Advertisement

Advertisement

primary care

A Review of Older Women's Health Priorities

A Review of Older Women's Health Priorities

Teaser: 

Deborah Radcliffe-Branch, PhD, University of Montreal, Centre de Recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC.
Cara Tannenbaum, MDCM, MSc, Assistant Professor, Department of Medicine, Division of Geriatrics, University of Montreal, Centre de Recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC.

Older women are one of the most rapidly growing segments of the Canadian population. This growth necessitates an evaluation of the quality and breadth of care women receive to promote successful aging in later life. Older women’s perceptions of health priorities being addressed by the current health care system and those for which improvements are required are reviewed. Recommendations include screening for memory loss, falls, muscle weakness, depression, and urinary incontinence. Guidelines for assessment and prevention as well as the adoption of a patient-centred approach to care are suggested to address the broader context of promoting physical, emotional, and social well-being for older women.
Key words: older women’s health, health priorities, patient-centred care, screening guidelines, primary care.

Primary Care Prevention of Suicide among Older Adults

Primary Care Prevention of Suicide among Older Adults

Teaser: 



Marnin J. Heisel, PhD, C.Psych,
Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Paul S. Links, MD, FRCP(C), Arthur Sommer Rotenberg Chair in Suicide Studies, Suicide Studies Unit, Department of Psychiatry, University of Toronto/St. Michael’s Hospital, Toronto, ON.


Older adults have high rates of suicide worldwide. Suicide rates increase with advancing age, and older adults typically use highly lethal means of self-destruction. In addition, suicidal older adults tend to pursue treatment in primary care rather than mental health settings, but current limitations in the primary care system potentially restrict suicide prevention in older patients. We briefly review the epidemiology of late-life suicide and suggest modifications in primary care to better address the psychosocial needs of at-risk older adults, supported by research on suicide risk and resiliency, clinical assessment and treatment options, and collaborative models of primary medicine and mental healthcare.
Key words: suicide, suicide ideation, suicidal behaviour, older adults, primary care.

Wandering: Clues to Effective Management

Wandering: Clues to Effective Management

Teaser: 


Donna L. Algase, PhD, RN, FAAN, FGSA, School of Nursing, University of Michigan, Ann Arbor, MI, USA.

Wandering is among the most challenging behaviours associated with dementia. While research is progressing toward a fuller understanding of this phenomenon, the basis for deriving effective and tested interventions has not been fully developed. In this paper, wandering is defined from multiple perspectives, and its various outcomes and risks are discussed. Putative causes of wandering are summarized. Finally, an approach to aid clinicians in discovering effective strategies for managing an individual’s wandering is presented.
Key words: wandering, dementia, assessment, intervention, primary care.

Medication Review for the 10-Minute Consultation: The NO TEARS Tool

Medication Review for the 10-Minute Consultation: The NO TEARS Tool

Teaser: 


Tessa L. Lewis, MD, General Practitioner, Carreg Wen Surgery, Church Road, Blaenavon, Torfaen, UK.

The NO TEARS structure can aid efficient medication review within a 10-minute consultation. It is a flexible system that can be tailored to the individual practitioner’s consultation style:
Need/indication
Open questions
Tests
Evidence
Adverse effects
Risk reduction
Simplification/switches

Key words: medication review, NO TEARS, primary care, older adults, polypharmacy.

Somatic Presentations of Distress in Primary Care

Somatic Presentations of Distress in Primary Care

Teaser: 

Chanaka Wijeratne, MD, MB, BS, FRANZCP, Conjoint Senior Lecturer in Psychiatry, University of New South Wales, Sydney, AUS.

Somatic presentations such as fatigue, headache, and abdominal and joint pain are common in primary care, although investigation may not readily identify an underlying cause. Such “functional somatic syndromes” are best conceptualized within a multifactorial, inclusive illness model rather than as diagnoses of exclusion (that is, of medical pathology). For instance, the syndrome of fatigue occurs in up to 25% of older people and is predicted by factors as diverse as female gender, more severe medical illness, and concurrent anxiety and depression. Although the management of functional somatic syndromes is frustrating to the clinician, the importance of a multimodal management model is emphasized.

Key words: functional somatic syndromes, older adults, primary care.

Detecting Depression in the Geriatric Primary Care Setting

Detecting Depression in the Geriatric Primary Care Setting

Teaser: 

Jennifer Pike, PhD, Neuropsychiatric Institute, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), CA, USA.

Michael Irwin, MD, Cousins Center for Psychoneuroimmunology, Neuropsychiatric Institute,
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), CA, USA.

Introduction
Depressive disorders are common in the geriatric primary care setting,1 and are associated with considerable costs and human suffering.2-4 In 1990, depression was ranked as the fourth leading cause of disability worldwide,5 with annual health care costs estimated at $44 billion in the United States alone. Much of this cost is a reflection of higher health care utilization rates in depressed individuals, irrespective of medical comorbidity and mental health visits.3

The prevalence of depressive disorders, defined by the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; Table 1), in the elderly is high and ranges from 6.5-17% in the primary care setting.1,6 The rates for dysthymia, minor depression or subsyndromal depressions are roughly double those for major depression. The functional impairments and medical burden of these minor depressed geriatric patients are comparable to those of younger patients with major depression.