Clinics in geriatric medicine
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Clin. Geriatr. Med. · May 2006
ReviewA geriatrician's guide to the use of the physical modalities in the treatment of pain and dysfunction.
The use of the physical modalities in the treatment of musculoskeletal conditions has a long and rich history. This article explores the various physical modalities and their indications, precautions, and contraindications, especially in their applied use in pain management. It also highlights the role of the physical modalities as agents for the management of pain in the geriatric population.
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Clin. Geriatr. Med. · May 2006
ReviewThe assessment of the older adult with a physical disability: a guide for clinicians.
As the population of older adults increases, so does the number of people aging with a disability. It is more important than ever that clinicians caring for these individuals ask appropriate questions and focus on key areas of the physical examination that are pertinent to the care of this population. This article is meant to provide clinicians with a framework for evaluating the older adult aging with a physical disability in a clinic or hospital setting.
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Clin. Geriatr. Med. · Feb 2006
Review Comparative StudyAntithrombotic therapy in atrial fibrillation.
Warfarin is highly effective at reducing the risk of stroke in atrial fibrillation. The benefit of oral anticoagulant therapy strongly outweighs the risk in most patients with atrial fibrillation. More data are needed to define better the overall risk-to-benefit ratio for patients age 80 years and greater. Because a significant proportion of elderly individuals may not be optimal candidates for anticoagulant therapy, alternative stroke prevention strategies must continue to be evaluated while redoubling efforts to understand the mechanisms underlying atrial fibrillation and thrombogenesis.
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Based on an individual assessment of risk factors for arterial or venous thrombosis and the risk of postoperative bleeding, this article outlines the preoperative and postoperative approach to anticoagulant management. Preceding this is a brief description of the therapies most commonly used in the perioperative period. The prevention of arterial thromboembolism is considered separately from the prevention of venous thrombosis.
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Advance directives have been promoted as being the best device for making decisions on behalf of patients who are unable to speak for themselves. It is believed that an advance directive would tell the health care professionals what to do. Conflicts would dissolve and the course would become clear. ⋯ This article reviews the research on advance directives, including proxy and instructional documents, and discusses the strengths and limitations of each. Advance directives are often thought of as static, binding documents. Recommendations will be offered on how to use these documents as tools to facilitate patient-centered, dynamic decisions.