Journal of the American Geriatrics Society
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Review Case Reports
Corticotropin-dependent Cushing's syndrome in older people: presentation of five cases and therapeutical use of ketoconazole.
Cushing's syndrome is a rare disorder. The corticotropin (ACTH)-dependent form of this syndrome generally results either from excessive ACTH secretion by a pituitary adenoma or ectopic secretion by a malignant tumor. Theoretically, the latter type can be assumed to occur more frequently in old age as the incidence of malignancy increases. ⋯ Pituitary-dependent Cushing's disease may occur more frequently in patients older than 75 years of age than has previously been assumed. Because surgical treatment is not always easily tolerated by older patients, the steroidogenesis inhibitor, ketoconazole, can be a valuable alternative for the control of hypercorticism.
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Little information is available about the costs, utilization patterns, and the delivery system used by Medicare beneficiaries with chronic illnesses. This information will become increasingly important as more Medicare beneficiaries with chronic illness enroll in managed care plans and delivery systems must be developed to meet their needs. ⋯ Current Medicare capitation payments to managed care plans may not meet the higher expected annual costs of care for beneficiaries with DAT. In turn, physicians (or physician groups) who accept capitation for Medicare beneficiaries with DAT should also consider how capitation rates are established by managed care plans and should learn ways to reduce financial risk.
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To assess whether urinary incontinence (UI) and its severity are associated with poor self-rated health in a national sample of community-living older adults and whether this relationship persists after controlling for confounding attributable to functional status, comorbidity, and demographic factors. ⋯ In this national sample, urinary incontinence was independently and positively associated with poor self-rated health after adjustment for age, comorbidity, and frailty for most community-dwelling older adults. This association between UI and poor self-rated health was weaker and statistically insignificant when IADL impairment was present or in non-white subjects. Further research is indicated to better understand the impact of urinary incontinence in specific cultural settings.
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To characterize the population and provide a 2-year follow-up for those patients for whom a geriatric consult was requested in the emergency department (ED) of an acute care hospital. ⋯ The older patients seen in the ED of the acute care hospital for whom multidisciplinary geriatric consult is requested constitute a high-risk population. Within 2 years after initial consultation, many are dead and more than half have been institutionalized. The results of our follow-up imply the need for multidisciplinary intervention early on in the course of an older patient's ED visit as well as close follow-up after hospital discharge.