Geriatrics
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Clostridium difficile is an important health care-associated pathogen, especially among older adults who are disproportionately affected by C difficile infection (CDI). During the current decade, there has been a dramatic increase in the incidence and severity of health care-associated CDI. ⋯ Prevention efforts should address patient-specific and facility-related risk factors. This article reviews the epidemiology, diagnosis, treatment, and prevention of C difficile infection.
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Delirium is very common among the elderly. For patients, their families, and the healthcare system, it is emotionally, functionally, and financially costly. This article takes the available guidelines for treatment and management of delirium one step further by providing practical tips from the perspective of a consultant geriatric psychiatrist working with these patients every day.
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Normal pressure hydrocephalus (NPH) is a chronic adult disorder of unknown cause. It is characterized by gradual onset of gait impairment, cognitive dysfunction, and urinary incontinence in the presence of enlarged ventricles. NPH is a relatively rare cause of these 3 common symptoms. ⋯ The differential diagnosis must consider common causes of each of the symptoms and include Alzheimer's disease (AD), Parkinson's disease (PD), vascular dementia, and spinal stenosis. Treatment involves CSF diversion, usually through implantation of a shunt from the ventricles to the peritoneal cavity. After surgery and in the absence of other contributing factors, the benefit of surgical intervention can be durable over years.
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Prostate cancer is the most common malignancy in men. Treatment with hormonal ablation is often accompanied by disabling hot flashes. This article reviews the pathophysiology of hot flashes and treatment options for this common side effect of treatment.