Clinics in Geriatric Medicine (CLIN GERIATR MED)

Publications in this journal

• Article: Preface.

  Amir K Jaffer
  Clinics in Geriatric Medicine 12/2008; 24(4):xi-xii.
• Article: Anemia in diabetic patients.

  David R Thomas
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  ABSTRACT: Anemia is common in diabetic patients and is associated with increased morbidity and mortality. The observations that diabetes-related chronic kidney disease is more common than chronic kidney disease of other etiologies, that anemia may occur earlier in diabetes-related chronic kidney disease than in other types of chronic kidney disease, and that anemia in diabetes-related kidney disease often is found without measurable renal impairment suggest that the diabetic population may have a predilection to the development of anemia. Anemia is associated with a poorer prognosis in diabetic-associated comorbid conditions, but targeted correction of anemia has improved diabetic patients' quality of life.
  Clinics in Geriatric Medicine 09/2008; 24(3):529-40, vii.
• Article: Diabetes. Preface.

  John E Morley
  Clinics in Geriatric Medicine 09/2008; 24(3):xi-xiii.
• Article: Diabetes, sarcopenia, and frailty.

  John E Morley
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  ABSTRACT: Frailty is a pre-disability condition. It now can be defined clinically. The major factors leading to frailty are sarcopenia and a decline in executive function. Stressors precipitate frail individuals into a state of disability. Diabetics develop the conditions necessary for frailty earlier than other aging individuals. Appropriate treatment of diabetes mellitus and frailty precursors can result in a slowing of the aging process.
  Clinics in Geriatric Medicine 09/2008; 24(3):455-69, vi.
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  Available from: fafp.org

  Article: Eye disease and the older diabetic.

  Nina Tumosa
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  ABSTRACT: Elderly diabetic persons are 1.5 times more likely than age-matched nondiabetic persons to develop vision loss and blindness. Annually, between 12,000 and 24,000 diabetic patients in the United States become legally blind because of complications caused by diabetic retinopathy. Even more diabetic persons experience vision loss caused by comorbid ocular and periocular conditions such as dry eye syndrome, cataracts, macular degeneration, and glaucoma. This article discusses the synergy between these conditions and diabetes. Standards of care that slow the progression of vision loss and exciting new research on new strategies of care that may reverse vision loss are presented.
  Clinics in Geriatric Medicine 09/2008; 24(3):515-27, vii.
• Article: Diabetes and aging: epidemiologic overview.

  John E Morley
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  ABSTRACT: Diabetes mellitus has long been recognized as a cause of accelerated aging. As the understanding of the metabolic syndrome has evolved, it has been recognized that the interaction of a panoply of factors in the presence of insulin resistance results in accelerated aging. This article explores the increasing prevalence of diabetes mellitus with aging and how insulin resistance leads to accelerated frailty, disability, hospitalization, institutionalization, and death.
  Clinics in Geriatric Medicine 09/2008; 24(3):395-405, v.
• Article: Nutrition and the older diabetic.

  Neelavathi Senkottaiyan
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  ABSTRACT: Diabetes mellitus is among the most common and complex chronic diseases that affect approximately 20 million individuals in the United States. An additional 26% of the population has impaired fasting glucose, making diabetes an epidemic. MNT in diabetes addresses not only glycemic control but also other aspects of metabolic status, including hypertension and dyslipidemia, which are major risk factors for cardiovascular disease. MNT is an integral component of diabetes management, which includes the process and system through which nutritional care and specific life style recommendations are provided to diabetic individuals. Cultural and ethnic preferences are taken into account and patients are involved in the decision-making process.
  Clinics in Geriatric Medicine 09/2008; 24(3):503-13, vii.
• Article: Oral diabetic medications and the geriatric patient.

  Alan B Silverberg, Kenneth Patrick L Ligaray
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  ABSTRACT: Current medications for management of diabetes mellitus in older individuals include first and second generation sulfonylurea medications, meglintinides, incretin medications, alpha glucosidase inhibitors, metformin, and thiazolidinediones. This article discusses indications for their usage, along with their beneficial and adverse effects.
  Clinics in Geriatric Medicine 09/2008; 24(3):541-9, viii.
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  Available from: yimg.com

  Article: Hyperlipidemia in the elderly.

  Nicole Ducharme, Rani Radhamma
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  ABSTRACT: People are now living longer, largely because of a combination of falling rates of fertility and mortality, thus producing a greater proportion of older people in society. Thirty times more centenarians were alive in 2000 than in 1900, and the population growth in the elderly segment of society is expected to continue at an exponential rate. Vascular disease is responsible for more than a quarter of all deaths worldwide. More than 80% of individuals who die of coronary heart disease are older than 65 years. Although a myocardial infarction may be perceived as fatal, heart attacks do not always lead to death but to conditions such as congestive heart failure, ischemic cardiomyopathy, and angina, which greatly impact quality of life. These issues are only a few that must be contemplated when considering the clinical and economic effects of preventive therapies in the elderly population.
  Clinics in Geriatric Medicine 09/2008; 24(3):471-87, vi.
• Article: Insulin resistance syndrome and glucose dysregulation in the elderly.

  Angela D Mazza
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  ABSTRACT: The incidence of insulin resistance in the geriatric population is growing as this population grows. The management of hyperglycemia and its associated risk factors depends on an expanding understanding of the underlying pathophysiology and progression of disease and of the currently available and future therapeutics, which are continually evolving. There is a major need for studies in the long-term care setting to determine the appropriate standard of care in prevention and treatment of metabolic dysregulation.
  Clinics in Geriatric Medicine 09/2008; 24(3):437-54, vi.
• Article: Hypertension and the older diabetic.

  Wilbert S Aronow
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  ABSTRACT: Hypertension is a common comorbidity in persons with diabetes mellitus, and its prevalence increases with advancing age. Both diabetes mellitus and hypertension are independent risk factors for development in older persons of coronary artery disease, ischemic stroke, peripheral arterial disease, and of congestive heart failure. This article reviews studies addressing the implications of hypertension and the older diabetic.
  Clinics in Geriatric Medicine 09/2008; 24(3):489-501, vi-vii.
• Article: Diabetic neuropathy in older adults.

  Aaron I Vinik, Elsa S Strotmeyer, Abhijeet A Nakave, Chhaya V Patel
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  ABSTRACT: Diabetic neuropathy is a heterogeneous disease with diverse pathology. Recognition of the clinical homolog of these pathologic processes is necessary in achieving appropriate intervention. Treatment should be individualized so the particular manifestation and underlying pathogenesis of each patient's clinical presentation are considered. In older adults, special care should be taken to manage pain while optimizing daily function and mobility, with the fewest adverse medication side effects. Older adults are at great risk for falling and fractures because of instability and weakness, and require strength exercises and coordination training. Ultimately agents that address large fiber dysfunction will be essential to reduce the gross impairment of quality of life and activities of daily living that neuropathy visits older people who have diabetes.
  Clinics in Geriatric Medicine 09/2008; 24(3):407-35, v.
• Article: Diabetic foot management in the elderly.

  E Sharon Plummer, Stewart G Albert
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  ABSTRACT: Guidelines for diabetes foot care are available and should be part of the routine care and evaluation of all elderly patients who have diabetes. Those individuals who have good sensation, good vascularity, without foot deformities, and are capable of reaching and seeing their feet may do well with education and reasonable approaches to footwear and foot care. Those who have advanced diabetic complications of neuropathy or vascular insufficiency should be seen by professionals and given intensive education. An experienced team familiar with the progression of illness should follow those who have ulcers. Guidelines are presented for the management of outpatient and inpatient therapy of foot ulcers.
  Clinics in Geriatric Medicine 09/2008; 24(3):551-67, viii.
• Article: Overview of pain management in older persons.

  Glenn Deane, Howard S Smith
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  ABSTRACT: The purpose of this article is to situate the social and demographic context of pain management in older adults. It summarizes representative literature on the age and sex composition of pain among older adults and considers sources of assessment bias that likely lead to the conflicting descriptions of prevalence. It also describes treatment options that are both available and acceptable to older adults.
  Clinics in Geriatric Medicine 06/2008; 24(2):185-201, v.
• Article: Pain perception in the elderly patient.

  Gary McCleane
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  ABSTRACT: In the elderly patient, the barriers to effective treatment of pain are substantial. Even the perception of pain may differ from that in those of less advanced years. Of course, many other factors impinge on the presence of, and treatment of, pain in elderly patients. Issues of physical accessibility to treatment, cost of drugs, the presence of coexisting illness, the use of concomitant medication, and even the ability to understand the complaints of the patient who has cognitive impairment are only some of those factors that contribute to the complexity of the situation.
  Clinics in Geriatric Medicine 06/2008; 24(2):203-11, v.
• Article: Assessment of pain in the elderly adult.

  Patricia Bruckenthal
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  ABSTRACT: The goals of a clinical assessment for pain in the elderly adult may be similar to those established for younger patients; however, unique characteristics of aging make this assessment more challenging for clinicians. The overarching goal of pain assessment in the elderly is to provide successful pain management. This article provides the clinician with the foundation to perform a successful pain assessment for older adults who are able to communicate by self-report. This provides a comprehensive base on which to build a relevant plan of care.
  Clinics in Geriatric Medicine 06/2008; 24(2):213-36, v-vi.
• Article: Assessment of pain in the nonverbal or cognitively impaired older adult.

  Karen Bjoro, Keela Herr
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  ABSTRACT: The inability of nonverbal older adults to communicate pain represents a major barrier to pain assessment and treatment. This article focuses on nonverbal older adult populations with dementia, delirium, and severe critical illness. A comprehensive approach to pain assessment is advocated encompassing multiple sources of information. Selected behavioral tools for nonverbal pain assessment are critiqued. Although there are tools with promise, there is currently no standardized behavioral tool that may be recommended for broad adoption in clinical practice and continued concerted effort to this end is needed.
  Clinics in Geriatric Medicine 06/2008; 24(2):237-62, vi.
• Article: Interventional techniques for back pain.

  William F Lavelle, Elizabeth Demers Lavelle, Howard S Smith
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  ABSTRACT: Most Americans will be afflicted by some form of spine-related pain in their lifetime. In older patients, the most frequent source of back pain is lumbar spinal stenosis or vertebral compression fracture. Although most back pain is self-limited, some patients will require interventional techniques. This article reviews minimally invasive techniques for treating back pain, lumbosacral radicular pain, lumbar spinal stenosis, and compression fractures.
  Clinics in Geriatric Medicine 06/2008; 24(2):345-68, viii.
• Article: Pharmacotherapy of pain in older adults.

  Scott A Strassels, Ewan McNicol, Rosy Suleman
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  ABSTRACT: Pain is a universal part of being human, and yet, there is ample evidence that many people from all backgrounds, stages of life, and levels of health care experience receive less than optimal treatment of their pain. This article reviews the pharmacotherapy of pain in older adults, with a focus on salicylates, nonsteroidal anti-inflammatory drugs, and opioids.
  Clinics in Geriatric Medicine 06/2008; 24(2):275-98, vi-vii.
• Article: Topical analgesic agents.

  Gary McCleane
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  ABSTRACT: Pain processing and transmission are achieved by a complex interaction of pathways and processes. Those parts of the process with peripheral representation may be amenable to therapeutic intervention by systemic administration to achieve a peripheral effect or by local application, including local topical administration to the skin overlying the painful area. Advantages include high level of patient acceptance, ease of administration, avoidance of systemic side effects, and reduced drug-drug interactions. Those drugs with topical analgesic effects include those with specific topical analgesic indication and others in which no such indication exists but that may offer a chance of pain therapy at reduced risk.
  Clinics in Geriatric Medicine 06/2008; 24(2):299-312, vii.