Clinics in geriatric medicine
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Constipation and irritable bowel syndrome are very common in older persons. Constipation is over diagnosed and over treated in older persons. Lifestyle changes, osmotic laxatives, and lubiprostone are the approaches of choice for the management of constipation. Irritable bowel syndrome should be considered in the differential diagnosis of abdominal pain, diarrhea and constipation in older persons.
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Herpes zoster (HZ) afflicts millions of older adults annually and causes significant suffering from acute and chronic pain, or postherpetic neuralgia (PHN). HZ is caused by the reactivation of varicella-zoster virus (VZV) in sensory ganglia in the setting of age, disease, and drug-related decline in cellular immunity. ⋯ For PHN, evidence-based pharmacotherapy can reduce pain burden. The zoster vaccine is effective in reducing pain burden and preventing HZ and PHN in older adults.
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Dyspnea is among the most frequent complaints in the elderly. The prevalence of comorbid medical conditions and the physiologic changes of aging present significant challenges in determining the cause. ⋯ Failure to diagnose life-threatening medical conditions presenting with dyspnea such as pulmonary embolus, acute coronary syndromes, congestive heart failure, asthma, obstructive pulmonary disease, pneumothorax, and pneumonia can lead significant morbidity and mortality. This article focuses on the rapid assessment and approach to the acutely dyspneic elderly patient.
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Failure to recognize psychiatric conditions in any age group particularly in the elderly could lead to a very complicated clinical picture and may lead to increased health expenditures. Psychiatric emergencies can be secondary to numerous factors: geriatric depression and suicide, behavioral disturbance secondary to underlying organic conditions, substance abuse, elder abuse, and medication-induced adverse events. This article discusses mainly geriatric depression, elder abuse, and conditions emanating from iatrogenic causes.
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Infectious diseases remain a significant cause of morbidity and mortality in the growing number of adults over the age of 65 years in the United States. Declining immunity coupled with aging anatomy and physiology set the stage for increased vulnerability to infections and the development of atypical presentations in the elderly. Pneumonia, urinary tract infection, and skin and soft tissue infections are illnesses commonly encountered in the care of this unique population. This article explores the etiology, diagnosis, and constantly evolving treatment of these conditions in the context of the elderly patient.