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General Internal Medicine

General Geriatric Medicine   

Questions discussed in this category

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
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 do you titrate opioids for pain and breathlessness in patients with a DNR/DNI code status, but who otherwise still wish to pursue life-prolonging treatments?
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 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
Is there a role for routine stress testing in intermediate-high risk CAD patients with a significantly elevated coronary calcium score who are otherwise asymptomatic?
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 do you balance the risks and benefits of stimulant treatment in patients with poorly controlled hypertension?
How do you weigh cardiovascular risks against the potential functional and emotional consequences of undertreated ADHD? What blood pressure thresholds...
2 Answers available
How do stroke-risk considerations affect your use of atypical antipsychotics for patients with dementia?
Related Q&A on antipsychotics in Alzheimer's.In light of the publication from Choma et al., PMID 41063545.
2 Answers available
Are there scenarios in which you would advise using benzodiazepines for the treatment of hyperactive delirium?
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
Do you consider using buspirone for the management of anxiety in older patients?
4 Answers available
Is there a role for suppressive antibiotic therapy when it comes to chronic femoral/tibial osteomyelitis?
1 Answer available


Papers discussed in this category

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 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.
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.
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 2013-06
Meta-analysis of increased heart rate and blood pressure associated with CNS stimulant treatment of ADHD in adults.
Case reports in cardiology, 2016
Adult ADHD Medications and Their Cardiovascular Implications.
The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2016 May-Jun
A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder.
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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