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.
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.
Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing concern for older adults. With older adults living longer and experiencing multiple chronic comorbidities, medication regimens are becoming increasingly complex and lengthy. It is not unusual to see patients taking 10 or more medications. Unfortunately, polypharmacy has been associated with an increased risk of adverse drug events (ADEs), drug-interactions, medication non-adherence, reduced functional capacity and multiple geriatric syndromes. This lecture will present real-world cases of polypharmacy and review the concepts of de-prescribing, what medications are no longer considered helpful to older adults, and how to safely reduce polypharmacy in real-world settings among patients.
Research and advancement increase the capability of medicine to provide complex care. Technology can keep patients alive in states that they might not desire. Today, clinicians are responsible for (1) anticipating future care needs and (2) guiding treatments as patients become more ill and less functional. An essential tool in the clinician armamentarium, advance care planning is a skill set that must be honed to ensure that patients receive care both consistent with their informed preferences and appropriate to their prognosis. Advance care planning includes serial discussion with patients about clinical circumstances and prognosis, incorporates specific tools, requires coordination among the team of clinicians caring for a patient across venues of care, and may be facilitated by advance care planning structures. Sometimes the process also 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.
Our patients are aging before our very eyes. A 72-year-old patient who used to come bounding down the hallway, is now, fifteen years later, using a walker and taking ten minutes to enter the exam room. We are facing questions from concerned adult children about whether their parents -- your patients -- are safe living, driving, or managing finances alone. Participants will review the factors that impact aging-in-place, learn about office-based tests evaluating a senior’s independence, receive information regarding available support resources, and gain insights on navigating transitions to long-term communities. The lecture will also discuss the options in long-term care living and innovative alternatives in the long-term care field.
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.