Geriatrics
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Studies of bacterial meningitis have documented a peak of incidence among persons age 60 and older. The most common bacterial pathogens in these patients differ from those seen in children. Presentation of meningitis in older patients may be atypical; fever is not a consistent finding, and nonspecific symptoms such as confusion are often seen. ⋯ Definitive diagnosis relies on interpretation of CSF studies. Ampicillin plus a third-generation cephalosporin should be administered for community-acquired meningitis until Gram's stain and culture results return. Cases of S pneumoniae meningitis may require varying strategies, based upon the degree of penicillin resistance.
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Constipation is a common complaint in older patients. Contributing factors are impaired general health, use of medications, and decreased mobility and physical activity. Diet has an indeterminate effect. ⋯ Although constipation is usually just an annoyance, it can have more serious consequences, such as impaction and ulceration. A combination of bowel training, dietary management, and regular exercise is the first phase of treatment. Bulk laxatives are second-line treatment, followed by other laxatives if needed.