Cognitive Screening Mini – Mental Status Exam – MMSE Montreal Cognitive Assessment – MOCA St Louis University Mental Scale – SLUMS Mood screening: Geriatric Depression.ScaleIADL: Instrumental Activities Of Daily Living Diagnosing Dementia: Rule out delirium and drug-related causes. Other causes: vitamin B12 deficiency, hypothyroidism, depression, NPH, opioids, sedative-hypnotics, antidepressants, anticholinergics, antiparkinson’s drugs Treatment: Initiate a cholinesterase inhibitor in […]
Geriatrics
Osteoporosis
All women over 65 and men over 70 should have bone mineral density (BMD) testing. If fractures or risks, test sooner. Initiate therapy if: Hip or spine fracture and BMD T-score -2.5 or below at hip, spine or femoral neck T-score is between -1.0 and -2.5 at femoral neck or spine and the 10-year probability of […]
Urinary Incontinence
Causes (DRIP): Drugs, delirium Retention, Restricted mobility Impaction, infection, inflammation Polyuria, prostatitis Treatment: Urge: Anti-muscarinic and anticholinergic: oxybutynin, tolterodine, fesoterodine, trospium, solifenacin, darifenacin B-agonist: mirabegron Stress: alpha-adrenergic agonists: pseudoephedrine, phenylephrine topical estrogens if other signs of estrogen deficiency SSRI/SNRI: only duloxetine Overflow: alpha-adrenergic agonists: alfuzosin, tamsulosin 5-alpha-reductase inhibitors: finasteride, dutasteride Parasympathomimetic: bethanechol Phosphodiesterase inhibitor: tadalafil BPH: Meds that […]
Glaucoma
Angle-closure is a medical emergency: 1 drop of timolol, apraclonidine, pilocarpine stat until ophthalmologist. Open-angle: brinzolamide, dorzolamide (carbonic anhydrase inihibitors) or latanoprost: prostaglandin
Arthritis
Osteoarthritis:Risk factors: age, female sex, obesity, genetics, sports, occupation, injury, acromegaly and other illnesses.Treatment: Lifestyle: weight loss, exercise, PT and surgery Drugs: APAP up to 3g daily NSAIDS if APAP not working. Take ASA at least 30 minutes before NSAID if on ASA. Topical agents, especially for the knee (capsaicin, diclofenac 1% gel) Intraarticular glucocorticoid […]