Clinics in geriatric medicine
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Both obstructive sleep apnea (OSA) and type 2 diabetes mellitus are commonly seen in older adults. Over the last decade, there has been increasing recognition that OSA is highly prevalent in persons with type 2 diabetes and related metabolic conditions such as insulin resistance and glucose intolerance. Intermittent hypoxemia and recurrent arousals in OSA trigger a repertoire of pathophysiological events, which can in turn alter glucose homeostasis and possibly increase the risk for type 2 diabetes. Conversely, there is evidence that type 2 diabetes may alter the progression and expression of sleep-disordered breathing.
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Symptoms of memory loss are caused by a range of cognitive abilities or a general cognitive decline, and not just memory. Clinicians can diagnose the syndromes of dementia (major neurocognitive disorder) and mild cognitive impairment (mild neurocognitive disorder) based on history, examination, and appropriate objective assessments, using standard criteria such as Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. ⋯ Brain imaging and biomarkers are making progress in the differential diagnoses among the different disorders. Treatments are still mostly symptomatic.
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The treatment of osteoporotic vertebral fractures is complicated because of the comorbid conditions of the elderly patient. Underlying osteoporosis leads to malalignment of the weakened bone and impedes fracture fixation. ⋯ As in other osteoporotic fractures in the elderly, the key for good outcome may be a combination of interdisciplinary treatment approaches and adapted surgical procedures. This article gives an overview of the underlying problems and possible treatment strategies for treatment of osteoporotic vertebral fractures in geriatric patients.
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Generalized weakness in the geriatric patient is a vexing chief compliant to address in any setting, especially in the hectic emergency department. Studies suggest that it is associated with poor outcomes, although the ideal workup is elusive. A minimum of laboratory and imaging testing is recommended with the addition of neuroimaging if focal weakness is discovered. Considering a wide differential with attention to geriatric-specific concerns is labor intensive but necessary for this presentation.
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This article summarizes the current literature regarding the structural and functional changes of the aging kidney and describes how these changes make the older patient more susceptible to acute kidney injury and fluid and electrolyte disorders. It discusses the clinical manifestations, evaluation, and management of hyponatremia and shows how the management of hypernatremia in geriatric patients involves addressing the underlying cause and safely correcting the hypernatremia. ⋯ The management of severe hypercalcemia is discussed in detail. The evaluation and management of acute kidney injury is described.