Clinics in geriatric medicine
-
Even those who do not experience dementia or mild cognitive impairment may experience subtle cognitive changes associated with aging. Normal cognitive changes can affect an older adult's everyday function and quality of life, and a better understanding of this process may help clinicians distinguish normal from disease states. This article describes the neurocognitive changes observed in normal aging, followed by a description of the structural and functional alterations seen in aging brains. Practical implications of normal cognitive aging are then discussed, followed by a discussion of what is known about factors that may mitigate age-associated cognitive decline.
-
Chronic kidney disease (CKD) is increasingly being recognized as a disease of elderly individuals. In recent years the definition and categorization of kidney disease has been standardized. ⋯ This article addresses the definitions of CKD, recently published revised CKD stages with risk stratifications, and limitations of using formulas to assess renal function in the elderly. Also discussed are management of common risk factors of progression CKD, nonrenal-related outcomes, prognosis of CKD in older individuals, and criteria for referral to nephrology.
-
During the last 2 decades, the number of kidney transplants performed in the candidates older than 65 years has grown dramatically. For selected geriatric patients with end-stage kidney failure, kidney transplantation has emerged as a potential option for treatment of their end organ failure. Aging is associated with functional changes to the immune system known as immunosenescence, and this age-related decline in immune function has important implications for immunosuppression in this subgroup of kidney transplant recipients.
-
Venous leg ulcers are arguably the most common type of venous ulcers seen in clinical practice. Compression therapy is the essential intervention in venous leg ulcer treatment, but coexisting arterial vascular insufficiency must be excluded before compression is initiated. ⋯ Venous leg ulcers are chronic and often difficult to heal, with only 40% to 70% healing after 6 months of treatment. Surgical procedures to reduce venous hypertension do not accelerate healing of a chronic ulcer, but trials suggest a decreased rate of future recurrence after surgery.
-
Clin. Geriatr. Med. · Feb 2013
ReviewEvolving prehospital, emergency department, and "inpatient" management models for geriatric emergencies.
Alternative management methods are essential to ensure high-quality and efficient emergency care for the growing number of geriatric adults worldwide. Protocols to support early condition-specific treatment of older adults with acute severe illness and injury are needed. Improved emergency department care for older adults will require providers to address the influence of other factors on the patient's health. This article describes recent and ongoing efforts to enhance the quality of emergency care for older adults using alternative management approaches spanning the spectrum from prehospital care, through the emergency department, and into evolving inpatient or outpatient processes of care.