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CARE OF THE ELDERLY

 

Frailty predicts adverse outcomes in older people with diabetes

23 Jan 2017Registered users

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 for an individual to recover from pre-frail to non-frail than to deteriorate 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 2016

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.

 

 

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.

Diagnosis and management of postherpetic neuralgia

22 Jan 2015Registered users

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.

Can exercise prevent cognitive decline?

22 Jan 2014Registered users

As the tolerability of pharmacological agents decreases with age, exercise may be particularly helpful as a possible treatment or stabiliser of mood and cognitive function in older age. The effects of exercise on reducing depressive symptoms are not dissimilar to the effects of antidepressant drugs and cognitive behaviour therapy. Exercise has a moderate effect on the ability of people with dementia to perform activities of daily living and may improve cognitive function. Midlife exercise may also have an impact on later cognitive function.

Early recognition improves prognosis in elderly onset RA

22 Jan 2014Registered users

Age at onset is particularly relevant in RA as the presentation may differ in elderly onset RA (EORA) compared with young onset RA (YORA). Patients with EORA frequently report a more acute presentation, especially if positive for rheumatoid factor (RF). Fever, fatigue and weight loss appear to be more common in EORA. Although small joints are most frequently involved in the RA population overall, there is common involvement of large joints in EORA and these proximal symptoms may mimic polymyalgia rheumatica (PMR). [With external links to the evidence base]

Tailor treatment in the older patient with type 2 diabetes

24 Jan 2013Paid-up subscribers

In older people, diabetes is a disabling disease due to the associated vascular complications, multiple comorbidities and the increased prevalence of geriatric syndromes. Because of the complexity of diabetes in old age a comprehensive assessment is important at initial diagnosis, with the aim of preventing loss of autonomy and preserving independence. Cognitive and physical dysfunction are common in older people with diabetes which may affect health outcomes and quality of life. Individual therapeutic targets should take into consideration functional status, life expectancy and patient preferences.

Early diagnosis beneficial in Alzheimer’s disease

24 Jan 2013Paid-up subscribers

A diagnosis of Alzheimer’s disease requires clinical and pathological evidence. In clinical practice, GPs should consider a diagnosis of dementia when a patient presents with functional impairment (e.g. needing a greater level of help with activities of daily living, struggling to manage own finances and bills) in addition to at least two changes in cognitive function e.g. short-term memory, language, reasoning, spatial orientation, or personality change. The patient, friends, family or professional carers should have noticed these changes for at least six months. Early diagnosis enables early, planned intervention, reduces crisis situations, delays planned admission to care homes (and helps prevent unplanned admissions).

Diagnosing and managing vascular dementia

24 Jan 2012Paid-up subscribers

Vascular dementia (VaD) is common. Pure vascular disease may account for 5–20% of all cases of dementia, while mixed dementia, Alzheimer's disease (AD) with VaD, occurs at least as frequently. It is unusually heterogeneous and frequently overlapping and comorbid with other conditions such as stroke, other cardiovascular and cerebrovascular diseases and their risk factors, as well as AD. There is no specific treatment or cure for VaD, but its proximity to other conditions may make it amenable to interventions at various stages of the disease.

Tackling anxiety and depression in older people in primary care

23 Jan 2012Registered users

Old age is often a time of loss: of physical health, sensory capacity, cognitive function, independence, work, income and social support. The diagnosis of anxiety and depression in older patients is difficult. There is a complex relationship between depression and physical illness, there is uncertainty regarding diagnostic criteria and the PHQ-9 should probably not be used. We are more likely to recognise late life anxiety and depression if we are aware of the risk factors and the less obvious ways in which patients can present.

Preventing osteoporotic fractures in older people

24 Jan 2011Registered users

Until recently, the management of osteoporosis was centred around the use of diagnostic thresholds based on bone mineral density (BMD) measured at the spine or hip by dual x-ray absorptiometry (DXA). This was reflected in UK guidance for the identification of individuals at high fracture risk from the Royal College of Physicians (RCP).The guidance was based on an opportunistic case-finding strategy where physicians were alerted to the possibility of osteoporosis and high fracture risk by the presence of clinical risk factors associated with fracture. This provided a trigger for the measurement of BMD, and treatment was considered in those with a BMD value that lay in the range of osteoporosis as defined by the WHO. Treatment was, however, also recommended for women with a prior fragility fracture without necessarily measuring BMD. Since the development of these guidelines, it has become apparent that the presence of several of the risk factors used to trigger a BMD test is associated with a fracture risk greater than can be accounted for by BMD alone. [With external links to the evidence base]

Tackling dementia in patients with Parkinson’s disease

24 Jan 2011Registered users

Cognitive symptoms in patients with Parkinson's disease are associated with more rapid deterioration and eventually, a two-fold increase in mortality. Patients with cognitive impairment place a greater burden on their care givers and many such patients are admitted to nursing homes. Primary care plays a significant role in the recognition of DLB and PDD. Early recognition and referral to a specialist memory clinic can help to educate the patient about their often worrying symptoms and initiate the relevant treatment. Through the involvement of the multidisciplinary team, appropriate care networks can be set up to provide support and education for both patients and carers.

Diagnosing joint pain in older people

20 Jan 2010Paid-up subscribers

 Musculoskeletal disease is the most common cause of chronic pain and disability in older people. The prevalence in those over 75 is 83% in the UK. Older adults with arthritis have been reported to make significantly greater use of medical services compared with those without.Joint pathology may lead to reduced mobility, increased risk of falls, low energy, dependency and depression. Chronic pain itself is strongly associated with psychological distress and fatigue. Overall, arthritis places an enormous burden on the individual and on society. Therefore, the importance of correctly diagnosing and managing joint pain in the elderly is paramount and the GP is central to this process. [With external links to the evidence base]