Geriatrics
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Altered drug metabolism, polypharmacy, multiple diseases, and errors in self-medication are all factors seen in the elderly which increase the risk for side effects from antirheumatic drug therapy. The geriatric presentation of central nervous system (CNS) toxicity, which is common yet frequently overlooked, is reviewed as it pertains to various drugs commonly used to treat rheumatic disease. Practical advice on avoiding common pitfalls in antirheumatic prescribing is offered.
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Temperature regulation disorders in the elderly are both common and life-threatening, yet often go unrecognized. Diagnosis and appropriate management depend largely on a clinician's high index of suspicion. Reviewed are the reasons why the elderly are more susceptible to such disorders, important diagnostic clues, restorative treatments and, most important, practical measures to prevent elderly patients from being exposed to the extremes of heat and cold.
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The elderly represent an increasing percentage of the population, and an important group of users of intravenous antibiotics. Therapy at home can provide a cost-effective means of treating many infectious diseases. ⋯ Choice of antimicrobial agent is dependent upon ease of administration, safety, efficacy, and cost. Careful patient selection, availability of appropriate home health care services, and diligent physician follow-up can allow many elderly patients to receive long-term intravenous antibiotic therapy outside the hospital.
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In the American legal system, the right to refuse treatment--the right, in other words, to be "let alone"--is an important aspect of autonomy and individuality. In health care decision making, people rarely choose to have no treatment at all, but usually choose from among various forms of medical treatment. ⋯ Particularly among the elderly, a series of small decisions may have to be made as health status worsens over time. No matter what the decision, in observing patients' wishes, physicians will find support in current ethical and legal concepts.