Geriatrics
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The aging cardiovascular and renal systems put the elderly patient at increased risk of end-organ damage from marked hypertension. Thus, the office-based physician needs to be skilled in making the diagnosis of a hypertensive urgency or emergency based on accurate blood pressure readings and an assessment of the heart, brain, retina, and kidney. Hypertension urgency and emergency are distinguished from each other by the clinical decision of how quickly the blood pressure must be lowered. The clinician has a wide variety of agents from which to choose for pharmacologic treatment, with the goal being a smooth and safe reduction in blood pressure.
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Physicians who provide primary care for the elderly are spending more time caring for terminally ill patients. Although curing these patients' illnesses is impossible, it is often possible to improve their quality of life and give them more control over their illness. ⋯ Symptoms such as pain, dyspnea, and nausea can usually be controlled. Other health care professionals and hospice care when appropriate can also be helpful.
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Many geriatric patients have concurrent physical and psychiatric illnesses, but at times it may be difficult to determine which is primary. Delirium, a transient syndrome that presents with psychiatric symptoms, is usually the manifestation of an organic disorder and, if undetected and untreated, can be fatal. Clinicians, therefore, must learn to recognize the syndrome, search diligently for the underlying etiology, and treat accordingly.
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Heart disease is the leading cause of mortality and a major cause of morbidity in women in the United States. Premenopausal and postmenopausal risk factors for cardiac disease must be reduced to protect women from this major health hazard. ⋯ Postmenopausal women have these risk factors in addition to a lack of estrogen. Most studies have shown that replacing estrogen in the menopausal woman reduces cardiovascular disease, probably by increasing HDL and decreasing LDL.