Showing posts with label Geriatrics. Show all posts
Showing posts with label Geriatrics. Show all posts

11 August 2013

Frontotemporal dementia Ppt and publications



Dementia
JEON, JOON-SEOK M.D.
http://www.pcom.edu

Neuroimaging of Alzheimer’s Disease
Kim Kinard
http://radiology.med.sc.edu

Managing rehabilitation challenges of patients with dementia
Tom Holmes, OTR, MA
http://www.uthct.edu

How Alzheimer’s Disease Differs from Frontal Temporal Lobe Dementia (Pick’s Disease)
Josepha A. Cheong, MD
http://alzonline.phhp.ufl.edu

Dementia Evaluation and Treatment
John Frederick MD
http://depts.washington.edu

Frontotemporal Dementia
http://novel.utah.edu

Racial Health Disparities in Dementia
DISHA KUMAR, ALLEDA MACK, SARA OLACK, SHARON RUCK
http://geriatricsrotation.uchicago.edu

Reflections on Dementia: differentiating dementias
Gregory A. Jicha, M.D.,Ph.D.
http://www.mc.uky.edu

Dementia
Michael J. Mintzer, MD
http://www.medicine.emory.edu

Dementia Assessment and Family Caregiving
Steven Chao, MD, PhD, Dolores Gallagher-Thompson, PhD, ABPP, Benjamin Kao, LCSW, MSW, Marian Tzuang, MSW
http://sgec.stanford.edu

Fronto-temporal Dementia
http://www18.homepage.villanova.edu

Dementias
Jack Twersky, MD
http://coegne.nursing.duke.edu/

Alzheimer’s Disease Delirium
Jennifer Almada, Nicole Leal, Jill Marcetti, Lidda Pongbandith, Leena Safdari, Aimee Simpson
http://www.mjc.edu

Structural and Functional Neuroimaging in the Diagnosis of Dementia
John M. Ringman, M.D
http://www.loni.ucla.edu

3D Geriatrics - Dementia Delirium and Depression
Gerry Gleich MD
http://www.umassmed.edu

232 Published articles on Frontotemporal dementia

Read more...

14 December 2012

Vascular dementia Ppts and 196 Free Full Text articles



Vascular dementia is a decline in thinking skills caused by conditions that block or reduce blood flow to the brain, depriving brain cells of vital oxygen and nutrients.

Dementia
http://radiology.med.sc.edu

What is Dementia?
JEON, JOON-SEOK M.D.
http://www.pcom.edu/

Dementia: Diagnosis and Treatment
Debra L. Bynum, MD
http://www.med.unc.edu

Dementia & Delirium
http://www.med.unc.edu

Dementia Evaluation and Treatment
John Frederick MD
http://depts.washington.edu

The Facts about Dementia and Other Related Conditions
http://www.uwosh.edu

Behavior Vs. Medication Management
http://blogs.law.uiowa.edu

Dementia
Michael J. Mintzer, MD
http://www.medicine.emory.edu

Non-medication Management of Agitated Behavior in Dementia Patients
Josepha A. Cheong, MD
http://alzonline.phhp.ufl.edu

Memory impairment
Jack Twersky, MD
http://coegne.nursing.duke.edu

Cognitive Disorders
http://www.abac.edu

Neuroimaging of Alzheimer’s Disease
Kim Kinard
http://radiology.med.sc.edu

Managing rehabilitation challenges of patients with dementia
Tom Holmes, OTR, MA
http://www.uthct.edu


196 Free Full Text articles on Vascular dementia

Read more...

12 April 2012

Geriatric Workshop Videos



Geriatric Workshop Videos from The University of Wisconsin School of Medicine and Public Health in Madison.


Picture from Geriatric Workshops - Osteoarthritis and Osteoporosis video
R. Breslow
 

Picture from Geriatric Workshops - Falling, Frailty, Failure to Thrive and Incontinence video
R. Breslow
 

Picture from Geriatric Workshops - The 3 Ds and Sleep: Assessment and Pharmacologic Challenges video
R. Breslow

Picture from Geriatric Workshops - The Two Faces of Polypharmacy video
R. Breslow

Read more...

24 February 2010

Treatment Options for Dementia



Treatment Options for Dementia
By:Deb Bynum, MD
Division of Geriatric Medicine
University of North Carolina

Objectives
* 1. Understand the use of cholinesterase inhibitors in the treatment of alzheimer type, vascular and mixed dementias
* 2. Review the current literature regarding the use of Memantine for severe dementia
* 3.Understand the appropriate use of nonpharmacologic strategies for behavioral problems with dementia
* 4. Review the appropriate use of antipsychotics for psychosis and behavioral symptoms in dementia
* 5. Discuss possible means of preventing dementia

Overview
* 1. Cholinesterase inhibitors in the treatment of AD, vascular and overlap dementias
* 2. Memantine
* 3. Treatment of behavioral symptoms
* 4. ?Prevention
* 5. Future Directions


The Cholinergic Hypothesis
* Depletion of acetylcholine and nicotinic receptors thought to occur early and relate to memory impairment with AD
* Focus on AD treatment with Acetylcholinesterase inhibitors: Recommended as first line treatment for patients with mild to moderate AD


Cholinesterase Inhibitors
* Trials in patients with mild to moderate disease (10-24 on MMSE)
* On average these drugs seem to stabilize cognitive function and activities of daily living and may have benefits with QOL and behavioral disturbances for at least one year
* Side Effects: GI

Tacrine
* Trials demonstrating delay of cognitive decline by 6 months
* Delayed time to nursing home placement: At 800 days, 45% in low dose or no tacrine underwent placement vs 21% in high dose tacrine group
* Evidence for long term cost effectiveness
* Reversible hepatotoxicity in 50%

Donepezil (Aricept)
Three large RCT demonstrate modest effectiveness in stabilizing cognitive function
Well tolerated (no difference in adverse events compared to placebo)
Not hepatoxic, no significant drug-drug interactions
Single bedtime dose: start 5 mg, increase to 10 mg after 4-6 weeks
Most common side effects: sleep disturbance, GI

Rivastigmine
* May have increased selectivity for hippocampus and neocortex (areas affected by AD)
* Modestly effective in treatment of mild to moderate AD (but only at high doses of 6-12 mg/day)
* Recommended starting dose: 1.5 mg BID with breakfast and dinner
* Minimize GI side effects with 4-6 week titration, increasing to 3 mg BID, 4.5 mg BID, 6 mg BID
* More GI side effects, weight loss (dose dependent)

Galantamine
* Potential second mechanism: modulator at nicotinic cholinergic receptor
* Three large RCTs indicate effectiveness in mild to moderate AD (same degree as other agents) at doses of 16, 24, 32 mg/day
* Open label 6 month extension of US trial: Possible disease modifying effect
* Starting dose: 4mg BID with meals, increase by 4mg BID every 4-6 weeks

Cholinesterase inhibitors in moderate to severe AD
* RCT of donepezil vs placebo: 24 week international trial of 290 patients (MMSE 5-18)
* 63 % of donepezil treated patients were stable/better vs 42% in placebo group

Comparison of Cholinesterase Inhibitors…
* Cochrane Dementia Group: 3 systematic reviews on efficacy of donepezil, rivastigmine, and galantamine
* Each drug seems to have similar treatment effect at 6 months on global and cognitive rating scales
* No double blind head to head trial

Cholinesterase Inhibitors and AD: Summary
* Approved for treatment of mild to moderate AD
* Probably effective in treatment of more severe AD
* Goal: stabilization (not miracle drugs)
* Delay in nursing home placement, decline in ADLS
* Probably benefits behavioral and functional status as well
* Data suggest no big difference in efficacy among the 3 agents, although donepezil is easier to titrate and better tolerated

Cholinesterase Inhibitors and Other Dementias…
* Vascular dementia and Dementia with Lewy Bodies each account for 10-15% cases
* Prominence of mixed pathology (especially vascular and AD in older population)

Galantamine: Vascular and AD/Vascular Dementia
* Placebo controlled trial, 6 months, 592 patients
* 50% in study had AD plus radiological evidence of CVD, 41% had probable vascular dementia, 9% indeterminant
* Results for the whole group were similar to previous trials in typical AD : 74% galantamine groupwere improved/stable vs 59% in placebo group
* AD-CVD subgroup similar effects to prior trials with AD patients


Summary of Galantamine and Vascular dementia
* Patients with typical features of AD mixed with features of CVD or evidence of CVD on radiological tests seem to respond similarly to patients with AD alone
* Subgroup with CVD alone does better over long term (even with placebo)
* Surprise: patients with what appears to be only CVD also seem to have some benefit (these patients not traditionally felt to have specific degeneration of cortical cholinergic pathways)

Cholinesterase Inhibitors and Other dementias
* Lewy Body Dementia: may respond even more than AD patients
* Frontal Lobe Dementia: often respond adversely to cholinesterase inhibitors with increased agitation and insomnia

Memantine
* NMDA (glutamate) receptor activation thought to be involved in neurodegeneration
* Memantine: NMDA antagonist aimed at protecting neurons from glutamate mediated excitotoxicity
* Approved in Europe in 2002 for treatment of severe AD (MMSE 3-14)
* Randomized, double blind, placebo controlled study: 166 patients with severe dementia (AD and vascular, MMSE <10)
* Cognitive and Behavioral Rating Scale significantly better with treatment, regardless of dementia type
* Other European studies have looked at treatment for moderate-severe Vascular Dementia, demonstrating similar efficacy
* 28 week RCT of 252 patients with severe AD (MMSE 3-14) in NEJM: memantine associated with less deterioration in cognitive and functional measures than placebo
* Problem: small numbers, high drop out rate
* Preliminary study: 400 patients with severe AD, 6 months RCT of memantine plus donepezil vs placebo plus donepezil: memantine group had significant benefit in comparison

Memantine: Summary
* Approved for treatment of moderate-severe AD
* Likely of benefit also in severe vascular and mixed dementias as well
* Likely will be used in combination with donepezil or other cholinesterase inhibitors
* Cochrane Dementia Group: “memantine is a safe drug and may be useful for treating AD, vascular and mixed dementia, although most of the trials so far reported have been small and not long enough to detect clinically important benefit”

Behavioral Symptoms: Nonpharmacologic Treatment
* Depression, agitation, aggression, wandering, sleep disturbance, paranoia, anxiety
* Assess for/treat depression
* Assess cause for increased symptoms (caregiver, environmental changes, medications, infection)
* Assess for caregiver depression
* ID and avoid triggers of negative behavior
* Redirection
* Environmental modification for wandering
* Sleep hygiene

Use of Atypical Antipsychotics
* Older, “typical” agents such as haloperidol and thioridazine (mellaril) associated with significant extrapyramidal symptoms
* Theoretically combination of dopamine and serotonin effects of atypical agents allow treatment of positive and negative psychotic symptoms with less EPS

Risperidone
* Evidence demonstrates efficacy in treatment of psychotic and behavior symptoms in patients with dementia
* Exacerbates movement disorder in patients with Parkinson’s
* Start .25/day, average daily dose 1-1.5mg/day
* EPS in dose dependent manner (6mg/day)
* Insomnia, hypotension, weight gain
* Elevation of prolactin levels

Olanzapine
* Evidence that it is effective in AD patients
* Increases motor symptoms in PD patients
* Recommended not to use with PD
* Start: 1.25-2.5/day, increase to 5/day (dosages of 10-15/day are not more effective!)
* More sedating than others (more anticholinergic effects)
* Sedation, weight gain, orthostatic hypotension, seizures, glucose intolerance
* Showing promise in patients with AD and PD
* Does not exacerbate movement disorder of PD
* May be first line for PD patients with psychosis
* 12.5 QHS, titrate every 3-5 days
* Sedation, HA, orthostatic hypotension
* ?Cataract formation

Ziprasidone (Geodon)
* New, clinical data lacking
* Non dose-dependent QT prolongation

Clozapine
* Very effective in treating psychosis in PD patients
* The most effective agent in treatment of drug induced psychosis in PD
* Some efficacy with AD patients
* Start: 6.5mg/day
* Agranulocytosis, frequent monitoring limits use

Antipsychotics in Dementia: Summary
* Start very low, monitor for hypotension, P450 effects, sedation, EPS
* Monitor and avoid use as “chemical restraint”
* Avoid if at all possible in Dementia with Lewy Bodies

Prevention of Dementia
* HTN and Hyperlipidemia
o Observational studies show less risk of AD in patients on statin agents (RCTs do not show effect)
o Original HTN in Elderly studies: patients initially on placebo with systolic HTN had persistent elevation in risk of dementia
* Vascular risk factors seem to play role even for AD!
* Evidence lacking for Vit E, Estrogen, NSAIDS

Future Directions
* Amyloid B peptide (plaque component) vaccination
* Amyloid modulators
* ?Anti-inflammatory drugs
* Treatment with statins
* ?Low flow VP shunting

Take Home Points
* Cholinesterase Inhibitors are MODESTLY effective in treatment of mild to moderate AD
* Cholinesterase Inhibitors are probably effective in more severe AD
* No large difference in efficacy between agents, but Donepezil more easily titrated and tolerated
* Evidence to support use of cholinesterase inhibitors for vascular and vascular/AD dementia
* Memantine looks to be effective for more severe AD and vascular dementia, will likely be used in combination with cholinesterase inhibitors
* Behavioral symptoms common, first line of treatment is nonpharmacologic
* Atypical antipsychotics can be effective, but use in low doses and watch carefully for problems (especially EPS, hypotension)
* For PD, quetiapine (seroquel) may be first line for psychotic symptoms
* Avoid antipsychotics with Lewy Body Disease!

Treatment Options for Dementia.ppt

Read more...

14 June 2009

Geropsychiatry: Delirium and Dementia



Geropsychiatry: Delirium and Dementia
By:Robert Averbuch, MD
Assistant Professor, Department of Psychiatry

Disorders of Cognition
* DSM-IV devotes an entire section to a subset of “organic” disorders that primarily affect cognition: “Delirium, Dementia, and Amnestic and other Cognitive Disorders”
What is “organic”?
* Previous differentiation between mental disorders with a clear “physical or biological” etiology (Organic) and those without (“Functional” or “Primary”)
* Falsely implied that Functional (or primary) disorders have no underlying pathophysiological basis
* Primary mental disorder- not due to a GMC or substance
Disorders of Cognition
* Delirium-disturbance in consciousness and cognition that develops rapidly
* Dementia- multiple cognitive deficits that include memory disturbance
* Amnestic Disorder- primarily memory impairment
Delirium: defined

* Disturbance of consciousness (awareness of the environment) and attention,
* PLUS…
o Changes in cognition (ie, “thinking”-memory, orientation, language, etc) OR
o Perceptual disturbances
The Course of Delirium
Delirium: Associated Features
* Disturbance in sleep-wake cycle
* Easily distracted by irrelevant stimuli
* Changes in activity level
o Restlessness, hyperactivity
o Picking at clothes, getting out of bed
o OR hypoactivity (lethargy)
* Emotional disturbances- mood lability, anger, irritability, euphoria, apathy
* Speech or language disturbances
* Perceptual abnormalities- common:
o Illusions, hallucinations, delusions
* Neurological deficits/dysfunction

What Are the Causes?
* DIRECT: Brain pathology: head injury, seizures (during and after), strokes, infections
* INDIRECT: Systemic Illness: electrolyte abnormalities, dehydration, uremia, hepatic encephalopathy, cardiovascular compromise
* Sensory deprivation
* After surgery (post-operative state)- ie. “ICU Psychosis”
* Side effects of medications or toxins or with abused recreational drugs:
Treating Delirium
* Considered a Medical Emergency
* Supportive care in an ICU setting
* Safety- close monitoring
* Remove offending agent, treat underlying cause
Dementia
Hallmark is Memory Impairment
Dementia- defined
Details: Aphasia
Disturbances in Executive Functioning
Associated Features
More associated features
Course of Dementia
What causes Dementia?
More causes:
Alzheimer’s Dementia of the Alzheimer’s Type (DAT)
Vascular Dementia
Aka Multi-Infarct Dementia
Treatment of Dementia
Medications

Geropsychiatry: Delirium and Dementia.ppt

Read more...

Delirium in the Elderly: Evaluation and Management



Delirium in the Elderly: Evaluation and Management
By:M. Andrew Greganti, MD

Outline of Discussion
* Case Presentation
* Characteristics of Delirium
* Etiology/Pathogenesis
* Risk Factors
* Prevalence
* Clinical Presentation
* Diagnosis
* Evaluation
* Prevention and Treatment
Case Presentation
Hospital Course
Post Hospital Course
Characteristics of Delirium
Other Characteristics
Etiology
Pathogenesis
How common is delirium?
Risk Factors
Other Risk Factors
Prodrome
Clinical Presentation
Diagnosis
Differential Diagnosis
Prognosis
Evaluation
Preventive Measures Perioperatively
Treatment
Treatment of “Yelling Out”
Summary of Key Points

Delirium in the Elderly: Evaluation and Management.ppt

Read more...

Delirium in the Elderly



Delirium in the Elderly
By:Bree Johnston MD MPH
UCSF Division of Geriatrics

Case Study
Atypical Presentations
Learning Objectives
* Recognize that delirium is a common presentation of disease in the elderly
* Recognize that delirium is associated with adverse outcomes
* Know how to distinguish between delirium and other diagnoses (dementia, depression)
* Identify risk factors for delirium and strategies for risk reduction
* Discuss management strategies, recognizing the limitations of current data
Definition
* “an acute disorder of attention and cognition” (de lira “off the path”)
* Standard definition not use until 1980 with publication of DSM III
* Other terms used include organic brain syndrome, metabolic encephelopathy, toxic psychosis, acute mental status change, exogenous psychosis, sundowning
Pathophysiology
Delirium Risk Factors
* Age
* Cognitive impairment
* Male gender
* Severe illness
* Hip fracture
* Fever or hypothermia
* Hypotension
* Malnutrition
* High number of meds
* Sensory impairment
* Psychoactive medications
* Use of lines and restraints
* Metabolic disorders:
* Depression
* Alcoholism
* Pain

Delirium Risk Model
Baseline Risk Group
Precipitating Factor Group
Surgical Prediction Rule
Clinical Prediction Rule for Post-surgical Delirium
Differential Diagnosis
* CNS pathology
* Dementia, particularly frontal lobe
* Other Psychiatric disorders
o Psychosis
* Depression: 41% misdiagnosed as depression Farrell Arch Intern Med 1995
o Bipolar disorder
* Aconvulsive status epilepticus
* Akathisia
* Overall, 32-67% missed or misdiagnosed

Diagnosis
Diagnostic Tools
Delirium versus Dementia
Medications and Delirium
Searching for the cause
103 treatment and 111 controls
Intervention: Surgery as soon as possible & geriatric evaluation pre and post op vs usual care
Outcomes Treatment Control
Possible Benefit From:
* Preoperative psychiatric assessment followed by nursing reorienation (33% vs 14%)
* Postoperative reorienation (87% vs 6%)
* Preoperative education about delirium (78% vs. 59%)
* Pre and post operative psychiatric intervention (13% vs 0)
Can Interventions Prevent Delirium?
Intervention Protocol
* Cognition Orientation, activities
* Sleep Bedtime drink, massage, music, noise reduction
* Immobility Ambulation, exercises
* Vision Visual aids and adaptive equipment
* Hearing Portable amplifiers, cerumen disimpaction
* Dehydration BUN, volume repletion
Preventing Delirium post Hip fracture
* Protocols for:
o Fluid/electrolytes
o Pain treatment
o Eliminating unnecessary medications
o Bowel/bladder function
o Nutrition
o Mobilization
o CNS oxygenation
o Prevention of complications (MI, PE, UTI, pneumonia)
o Environmental stimuli
o Treatment of agitated delirium
Delirium in Hip fracture
Severe delirium, cumulative incidence
Delirium, cumulative incidence
Delirium at discharge
Interventions that May Help
Drug therapy
Drug Therapy of Delirium
Neuroleptics
Use of Haloperidol
Atypical neuroleptics
Benzodiazepines
Other agents
Delirium in the ICU
Sedation in the ICU
Prevention is the Best Medicine

Delirium in the Elderly.ppt

Read more...

29 May 2009

PREVENTIVE GERIATRICS



PREVENTIVE GERIATRICS
Dr.I.Selvaraj,I.R.M.S
B.Sc., M.B.B.S.,(M.D Community medicine).,
D.P.H.,D.I.H.,P.G.C.H&FW (NIHFW, New Delhi)
Sr.D.M.O (Selection Grade Officer)
INDIAN RAILWAYS MEDICAL SERVICE

It is the art and science of preventing disease in the geriatric population and promoting their health and efficiency

* Hippocrates noted conditions common in later life
* Aristotle offered theory of ageing based on loss of heat
* The word geriatrics was invented by Ignatz L. Nascher, a vienna born immigrant to the united states
* Geriatric medicine was a product of the British NHS
* Nascher was the father of geriatrics and Majory Warren was its Mother
* The 1st Geriatric service was started in U.K in 1947.
* Geriatric department at GH, Chennai was established in 1978.
* Post Graduate course in Geriatric medicine has been started in 1996 at Madras medical college.
* Prof. V.S. Natarajan was the first Geriatric professor in India
* The study of physical and psychological changes that occur in old age is called “gerontology”.
* Geriatrics is the branch of general medicine concerned with clinical, preventive, medical and social aspects of illness in the elderly.
* The old age is defined as the age of retirement. In our country it is fixed at 60 years and above.

Present scenario in INDIA
* Cataract &Visual impairment- 88%
* Arthritis &locomotion disorder-40%
* CVD &HT – 18%
* Neurological problems- 18%
* Respiratory problems including Chronic bronchitis- 16%
* GIT problems- 9%
* Psychiatric problems- 9%
* Loss of Hearing – 8%

Theory of aging
* Somatic mutation theory
* Autoimmune theory
* Hayflick’s theory of aging

Geriatrics
* Senility
* Decline in sexual prowess
* Diminution in endocrine activity
* Loss of elasticity of blood vessels
* Rise in B.P

RISK OF GERIATRICS
* PRONE FOR INFECTIONS
* PRONE FOR INJURIES
* NEED SPECIAL ASSISTANCE
* PRONE FOR PSYCHOLOGICAL PROBLEMS
* PRONE FOR DEGENERATIVE DISORDERS
* INCREASED RISK FOR DISEASE
* INCREASED RISK OF DISABILITY
* INCRASED RISK OF DEATH

AIM OF GERIATRIC MEDICINE
* Maintenance of health in old age by high levels of engagement and avoidance of disease
* Early detection and appropriate treatment of disease
* Maintenance of maximum independence consistent with irreversible disease and disability
* Sympathetic care and support during terminal illness

GERIATRIC PEOPLE PROBLEMS
* HEALTH PROBLEMS

1.Joint problems
2.Impairment of special senses
3. Cardio vascular disease
4.Hypothermia
5.Cancer, Prostate enlargement, Diabetes& Accidental falls

* Psychological problems
1. Emotional problems
2. Suicidal tendency
3. Senile dementia, Alzheimer’disease

* Social problems
* Poverty, Loneliness, Dependency, Isolation, Elder abuse, Generation Gap

GERIATRIC TEAM
* Geriatricians
* Nurses
* Physiotherapist
* Social worker
* And Health worker
* Investigation is an essential tool in the diagnosis of elderly patients.
* Under or over investigations to be avoided.
* Know the age related variables while interpreting the results.
* Non-invasive tests are preferred than invasive.
* The objective of the investigations is to improve the quality of life.
* One must try to get the diagnosis right, as wrong diagnosis is harbinger of wrong treatment
* Polypharmacy should be avoided whenever possible
* Regular review of medication is a must
* Poor drug compliance could be due to poor advice
* Proper nutrition is vital for healthy living
* A well balanced nutritious diet is ideal for older age
* It is not the quantity but the quality

Indicators of health status of aged
* Age proportional mortality rate
* Age specific death rate persons over 55 years
* Age specific prevalence rates for cvd, cancers and accidents.
* % elders taking three or more drugs/day
* Cumulative percentage of elders undergone cataract surgery
* Proportion of elders admitted to the hospital in the past one year

PREVENTION
* Primordial prevention
* Pre geriatric care
* Primary prevention
* Health education
* Exercise
* Secondary prevention
* Annual medical check-up
* Early detection ( Universal approach, Selective approach)
* Treatment
* Tertiary prevention
* Counseling and Rehabilitation
* Welfare activities (Sanjay Niradhar Yojana, Vridhashrama)
* Chiropody services
* Improving quality of life
* Cultural programme
* Old age club
* Meals-on wheel service
* Home help
* Old age home

PREVENTIVE GERIATRICS.ppt

Read more...

17 April 2009

Geriatric Grand Rounds - Videos



Geriatric Grand Rounds - Videos
by the University of Arizona College of Medicine at the Arizona Health Sciences Center.

Ethnicity and Aging
Donald E. Gelfand, PhD, Research Associate, Arizona Center on Aging, Professor, Dept. of Sociology, Wayne State University, Coordinator, End-of-Life Interdisciplinary Project, Wayne State University, Detroit Michigan
Mediaplayer Format
Realplayer Format

Anesthesiology and the Older Patient
Steven Barker, MD, PhD, Professor and Department Head, Anesthesiology, College of Medicine, University of Arizona
Mediaplayer Format
Realplayer Format

A Pragmatic and Clinical Approach to the Diagnosis and Treatment of Alzheimer's Dementia
Byron Bair, MD, Associate Professor (Clinical): Department of Psychiatry, University of Utah Health Services Center
Mediaplayer Format
Realplayer Format

Hormone Replacement and Menopause: What Now?
Carla J. Herman, MD, MPH, Chief, Division of Geriatrics, University of New Mexico Center on Aging
Mediaplayer Format
Realplayer Format

The Special Issues of Communicating with Persons Who Have Dementia
Randal Scott, MSW, MBA
Mediaplayer Format
Realplayer Format

General Pharmacologic Principles of Aging: Medical Effects on the Health of the Elderly
Martin Higbee, PharmD, Associate Professor, Department of Pharmacy Practice, The University of Arizona
Mediaplayer Format
Realplayer Format

Nutrition and Aging
Wanda Howell, PhD, University distinguished professor - Nutrit sci-ins.
Mediaplayer Format
Realplayer Format

Read more...

Perioperative Care in Geriatrics



Perioperative Care in Geriatrics
Presentation by
Tomas L. Griebling, MD, FACS, FGSA
Department of Urology
The Landon Center on Aging

Surgical Care in Older Adults
ACOVE Surgical Indicators
Preoperative Care
Capacity to Consent
Discussion of Goals of Care
Preoperative Pulmonary Evaluation
Preoperative Cardiovascular Evaluation
Preoperative Diabetes Evaluation
Preoperative Delirium Risk Factor Assessment
Prevention of Surgical Site Infection
Perioperative Beta-blockade
Anticoagulation for Hip Fracture and Replacement
Anticoagulation Prophylaxis in Other Surgical Cases
Diabetes Control
Screen for Postoperative Delirium
Cognition and Function at Discharge
Summary


Perioperative Care in Geriatrics.ppt

Read more...

Common Problems in Geriatrics for Orthopedic Surgeons



Common Problems in Geriatrics for Orthopedic Surgeons
Presentation by
Steven Zweig, MD

Family and Community Medicine
MU School of Medicine

Goals

* Recognize the importance of aging physiology in the development and treatment of specific problems
* Prevent and treat delirium
* Recognize the significance of polypharmacy
* Identify patients at risk for elder abuse

Case 1 - 80 year old woman with hip fracture
Delirium
* Physical exam for VS, neuro, skin, infections
* Mental status exam
* Lab and x-ray for infections (lung, urine), fluid and lytes, hypoxia, BS, new trauma, systemic dx

Mental Status Evaluation

Case 2 - 76 year old woman with osteoarthritis
Altered Drug Distribution
Altered Drug Metabolism
Altered Renal Excretion
Common Adverse Drug Reactions
Principles of Geriatric Prescribing


Case 3- 75 year old woman with upper arm pain

X- ray and lab findings
Elder Abuse
Risk factors
Management

Tips for Coordinating Care

* Medicare home care - requires need for skilled nurse or PT
* Admission to SNF requires 3 day hospital stay - contact the NH physician to plan
* PPS means capitated reimbursement to SNFs
* Medicare does not cover costs of drugs
* Get SW involved if any care problems anticipated

Common Problems in Geriatrics for Orthopedic Surgeons.ppt

Read more...

Geriatrics in a Nutshell



Geriatrics in a Nutshell
Presentation by: Karen E. Hall, M.D., Ph.D.

Clinical Associate Professor of Internal Medicine
University of Michigan, Ann Arbor VA Health Systems
Research Scientist,
Geriatric Research, Education and Clinical Center

Covers the following topics
Geriatric Syndromes
Common Diseases in Elderly
Documentation/Skills
First rule of history and physical exam
Physical Exam
Diagnosis belongs in the Impression / Plan
Develop a Plan rather than a Diagnosis
Social, Ethical, Cultural

Geriatrics in a Nutshell.ppt

Read more...

Scope of Ayurveda in Geriatric Health Care



Scope of Ayurveda in GERIATRIC HEALTH CARE
Dr. B Rajeev MD (Ay), PhD (Psych)
Honorary Consultant- Holistic Medicine
Amrita Institute of Medical Sciences & Research Centre,
AIMS, Kochi, Kerala

Objective of Geriatrics
Gerontology
Problems of Geriatric age group
Common manifestations
Medical care & Management for the old
Preventive Geriatrics
Geriatric rehabilitation
Concept of Geriatrics in Ayurveda
Chikitsa yojana
Chikitsa Padhati
Rasayana – Vajeekarana
Vyadhi Pratyaneeka chikitsa
Glimpses on Diseases where Panchakarma offers better management options
Manasopachara / Achara rasayana

Scope of Ayurveda in Geriatric Health Care.ppt

Read more...
All links posted here are collected from various websites. No video or powerpoint files are uploaded on this blog. If you are the original author and do not wish to display your content on this blog please Email me anandkumarreddy at gmail dot com I will remove it. The contents of this blog are meant for educational purpose and not for commercial use. If you use any content give due credit to the original author.

This site uses cookies from Google to deliver its services, to personalise ads and to analyse traffic. Information about your use of this site is shared with Google. By using this site, you agree to its use of cookies.

  © Blogger templates Newspaper III by Ourblogtemplates.com 2008

Back to TOP