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.

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.

Falls are a major cause of morbidity and serious health issues in older adults that can have devastating outcomes. Using real-world cases and audience participation, this lecture will discuss a hands-on approach to identifying fall risks, preventing falls, assessing patients post-fall, and treating older adults. Office-based balance and gait assessments that can be conducted in small spaces will be demonstrated. Evidence will be presented about updated recommendations on fall treatments, including simple recommendations to multi-level interventions that improve the care of older adults. Advice on selecting the right durable medical equipment (e.g., canes, walkers, rollators, wheelchairs, and scooters) and measuring for the correct size equipment will be provided. Very few people outlive their canes so many older adult patients use hand-me-downs, resulting in poor posture, gait instability, and additional falls. After attending this lecture, you will understand how to best care for your older adult patients who are prone to fall. Please note that any data, indications, and guidelines presented in this activity are current as of the recording/release on February 8, 2020, and they are subject to change as new information is published.

The role of the primary care clinician is crucial in defining the quality of care and life a patient experiences in the final months and year. Caring for patients longitudinally is core to the principles of primary care. Even nearing the end, there is always more we can do, and navigating and supporting patients in crafting what optimal care looks like for them in key to the alleviation and prevention of suffering and enhancement of quality of life as disease progress. In this talk we will explore practical clinical, communication, and operations skills to integrate of palliative care principles into primary care, at all stages of a serious illness.

Primary care patients who present with cognitive change represent a clinical challenge. Delirium must be differentiated from dementia, as delirium represents a medical emergency. Potential causes of delirium, Alzheimer disease and other leading causes of dementia will be reviewed. Clinical findings, screening tools, diagnostic studies and potential therapies will be discussed.

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!

This talk will focus on the normal aging process in older adults. Specifically, the faculty will discuss hormonal changes, including changes in estrogen and testosterone levels. The faculty will also review physiologic changes and speak to how age impacts the circadian pattern of body temperature, cortisol levels, and sleep. Following this session, you will have a full picture of possible treatments—as well as their risks and benefits—for common symptoms associated with age-related hormonal changes.

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! Please note that any data, indications, and guidelines presented in this activity are current as of the recording/release on February 8, 2020, and they are subject to change as new information is published.

In this session, the speaker will discuss some challenging diagnostic cases that primary care practitioners may face in their practice. These cases will feature interpretation of laboratory and imaging studies as well as encounters with rare diseases and conditions. You will learn which aspects of the history and physical exam are most useful to establish certain diagnoses, increase your awareness of certain uncommon but “can’t miss” diagnoses, and become familiar with clinical decision aids that improve diagnostic accuracy for certain common diagnoses.

What do primary care providers need to know about SSRI and dementia? Join expert faculty as they review important questions they get asked about these topics!

What do primary care providers need to know about PCPs in Diabetes, atrial Fibrillation, Mild Cognitive Impairment? Join expert faculty as they review important questions they get asked about these topics!

Data are limited regarding statin therapy for primary prevention of atherosclerotic cardiovascular disease in adults 75 years and older. During this episode we will review recent studies on the use of statins in elderly patients and discuss how to consider this data in your clinical practice.