Cinzia Maraldi, MD, Department of Clinicial and Experimental Medicine, Division of Internal Medicine, Gerontology, and Geriatrics, University of Ferrara, Ferrrara, Italy; Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FL, USA.
Marco Pahor, MD, Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida; Geriatric Research, Education and Clinical Center (GRECC), Malcolm Randall Veteran’s Affairs Medical Center, Gainesville, FL, USA.

Maintaining independence is one of the major goals in geriatric care, and identification of modifiable conditions that may promote the onset and progression of disability is of paramount importance in the clinical approach to the older patient. Anemia is key among those factors that may affect physical function in older adults. It is a common condition that appears to predict the onset of functional decline and disability in older adults. Early diagnosis of anemia and identification of its underlying causes is important not only in order to prevent the condition from worsening but also to prevent its associated poor health outcomes.
Key words: anemia, aging, disability, hemoglobin, functional decline.

Meera George, JD, Postgraduate Fellow, Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Houston,TX, USA.
Aanand D. Naik,MD, Assistant Professor, Health Services Research and Geriatrics, Baylor College of Medicine; Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Houston,TX, USA.

Many older adults have difficulty bathing.Those unable to bathe are more likely to need formal home care and to be admitted to long-term care than those who can bathe without help. Disability with bathing function is complex, involving multiple subtasks; inability to perform those subtasks has many attributable causes. Bathing disability can be remediated through timely diagnosis and prescription of appropriate assistive devices and adaptations to the home bathing environment. Clinicians have an important role in the diagnosis of bathing disability, and collaborative planning of bathing remediation with patients, caregivers, and allied health providers is key.
Keywords: activities of daily living, assessment, disability, assistive devices.

Post-Stroke Depression

Ricardo E. Jorge, MD, Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Robert G. Robinson, MD, Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.

In most western countries, 0.2 % of the population suffer a stroke each year. One-third of them die over the next year, one- third remain permanently disabled, and the other third make a good recovery. Depression is one of the most common emotional disorders associated with cerebrovascular disease. Longitudinal studies of stroke patients have shown that about 20% of these patients will develop major depression and another 20% will develop minor depression during the first year after stroke. Depression has also been demonstrated to significantly effect clinical recovery and mortality and, more important. Post-stroke depression responds to antidepressant treatment.

Key words: stroke, mood disorders, antidepressants, cognitive disorders, disability.

Mobility Devices and Good Caregivers Facilitate Recovery and Deter More Falls

Nariman Malik, BSc

Falls in the elderly are a common problem, and often can have serious sequelae. The physical injuries that may be sustained after a fall can lead to hospitalization or even institutionalization. Falls are often considered to be an inevitable consequence of aging; however, they may in fact signal the onset of an illness or an underlying cause of frailty.¹

Falls are a significant cause of disability and death in older persons.² Fractures are a result in 3-5% of cases.³ The most serious fracture in the elderly is the hip fracture, which often requires surgical repair, a procedure which itself is plagued by a high incidence of morbidity and mortality.³ A fall may also lead to immobility which can lead to dehydration, rhabdomyolysis and pressure ulceration. Falls can also often lead to a fear of falling, which may result in withdrawal from usual activities and even social isolation and/or depression which ultimately results in both decreased mobility and a loss of independence.^2,4 Primary care physicians managing elderly patients should be prepared to assess appropriately patients who have fallen, and strive to develop a management plan tailored to meet patients' needs.