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General Internal Medicine

Geriatric Medicine   

Questions discussed in this category

In older adults with chronic mild hyponatremia (Na 128–132) attributed to SSRIs but good psychiatric response, do you tolerate persistent hyponatremia, reduce the dose, or switch agents? At what sodium level do you intervene?
1 Answer available
In adults ≥80 years with TSH 6–10 mIU/L and minimal symptoms, do you initiate levothyroxine, monitor, or avoid treatment entirely?
Does frailty change your threshold?
2 Answers available
What is your approach to the management of asymptomatic bacteriuria in an elderly patient without clear urinary symptoms but with cognitive changes and falls?
4 Answers available
What is your antipsychotic of choice and general titration regimen in the outpatient setting for a patient with dementia and behavioral disturbances (assuming reversible causes such as urinary retention, constipation, etc. have been addressed)?
3 Answers available
How would you approach the consideration of continuing or ceasing colonoscopy for colon cancer screening in a relatively fit man in his 80s without a history of polyps on prior colonoscopies?
1 Answer available
In older adults with mild cognitive impairment, do you ever prescribe cholinesterase inhibitors and/or memantine?
How do you counsel patients on this off-label use?
7 Answers available
Do you recommend vitamin K2 supplements in patients with osteoporosis?
1 Answer available
What is the role for checking uric acid levels in evaluation of SIADH in hospitalized older adults?
1 Answer available
When considering deprescribing antihypertensives in older patients, how do you approach prioritization of which antihypertensives to target first?
1 Answer available
How do you approach the choice of pharmacological therapy when treating insomnia in older adults in the outpatient setting with a high falling risk?
Are there any pearls re: which therapies that may be slightly safer vs to be strongly avoided?
1 Answer available
What is your approach to counseling severely frail older adults regarding their planning for invasive life-sustaining therapy?
2 Answers available
Should we be recommending a specific daily protein intake to prevent sarcopenia in geriatric patients, or do you find it more beneficial to focus on encouraging activity within their mobility limitations to preserve muscle mass?
1 Answer available
How are you incorporating the newer RCT data suggesting no mortality benefit to indefinite beta-blocker therapy for patients who are several years out from an MI with preserved LVEF and no angina or arrhythmia?
As per the REDUCE-AMI trial. Are you routinely de-prescribing, selectively stopping based on symptoms or risk profile, or still continuing by def...
1 Answer available
What practical next steps would you recommend once identifying loneliness in an older adult patient?
1 Answer available
How do you differentiate cognitive impairment from normal age-related cognitive decline?
Especially in the era of novel AD biomarkers (blood-based, CSF, PET scans), AD treatments, and new definitions of Alzheimer's (Alz Association 2025) -...
2 Answers available
How do you select between antipsychotics in the treatment of delirium refractory to nonpharmacological management in hospitalized older adults with dementia?
From a geriatrics harm-reduction standpoint, can we recommend any particulars regarding dosing or selection of therapies when used as a last resort?
2 Answers available
How do you counsel older adults regarding the use of melatonin (dose and timing) for sleep-related problems?
2 Answers available
How do you approach the management of older adult patients with dementia who repeatedly aspirate with oral intake but whose family/HCP may be unwilling to accept the aspiration risk associated with comfort eating?
Considering poor outcomes/lack of long-term benefit for NGT/PEG placement in this population.
2 Answers available
What strategies do you find helpful in advanced care planning with patients/families who are very "miracle" centered?
For example, prolonging life-sustaining measures as they "wait for a miracle" of an unrealistic outcome. 
2 Answers available
How soon after a fracture would it be safe to start anti-resorptive therapy?
3 Answers available
What are your thoughts about lion's mane supplementation to slow the decline or improve cognitive capacity for those at risk of dementia?
1 Answer available
How do you manage sleep disturbances in patients with Alzheimer’s disease without relying heavily on deliriogenic medications?
2 Answers available
Do you recommend starting a statin in patients above 75 years old with diabetes but no known ASCVD?
3 Answers available
How do you counsel older adults regarding the use, dosing, and safety of CBD-containing products for insomnia?
1 Answer available
How do you choose among SSRIs and dosing strategies for the management of behavioral and psychological symptoms of dementia?
What factors might drive decisions for different SSRIs and/or doses?
1 Answer available
Do you routinely adjust your interpretation of SLUMS and/or MOCA tests in patients depending on their level of education?
2 Answers available
What is your approach to bisphosphonate use in patients with advanced chronic kidney disease and osteoporosis?
3 Answers available
What are the best practices for optimizing transitions from hospital to skilled nursing facilities for older adult patients, with specific regard to adapting hospital medication regimens to the skilled nursing facility setting?
3 Answers available
What are some practical tips in distinguishing between metabolic bone disease due to chronic kidney disease and osteoporosis?
1 Answer available
What is your approach to the use of GLP-1 agonists in older adults with diabetes with or at risk of sarcopenia?
3 Answers available
Would you recommend a GLP-1 agonist as an option to reduce the risk of dementia in patients with a strong family history?
As studied in Tang H, Donahoo WT, DeKosky ST, et al. GLP-1RA and SGLT2i Medications for Type 2 Diabetes and Alzheimer Disease and Related De...
1 Answer available
For patients over 70 with elevated ASCVD risk but no prior cardiovascular events, do you ever recommend continuing or initiating low-dose aspirin?
Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication
1 Answer available
What is your systolic blood pressure target for patients over 80 with frailty and multiple comorbidities?
1 Answer available
How do you approach balancing the treatment of urinary incontinence with anticholinergic medications with the use of cholinesterase inhibitors in dementia?
1 Answer available
Do you consider using buspirone for the management of anxiety in older patients?
4 Answers available
What is your approach to deprescribing gabapentinoids so as to prevent withdrawal effects?
1 Answer available
How do you counsel patients who are concerned that discontinuation of certain chronic medications may actually perpetuate suffering at the end of life?
Do you ever continue medications such as rate-control agents for tachyarrhythmias, anticoagulation for blood clots, immunosuppression to prevent trans...
1 Answer available
For elderly patients (i.e. older than 80) with only one documented episode of paroxysmal atrial fibrillation following a stress event (such as acute illness/steroid administration) and a CHADsVASc score greater than 1, how would you counsel them on the risks/benefits of anticoagulation and subsequent monitoring for afib recurrence?
6 Answers available
What is the next best osteoporosis treatment option for patients who completed 2 years of teriparatide, but has contraindication to bisphosphosnate therapy (e.g. history of atypical femur fracture)?
1 Answer available
Is there any benefit in maintaining statin or aspirin therapy in patients >75 years old with stable, multivessel ischemic heart disease in light of challenges encountered with polypharmacy?
2 Answers available
Would you use a parathyroid hormone analog for treatment of osteoporosis in a patient with mildly elevated AlkPhos of unclear etiology?
1 Answer available
During treatment of severe osteoporosis with PTH analogs (abaloparatide), would a rise in alkaline phosphatase level >200 (in the setting of normal GGT) warrant discontinuation of medication?
There is concern for elevation in alkaline phosphatase as a precursor for bone pathology, such as an increase in risk of bone malignancy, potentially ...
1 Answer available
Does aspirin dose (81 mg vs 325 mg) matter for secondary stroke prevention?
Should some patients get 325 mg instead of 81mg at least for a certain amount of time, such as patients in the acute phase of ischemic stroke or patie...
1 Answer available
How would you approach the work up of SLE in a patient over 80 years old?
How would you work up an elderly female with persistent anemia secondary to warm AIHA requiring almost monthly transfusion, with positive ANA,dsDNA (b...
3 Answers available
What criteria are used to choose a specific dose of aspirin in ischemic stroke?
We have seen 81 vs 162 vs 325 mg up to 1300 mg.
3 Answers available
What duration of dual antiplatelet therapy do you use for secondary prevention of ischemic stroke due to intracranial atherosclerotic disease?
While some have the practice of 90 days per SAMMPRIS trial, the lower rates of ischemic stroke in the medical therapy group were driven by events with...
8 Answers available
Would you recommend PFO closure in patients >60 years old with presumed paradoxical embolism as their mechanism of stroke?
2 Answers available
How do you approach a mildly positive finding on an autoimmune encephalitis panel when there is no other evidence of encephalitis (such as elevated CSF protein, abnormal imaging, or EEG findings)?
For example, a GAD65 Ab of 0.07 when the cut-off is 0.02. Does this answer change if you consider adult vs pediatric populations?
2 Answers available


Papers discussed in this category

Neurology, 2015-09-29
Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE.
Stroke, 2017-08
Challenges in the Medical Management of Symptomatic Intracranial Stenosis in an Urban Setting.
Stroke, 2021 May 24
2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association.
Lancet (London, England), 2014-01-25
Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial.
Circulation, 2019-08-20
Time Course for Benefit and Risk of Clopidogrel and Aspirin After Acute Transient Ischemic Attack and Minor Ischemic Stroke.
Archives of neurology, 2009-06
Ganglionic acetylcholine receptor autoantibody: oncological, neurological, and serological accompaniments.
Muscle & nerve, 2013-04
Striational antibodies in a paraneoplastic context.
Muscle & nerve, 2016-08
P/Q- and N-type calcium-channel antibodies: Oncological, neurological, and serological accompaniments.
Muscle & nerve, 2017-07
GAD65 neurological autoimmunity.
Annals of neurology, 2017-07
Expanded phenotypes and outcomes among 256 LGI1/CASPR2-IgG-positive patients.
The New England journal of medicine, 2013-03-21
Closure of patent foramen ovale versus medical therapy after cryptogenic stroke.
Neurology, 2013-08-13
An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke.
The New England journal of medicine, 2017-09-14
Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke.
Circ Cardiovasc Interv, 2022 Jun 23
Transcatheter Closure of Patent Foramen Ovale in Older Patients With Cryptogenic Thromboembolic Events.
JAMA, 2021 Dec 14
Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke.
JAMA Neurol, 2020 Jul 01
Proposal for Updated Nomenclature and Classification of Potential Causative Mechanism in Patent Foramen Ovale-Associated Stroke.
JAMA Neurol, 2022 Nov 01
Association of Atrial Septal Aneurysm and Shunt Size With Stroke Recurrence and Benefit From Patent Foramen Ovale Closure.
Circulation, 2016-11-22
Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association.
JAMA, 2022 Apr 26
Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement.
Lancet (London, England), 2018-08-04
Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: analysis of individual patient data from randomised trials.
Lupus, 2024 Jan 16
Complement C4d as a biomarker for systemic lupus erythematosus and lupus nephritis.
Arthritis care & research, 2022 Feb 08
A 79-Year-Old Female Patient With Altered Mental Status and Anemia.
The journals of gerontology. Series A, Biological sciences and medical sciences, 2023 Jun 16
Nutritional Interventions: Dietary Protein Needs and Influences on Skeletal Muscle of Older Adults.
Mayo Clinic proceedings, 2000 Jan
The biology of aging.
Journal of the American Geriatrics Society, 2000 Jun
Epidemiology of sarcopenia.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2021 Feb 08
Safety of Oral Bisphosphonates in Moderate-to-Severe Chronic Kidney Disease: A Binational Cohort Analysis.
Current opinion in nephrology and hypertension, 2022 Jun 10
Clinical utility of bone turnover markers in patients with chronic kidney disease.
The Journal of clinical endocrinology and metabolism, 2022 Dec 17
Inpatient Zoledronic Acid and Integrated Orthopedic and Fracture Liaison Services Improve Osteoporosis Treatment Rates.
J Bone Miner Res, 2024 Aug 21
Zoledronic acid for hip fracture during initial hospitalization.
J Clin Endocrinol Metab, 2023 Oct 18
Safety of Inpatient Zoledronic Acid in the Immediate Postfracture Setting.
The Cochrane database of systematic reviews, 2018 Aug 23
Impact of medication reconciliation for improving transitions of care.
Journal of pain and symptom management, 2018-03
"They Need to Have an Understanding of Why They're Coming Here and What the Outcomes Might Be." Clinician Perspectives on Goals of Care for Patients Discharged From Hospitals to Skilled Nursing Facilities.
Journal of general internal medicine, 2023 Oct 02
Hospitalists Improving Transitions of Care Through Virtual Collaborative Rounding with Skilled Nursing Facilities-the HiToC SNF Study.
Annals of internal medicine, 2025 Sep 30
Trends in Dispensed Gabapentin Prescriptions in the United States, 2010 to 2024.
British journal of clinical pharmacology, 2023 Jun 13
Deprescribing interventions for gabapentinoids in adults: A scoping review.
Journal of the American Geriatrics Society, 2013 Sep
Gabapentin withdrawal: case report in an older adult and review of the literature.
The Cochrane database of systematic reviews, 2006-07-19
Azapirones for generalized anxiety disorder.
Psychiatry and clinical neurosciences, 2010 Feb 01
Randomized, single-blind, trial of sertraline and buspirone for treatment of elderly patients with generalized anxiety disorder.
Basic & clinical pharmacology & toxicology, 2023 Jun 20
Serotonin syndrome-A focused review.
Ochsner journal, 2013 Winter
Serotonin syndrome.
The American journal of psychiatry, 2016-05-01
Heterogeneity of Treatment Response to Citalopram for Patients With Alzheimer's Disease With Aggression or Agitation: The CitAD Randomized Clinical Trial.
The American journal of psychiatry, 2016-05-01
Effects of Citalopram on Neuropsychiatric Symptoms in Alzheimer's Dementia: Evidence From the CitAD Study.
JAMA, 2014 Feb 19
Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial.
Frontiers in aging neuroscience, 2023 Mar 03
Comparative efficacy and safety of antidepressant therapy for the agitation of dementia: A systematic review and network meta-analysis.
Journal of Alzheimer's disease : JAD, 2020
The Efficacy of Sertraline, Escitalopram, and Nicergoline in the Treatment of Depression and Apathy in Alzheimer's Disease: The Okayama Depression and Apathy Project (ODAP).
Journal of the American Geriatrics Society, 2025 Apr 28
Treatment of Inappropriate Sexual Behavior in Persons With Dementia: A Systematic Review.
Journal of the American Geriatrics Society, 2016 Mar 23
Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis.
The Cochrane database of systematic reviews, 2018 Jun 18
Antipsychotics for treatment of delirium in hospitalised non-ICU patients.
Diabetes research and clinical practice, 2021 Mar 08
GLP-1 receptor agonists and SGLT2 inhibitors for older people with type 2 diabetes: A systematic review and meta-analysis.
Journal of diabetes, 2025 Jun
Monitoring Sarcopenia With Incretin Receptor Activator Treatment.
JAMA, 2011-09-28
Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis.
Psychiatry research, 2020 Dec 13
The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An update on management of behavioral and psychological symptoms in dementia.
Drugs & aging, 2001
Hypertension in the Very Elderly Trial (HYVET): protocol for the main trial.
Circulation research, 2019 Mar 29
Hypertension Management in Older and Frail Older Patients.
The Cochrane database of systematic reviews, 2014-03-21
Pharmacotherapies for sleep disturbances in Alzheimer's disease.
Translational psychiatry, 2022 Apr 01
Sleep in Alzheimer's disease: a systematic review and meta-analysis of polysomnographic findings.
Journal of sleep research, 2020 Dec 02
Pharmacological and non-pharmacological interventions to enhance sleep in mild cognitive impairment and mild Alzheimer's disease: A systematic review.
Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society, 2016 Jan 27
Mirtazapine does not improve sleep disorders in Alzheimer's disease: results from a double-blind, placebo-controlled pilot study.
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 2022 Dec 01
Effects of quetiapine on sleep: A systematic review and meta-analysis of clinical trials.
CNS drugs, 2024 Aug 09
Effects of Trazodone on Sleep: A Systematic Review and Meta-analysis.
Journal of oncology practice, 2017-10
REMAP: A Framework for Goals of Care Conversations.
Journal of the American Geriatrics Society, 2019 Aug 20
Swallowing Disorders in the Older Population.
Handbook of clinical neurology, 2022
Prognostication in dementia.
Journal of the American Geriatrics Society, 2014 Jul 17
American Geriatrics Society feeding tubes in advanced dementia position statement.
JAMA, 2025 Aug 12
Eating and Swallowing Problems in People With Advanced Dementia.
BMC geriatrics, 2019 Feb 04
The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing - a systematic literature review.
BMC endocrine disorders, 2017 Feb 03
Study protocol; Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism - a randomised placebo controlled Trial (TRUST).
Nutrition (Burbank, Los Angeles County, Calif.), 2001-04
Japanese fermented soybean food as the major determinant of the large geographic difference in circulating levels of vitamin K2: possible implications for hip-fracture risk.
International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition, 2022 Aug 30
Role of vitamin K2 in bone-vascular crosstalk.
Frontiers in endocrinology, 2025 Nov 05
The effect of vitamin K2 supplementation on bone turnover biochemical markers in postmenopausal osteoporosis patients: a systematic review and meta-analysis.
Frontiers in public health, 2022 Aug 11
Efficacy of vitamin K2 in the prevention and treatment of postmenopausal osteoporosis: A systematic review and meta-analysis of randomized controlled trials.

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