Clinics in geriatric medicine
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Clin. Geriatr. Med. · Feb 2013
ReviewTrauma in the older adult: epidemiology and evolving geriatric trauma principles.
The older adult patient with trauma is becoming a growing part of the overall trauma population. With the world population increasing in age, the rate of the traumatically injured older adult will continue to increase. ⋯ This review discusses these issues, as well as appropriate triage and treatment of injuries and associated comorbidities. Early recognition of injury, even minor, and expedited care using specialized teams will help to improve outcomes for these patients.
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Clin. Geriatr. Med. · Feb 2013
ReviewAcute pain management in older adults in the emergency department.
Effective treatment of acute pain in older patients is a common challenge faced by emergency providers. Because older adults are at increased risk for adverse events associated with systemic analgesics, pain treatment must proceed cautiously. Essential elements to quality acute pain care include an early initial assessment for the presence of pain, selection of an analgesic based on patient-specific risks and preferences, and frequent reassessments and retreatments as needed. This article describes current knowledge regarding the assessment and treatment of acute pain in older adults.
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Bradyarrhythmias and tachyarrhythmias are common in elderly patients as a result of aging and acquired cardiac disease. Antiarrhythmic drugs are effective in elderly patients for the management of supraventricular and ventricular arrhythmias; however, dosing of drugs must be performed with care because of age-related changes in drug pharmacokinetics, the presence of concomitant disease, and frequent drug-drug interactions. Despite the large number of antiarrhythmic drugs having different electrophysiologic actions, as described in this article, only the β-blockers have been shown to be effective in reducing mortality and to lack proarrhythmic actions.
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Atrial fibrillation (AF) is an increasingly prevalent disease in the elderly. Patients with AF are at increased risk of ischemic stroke, resulting in significant morbidity and mortality. ⋯ Appropriate risk stratification for stroke should be performed for all patients with AF to guide antithrombotic therapy. For patients at lower stroke risk, bleeding risk stratification tools can also be used when the benefit of anticoagulant therapy is unclear.
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Clin. Geriatr. Med. · Aug 2012
ReviewPatient-reported outcomes for total hip and knee arthroplasty: commonly used instruments and attributes of a "good" measure.
Although the effectiveness of THA and TKA as interventions for end-stage degenerative joint disease has been well established, the use of instruments that measure outcome from the patient's perspective are relatively poorly investigated. Considering the increasing prevalence, associated risks, and high personal and financial cost associated with THA and TKA, patient-reported outcomes are required to ensure optimal selection of patients, and that postoperative outcomes outweigh the burden associated with surgical procedures. It is clear from the information presented that clinicians need to consider a number of factors when selecting a "good" patientreported outcome for use in their TJA patients. ⋯ It is clear that further studies are required, particularly to fill some of the gaps regarding known psychometric properties of patient-reported outcomes for THA and TKA. Based on data acquired in THA and TKA patients for the instruments reviewed, it appears that OA-specific and TJA-specific measures for which patients have been involved in the developmental process (HOOS, KOOS, WOMAC, Oxford Hip and Knee Scores) can more consistently be considered "good" patient-reported outcomes for THA and TKA. Clinicians wishing to evaluate a broader range of dimensions may choose to complement these with one of the generic measures evaluated, bearing in mind the practical issues and psychometric limitations of these instruments when applied to THA and TKA patients.