Items in AFP with MESH term: Aged
Diagnosis of Urinary Incontinence - Article
ABSTRACT: Urinary incontinence is common, increases in prevalence with age, and affects quality of life for men and women. The initial evaluation occurs in the family physician’s office and generally does not require urologic or gynecologic evaluation. The basic workup is aimed at identifying possible reversible causes. If no reversible cause is identified, then the incontinence is considered chronic. The next step is to determine the type of incontinence (urge, stress, overflow, mixed, or functional) and the urgency with which it should be treated. These determinations are made using a patient questionnaire, such as the 3 Incontinence Questions, an assessment of other medical problems that may contribute to incontinence, a discussion of the effect of symptoms on the patient’s quality of life, a review of the patient’s completed voiding diary, a physical examination, and, if stress incontinence is suspected, a cough stress test. Other components of the evaluation include laboratory tests and measurement of postvoid residual urine volume. If the type of urinary incontinence is still not clear, or if red flags such as hematuria, obstructive symptoms, or recurrent urinary tract infections are present, referral to a urologist or urogynecologist should be considered.
ABSTRACT: Iron deficiency is the most common nutritional disorder worldwide and accounts for approximately one-half of anemia cases. The diagnosis of iron deficiency anemia is confirmed by the findings of low iron stores and a hemoglobin level two standard deviations below normal. Women should be screened during pregnancy, and children screened at one year of age. Supplemental iron may be given initially, followed by further workup if the patient is not responsive to therapy. Men and postmenopausal women should not be screened, but should be evaluated with gastrointestinal endoscopy if diagnosed with iron deficiency anemia. The underlying cause should be treated, and oral iron therapy can be initiated to replenish iron stores. Parenteral therapy may be used in patients who cannot tolerate or absorb oral preparations.
ABSTRACT: Adverse drug events occur in 15 percent or more of older patients presenting to offices, hospitals, and extended care facilities. These events are potentially preventable up to 50 percent of the time. Common serious manifestations include falls, orthostatic hypotension, heart failure, and delirium. The most common causes of death are gastrointestinal or intracranial bleeding and renal failure. Antithrombotic and antidiabetic medications, diuretics, and nonsteroidal anti-inflammatory drugs cause most of the preventable hospital admissions due to adverse drug events. Strategies to reduce the risk of adverse drug events include discontinuing medications, prescribing new medications sparingly, reducing the number of prescribers, and frequently reconciling medications. The Beers, STOPP (screening tool of older persons’ potentially inappropriate prescriptions), and START (screening tool to alert doctors to right treatment) criteria can help identify medications causing adverse drug events. Not all potentially inappropriate medications can be avoided. Clinicians should involve patients in shared decision making and individualize prescribing decisions based on medical, functional, and social conditions; quality of life; and prognosis.
Screening for Hearing Loss in Older Adults - Putting Prevention into Practice
Diabetes: Treating Hypertension - Clinical Evidence Handbook
Nodule Arising in a Surgical Scar - Photo Quiz
Appropriate Use of Polypharmacy for Older Patients - Cochrane for Clinicians
Complex Care: Treating an Older Patient with Multiple Comorbidities - Curbside Consultation
ACOG Releases Practice Bulletin on Osteoporosis - Practice Guidelines