - August 19, 2015 Category: Geriatrics Source Type: research
Indications and Utility of Percutaneous Balloon Aortic Valvuloplasty in Older Adults
Abstract
Balloon aortic valvuloplasty (BAV) was originally considered as an alternative to surgery for the treatment of aortic stenosis. However, due to the poor durability of its effects, it was largely relegated to palliative use. Recently, there has been increased application of BAV, particularly as a bridging procedure to transcatheter aortic valve replacement (TAVR) therapy. Furthermore, stand-alone BAV is now more frequently employed as palliative procedure for the growing population of older adults with aortic stenosis (AS) with limited life expectancy. Accordingly, BAV use has increased both in th...
Source: Current Geriatrics Reports - August 17, 2015 Category: Geriatrics Source Type: research
Update on Disease-Modifying/Preventive Therapies in Alzheimer’s Disease
Abstract
Alzheimer’s disease (AD) is increasingly becoming a major health problem throughout the US and Western Europe. As the remnants of the Baby Boom generation begin to reach their seniority at the turn of the twenty-first century, the disease has been unwillingly brought to the attention of the public eye. A disease that has traditionally been associated with an aging population has thus become a heated topic of discussion as modern research attempts to prevent and treat this major health burden and plague of the next decade. (Source: Current Geriatrics Reports)
Source: Current Geriatrics Reports - July 29, 2015 Category: Geriatrics Source Type: research
Current Concepts in the Diagnosis, Pathophysiology, and Treatment of Delirium: A European Perspective
Abstract
Delirium is a complex syndrome defined as an acute, fluctuating syndrome of altered attention, awareness, and cognition. Delirium is common in the elderly, but unfortunately underdiagnosed. The consequences could be significant such as an increase in mortality, hospitalization, loss of autonomy, and increased risk to be institutionalized. The predisposing and precipitating factors are well known, but the pathogenesis is not yet identified clearly. However, evidence that delirium is a neurotoxic factor which develops due primarily to neurotransmitter (cholinergic insufficiency) and inflammatory (i...
Source: Current Geriatrics Reports - July 29, 2015 Category: Geriatrics Source Type: research
