Geriatric Medicine

Do you ever continue medications such as rate-control agents for tachyarrhythmias, anticoagulation for blood clots, immunosuppression to prevent trans...

1 Answer 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?

1 Answer available

How do you decide when to initiate medical workup (e.g., thyroid, B12, infection) in a geriatric patient experiencing new onset or worsening low mood?

2 Answers available

Do you routinely prescribe vitamin D to reduce the risk of fall-related fractures in elderly patients regardless of their serum levels?

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

Would you start romosozumab in an active smoker?

1 Answer available

What is your approach to bisphosphonate use in patients with advanced chronic kidney disease and osteoporosis?

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

How do you recommend counseling patients on the prognosis of advanced cancer as a generalist who is not highly specialized in cancer literature or cancer-directed therapies?

2 Answers available

For patients over 90 years old, is there any foreseeable benefit to undergoing left atrial appendage occlusion over permanent cessation of anticoagulation, particularly for those at high risk for major bleeding?

2 Answers available

Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?

6 Answers available

When do you consider using aspirin 81 mg PO BID for VTE prophylaxis over other agents in patients with a fracture, considering recent trial data?

O'Toole et al., PMID 36652352

1 Answer available

How do you counsel non-diabetic patients who wish to start metformin to reduce the risk of developing dementia?

2 Answers available

What is your approach to a newly diagnosed LBBB in individuals >70 years old who are free of any signs or symptoms of heart disease and without other significant ASCVD risk factors besides age?

If the ECG was obtained prior to major orthopedic surgery (such as hip replacement) would that change your approach?

3 Answers available

Is a target TSH closer to the mid normal range justified in older individuals (age 70 or above) without any known cardiac ischemia or dysrhythmia or osteoporosis?

Is this recommended TSH target of 7 or higher based on the fact that globally iatrogenic hyperthyroidism is common in older individuals on levothyroxi...

1 Answer available

How do you approach revascularization in patients over 75 years with NSTEMI, given recent evidence from the SENIOR-RITA trial that an invasive strategy does not significantly reduce cardiovascular events compared to a conservative strategy?

Kunadian, et al., PMID 39225274

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

Is there any role for 25-OH Vitamin D testing in patients older than 75 years old in the general population?

Demay, et al., PMID 38828931

2 Answers available

How do you approach selecting biologic therapy vs non-biologic DMARD (such as methotrexate) as initial therapy in patients with new RA diagnosis with significant erosive disease?

This question is part of a collaboration with RheumMadness and is specifically in reference to: NORD-STAR (Østergaard et al., PMID 3742364...

5 Answers 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

Do you typically screen every patient with headaches after the age of 60 with ESR?

6 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

Do you recommend performing cognitive testing in the clinic to determine the blood pressure target in patients 80 years or older?

1 Answer available

Would you recommend AV fistula placement in a CKD Stage 5 patient who is over the age of 80?

2 Answers available

Would you recommend PFO closure in patients >60 years old with presumed paradoxical embolism as their mechanism of stroke?

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

How do you manage myasthenia gravis in patients over the age of 90?

What is the best way to treat late onset myasthenia gravis (in this case, age >90)? Would the newer complement inhibitors be safe? Steroids in this...

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

Do you still plan to offer tofacitinib to RA patients over 65 if they have one or more additional CV risk factors?

2 Answers available

Given the "LDL Paradox", in which RA patients with the highest levels of inflammation can have ultra-low levels of LDL (<70), how do you approach initiation of statin therapy in these patients?

Dr. Charles-Schoeman presented data at ACR 21 showing that, paradoxically, there is a U-shaped relationship between inflammation and LDL levels in pat...

1 Answer available

In patients with thrombocytosis with negative MPN workup from peripheral blood and bone marrow, is there a role for daily 81mg aspirin or other treatment?

2 Answers available

What is your approach to checking serum vWF antigen levels in adult patients with CNS vasculitis for monitoring disease activity?

Small study in pediatric PACNS have evaluated this as a potential marker (Cellucci et al., PMID 22740622)

1 Answer 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.

Front Neurol, 2019 Jun 06

Primary Angiitis of the Central Nervous System: New Potential Imaging Techniques and Biomarkers in Blood and Cerebrospinal Fluid.

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.

JAMA, 2019-02-12

Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial.

JAMA, 2019-08-13

Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions.

Kidney Int, 2019 Jan

Hemodialysis vascular access in the elderly-getting it right.

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.

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.

The New England journal of medicine, 2024 Sep 01

Invasive Treatment Strategy for Older Patients with Myocardial Infarction.

The New England journal of medicine, 2023 Jan 19

Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after a Fracture.

JAMA, 2022 Aug 23

Effect of Aspirin vs Enoxaparin on Symptomatic Venous Thromboembolism in Patients Undergoing Hip or Knee Arthroplasty: The CRISTAL Randomized Trial.

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.

Journal of palliative medicine, 2012-02

Systematic review of cancer presentations with a median survival of six months or less.

Journal of the American Medical Directors Association, 2022 Mar 23

Post-Acute Care Outcomes and Functional Status Changes of Adults with New Cancer Discharged to Skilled Nursing Facilities.

Palliative medicine, 2022 Jul

The utility of the surprise question: A useful tool for identifying patients nearing the last phase of life? A systematic review and meta-analysis.

JAMA, 2021 Apr 13

Screening for Vitamin D Deficiency in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Journal of the American Geriatrics Society, 2025 Jan 29

Updating STEADI for Primary Care: Recommendations From the American Geriatrics Society Workgroup.

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.

Archives of general psychiatry, 2008 Dec

Incidence and recurrence of late-life depression.

Current nutrition reports, 2022 Sep 13

Is Vitamin D Important in Anxiety or Depression? What Is the Truth?

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.

Arthritis Rheumatol, 2021 Jul

2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.

Rheumatology (Oxford, England), 2023 Oct 19

A real-world 2-year prospective study of medication tapering in patients with well-controlled rheumatoid arthritis within the rheumatoid arthritis medication tapering (RHEUMTAP) cohort.

Arthritis research & therapy, 2015 Aug 03

Sustained biologic-free and drug-free remission in rheumatoid arthritis, where are we now?

Arthritis and rheumatism, 2009 Aug

Prevalence of and predictive factors for sustained disease-modifying antirheumatic drug-free remission in rheumatoid arthritis: results from two large early arthritis cohorts.

The Cochrane database of systematic reviews, 2018 Aug 23

Impact of medication reconciliation for improving transitions of care.

Journal of pain and symptom management, 2002-05

An open-label, crossover trial of mirtazapine (15 and 30 mg) in cancer patients with pain and other distressing symptoms.

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.

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.

Annals of internal medicine, 2021 Nov 23

Risk for Recurrent Venous Thromboembolism in Patients With Subsegmental Pulmonary Embolism Managed Without Anticoagulation : A Multicenter Prospective Cohort Study.

JAMA, 2011-09-28

Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis.

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.

Geriatric Medicine

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