In primary care we are tasked with treating multiple conditions, therefore many of our patients are on numerous medications. Some of these medications are prescribed to deal with side effects of other medications. Often clinicians may not be aware that they are treating preventable drug side effects and wind up prescribing even more medications. This causes a cascade effect that results in significant polypharmacy. Join us while we discuss this common phenomenon and strategies to minimize or avoid it entirely.
Lack of in-person social encounters and out-of-the-house activities are difficult for anyone but can be especially detrimental for our elderly patients and family. In this podcast, geriatrician Lee Lindquist, MD, will discuss ways to help older adults during shelter-in-place and social distancing. She will review methods to stimulate cognition, encourage socialization, and describe activities to do from a distance. She will discuss pointers for maintaining physical and emotional well-being in this population, which can apply to any period where an older adult is homebound.
Join us as we discuss falls: a clinical issue that warrants regular assessment in adults over the age of 65.
Falls in the older population are associated with significant morbidity and mortality yet little evidence exists to determine best practices for prevention. Join us while we discuss a recent RCT that examined Tai Chi versus more traditional exercising in older individuals and its impact on reduction in falls for those at greatest risk.
Genetic and lifestyle risk factors have been implicated in the development of Alzheimer’s dementia (AD) as well as other subtypes of dementia. Specific genetic protein mutations have been identified in individuals who develop AD. There is also an abundant amount of evidence that suggests the risk of dementia can be reduced by avoiding tobacco smoking, limiting alcohol consumption, keeping physically active, and maintaining a healthy diet. Join our discussion of a recent study that shows a healthy lifestyle is associated with decreased risk of dementia in those with both low and high genetic risk.
This episode focuses on older adults and caregivers/partners in relation to their intimacy and sexuality for patients experiencing changes in cognition.
Join us as we discuss deprescribing; the provider-supervised process of discontinuing inappropriate medication(s). We will review minimizing risk, improving quality of life and maximizing patient-centered care.
Polypharmacy results in medication overload for many patients with chronic diseases; it is especially prevalent in the elderly. A recent report from the Lown Institute refers to this as ‘An Epidemic of Too Much Medication.’ We will review the data behind this claim and discuss how clinicians can work to minimize such problems.
Mobility disorders are a menace of old age, often resulting in falls, injuries, and especially hip fractures -- the sixth leading cause of death in the elderly. Primary care physicians have difficulties in both detecting and correctly identifying these abnormalities. In a paper published in the Journal of the American Geriatrics Society in 2004 [52(9):1527-31], the authors concluded that "community physicians appear to underdetect falls and gait disorders, leading to a paucity of recommendations and treatments." Hence the need to revisit the most common gait abnormalities. This multimedia presentation will provide a panorama of bipedalism, from its origin six million years ago in the savannahs of East Africa, to its rise as the unique trait of our species, and eventually to its status as a major cause of disability once full bipedalism is lost. The talk will review the physiology of ambulation and the prevalence of gait disorders in the population. In addition to detailed information on psychogenic and antalgic gaits, participants will learn about the seven major gait abnormalities. Whenever possible, the speaker will enliven the delivery by reviewing "famous patients," or vignettes of historical figures and celebrities who suffered the disorder.
As the proportion of older adults increases, providing up to date and quality care to them is of great importance to general internists, who provide the bulk of their primary care. Update in Geriatrics will review important advances in the clinical care of older adults published recently. Topics will include advances in the diagnosis and management of geriatric syndromes, management of multi-morbidity, and systems of care. Chronic disease treatment trials focused on older adults or with a significant proportion of older adults will also be included. The strength of the evidence will be discussed as well as potential impact the work could have on current clinical practice and education. Articles selection criteria will emphasize high quality studies that may be immediately applicable in practice.
This session aims to refresh your knowledge and stimulate interest in performing a thorough and focused physical exam (PE), particularly in the geriatric population. Whether part of a Medicare evaluation or a routine office visit, the PE provides an opportunity to develop rapport, trust, and potentially to discover clinically significant findings that might otherwise have gone unrecognized. A series of brief scenarios will be used to illustrate important yet basic concepts such as differentiation between normal age-related findings versus indicators of worrisome disease processes and atypical presentation of disease. Now, Let’s Get Physical!
Now that the capabilities of medicine provide increasingly complex care and technology to keep patients alive in health states they might not desire, the clinician is responsible for anticipating future care needs and guiding treatments as patients become more ill and less functional. Advance care planning is an essential tool in the primary care practitioner’s armamentarium, and this skill set must be honed to ensure that patients receive care consistent with their informed preferences and appropriate to their prognosis. Clinicians must feel comfortable introducing advance care planning, carrying out serial discussions with patients about prognosis, using appropriate tools and practice structures, and coordinating care among the team of clinicians caring for their patients across care venues. Sometimes the process requires setting limits and addressing maladaptive coping. Building strong relationships with patients and families and a consistent focus on goals of care is key to high quality treatment for the complex patient and achieving optimal end of life care.