Geriatric Medicine
Physician insights on aging-related care, polypharmacy management, cognitive decline, and geriatric syndromes.
Recent Discussions
What is your preferred medication of choice for UTI prophylaxis in older men with chronic indwelling catheters and recurrent UTIs?
Clean the catheter and urethral meatus with soap and water.
How do you approach the management of extremely low LDL levels in older adult patients receiving statin therapy for primary prevention of cardiovascular disease?
In the absence of side effects, I am not concerned about very low LDL levels (e.g., less than 20 mg/dL), as there is a fairly linear association between LDL and CV risk, and there is no convincing evidence that even extremely low LDL levels are associated with cognitive impairment, intracranial hemo...
In older adults with mild cognitive impairment, do you ever prescribe cholinesterase inhibitors and/or memantine?
This is a great question, and of course, "do you ever" will get you in trouble every time! Let me start by saying that, in general, I do not prescribe these drugs for MCI. Cholinesterase inhibitors are clearly indicated for the mild-moderate stage of some kinds of dementia (some people would include...
How do you approach timing of repeat plasma p-tau217/Aβ42 monitoring to detect conversion in MCI due to suspected Alzheimer’s disease?
I think that this question is purely “academic” and not relevant for clinical practice. If a patient has clear evidence of MCI based on history and bedside cognitive testing results, and ptau217/Αβ42 ratio falls within the intermediate/non-diagnostic range, then the appropriate course of action, if ...
How do you counsel patients with cognitive decline due to Alzheimer's with an indication for anticoagulation (e.g., for atrial fibrillation) who ask about potentially ceasing anticoagulation therapy in order to become a candidate for monoclonal anti-amyloid therapy?
The approach to this is going to vary by patient. In general, the benefits of anticoagulation for stroke prevention almost certainly outweigh the benefits of antiamyloid therapy. That said, there are going to be patients who are willing to take this risk. I would say that there are currently two opt...
Do you recommend structured Tai Chi for patients with osteopenia and osteoporosis?
While I am not an expert, I am very supportive of Tai Chi or similar disciplines that work to improve balance. I have read some well done clinical trials that show improved balance. I live in a community (Phoenix) with lots of active retired people. Nearly every community has a Tai Chi or balance cl...
How do you counsel older adults regarding the use, dosing, and safety of CBD-containing products for insomnia?
When counseling older adults on CBD use for insomnia, I usually explain that evidence for safety and effectiveness is limited. Most products are not FDA-approved, and their labeling, purity, and dosing can be inconsistent. It’s important to review the patient’s comorbidities and medications closely,...
What is the goal oxygen saturation for patients with COPD and pulmonary hypertension?
Although an oxygen saturation target of 88–92% is commonly used in patients with COPD to reduce the risk of oxygen-induced hypercapnia, a higher saturation goal is appropriate in patients with pulmonary hypertension associated with COPD. In this population, we generally aim for an oxygen saturation ...
What is your approach to management of postoperative delirium follow-up (whether resolved or even if ongoing) in the transitional phase post-hospitalization when transitioning to post-acute care and/or outpatient setting?
It's a very important part of treatment. My experience is that the receiving team has to be prepared and educated about the patient before accepting the patient in a post-acute setting. The environmental factors have to be adjusted to the patient's condition. First, that is why education of the rece...
How have you improved your serious illness conversation skills over the course of your career?
I surely hope that my communication skills have improved over the course of my career (in the same way that being a doctor has improved). However, improvement as a clinician doesn't just happen. One has to be intentional about it. Things that will help: Take a course. VitalTalk runs a number of edu...