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Geriatric Medicine

General Geriatric Medicine   

Questions discussed in this category

In an older adults with dementia-related behavioral symptoms refractory to nonpharmacological management in whom you are starting SSRI, do you ever consider a short course of antipsychotic medication to overlap with the initiation of SSRI while waiting for therapeutic effect?
And if so, how would you advise on choice of agent/dosing considerations?
1 Answer available
For older adults undergoing intermediate-risk non-cardiac surgery, do you routinely check pre-operative pro-BNP levels for risk stratification based on emerging data and updated Canadian guidelines?
Duceppe et al., PMID 27865641
1 Answer available
What are the clinical prompts that lead you to consider deprescribing bisphosphonate therapy in older adults with osteoporosis?
1 Answer available
How do you select an SSRI and dosing strategy for older adults newly being treated for depression?
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
In light of recent measles outbreaks in the US, would you recommend an MMR booster for immunocompetent patients born before 1957?
6 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
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
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
What is your clinical approach to deprescribing vs continuing low-dose aspirin used for primary prevention in older adults who are already taking this medication?
Are there any pearls for strong factors that would push you towards vs away from deprescribing?
1 Answer available
In outpatient primary care settings, would you recommend routinely checking Cystatin-C as a marker of renal function in older adults?
3 Answers available
Have you changed your approach to delaying hip surgery in the context of decompensated CHF given the findings of the HIP-ATTACK study?
HIP ATTACK Investigators, PMID 32050090 
1 Answer 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
How would you approach counseling an older patient with significant hearing loss and nonadherence to use of hearing aids?
1 Answer available
How do you approach the management of newly discovered prediabetes in adults over the age of 65?
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
Do you have any pearls for how to manage OSA with CPAP in older adults with cognitive impairment?
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
How do you approach decision-making around initiation of osteoporosis therapy in patients with advanced dementia?
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
What treatment options are there for uremic pruritus in an elderly patient with risk of sundowning?
How can treatments be combined or escalated?
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
How do you determine whether to continue anti-dementia medications (such as cholinesterase inhibitors) for patients with dementia when enrolling in hospice?
3 Answers available
Would you continue or stop anticoagulation for a DVT/PE in a patient with active cancer who has completed 6 months of therapy?
Mahé et al., PMID 40162636
3 Answers available
What patient factors are most important when considering who needs a broader workup for osteoporosis prior to starting therapy?
Do you routinely rule out secondary causes of osteoporosis (i.e., TSH) in all patients prior to starting therapy? If you work up all patients, what la...
1 Answer 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
What is your preferred approach to obtaining an objective measure of frailty on physical exam in a primary care practice setting?
For example, do you use Timed Up and Go? Chair stands? Other measures?
1 Answer 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 would you approach the management of asymptomatic ALT and GGT elevation in an older adult patient with depression with psychosis and without history of hepatitis who recently had dose of quetiapine increased and new initiation of SNRI?
1 Answer available
How do you approach the management of extremely low LDL levels in older adult patients receiving statin therapy for primary prevention of cardiovascular disease?
1 Answer available
How do you approach Vitamin D testing and supplementation in older adults following a fragility fracture?
1 Answer available
How would you recommend approaching screening for elder abuse in the primary care setting for older adults?
Are there any especially recommended screening instruments/resources?
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
What is your systolic blood pressure target for patients over 80 with frailty and multiple comorbidities?
1 Answer available
How do you approach individualizing A1c goals in patients with dementia?
2 Answers available
Do you consider using buspirone for the management of anxiety in older patients?
4 Answers available
What is your approach to determining eligibility for hospice in persons with Alzheimer's disease?
1 Answer available
When stopping denosumab and transitioning to PO bisphosphonate, do you wait for 6 months after the last denosumab injection to start PO bisphosphonate?
2 Answers available
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
6 Answers available
How do you counsel non-diabetic patients who wish to start metformin to reduce the risk of developing dementia?
2 Answers available
Do you recommend life long aspirin 81 mg daily for non-specific T2 white matter hyper-intensities on MRI brain?
7 Answers available


Papers discussed in this category

Journal of the Endocrine Society, 2022 Dec 02
Perioperative Evaluation and Management of Patients on Glucocorticoids.
Diagnostics (Basel, Switzerland), 2021 Apr 20
Glucocorticoid Withdrawal-An Overview on When and How to Diagnose Adrenal Insufficiency in Clinical Practice.
Lancet (London, England), 2015 Mar 12
A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial.
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.
The New England journal of medicine, 2025 Mar 29
Extended Reduced-Dose Apixaban for Cancer-Associated Venous Thromboembolism.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2018-02
A Systematic Review of Practice Guidelines and Recommendations for Discontinuation of Cholinesterase Inhibitors in Dementia.
JAMA internal medicine, 2025 May 01
Continued Use of Cholinesterase Inhibitors and Memantine in Hospice.
Alzheimer's & dementia (New York, N. Y.), 2022 Jan 31
CCCDTD5 recommendations on the deprescribing of cognitive enhancers in dementia.
The Medical journal of Australia, 2019 Feb 16
Deprescribing cholinesterase inhibitors and memantine in dementia: guideline summary.
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.
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.
The journal of nutrition, health & aging, 2008 May
Importance of vitamin D in hospital-based fracture care pathways.
The New England journal of medicine, 2022 Jul 28
Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults.
Metabolism open, 2024 Jul 16
Effect of vitamin D on risk of falls and fractures - The contribution of recent mega-trials.
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2021 May 20
How can the orthopedic surgeon ensure optimal vitamin D status in patients operated for an osteoporotic fracture?
Geriatric orthopaedic surgery & rehabilitation, 2011 May
Is supplementation of vitamin d beneficial for fracture healing? A short review of the literature.
JAMA, 2025 Dec 02
Discordance in Creatinine- and Cystatin C-Based eGFR and Clinical Outcomes: A Meta-Analysis.
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.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2025 Mar 09
Denosumab discontinuation in the clinic: implications of rebound bone turnover and emerging strategies to prevent bone loss and fractures.
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.
JAMA internal medicine, 2022 Jan 01
Time to Benefit of Bisphosphonate Therapy for the Prevention of Fractures Among Postmenopausal Women With Osteoporosis: A Meta-analysis of Randomized Clinical Trials.
Annals of internal medicine, 2023 Jan 03
Effectiveness and Safety of Treatments to Prevent Fractures in People With Low Bone Mass or Primary Osteoporosis: A Living Systematic Review and Network Meta-analysis for the American College of Physicians.
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.
Circulation, 2024 Sep 24
2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Lancet (London, England), 2020 Feb 09
Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial.
The Journal of bone and joint surgery. American volume, 2024 Jul 25
Myocardial Injury in Patients with Hip Fracture: A HIP ATTACK Randomized Trial Substudy.
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.
Journal of clinical anesthesia, 2023 Jul 11
Diagnostic and prognostic value of cardiac stress testing before major noncardiac surgery-A cohort study.
Hypertension (Dallas, Tex. : 1979), 2005 Jun 06
Effect of compensated renal dysfunction on approved heart failure markers: direct comparison of brain natriuretic peptide (BNP) and N-terminal pro-BNP.
European journal of heart failure, 2022 Aug 08
Clinical effect of obesity on N-terminal pro-B-type natriuretic peptide cut-off concentrations for the diagnosis of acute heart failure.

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