Risk prediction after TIA: the ABCD system and other methods.

Geriatrics. 2008 Oct;63(10):10-3, 16

Authors: Giles MF, Rothwell PM

Transient ischemic attack (TIA) is common in the elderly and total numbers are likely to increase with the aging of the population. The risk of stroke early after TIA has recently been shown to be approximately 5 percent at 7 days and 10 to 15 percent at 3 months, while overall cardiovascular risk is increased in the longer term. The ABCD system (Age, Blood pressure, Clinical features, Duration of symptoms) is a clinical score that can be rapidly worked out at the time of presentation and reliably predicts early risk of stroke. It can be used in patient triage to secondary care, informing public education and in the effective targeting of secondary prevention. The vascular territory and etiology of the TIA and results of cerebral imaging can also be used to predict early risk of stroke but the degree of the interaction between all these factors is uncertain.

PMID: 18828651 [PubMed - indexed for MEDLINE]

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Hypertension 2008, refining our treatment.

Geriatrics. 2008 Oct;63(10):14-5, 17-20

Authors: Leibovitch ER

Clinical studies continue to modify our approach to the older hypertensive patient. The pathophysiology of hypertension is now better understood from data derived from ambulatory blood pressure monitoring, the assessment of central arterial pressure and of vascular stiffness. This is altering both the ways we assess, monitor, and treat our older hypertensive patients as well as our choice of pharmacological agents. New data have confirmed the importance of treating the very elderly patient’s blood pressure and of modifying the increasing incidence of atrial fibrillation. Resistant hypertension is frequently the result of excessive aldosterone production, a situation easily treated. Several investigators have raised the question of the prehypertensive state and of possible therapy.

PMID: 18828652 [PubMed - indexed for MEDLINE]

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Treatment of hypertension in the elderly.

Geriatrics. 2008 Oct;63(10):21-5

Authors: Aronow WS

Numerous double-blind, randomized, placebo-controlled studies have shown that antihypertensive drug therapy reduces cardiovascular events in elderly persons. In the Hypertension in the Very Elderly Trial, patients aged 80 years and older treated with antihypertensive drug therapy had, at 1.8-year follow-up, a 30 percent reduction in fatal or nonfatal stroke, a 39 percent reduction in fatal stroke, a 21 percent reduction in all-cause mortality, a 23 percent reduction in death from cardiovascular causes, and a 64 percent reduction in heart failure. The goal of treatment of hypertension in elderly persons is to lower the blood pressure to less than 140/90 mmHg and to less than 130/80 mmHg in older persons with diabetes or chronic renal insufficiency. All antihypertensive drugs may predispose the elderly person to develop symptomatic orthostatic hypotension and postprandial hypotension and syncope or falls. Adverse effects depend upon the antihypertensive drugs used, the doses of these drugs, the comorbidities in the elderly patients taking these drugs, and drug-drug interactions.

PMID: 18828653 [PubMed - indexed for MEDLINE]

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Therapeutic challenges in the management of gout in the elderly.

Geriatrics. 2008 Jul;63(7):13-8, 20

Authors: Singh H, Torralba KD

Gout is the most common inflammatory arthritis in the elderly population. Management in the elderly requires special consideration. Physiologic changes associated with aging and co-morbidities make the elderly prone to adverse effects of drugs otherwise successfully used in younger counterparts. Use of colchicine, non-steroidal anti-inflammatory drugs, and urate-lowering therapies may be restricted in those with limited renal reserve. Corticosteroids are safe alternatives for short-term use in acute gout. Elderly patients need laboratory monitoring for side effects more frequently than usual. Non-pharmacologic measures such as dietary modifications, regular exercise, and ice therapy should be considered vital adjunctive treatments. A brief review of future therapies is also discussed.

PMID: 18593209 [PubMed - indexed for MEDLINE]

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Dysphagia: causes, assessment, treatment, and management.

Geriatrics. 2008 May;63(5):15-20

Authors: White GN, O’Rourke F, Ong BS, Cordato DJ, Chan DK

Dysphagia, or difficulty in swallowing, is a condition with a strong age-related bias. Rates of dysphagia vary due to differences in method between studies; eg, clinical history of “swallowing difficulty,” evidence of aspiration, or dysphagia confirmed by swallowing investigations. In general, the rate is lower in the community than in nursing home facilities. The management and treatment of dysphagia among geriatric patients is complicated by cognitive decline, lowered immunity, malnutrition, and end-of-life decisions. This article reviews the current assessment, treatment, and management techniques for dysphagia; covers new developments in research and pilot studies; and reviews the ethical issues related to treatment when prognosis is poor.

PMID: 18447407 [PubMed - indexed for MEDLINE]

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