Clinics in geriatric medicine
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Clin. Geriatr. Med. · Nov 2010
ReviewAn older adult falls research agenda from a public health perspective.
This article reviews fall prevention research using the Centers for Disease Control public health model and suggests several critical research questions at each step. Research topics include surveillance and data systems, fall risk factors, development, evaluation and implementation of fall interventions, translation of interventions into programs, and promotion, dissemination, and widespread adoption of fall prevention programs. These broad topics provide a framework for research that can guide future advances in older adult fall prevention.
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Increased longevity and population aging will increase the number of men with late-onset hypogonadism, a common condition that is often under diagnosed and under treated. The indication of testosterone replacement therapy (TRT) treatment requires the presence of low testosterone level and symptoms and signs of hypogonadism. Although there is a lack of large-scale, long-term studies assessing the benefits and risks of TRT in men with hypogonadism, reports indicate that TRT may produce a wide range of benefits that include improvement in libido and sexual function, bone density, muscle mass, body composition, mood, erythropoiesis, cognition, quality of life, and cardiovascular disease. ⋯ Despite this controversy, testosterone supplementation in the United States has increased substantially in the past several years. The physician should discuss with the patient the potential benefits and risks of TRT. This review discusses the benefits and risks of TRT.
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Hip fractures in elderly men present many significant challenges and are a leading cause of morbidity and mortality in this age group. A multidisciplinary team approach before surgical intervention is the most efficient way to manage this patient group and achieve the best possible outcome while attempting to return patients to their previous level of function. Timely surgical intervention allows the patient's early mobilization and decreases the risk of potential complications in the postoperative period. Patient education and close follow-up are necessary to ensure compliance with the rehabilitation protocol as well as the prevention of future fractures.
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Older adults carry the highest risk for coronary artery disease and the highest burden of atherosclerosis. Although most clinical trials of cholesterol-lowering therapy have not specifically targeted older persons, growing evidence supports treatment of elevated low-density lipoprotein cholesterol levels in older patients, especially those at high risk for coronary events. The decision to treat a high or high-normal cholesterol level in an elderly individual must be individualized based on chronologic and physiologic age. This article summarizes current data on lipid-lowering therapy in older adults and the management of hyperlipidemia in elderly patients.
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Rates of chronic kidney disease and end-stage renal disease are increasing as the United States population ages. The elderly with chronic kidney disease or end-stage renal disease face specific challenges with regard to medical care. ⋯ As the United States population ages, physicians will have to face many challenges associated with aging, whether medical, psychosocial, or ethical. This article discusses issues specific to the geriatric dialysis population.