Geriatrics
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Dizziness is one of the most common complaints among patients age 50 and older who present to primary care physicians. The evaluation of dizziness is challenging due to the wide range of diagnostic possibilities, including four symptom categories each with multiple potential underlying causes. ⋯ These strategies include use of medications to control acute vestibular and autonomic symptoms as well as vestibular rehabilitation exercises. Difficult cases that do not respond to treatment efforts should be referred to an otolaryngologist for further evaluation and treatment.
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Sleep disorders may affect one out of two older Americans and may present as insomnia, excessive daytime sleepiness, or both. Age-related changes seem to cause a decreased need for sleep. The average 70-year-old sleeps only 6 hours a night, but may obtain an additional hour or even 2 during daytime naps. ⋯ The two most common geriatric sleep disorders are obstructive sleep apnea syndrome and restless legs syndrome. Detailed diagnostic workup and treatment are usually referred to a center for sleep medicine where polysomnographic studies are performed. Left untreated, sleep disorders may present a serious threat to the patient's health and lead to increased morbidity and mortality.
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Urinary tract infections (UTIs)--including cystitis, pyelonephritis, and catheter-associated infections--are among the most common nursing home-acquired infections. Asymptomatic bacteriuria can be identified in 20 to 50% of nursing home residents who do not have bladder catheters and in 100% of those who do. ⋯ Treatment of cystitis can usually be managed in the nursing home with oral antibiotics. Initial therapy with a parenteral agent is often recommended in nursing home-acquired pyelonephritis.
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Review
Herpetic neuralgia. Use of combination therapy for pain relief in acute and chronic herpes zoster.
Herpes zoster (shingles) is a localized infection that begins in the dorsal root ganglla of the cranial or spinal nerves and spreads as a rash over the corresponding dermatome. It usually is caused by reactivation of latent varicella-zoster virus remaining from childhood chicken pox. ⋯ Management of zoster-related pain should begin as soon as possible after the onset of symptoms. Combination therapy--including antiviral, antidepressant, corticosteroid, opioid, and topical agents--provides the most effective analgesia.
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For many older patients, surgery is an inevitable component of healthcare. Thorough and effective preoperative patient evaluation is imperative because comorbidities, polypharmacy, functional problems, and socio-economic issues all can affect perioperative decisions and complicate recovery. ⋯ Other major considerations include functional status, the risk level of the surgery to be performed, expected blood loss, and anesthesia duration. The primary care physician must synthesize and relay this patient data to the surgical team so that appropriate measures can be taken to minimize perioperative risks and promote uncomplicated recovery.