Multiple myeloma (MM) is an uncommon malignant plasma cell disorder that often presents in older adults. An accurate diagnosis is critical as a spectrum of plasma cell disorders have been defined, including monoclonal gammopathy of undetermined significance, smouldering/asymptomatic multiple myeloma, multiple myeloma, and plasma cell leukemia. Although multiple myeloma is incurable disease, survival over 7 years is possible, during which patients can enjoy a good quality of life. Many therapeutic options now exist for individuals with MM who are ineligible for autologous stem cell transplantation; these include adding thalidomide, bortezomib, and lenalidomide to the current standard of melphalan and prednisone.
Key words: multiple myeloma, MGUS, older adults, plasma cell leukemia, supportive care.
The management of neuropathic pain at any age is aimed at the relief of suffering rather than focusing on decreasing pain scores, and it should involve even simple measures that affect pain and coping. Addressing physical stressors—poor diet, hydration, and sleep quality and quantity—is particularly relevant in older adults. Medications relieving neuropathic pain may be adjunctive to initial interventions and need to be carefully assessed for efficacy and side effects to ensure they relieve, rather than add to, suffering.
Key words: neuropathic pain, analgesics, older adults, mindfulness, psychological interventions.
The World Health Organization has named hypertension the leading risk for death globally in adults. Antihypertensive therapy reduces the risks of major cardiovascular complications. As blood pressure increases with increasing age, frequent screening for hypertension is advisable in older adults. The risk of developing hypertension is about 90% even in normotensive 65 year olds. Until recently, data supporting antihypertensive therapy in the very old had been inconclusive. However, the HYVET trial published in 2008 shows a clear reduction in cardiovascular events and mortality. Based on this study the Canadian Hypertension Education Program recommends treating hypertension regardless of age. Attention should also be given to reducing overall cardiovascular risk.
Key words: hypertension, high blood pressure, older adults, recommendations, HYVET study.
In this article, we discuss skin findings affecting older adults, with a focus on pruritus, flushing, dermatitis, and ulcers, and consider related internal diseases. Our goal is to make this information readily transferable to the clinical setting for the non-dermatologist.
Key words: dermatology, skin manifestations, older adults, pruritus, flushing, dermatitis, ulcers.
The prevalence of gallstones has been increasing among the aging population. Common sequelae of cholelithiasis include asymptomatic gallstones, biliary colic, acute cholecystitis, choledocholithiasis, cholangitis, and gallstone pancreatitis. Among individuals over age 65, gallstone diseases represent an important cause of recurrent abdominal symptoms and surgical admissions. As advanced age is correlated with increased mortality and morbidity in complicated gallstone disease, timely diagnosis and appropriate management are essential to improving disease outcomes.
Key words: older adults, gallstones, cholecystitis, choledocholithiasis.
Increases in life expectancy and the aging of the baby boomer generation has resulted in unprecedented high numbers of older adults in the U.S. and Canada and, thus, a rising number of frail older adults with chronic medical conditions. Informal caregivers, primarily family members, have traditionally provided a large proportion of care at home, and their contribution is expected to be of even greater significance. Informal caregivers provide care at great expense to themselves, because caregiving can result in emotional, physical, and financial stresses. This article discusses the role physicians play in identifying and alleviating caregiver stress.
Key words: family caregivers, informal caregivers, caregiver stress, physician, older adults.
Primary care physicians often see older adults using gait aids during office visits. Gait aids can provide increased independence with functional mobility but, if used incorrectly, can lead to injury. Unfortunately, gait aids are often purchased without professional advice. Gait aid prescription requires consideration of multiple factors. This article outlines general tips primary care physicians can use to help decide which gait aid might be most appropriate for a patient. Primary care physicians should examine an older patient’s gait aid as physical mobility needs change, and consider referring the patient to a physiotherapist for a complete assessment and gait training.
Key words: gait aid, cane, walker, older adults, ambulation.
Chronic angina is a common problem among older adults. The burden of coronary heart disease in patients over age 75 is high. Coronary angiography, percutaneous coronary intervention with or without stenting, and coronary artery bypass graft surgery all entail higher risk in the older population. Nevertheless, patients older than 75 also may accrue a greater benefit, given their increased risk for overall cardiac mortality. We suggest a measured approach to revascularization in older adults with chronic angina, considering their severity of symptoms, the adequacy of treatment of angina, their left ventricular ejection fraction, patient preference, other comorbidities, and ischemic burden identified by noninvasive testing.
Key words: angina, revascularization, older adults, coronary disease, coronary angiography.
The translation of effective treatments for obesity and diabetes management into clinical care has been slow. However, self-management education and counselling regarding diet and physical activity can improve weight, blood glucose, and lipid levels, and blood pressure control among older adults with type 2 diabetes. A collaborative approach to counselling is more effective than simply lecturing in promoting and sustaining behaviour change. The five A’s to behavioural counselling—assess, advise, agree, assist, and arrange—provide a model for care. A key component of the five A’s for counselling is the development of an action plan that specifies goals and implementation intentions for behaviour change.
Key words: type 2 diabetes mellitus, older adults, behavioural research, patient education, behavioural therapy.
Over the past decade, eight classes of drugs have been used to treat diabetes; however, insulin remains the most effective and least costly treatment for older adults. The American Diabetes Association has recommended that the approach to drug therapy of diabetes consider insulin a first-tier therapy. Nevertheless, there is a general reluctance among physicians and patients alike to accept insulin. The initiation of insulin therapy is especially challenging in older adults, who often have multiple comorbidities and physical limitations. In this article, we present a case-based approach to the initiation of insulin therapy in older adults.
Key words: diabetes, older adults, insulin therapy, glycemic goals, antihyperglycemic agents.
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