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By: John Hunter Peel Alexander, MD
https://medicine.duke.edu/faculty/john-hunter-peel-alexander-md
Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults buy vega extra cobra 120mg free shipping. Potentially inappropriate treatment of urinary tract infections in two Rhode Island nursing homes. Postural instability and consequent falls and hip fractures associated with use of hypnotics in the elderly: a comparative review. Risk of fractures requiring hospitalization after an initial prescription for zolpidem, alprazolam, lorazepam, or diazepam in older adults. Inpatient pharmacological sleep aid utilization is common at a tertiary medical center. Diagnostic value of history in patients with syncope with or without heart disease. Diagnostic yield and utility of neurovascular ultrasonography in the evaluation of patients with syncope. Standardized approaches to the investigation of syncope: Canadian Cardiovascular Society position paper. Guidelines for the prevention, diagnosis and management of delirium in older people in hospital [Internet]. Computerized tomography of the brain for elderly patients presenting to the emergency department with acute confusion. Clinical yield of computed tomography brain scans in older general medical patients. Diagnostic yield of head computed tomography for the hospitalized medical patient with delirium. Polypharmacy, often defned as taking fve or more medications at the same time, has been associated with a variety of adverse health outcomes. Therapy with a medication is initiated when the patient and care team conclude that the benefts of taking the medication outweigh the risks of not starting therapy. However, over time, patients and their conditions or goals of care change, new evidence is discovered, and other factors can tip the balance, such that the benefts no longer outweigh the risks or burdens of continued treatment. Patients and caregivers should be made aware of the planned duration of therapy and the outcomes desired, and should feel empowered to follow up with providers to ensure that the benefts of therapy continue to outweigh the risks. The performance of medication reconciliation and transitions of care—such as admission to or discharge from a hospital—may serve as critical activities for deciding whether to continue therapy or create a plan to safely stop a medication. Don’t use a medication for long-term risk reduction if life expectancy is shorter than the 2 time to beneft of the medication. The “time to beneft” is the period between initiation of an intervention (in this case, a medication) and the point when the patient begins to experience a beneft.
Children who are abusive tend to 120 mg vega extra cobra with mastercard be dependent on their parents for financial, housing, and emotional support. Substance use, mental illness, and chronic unemployment increase dependency on parents, which can then increase the possibility of elder abuse. Prosecuting a family member who has financially abused a parent is very difficult. The victim may be reluctant to press charges and the court dockets are often very full resulting in long waits before a case is heard. According to Tanne, family members abandoning older family members with severe disabilities in emergency rooms is a growing problem as an estimated 100,000 are dumped each year (as cited in Berk, 2007). Paid caregivers and professionals trusted to make decisions on behalf of an elder, such as guardians and lawyers, also perpetuate abuse. When elders feel they have social support and are engaged with others, they are less likely to suffer abuse. Substance Abuse and the Elderly Alcohol and drug problems, particularly prescription drug abuse, have become a serious health concern among older adults. Although people 65 years of age and older make up only 13% of the population, they account for almost 30% of all medications prescribed in the United States. Benzodiazepines, a type of tranquilizing drug, are the most commonly misused and abused prescription medications. Risk factors for psychoactive substance abuse in older adults include social isolation, which can lead to depression (Youdin, 2016). This can be caused by the death of a spouse/partner, family members and/or friends, retirement, moving, and reduced activity levels. Additionally, medical conditions, chronic pain, anxiety, and stress can all lead to the abuse of substances. For example, compared to adolescents and younger adults, older adults are not looking to get high, but rather become dependent by accident. Additionally, stereotypes of older adults, which include memory deficits, confusion, depression, agitation, motor problems, and hostility, can result in a diagnosis of cognitive impairment instead 423 of a substance use disorder. Further, a diagnosis of a substance use disorder involves impairment in work, school, or home obligations, and because older adults are not typically working, in school or caring for children, these impairments would not be exhibited. Stigma and shame about use, as well as the belief that one’s use is a private matter, may keep older adults from seeking assistance. Siriwardena, Qureshi, Gibson, Collier, and Lathamn (2006) found that family physicians prescribe benzodiazepines and opioids to older adults to deal with psychosocial and pain problems rather than prescribe alternatives to medication such as therapy. Those in late adulthood are also more sensitive to the effects of alcohol than those younger because of Source an age-related decrease in the ratio between lean body mass and fat (Erber & Szuchman, 2015). Additionally, “liver enzymes that metabolize alcohol become less efficient with age and central nervous system sensitivity to drugs increase with age” (p. Those in late adulthood are also more likely to be taking other medications, and this can result in unpredictable interactions with the psychoactive substances (Youdin, 2016). Cannabis Use: Blazer and Wu (2009) found that adults aged 50-64 were more likely to use cannabis than older adults.
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