Geriatrics
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This final installment of a special series on nutrition in the elderly considers dietary pitfalls and their sequelae. Years of poor dietary habits contribute to biological risk and lifestyle changes in the elderly. Clinicians must properly evaluate the nutritional status of their older patients to restore nutritional adequacy and healthy aging.
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Restless legs syndrome (RLS) is a sensorimotor disorder characterized by a distressing urge to move the legs and sometimes other parts of the body. Diagnosis is based on clinical features that may be easily remembered with the mnemonic URGE: Urge to move, Rest induced, Gets better with activity, and Evening and night accentuation. RLS is common, its prevalence increases with age, and women are more frequently affected. ⋯ Primary RLS is familial and likely to be genetic. Important causes of secondary RLS are end-stage renal disease, pregnancy, and iron deficiency. Every patient should be checked for iron status with a serum ferritin measurement.
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Deep brain stimulation (DBS) can improve symptoms in well-selected patients with Parkinson's disease. Primary care physicians must take into account many important issues when considering referral for DBS. The Florida Surgical Questionnaire for PD (FLASQ-PD), a 5-section screening tool that can help primary care providers identify appropriate DBS candidates, can be filled out and scored by a general practitioner, advanced clinical nurse practitioner, physician assistant, or trained nurse. Potential candidates who score well on this questionnaire can be referred for presurgical multidisciplinary evaluation at an experienced DBS implanting center.
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Concomitant administration of grapefruit juice can increase the plasma concentration of numerous drugs in humans and decrease the concentration of a few others. Such elevations of drug plasma concentrations have, on occasion, resulted in adverse clinical effects. ⋯ The effect of grapefruit juice on drug metabolism is most pronounced in drugs with a high first-pass metabolism (eg, felodipine, amiodarone), in which it inhibits the first-pass metabolism of the CYP 3A4 substrates leading to an increase in Cmax and area under the concentration time curve (AUC). The use of grapefruit juice with a few specific drugs (eg, fexofenadine, digoxin) may lower plasma drug concentrations by inhibiting drug absorption catalyzed by the organic anion transporting polypeptide (OATP).
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Delirium is a common neuropsychiatric condition that affects 15% to 70% of elderly medical and surgical patients. It tends to be a transient disorder, although long-term complications are not uncommon. Medical comorbidity is the rule, and predisposing, as well as precipitating, factors are important to consider in its management. ⋯ Delirium is associated with several adverse outcomes including mortality, increased length of hospital stay, increased risk of dementia, and high rates of institutional placement. Delirium is distressing for patients, families, and staff. Nonpharmacologic-integrated intervention programs may improve outcome and may be incorporated into the overall medical management.