Pneumonia in the long-term resident.
Clin Geriatr Med. 2011 May;27(2):117-33
…

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Cardiac causes for falls and their treatment.
Clin Geriatr Med. 2010 Nov;26(4):539-67
Authors: Cronin H, Kenny RA
Abstract
Cardiovascular disorders are a common cause of falls and syncope in older adults. The m…

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Medication and falls: risk and optimization.
Clin Geriatr Med. 2010 Nov;26(4):583-605
Authors: Boyle N, Naganathan V, Cumming RG
Abstract
The association between drugs and falls has been widely studied in the p…

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Preventing falls and fall-related injuries in hospitals.

Clin Geriatr Med. 2010 Nov;26(4):645-92

Authors: Oliver D, Healey F, Haines TP

Falls are a widespread concern in hospitals settings, with whole hospital rates of between 3 and 5 falls per 1000 bed-days representing around a million inpatient falls occurring in the United States each year. Between 1% and 3% of falls in hospitals result in fracture, but even minor injuries can cause distress and delay rehabilitation. Risk factors most consistently found in the inpatient population include a history of falling, muscle weakness, agitation and confusion, urinary incontinence or frequency, sedative medication, and postural hypotension. Based on systematic reviews, recent research, and clinical and ethical considerations, the most appropriate approach to fall prevention in the hospital environment includes multifactorial interventions with multiprofessional input. There is also some evidence that delirium avoidance programs, reducing sedative and hypnotic medication, in-depth patient education, and sustained exercise programs may reduce falls as single interventions. There is no convincing evidence that hip protectors, movement alarms, or low-low beds reduce falls or injury in the hospital setting. International approaches to developing and maintaining a fall prevention program suggest that commitment of management and a range of clinical and support staff is crucial to success.

PMID: 20934615 [PubMed - indexed for MEDLINE]

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The clinical care of frail, older adults.

Clin Geriatr Med. 2011 Feb;27(1):89-100

Authors: Ko FC

Frailty and its management represent an emerging area of clinical care in older adults. Geriatricians have long recognized a syndrome of multiple comorbid conditions, immobility, weakness, and poor tolerance of physiologic stressors in older adults. Patients with these characteristics are described as frail and suffer increased adverse clinical outcomes. This article reviews the clinical spectrum of frailty in older adults, its biologic etiology, and potential clinical interventions. Several operational definitions of frailty and the associated clinical signs, symptoms, and outcomes are outlined. The biologic mechanisms hypothesized to underlie frailty are explored, particularly in the musculoskeletal, endocrine, and immune systems. Treatment options for frail, older adults are discussed, including physiologic system-targeted interventions and geriatric models of care.

PMID: 21093725 [PubMed - indexed for MEDLINE]

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Renin angiotensin system inhibition in the older person: a review.

Clin Geriatr Med. 2009 May;25(2):245-57

Authors: Mohamed MA, Weir MR

The efficacy and safety of rennin angiotensin system (RAS) inhibition for lowering blood pressure in older populations has been demonstrated in a number of clinical trials. Whether a patient’s age influences the overall ability of these drugs to lower blood pressure and protect against progress of cardiovascular and kidney disease has been the focus of few clinical trials. Herein, the author’s review the mechanism of action of the renin angiotensin cascade and then discuss the clinical evidence surrounding the use of RAS-blocking drugs in the older population.

PMID: 19555871 [PubMed - indexed for MEDLINE]

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Drug treatment of hypertension in older hypertensives.

Clin Geriatr Med. 2009 May;25(2):235-44

Authors: Rashidi A, Wright JT

There is strong evidence supporting the benefit of antihypertensive treatment in older patients. Blood pressure goal and drug selection in the elderly is similar to that in younger populations, but there are a few special considerations in these patients. A number of studies have been conducted to determine the drugs or drug classes most effective for reducing cardiovascular complications in older patients with hypertension. This article reviews the evidence for drug treatment in this population.

PMID: 19555870 [PubMed - indexed for MEDLINE]

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Preoperative pulmonary update.

Clin Geriatr Med. 2008 Nov;24(4):607-24, vii

Authors: Smetana GW, Conde MV

Postoperative pulmonary complications are an important source of surgical morbidity. In this paper, the authors review recent studies that shed light on emerging risk factors, a multifactorial index for respiratory failure, and the value of specific risk reduction strategies. Novel risk factors include advanced age, congestive heart failure, pulmonary hypertension, and obstructive sleep apnea. Important risk reduction strategies include postoperative lung expansion maneuvers, the selective use of nasogastric tubes, epidural analgesia, and inspiratory muscle training.

PMID: 18984376 [PubMed - indexed for MEDLINE]

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Perioperative anemia in the elderly.

Clin Geriatr Med. 2008 Nov;24(4):641-8, viii

Authors: Kumar A, Carson JL

Anemia is characterized by less than the normal number of red blood cells (RBCs) (as a result of underproduction, increased loss, or destruction) or decreased quantity of hemoglobin (Hgb) in the blood, thereby reducing the blood’s oxygen-carrying capacity.

PMID: 18984378 [PubMed - indexed for MEDLINE]

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Perioperative care of the geriatric patient with diabetes or hyperglycemia.

Clin Geriatr Med. 2008 Nov;24(4):649-65, viii

Authors: Maynard G, O’Malley CW, Kirsh SR

The incidence of diabetes in the geriatric population is increasing and the resulting co-morbidities have led to corresponding increases in hospital admissions and surgeries. The weight of the evidence and national guidelines should dissuade us from allowing uncontrolled hyperglycemia in the geriatric perioperative population, but the glycemic target should be modified upwards based on the individual patient characteristics, and in environments that do not have an established track record of reaching more aggressive targets safely. Insulin is the most effective and flexible regimen to achieve inpatient glycemic control, whether by infusion or by subcutaneous basal bolus regimens. Strategies for safe and effective dosing and adjustment of insulin regimens, and methods to avoid hypoglycemia in the perioperative period are outlined. Finally, discharge planning should take into consideration a patient’s HbA1c, preoperative glycemic control, inpatient glycemic regimen and control, financial and physical limitations, social support, co-morbid medical conditions, episodes of hypoglycemia, and overall prognosis to create an individualized safe and effective medication regimen for optimal glycemic control at home.

PMID: 18984379 [PubMed - indexed for MEDLINE]

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Evaluation and management of the elderly patient at risk for postoperative delirium.

Clin Geriatr Med. 2008 Nov;24(4):667-86, viii

Authors: Bagri AS, Rico A, Ruiz JG

Geriatric patients are at a high risk for the development of postoperative delirium. By recognizing predisposing and precipitating risk factors, preventive measures can be undertaken to reduce this risk. Accurate and timely diagnosis is essential, and we offer therapeutic strategies to help reduce the high morbidity and mortality of this important condition.

PMID: 18984380 [PubMed - indexed for MEDLINE]

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Postoperative renal failure.

Clin Geriatr Med. 2008 Nov;24(4):721-9, ix

Authors: Noor S, Usmani A

Acute renal failure (ARF) or acute kidney injury (AKI) is a common problem occurring in about 1% to 5% of all hospitalized patients. It leads to poor quality of life and increased length of stay (LOS), cost of care, morbidity, and mortality. The survival rate for ARF has not drastically changed over the past 4 decades because of the aging population and presence of multiple comorbid conditions. About 200 patients per million population develop severe ARF each year. Approximately one-third of these patients require ICU care. Recent studies have shown that even milder forms of renal dysfunction are associated with increased LOS and mortality.

PMID: 18984383 [PubMed - indexed for MEDLINE]

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Prevention of venous thromboembolism after surgery.

Clin Geriatr Med. 2008 Nov;24(4):625-39, viii

Authors: Jaffer AK, Brotman DJ

Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, is the third leading cause of cardiovascular death after myocardial infarction and stroke in the United States. Recommendations regarding the type and duration of prophylaxis for the various conditions are summarized herein.

PMID: 18984377 [PubMed - indexed for MEDLINE]

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Perioperative cardiac evaluation: assessment, risk reduction, and complication management.

Clin Geriatr Med. 2008 Nov;24(4):585-605, vii

Authors: Mauck KF, Manjarrez EC, Cohn SL

Perioperative cardiac complications are among the most feared outcomes after surgery. Using evidence-based guidelines and expert opinion, physicians can perform a risk assessment and decide whether further cardiac testing, medical therapy, or coronary intervention is necessary to optimize the patient’s medical condition prior to surgery. This article reviews the major concepts and recommendations from the ACC guidelines for preoperative cardiac evaluation and perioperative management to reduce risk. Medical management of the major postoperative cardiac complications is also discussed.

PMID: 18984375 [PubMed - indexed for MEDLINE]

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Diabetic foot management in the elderly.

Clin Geriatr Med. 2008 Aug;24(3):551-67, viii

Authors: Plummer ES, Albert SG

Guidelines for diabetes foot care are available and should be part of the routine care and evaluation of all elderly patients who have diabetes. Those individuals who have good sensation, good vascularity, without foot deformities, and are capable of reaching and seeing their feet may do well with education and reasonable approaches to footwear and foot care. Those who have advanced diabetic complications of neuropathy or vascular insufficiency should be seen by professionals and given intensive education. An experienced team familiar with the progression of illness should follow those who have ulcers. Guidelines are presented for the management of outpatient and inpatient therapy of foot ulcers.

PMID: 18672189 [PubMed - indexed for MEDLINE]

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