Clinics in geriatric medicine
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Normal physiologic changes of aging increase the likelihood of renal-electrolyte disorders in the elderly surgical patient. The most important of these changes are a decrease in the GFR, decreased urinary concentrating ability, and narrowed limits for the excretion of water, sodium, potassium, and acid. Because of the decrease in GFR, the elderly surgical patient is at increased risk for virtually every cause of acute renal failure, an outcome associated with a mortality of greater than 50%. ⋯ The most important principles of prevention in the elderly surgical patient are to maintain normal intravascular volume and avoid hypovolemia. Meticulous attention must be paid to salt and water balance and to drug dosing. Should perioperative renal insufficiency occur, evaluation and management in the elderly patient are similar to usual practices in a younger individual.
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Clin. Geriatr. Med. · May 1988
ReviewApproach to the diagnosis and management of musculoskeletal disease.
Musculoskeletal disease is not an inevitable consequence of aging. Complaints of musculoskeletal disease indicate disease. Differential diagnosis relies on clinical skills. Management is directed toward maintaining function.
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The most common forms of brain tumor in the elderly are metastasis, glioma, meningioma, pituitary adenoma, and acoustic neuroma. They produce a variety of neurologic symptoms and usually can be readily diagnosed by CT scan. ⋯ The prognosis of a patient with a brain tumor depends on the tumor's histology, its location, and the patient's ability to tolerate therapy. Early diagnosis is important for successful treatment.
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In order to approach infections in elderly patients with cancer, one must have an understanding of infections in normal elderly populations. This article approaches infections in elderly patients by an examination of host factors, presentation of various organisms, infections of various body sites, diagnosis, treatment, and prevention.
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Some of the considerations that go into resuscitation decision making and the withdrawal of life support are discussed. These considerations include: ethical principles (benevolence, autonomy, and informed consent); surrogate decision making (the principles of substituted judgment, patients' best interests, and reason); medical decisions concerning resuscitation; and guiding principles for the individual care giver.