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Symposium: Care of the elderly

Diagnosing and treating mood disorders in older people

05 Feb 2019Registered users

Depression in older adults is common. Depressive symptoms may be part of a recurrent depressive disorder or experienced for the first time in later life as a result of changes in risk and resilience factors. There is an association between cerebrovascular pathology, vascular risk factors and depression. Physical illnesses, particularly those associated with frailty, are also important risk factors for depression. Depression has a distinct presentation in late life and low mood may not be the predominant presenting symptom. Older patients may present with physical symptoms, apathy, cognitive symptoms, agitation, retardation, fatigue or weight loss.

Managing arrhythmias in coronary artery disease

23 Jan 2019Registered users

A detailed history is essential in patients with coronary artery disease (CAD) to elucidate red flag symptoms necessitating urgent specialist assessment. Red flags include syncope and presyncope, particularly in patients with concomitant left ventricular systolic dysfunction. Palpitations with severe chest pain and breathlessness also warrant urgent assessment. Undiagnosed atrial fibrillation (AF) is common in older populations. LVEF of 35% or less is a predictor of increased risk of sudden death. All patients with CAD should therefore undergo assessment of LVEF, usually by transthoracic echocardiography.

Timely diagnosis of vascular dementia key to management

23 Jan 2018Paid-up subscribers

Vascular dementia is the second most common type of dementia, after Alzheimer’s disease, and accounts for 15% of cases. The core diagnostic features include cognitive impairment in at least two domains (orientation, attention, language, visuospatial function, executive function, motor control and praxis), which affect social or occupational function, together with evidence of cerebrovascular disease (focal neurological signs or neuroimaging). Crucially there should be a temporal relationship between cerebrovascular disease and the onset of cognitive changes.

Pulmonary rehabilitation improves exercise capacity and quality of life

23 Jan 2018Registered users

Pulmonary rehabilitation is a multifaceted programme of exercise and education that aims to improve breathlessness, exercise capacity, and quality of life, and aid self-management. Patients with chronic respiratory failure, those on long-term or ambulatory oxygen and patients with anxiety and depression can all benefit from rehabilitation. It is one of the most beneficial and cost-effective treatments for COPD and should be considered a fundamental component of disease management rather than an option.

Frailty predicts adverse outcomes in older people with diabetes

23 Jan 2017Paid-up subscribers

In older people living with diabetes, geriatric syndromes, which indicate frailty, are emerging as a third category of complications in addition to the traditional microvascular and macrovascular sequelae. Frailty is defined by the presence of three or more phenotypes (weight loss, weakness, decreased physical activity, exhaustion and slow gait speed). Patients may progress from a non-frail to pre-frail or frail state. With timely intervention, there is a greater chance of an individual recovering from pre-frail to non-frail than deteriorating into frailty.

Depression is linked to dementia in older adults

23 Jan 2017Registered users

Depression and dementia are both common conditions in older people, and they frequently occur together. Rather than a risk factor, depression with onset in later life is more likely to be either prodromal to dementia or a condition that unmasks pre-existing cognitive impairment by compromising cognitive reserve. The distinction between depression and early dementia may be particularly difficult. Detailed histories obtained from patients and their relatives as well as longitudinal follow-up are important. 

Controlling joint pain in older people

25 Jan 2016Paid-up subscribers

The prevalence of chronic pain in older people in the community ranges from 25 to 76% and for those in residential care, it is even higher at 83 to 93%. The most common sites affected are the back, hip, or knee, and other joints. There is increased reporting of pain in women (79%) compared with men (53%). Common conditions include osteoarthritis and, to a lesser extent, the inflammatory arthropathies such as rheumatoid arthritis. The differential diagnosis includes non-articular pain such as vascular limb pain and nocturnal cramp, some neuropathic pain conditions (such as compressive neuropathies and postherpetic neuralgia), soft tissue disorders such as fibromyalgia and myofascial pain syndromes. 

Anxiety in older adults often goes undiagnosed

25 Jan 2016Paid-up subscribers

Anxiety disorder in the elderly is twice as common as dementia and four to six times more common than major depression. Anxiety is associated with poorer quality of life, significant distress and contributes to the onset of disability. Mortality risks are also increased, through physical causes, especially cardiovascular disease, and suicide. Diagnosing anxiety disorders in older adults remains a challenge because of the significant overlap in symptoms between physical disorders and depression.

 

 

Diagnosis and management of postherpetic neuralgia

22 Jan 2015Paid-up subscribers

Risk factors for postherpetic neuralgia (PHN) include: increasing age; a prodrome of pain before rash onset; the degree of spread of the rash, particularly if it extends beyond a single dermatome; and severity of pain during the acute attack. Forty per cent of patients over 50 and 75% of those over 75 develop PHN following resolution of the rash. Patients with severe pain or those whose condition is affecting their daily activities and function should be referred to a specialist in pain management.

Establishing the cause of memory loss in older people

22 Jan 2015Registered users

Common causes of memory loss in older people are mild cognitive impairment, the various types of dementia, and psychiatric illness, mainly depression. Around 10% of patients with mild cognitive impairment progress to dementia each year. NICE guidance suggests examination of: attention, concentration, short- and long-term memory, praxis, language and executive function.

 

Photoguide

Skin conditions affecting the elderly

21 Mar 2013

 • Actinic keratoses • Asteatotic eczema  • Bowen’s disease  • Seborrhoeic keratoses  • Basal cell carcinoma  • Varicose eczema

Skin conditions in the elderly

01 Jun 2009Registered users

  • Entropion
  • Seborrhoeic warts
  • Dupuytren's contracture
  • Erythema ab igne
  • Hallux valgus
  • Chondrodermatitis nodularis chronica helicis
 

Editorials

Statins underused for primary prevention in older patients

19 Sep 2012Paid-up subscribers

'A treatment-risk paradox where patients become less likely to receive appropriate treatment with advancing age has been observed in the secondary prevention of cardiovascular disease (CVD). This is particularly apparent for cholesterol-lowering treatment with one study showing the likelihood of statin treatment was 6% lower with each year increase in age. However, it is not clear if such a paradox exists in primary prevention and a recent UK study published in the BMJ addresses this issue...'

GPs’ vital role in end of life care

20 Jun 2012Paid-up subscribers

The aims of palliative care are to provide the best quality of life for patients and their families, and to facilitate a good death. The NICE quality standard on end of life care, published in November 2011, consists of 16 quality statements which inform patients of the standard of care which they should expect and define aspirational standards for clinical governance. If patients are to die well, they need to be prepared for death, to achieve a sense of control, to be free of pain, to be respected as an individual, and to spend meaningful time with close family and friends in familiar surroundings.