Geriatrics
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Delirium is a common development in at-risk older patients hospitalized for acute illness or postoperative care. Although delirium's risk factors are well documented, less is known about its pathophysiology and long-term prognosis or about the relationship between delirium, dementia, and depression. ⋯ Management consists of prevention, treatment of underlying causes or associated factors, supportive care, and pharmacologic intervention (as indicated). Studies that have looked at the reversibility of delirium suggest that patients often are slow to recover their previous level of function.
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A variety of age-related physiologic factors and disease states predispose older patients to hypothermia. These include a decreased ability to produce heat, malnutrition, medications, infections, and social factors such as isolation and poverty. ⋯ The challenge for the physician is to clinically recognize hypothermia and provide prompt diagnosis and treatment. Medical management of the older patient with moderate to severe hypothermia requires in-hospital intensive care, as life-threatening conditions may arise during stabilization and resuscitation.
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Significant variability of medical care exists in the United States that cannot be readily explained on the basis of severity of illness, patient demographics, or clinical necessity. One approach to promoting appropriate decision-making is to make the most recent and relevant information available to physicians in a practice guideline. Physicians are most likely to accept practice guidelines that address a specific need, are supported with scientific evidence, and offer the potential for improving patient outcomes. The implementation of a clinical practice guideline and its impact on the care of patients with uncontrolled hypertension are described.