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Considerations in the Management of Epilepsy in the Elderly

Considerations in the Management of Epilepsy in the Elderly

Teaser: 

Warren T. Blume, MD, FRCPC, London Health Sciences Centre, University Campus, Epilepsy Unit; Professor, University of Western Ontario, London, ON.
David J. Harris, LRCP(Lond), MRCS(Eng), FRCPC, MRCPsych, London Health Sciences Centre, South Street Campus, Geriatric Mental Health Program; Associate Professor, University of Western Ontario, London, ON.

Management of epilepsy in an elderly person requires accurate classification of seizures, a sufficient neurologic assessment to define etiology, and awareness of the patient's health and social situation. Treatment with an antiepileptic drug requires an understanding of the general health of the patient and the nature of all medications being given to the patient by other physicians. Effective communication with the patient, spouse, any adult children or other caregivers aims to ensure that all understand the goals of treatment, medication side effects and monitoring methods. Concomitant illness such as neurological, psychiatric, metabolic or cardiac disorders will require individualization of treatment plans.
Key words: epilepsy, elderly, differential diagnosis, management.

The Use of Electroconvulsive Therapy for Depression in the Elderly

The Use of Electroconvulsive Therapy for Depression in the Elderly

Teaser: 

Kiran Rabheru, MD, CCFP, FRCP, ABPN, Physician Leader, Geriatric Psychiatry Program, Regional Mental Health Care; Chair, Division of Geriatric Psychiatry, University of Western Ontario, London, ON.

Electroconvulsive therapy (ECT) is an effective and relatively safe procedure for treating severe, treatment-refractory mood disorders in special populations, particularly in the elderly. The frail elderly are especially good candidates for ECT because they are often unresponsive to, or intolerant of, psychotropic medications. The central nervous, cardiovascular and respiratory systems require special attention during the course of ECT. With modern anesthesia techniques and careful medical management of each high-risk patient, most elderly can successfully complete a course of ECT. Obtaining informed consent for ECT from incapable patients is a challenging issue with few concrete guidelines.
Key words: electroconvulsive therapy, elderly, depression, special patient population.

Assessment and Management of Coagulopathies in the Elderly

Assessment and Management of Coagulopathies in the Elderly

Teaser: 

 

Anne G. McLeod, MD, FRCPC, Assistant Professor, Department of Medicine, University of Toronto; Staff Physician, Department of Medical Oncology and Hematology, University Health Network, Toronto, ON.

Bleeding in the elderly is a common problem. Careful assessment of a patient's bleeding history and physical examination is essential to try to establish if a clinically significant bleeding disorder is present. Initial laboratory testing should include a complete blood count, blood film review, PT/INR and PTT. Common etiologies of bleeding in the elderly include thrombocytopenia and medications such as Aspirin, non-steroidal anti-inflammatory agents and anti-coagulants. Unfortunately, no single approach to the treatment of coagulopathy exists; rather, a clear understanding of the cause of the bleeding disorder is needed to direct management.
Key words: coagulopathy, elderly, bleeding, hemostasis, clotting.

Physical Illness and Suicide in the Elderly

Physical Illness and Suicide in the Elderly

Teaser: 

Margda Wærn, MD, PhD, Institute of Clinical Neuroscience, Sahlgrenska University Hospital, Göteborg, Sweden.

Seniors who commit suicide often consult their doctors a short time before they take their lives, but few communicate their suicide intent. Rather, they may focus on somatic complaints. This paper reviews the literature on the connection between physical illness and suicide. Recent research shows that over half of those who commit suicide late in life suffer from serious physical illness or impairment. The association between physical illness and suicide may be stronger in men than in women. Since most physically ill persons who commit suicide suffer from depression, depression should be treated aggressively in seniors with concomitant physical disorders.
Key words: suicide, suicide attempts, physical illness, depression, elderly.

The Romanow Report: Implications for the Elderly

The Romanow Report: Implications for the Elderly

Teaser: 

Rory H. Fisher, MB, FRCP(Ed)(C), Director, The Regional Geriatric Program of Toronto and Interdepartmental Division of Geriatrics, Faculty of Medicine, University of Toronto, Toronto, ON.

The impact of the Romanow Report on the elderly is reviewed here. Recommendations for a Health Council, modernization of the Canada Health Act, improved home care and a National Drug Agency would benefit all elderly Canadians. However, the current unmet needs of the elderly, the value of specialized geriatric services and the developments in other jurisdictions are not recognized. The Romanow Commission fails senior citizens by ignoring their current unmet needs.
Key words: Romanow Report, recommendations, elderly.

A Review of Acute Viral Hepatitis in the Elderly

A Review of Acute Viral Hepatitis in the Elderly

Teaser: 

 

D'Arcy Little, MD, CCFP, Lecturer and Academic Fellow, Department of Family and Community Medicine, University of Toronto; Director of Medical Education, York Community Services; 2002 Royal Canadian Legion Scholar in Care of the Elderly, Toronto, ON.

Viral hepatitis is a major cause of acute and chronic liver disease worldwide. This article will review the epidemiology, etiology, presentation, diagnosis, management and prevention of acute viral hepatitis (Types A, B and C), with specific reference to the elderly population. Both similarities and differences between management in the elderly and the general population will be detailed. A cost-effective approach to diagnosis will also be formulated.
Key words: hepatitis A, hepatitis B, hepatitis C, acute viral hepatitis, elderly.

Treatment of Renovascular and Adrenocortical Hypertension in the Elderly

Treatment of Renovascular and Adrenocortical Hypertension in the Elderly

Teaser: 

J. David Spence, MD, FRCPC, Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, London, ON.

Effective treatment of hypertension is even more beneficial in the elderly than in younger patients because the elderly have a higher absolute risk of vascular events. Treating hypertension not only prevents stroke, but also reduces risk of dementia. Effective blood pressure control is based on identifying and treating its physiological cause. Renal hypertension, primary hyperaldosteronism and renal tubular abnormalities such as Liddle's syndrome can be identified by measuring the plasma renin and aldosterone. Most elderly patients require diuretic therapy for control, but most will require additional drugs to achieve the lower targets now supported by evidence.
Key words: hypertension, elderly, adrenocortical, renovascular.

Screening for Secondary Causes of Hypertension in the Elderly

Screening for Secondary Causes of Hypertension in the Elderly

Teaser: 

Xiumei Feng, MD, MSc and Norm R.C. Campbell, MD, Division of General Internal Medicine, University of Calgary, Calgary, AB.

Normal blood pressure is less common than "hypertension" in the elderly, and most hypertension is primary, or essential. Nevertheless, secondary hypertension in the elderly should be considered in patients with suggestive features, as the prevalence of secondary hypertension increases with age. The most common causes of secondary hypertension in the elderly are renal parenchyma diseases, primary aldosteronism, renal vascular stenosis and drug induced. Timely recognition and treatment of secondary hypertension will reduce the morbidity and mortality associated with uncontrolled hypertension.
Key words: hypertension, high blood pressure, elderly, secondary causes.

Isolated Systolic Hypertension in the Elderly

Isolated Systolic Hypertension in the Elderly

Teaser: 

Sheldon Tobe, MD, FRCP(C), Assistant Professor of Medicine, Nephrology, University of Toronto; Division Director Nephrology, Sunnybrook & Women's College Health Sciences Centre, Toronto, ON.
Sudha Cherukuri, MD, DNB(Nephrology), Clinical Fellow, University of Toronto, Toronto, ON.

Isolated systolic hypertension (ISH) is a common disorder in the elderly. Several studies have shown a constant positive and graded association between the level of systolic blood pressure and subsequent mortality from cardiovascular disease and stroke. ISH is defined as an elevated systolic pressure above 160mmHg and a diastolic pressure below 90mmHg. Arterial stiffening is the main cause of increasing systolic pressure in the elderly. The finding of high systolic blood pressure with diastolic below 90mmHg is a marker of higher cardiovascular risk and an indication to follow this patient more closely. The placebo-controlled SHEP and Syst-Eur trials have demonstrated that the treatment of ISH with diuretics or long-acting calcium channel blockers results in a marked reduction in cardiovascular events and stroke.
Key words: hypertension, isolated systolic hypertension, clinical trials, drug therapy, elderly.

Treatment of Hyperglycemia in the Elderly

Treatment of Hyperglycemia in the Elderly

Teaser: 

A.D. Baines, MD, PhD, FRCPC, Professor, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON.

This article presents a summary of recent recommendations for the diagnosis and treatment of Type 2 diabetes in the elderly. Onset of nephropathy, neuropathy and retinopathy can be slowed by treatment designed to reach realistic target values for fasting plasma glucose and HbA1c. Therapy also should minimize the dangers of hypoglycemia. Hepatic and renal function must be monitored when selecting drugs and dosages. Significant reductions in renal function may be associated with serum creatinine within the normal reference range. A stepwise approach to therapy beginning with diet and exercise and proceeding to single and multidrug treatment is outlined. The mode of action, advantages, disadvantages and contraindications for five groups of hypoglycemic agents are summarized.
Key words: Type 2 diabetes, diagnosis, stepped treatment, oral drugs, elderly.