Primary care
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Dementia represents one of the most important and growing public health issues facing society today. Primary care clinics serve a crucial role as the first line of defense in the recognition and treatment of dementia. ⋯ Diagnostic workup should include screening for medical and nondegenerative causes of cognitive impairment that may be remedial. Treatment approaches should include multimodal approaches to address cognitive decline and behavioral/psychiatric symptoms of dementia in an effort to maximize quality of life for both patients and caregivers.
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Hypertension is common among adults and is associated with significant morbidity and mortality and should be routinely addressed in primary care practice. Optimal blood pressure targets have evolved in the past decade with the release of large studies including older persons. ⋯ The relationship between blood pressure treatment and falls or cognitive impairment is still an area of concern and debate. A strategy to address hypertension in older persons should consider an individual's fitness and the likelihood of adverse effects and worsening of conditions that adversely affect quality of life.
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Polypharmacy is an underappreciated factor in undesirable patient outcomes. In older adults, polypharmacy is considered a syndrome of harm and presents a challenge to primary care providers. ⋯ With the aging population, and polypharmacy a significant part of the lives of older adults, management of polypharmacy poses both a growing challenge and an opportunity for all health care providers. This article provides an overview of skills to improve medication use management in older adults living with polypharmacy.