Clinics in geriatric medicine
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Diabetes mellitus has become a global threat, especially in the emerging economies. In the United States, there are about 24 million people with diabetes mellitus. ⋯ Artificial intelligence can address many problems posed by the prevalence of diabetes mellitus and the impact of diabetes on individual and societal health. We provide a brief overview of artificial intelligence and discuss case studies that illustrate how artificial intelligence can enhance diabetes care.
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The wait before elective cardiac intervention or surgery presents an opportunity to prevent further physiologic decline preoperatively in older patients. Implementation of prehabilitation programs decreases length of hospital stay postoperatively, decreases time spent in the intensive care unit, decreases postoperative complications, and improves self-reported quality of life postsurgery. ⋯ High-quality research in larger cohorts is needed, and interventions focusing on underrepresented frailer populations and women. Creative ways to improve accessibility, adherence, and benefits received from prehabilitation should be explored.
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Anemia in the elderly is common and is associated with exposure to blood transfusion and higher perioperative morbidity and mortality. These patients would benefit from early diagnosis and work-up of the cause of preoperative anemia systematically. ⋯ Intravenous iron leads to a more rapid hemoglobin response, and is devoid of gastrointestinal side effects. More data are needed to determine if preoperative correction of iron-deficiency anemia reduces the morbidity associated with anemia.
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Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia following Alzheimer disease. It stems from the formation of Lewy bodies, which contain aggregates of the misfolded protein, α-synuclein. ⋯ Because of its clinical overlap with other forms of dementia, DLB is often underdiagnosed and misdiagnosed. There is currently no cure for DLB and treatments are aimed at ameliorating specific symptoms.
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Older patients with advanced illness are presenting more frequently to emergency departments (EDs). These patients have complex needs, which challenge busy EDs tuned to provide emergent, life-sustaining interventions, and rapid dispositions. This article outlines communication skills to assess patient goals so that the ED provider can create a care plan that matches level of medical intervention with patient wishes. Furthermore, this article outlines symptom-based care for the actively dying geriatric patient in the ED, specifically, acute pain, dyspnea, terminal delirium, secretions, dry mouth, fever, and bereavement.