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1.
J Prim Care Community Health ; 14: 21501319231205979, 2023.
Article in English | MEDLINE | ID: mdl-37933569

ABSTRACT

BACKGROUND: Patients with lesions suspicious for skin cancer often present to primary care physicians (PCPs), who may have limited training in skin cancer diagnosis. OBJECTIVE: To measure the impact of an adjunctive handheld device for PCPs that employs elastic scattering spectroscopy (ESS) on the diagnosis and management of skin cancer. METHODS: Fifty-seven PCPs evaluated 50 clinical images of skin lesions (25 malignant and 25 benign), first without and then with knowledge of the handheld ESS device output, and in each case indicated if a lesion was likely to be benign or malignant. RESULTS: The diagnostic sensitivity of the PCPs with and without the use of the ESS device was 88% (95% CI, 84%-92%) and 67% (95% CI, 62%-72%), respectively (P < .0001). In contrast, no significant difference was observed in the diagnostic specificity. The management sensitivity of the physicians with and without the use of the ESS device was 94% (95% CI, 91%-96%) and 81% (95% CI, 77%-85%), respectively (P = .0009). Similarly, no significant difference was observed in the management specificity. CONCLUSION: The use of the ESS device may have the potential to help improve skin cancer diagnosis and confidence in management decision-making in a primary care setting.


Subject(s)
Melanoma , Physicians, Primary Care , Skin Neoplasms , Humans , Melanoma/diagnosis , Melanoma/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Spectrum Analysis , Artificial Intelligence
2.
J Am Geriatr Soc ; 70(10): 2786-2792, 2022 10.
Article in English | MEDLINE | ID: mdl-35978538

ABSTRACT

Medicare annual wellness visits (AWV) were initiated 10 years ago. Though AWVs emphasize on disease prevention and health promotion for older adults was a huge step forward, the current "one size fits all" approach does not adequately meet the wellness needs of a diverse population of older adults. Current AWVs do not sufficiently take into consideration the medical, psychological, functional, racial, cultural and socio-economic diversity of older adults. Updated AWVs should be tailored to meet the needs and priorities of older adults receiving them. Several geriatrics approaches to care, including geriatrics Glidepaths and the 4Ms of an Age-Friendly Health System, could help develop and guide a more patient-specific geriatrics focused approach to AWVs. Medicare's IPPE is an ideal time to advise new Medicare beneficiaries regarding what they should and should not do to maximize their ability to be healthy and functionally independent into their 80s, 90s, and 100s.


Subject(s)
Health Promotion , Medicare , Aged , Humans , Racial Groups , United States
3.
J Geriatr Cardiol ; 19(1): 1-8, 2022 Jan 28.
Article in English | MEDLINE | ID: mdl-35233218

ABSTRACT

Cancer and atrial fibrillation (AF) are common co-morbid conditions in older adults. Both cancer and cancer treatment increase the risk of developing new AF which increases morbidity and mortality. Heart rate and rhythm control along with anticoagulation therapy remain the mainstay of treatment of AF in older adults with both cancer and AF. Adjustments to the treatment may be necessary because of drug interactions with concurrent chemotherapy. Cancer and old age increase the risk of both, thromboembolism and bleeding. The risk of these complications is further enhanced by concomitant cancer therapy, frailty, poor nutrition status and, coexisting geriatric syndromes. Therefore, careful attention needs to be given to the risks and benefits of using anticoagulant medications. This review focuses on the management of AF in older patients with cancer, including at the end-of-life care.

4.
Complement Ther Med ; 59: 102731, 2021 Jun.
Article in English | MEDLINE | ID: mdl-33989797

ABSTRACT

OBJECTIVES: We compared the health benefits of two different Tai Chi interventions tailored for improving blood pressure (BP) (PRESSURE) or balance (BALANCE). DESIGN: randomized controlled trial. SETTING: Community dwelling older adults (≥60yr) practiced Tai Chi at the fitness center of a continuous care community. INTERVENTIONS: We tailored PRESSURE to emphasize breathing techniques and mental relaxation and BALANCE to emphasize movement principles that challenged balance. Subjects were randomized to PRESSURE (n = 12), BALANCE (n = 13), or CONTROL (n = 10). Tai Chi was practiced 3 sessions/wk, 60 min/session for 12 wk. CONTROL performed normal daily activities. MAIN OUTCOME MEASURES: We compared the change in cardiometabolic health, balance, and functional fitness between groups with ANCOVA using baseline values, age, and body mass index as covariates. RESULTS: Subjects were physically active, Tai Chi naive (97.1 %), white, mostly female (82.9 %), and older (78.9 ± 5.7 yr) with resting systolic BP (SBP) of 126.5 ± 14.4 mmHg and diastolic BP of 69.3 ± 8.4 mmHg. PRESSURE significantly improved Chair Sit-to-Stand Test (CSTS) (1.0 ± 1.8 vs.-0.6 ± 0.8times/30s,p = 0.03) versus CONTROL, and gait speed (12.8±43.3 vs.-24.1±22.4cm/sec, p = 0.02) versus BALANCE. Meanwhile, BALANCE significantly improved Single Leg Stance Test (5.4±18.0 vs.-8.2±10.3 s, p = 0.049) and CSTS (1.0±1.7 vs.-0.6±0.8times/30s, p = 0.03), and tended to lower SBP (-4.2±16.0 vs. 3.5±8.3mmHg, p = 0.052) versus CONTROL. CONCLUSION: Within 3 months, Tai Chi improved several health outcomes independent of the type of practice among physically active, Tai Chi naive older adults. Therefore, healthcare and exercise professionals may recommend Tai Chi to physically active older adults without specifying the type of practice.


Subject(s)
Tai Ji , Aged , Exercise , Exercise Therapy , Female , Humans , Male , Outcome Assessment, Health Care , Postural Balance
5.
BMJ Case Rep ; 14(4)2021 Apr 01.
Article in English | MEDLINE | ID: mdl-33795283

ABSTRACT

A 59-year-old woman presented to the emergency department with shortness of breath. She had significant oropharyngeal swelling obstructing her upper respiratory tract. A diagnosis of laryngeal myxoedema was made, which was attributed to severe hypothyroidism. She required invasive ventilation and subsequently a tracheostomy. She was treated with levothyroxine and hydrocortisone. She completely recovered with this therapy. In this review, we will discuss similar cases and different therapeutic options. This case also highlights the fact that establishing a diagnosis of laryngeal myxoedema, a condition that can potentially have lethal outcomes and can be challenging.


Subject(s)
Hypothyroidism , Larynx , Myxedema , Female , Humans , Hypothyroidism/complications , Hypothyroidism/drug therapy , Larynx/diagnostic imaging , Middle Aged , Myxedema/complications , Myxedema/diagnosis , Myxedema/drug therapy , Thyroxine/therapeutic use , Tracheostomy
6.
J Am Geriatr Soc ; 69(5): 1388-1398, 2021 05.
Article in English | MEDLINE | ID: mdl-33624287

ABSTRACT

Osteoporosis and sarcopenia are common in older adults. Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Bone fractures can result in changes in posture, pain, the need for surgical repair and functional impairment. Sarcopenia is the progressive and generalized loss of skeletal muscle mass, strength and/or physical performance. Older adults with sarcopenia experience increased risk of frailty, disability, hospitalizations, mortality, and a reduced quality of life. In this narrative review we provide guidance regarding the prevention of both osteoporosis and sarcopenia, including interventions that prevent both conditions from occurring, recommended screening and treatment to prevent progression.


Subject(s)
Osteoporosis/prevention & control , Sarcopenia/prevention & control , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged
7.
J Am Geriatr Soc ; 69(5): 1272-1282, 2021 05.
Article in English | MEDLINE | ID: mdl-33598936

ABSTRACT

OBJECTIVES: To examine age-related trajectories of cardiovascular risk and use of aspirin and statin among U.S. adults aged 50 or older. DESIGN: Repeated cross-sectional study using data from 2011 to 2018 National Health and Nutrition Examination Surveys. SETTING: Nationally representative health interview survey in the United States. PARTICIPANTS: Non-institutionalized adults aged 50 years and older (n = 11,392 unweighted). MEASUREMENTS: Primary prevention was defined as the prevention of a first cardiovascular event including coronary heart disease, angina/angina pectoris, heart attack, or stroke, whereas secondary prevention was defined as those with a history of these clinical conditions. Medication use was determined by self-report; aspirin use included dose and frequency, and statin use included generic names, days of prescription fills, and indications. We examined linear trends between age and each medication use, after controlling for period, sex, and race/ethnicity. RESULTS: Prevalence of those eligible for primary prevention treatment increased with age from 31.8% in ages 50-54 to 52.0% in ages ≥75 (p < 0.001). Similarly, those eligible for secondary prevention treatment increased with age from 2.7% in ages 50-54 to 21.1% in ages ≥75 (p < 0.001). Low-dose daily aspirin use increased with age (p < 0.001), and 45.3% of adults aged ≥75 took low-dose aspirin daily for primary prevention. Statin use also increased with age (p < 0.001), and 56.4% of adults aged ≥75 had long-term statin use for secondary prevention. CONCLUSION: While adults aged ≥75 do not benefit from the use of aspirin to prevent the first CVD, many continue to take aspirin on a regular basis. In spite of the clear benefit of statin use to prevent a subsequent CVD event, many older adults in this risk category are not taking a statin. Further education and guidance for both healthcare providers and older adults regarding the appropriate use of aspirin and statins to prevent CVD is needed.


Subject(s)
Age Factors , Aspirin/therapeutic use , Cardiovascular Diseases/prevention & control , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Primary Prevention/statistics & numerical data , Secondary Prevention/statistics & numerical data , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Heart Disease Risk Factors , Humans , Male , Middle Aged , Nutrition Surveys , Prevalence , United States/epidemiology
8.
J Am Geriatr Soc ; 69(3): 572-580, 2021 03.
Article in English | MEDLINE | ID: mdl-33470421

ABSTRACT

Older adults have been markedly impacted by the coronavirus disease 19 (COVID-19) pandemic. The American Geriatrics Society previously published a White Paper on Healthy Aging in 2018 that focused on a number of domains that are core to healthy aging in older adults: health promotion, injury prevention, and managing chronic conditions; cognitive health; physical health; mental health; and social health. The potentially devastating consequences of COVID-19 on health promotion are recognized. The purpose of this article is multifold. First, members of the Healthy Aging Special Interest Group will present the significant difficulties and obstacles faced by older adults during this unprecedented time. Second, we provide guidance to practicing geriatrics healthcare professionals overseeing the care of older adults. We provide a framework for clinical evaluation and screening related to the five aforementioned domains that uniquely impact older adults. Last, we provide strategies that could enhance healthy aging in the era of COVID-19.


Subject(s)
COVID-19 , Geriatric Assessment/methods , Geriatrics/methods , Health Promotion/methods , Healthy Aging , Aged , Aged, 80 and over , Female , Humans , Male , SARS-CoV-2
9.
J Am Geriatr Soc ; 68(10): 2399-2406, 2020 10.
Article in English | MEDLINE | ID: mdl-32880888

ABSTRACT

The incidence of most cancers increases with age. Cancer is the second most common cause of death in older adults after cardiovascular disease. Many common cancers in older adults can be prevented from occurring or can be identified at an early stage and treated effectively. The prevention and identification of cancer in its early stages, in an attempt to reduce discomfort and disability associated with advanced cancer and cancer treatment, is also a priority. Overscreening for cancer in older adults can lead to unnecessary diagnostic testing and unnecessary treatment. Both older adults and their healthcare providers need guidance on the appropriate use of cancer prevention and screening interventions. This first of a two-part review addresses special considerations regarding cancer prevention for adults aged 65 and older. Screening decisions and the impact of limited life expectancy and an older adult's ability to tolerate cancer treatment are also addressed. Guidance is provided regarding the prevention and early identification of lung, colorectal, bladder, and kidney cancer in older adults. The prevention of breast, prostate, and female urogenital cancers are addressed in Part 2. J Am Geriatr Soc 68:2399-2406, 2020.


Subject(s)
Colorectal Neoplasms/prevention & control , Early Detection of Cancer , Kidney Neoplasms/prevention & control , Lung Neoplasms/prevention & control , Urinary Bladder Neoplasms/prevention & control , Aged , Aged, 80 and over , Female , Humans , Male , Practice Guidelines as Topic
10.
J Am Geriatr Soc ; 68(11): 2684-2691, 2020 11.
Article in English | MEDLINE | ID: mdl-32880894

ABSTRACT

The incidence of most cancers increase with age. Cancer is the second most common cause of death in older adults after cardiovascular disease. Many common cancers in older adults can be prevented from occurring or can be identified at an early stage and treated effectively. Although cancer is feared primarily because of premature mortality, for many older adults, preventing and identifying cancer in its early stages, in an attempt to reduce discomfort and disability associated with advanced cancer and cancer treatment, is also a priority. Overscreening for cancer in older adults can lead to unnecessary diagnostic testing and unnecessary treatment. Both older adults and their healthcare providers need guidance on the appropriate use of cancer prevention and screening interventions. This is the second part of a two-part clinical review on cancer prevention and screening for adults aged 65 and older. Guidance is provided regarding the prevention and early identification of breast, prostate, cervical, ovarian, and endometrial cancer. The prevention of lung, colorectal, bladder, and kidney cancer is addressed in Part 1.


Subject(s)
Early Detection of Cancer/methods , Genital Neoplasms, Female/diagnosis , Genital Neoplasms, Female/prevention & control , Mass Screening/methods , Aged , Breast Neoplasms/epidemiology , Breast Neoplasms/prevention & control , Early Detection of Cancer/adverse effects , Female , Genital Neoplasms, Female/epidemiology , Humans , Incidence , Male , Mass Screening/adverse effects , Medical Overuse , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/prevention & control , Risk Factors , SEER Program/statistics & numerical data , United States/epidemiology
11.
J Am Geriatr Soc ; 68(5): 1098-1106, 2020 05.
Article in English | MEDLINE | ID: mdl-32031247

ABSTRACT

Cardiovascular disease (CVD) is common in older adults. CVD is a significant cause of both death and disability in old age. Though the prevention and treatment of CVD have been extensively studied, historically older adults and especially those older than 75 years have been underrepresented in clinical investigations designed to determine the best way to prevent or treat CVD. As a result, geriatrics clinicians frequently need to decide which interventions to recommend for their patients by extrapolation from existing data, which may or may not be applicable to the patients they are caring for. This narrative review summarizes existing data regarding the prevention of three common CVDs in older adults: stroke, coronary artery disease, and peripheral artery disease. Special emphasis is given to the prevention of CVD in those aged 75 years or older. J Am Geriatr Soc 68:1098-1106, 2020.


Subject(s)
Coronary Artery Disease/prevention & control , Peripheral Arterial Disease/prevention & control , Stroke/prevention & control , Aged , Geriatrics/education , Humans , Risk Factors , Smoking Cessation
12.
J Am Geriatr Soc ; 68(2): 411-416, 2020 02.
Article in English | MEDLINE | ID: mdl-31479533

ABSTRACT

The oral cavity is exposed to the external environment and from a very young age is colonized by infectious agents. Under certain circumstances including poor oral hygiene, dry mouth, trauma, and the use of antibiotics, oral infections can occur. They can result in damage to the oral cavity including teeth and their support structures. Oral infections can also lead to the extension of infection into surrounding tissues and to systemic infections. Chronic oral infection is a recognized risk factor for heart disease. Older adults are at high risk for oral infections and associated complications. Tooth loss, for which infection is the most significant cause, leads to cosmetic changes and a decreased ability to masticate certain foods that can lead to malnutrition. Chronic oral infections and the manipulation of teeth and supporting structures can lead to the hematogenous spread of infection including the infection of artificial joints and endocardial implants. Good oral hygiene, the use of fluoride, regular dental care, and the appropriate use of antibiotics can all reduce oral infections and their associated complications. J Am Geriatr Soc 68:411-416, 2020.


Subject(s)
Coinfection/prevention & control , Geriatric Dentistry/methods , Oral Health/standards , Oral Hygiene/methods , Aged , Antibiotic Prophylaxis/methods , Dental Caries/complications , Dental Caries/prevention & control , Diabetes Complications/prevention & control , Humans , Periodontal Diseases/complications , Periodontal Diseases/prevention & control
13.
J Am Geriatr Soc ; 68(1): 207-214, 2020 01.
Article in English | MEDLINE | ID: mdl-31613000

ABSTRACT

All living beings are at risk for experiencing infections; humans are no exception. The prestige and credibility of modern medicine is built in large part on achievements in preventing and treating infectious diseases. For most of human history, there was little that could be done to prevent and treat infections. Millions of humans, of all ages, have died from infections; and in some parts of the world, infection-related deaths remain common. Advances in preventing and treating infectious diseases include improved sanitization, sterilization, pasteurization, immunization, and antibiotics. Vaccination has played a major role in the prevention of lethal diseases, such as smallpox, diphtheria, cholera, and influenza. Because of developing or waning immune function, the young and the old are at particularly high risk of experiencing infections. Influenza and pneumonia remain common causes of death in older adults. Influenza, in particular, has the potential to result in premature mortality for all age groups, including those who are older and particularly those who live in congregate settings. Vaccination is important in promoting healthy aging. J Am Geriatr Soc 68:207-214, 2019.


Subject(s)
Healthy Aging , Influenza Vaccines/administration & dosage , Influenza, Human/prevention & control , Vaccination , Humans , Influenza, Human/immunology
16.
J Am Geriatr Soc ; 67(1): 17-20, 2019 01.
Article in English | MEDLINE | ID: mdl-30382585

ABSTRACT

In July 2015, the Journal of the American Geriatrics Society published a manuscript titled, "Failing to Focus on Healthy Aging: A Frailty of Our Discipline?" In response, the American Geriatrics Society (AGS) Clinical Practice and Models of Care Committee and Public Education Committee developed a white paper calling on the AGS and its members to play a more active role in promoting healthy aging. The executive summary presented here summarizes the recommendations from that white paper. The full version is published online at GeriatricsCareOnline.org. Life expectancy has increased dramatically over the last century. Longer life provides opportunity for personal fulfillment and contributions to community but is often associated with illness, discomfort, disability, and dependency at the end of life. Geriatrics has focused on optimizing function and quality of life as we age and reducing morbidity and frailty, but there is evidence of earlier onset of chronic disease that is likely to affect the health of future generations of older adults. The AGS is committed to promoting the health, independence, and engagement of all older adults as they age. Geriatrics as an interprofessional specialty is well positioned to promote healthy aging. We draw from decades of accumulated knowledge, skills, and experience in areas that are central to geriatric medicine, including expertise in complexity and the biopsychosocial model; attention to function and quality of life; the ability to provide culturally competent, person-centered care; the ability to assess people's preferences and values; and understanding the importance of systems in optimizing outcomes. J Am Geriatr Soc 67:17-20, 2019.


Subject(s)
Geriatrics/standards , Health Promotion/standards , Healthy Aging , Aged , Aged, 80 and over , Female , Humans , Male , Societies, Medical , United States
17.
Conn Med ; 77(5): 275-9, 2013 May.
Article in English | MEDLINE | ID: mdl-23777039

ABSTRACT

Laws pertain to almost every aspect of our lives. How a law applies to a person or one situation is dependent on many variables. One important variable is the capacity of a person to understand the ramifications of their actions. One of the most common reasons for permanent loss of decisional capacity is the development of dementia. Dementia is primarily a disease of old age. As the population of Connecticut ages and the prevalence of dementiaincreases, physicians will be presented with an increasing number of difficult decisions, where the interface between the law and medical practice will have an impact on their approach to the patient and their medical care. Familiarity with pertaining Connecticut laws and the appropriate procedures to follow as outlined by those laws will help physicians address these complex issues.


Subject(s)
Dementia , Legislation, Medical , Mental Competency/legislation & jurisprudence , Advance Directives/legislation & jurisprudence , Connecticut , Humans , Legal Guardians/legislation & jurisprudence
18.
Explore (NY) ; 5(2): 121-3, 2009.
Article in English | MEDLINE | ID: mdl-19272586

ABSTRACT

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr Sierpina at vssierpi@utmb.edu or Dr Kreitzer at kreit003@umn.edu. Submissions should be no more than 500 to 1,500 words. Please include any Web site or other resource that is relevant, as well as contact information.


Subject(s)
Clinical Competence/standards , Complementary Therapies/education , Education, Medical/organization & administration , Mind-Body Relations, Metaphysical , Schools, Medical/organization & administration , Alberta , Curriculum/standards , Diffusion of Innovation , Holistic Health , Humans , Interdisciplinary Communication , Organizational Innovation , Universities/organization & administration
19.
Biopsychosoc Med ; 2: 6, 2008 Feb 21.
Article in English | MEDLINE | ID: mdl-18291028

ABSTRACT

The purpose of this paper is to provide primary care physicians and medical specialists with an experiential psychosomatic framework for understanding patients with body distress symptoms. The framework relies on somatic awareness, a normal part of consciousness, to resolve the dualism inherent in conventional multidisciplinary approaches. Somatic awareness represents a guiding healing heuristic which acknowledges the validity of the patient's physical symptoms and uses body sensations to identify the psychological, physiological, and social factors needed for symptom self-regulation. The experiential approach is based on psychobiologic concepts which include bodily distress disorder, central sensitization, dysfunctional breathing, and contextual nature of mood.

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