RESUMO
Diabetes, a disease commonly seen in the young, is more frequently seen in the geriatric age group (older than 65 years of age). This frequency has been estimated at 30 to 50 percent, although because of underdiagnosis, reported cases have approximately a 20 percent occurrence, the majority of which is Type II or non-insulin-dependent diabetes (NIDDM). Although the presentation in older adults is similar to that in younger patients, there are considerations for both evaluation and therapy that are unique to the geriatric patient.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Gerenciamento Clínico , Avaliação Geriátrica , Resultado do Tratamento , Idoso , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/dietoterapia , Humanos , Monitorização Fisiológica , Fatores de Risco , Estados UnidosRESUMO
This Grand Rounds will review the problem of alcoholism and prescription drug abuse in the elderly. Several case vignettes will be presented. The pharmacology of alcohol and potentially addictive prescription medications will be reviewed. The clinical presentation of and psychiatric symptoms associated with these disorders will be discussed. The process of addiction and issues regarding the clinical evaluation of the elderly addict will be discussed. The medical complications of these disorders will be reviewed, followed by a discussion of guidelines for the appropriate use of these drugs in the elderly. The grand rounds will conclude with a discussion of the treatment of patients with these disorders.
Assuntos
Alcoolismo/epidemiologia , Prescrições de Medicamentos , Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/complicações , Alcoolismo/terapia , Protocolos Clínicos/normas , Comorbidade , Sinergismo Farmacológico , Feminino , Avaliação Geriátrica , Geriatria/normas , Humanos , Masculino , Programas de Rastreamento , Transtornos Mentais/complicações , Transtornos Mentais/terapia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
We have seen that UGI bleeding is a serious and apparently growing problem for seniors. Of special concern in the older patient are the frequency with which serious peptic disease presents silently, the limitation frequently imposed on adequate pain relief from NSAIDs, and the higher complication rates from most of the causes of UGI bleeding. Care of the elderly would be enhanced by research focused on defining those older patients most at risk of experiencing NSAID-induced peptic complications, improved methods for preventing or treating NSAID-induced ulceration that are well tolerated and cost-effective, and better regimens for preventing the recurrence of ulcers and UGI bleeding in these patients. In regard to the last, future investigation of the role of H. pylori, methods for successfully eliminating the organism, and the effect of eradication on patients' subsequent course may be particularly helpful.
