Geriatric Medicine
Physician insights on aging-related care, polypharmacy management, cognitive decline, and geriatric syndromes.
Recent Discussions
How do you approach the use and interpretation of the FDA-approved plasma pTau181 blood test for Alzheimer's disease in a community-dwelling older adult with subjective cognitive complaints and a normal cognitive screen?
I follow current guidelines, which recommend against testing in those without objective cognitive impairment, given the high rate of false positives. Unless the pre-test probability is high, I would not test. That having been said, future developments (such as subQ modes of anti-amyloid Rx, greater ...
Have you used POCUS with color power Doppler to assess blood pressure in a patient whose cuff readings are in doubt?
Thank you for bringing up this question, as it focuses on a POCUS topic I often think about. I will split my assessment into two categories: clinical utility and physiologic limitations, with a brief EBM note at the end. Clinical Utility While the referenced study suggests this technique is feasible...
What go-to resources or apps do you recommend for CBT-I for older adults with insomnia?
A great place to start is at the American Academy of Sleep Medicine's "Insomnia Toolkit for Clinicians". The toolkit provides links for free digital CBTI platforms, as well as other resources for treatment.
In what patient population(s) do you recommend RSV vaccination in adults 50-74 years old who would not meet the general age recommendation (>75 years old)?
For adults 50–74 years old who do not meet the routine age-based recommendation (>75 years), I would consider RSV vaccination for those at increased risk for severe RSV disease, consistent with guidance from the Advisory Committee on Immunization Practices (ACIP) of the CDC. In practice, this includ...
Do you recommend any specific tools or processes/references to help with the determination of capacity for decision-making for hospitalized older adults with cognitive impairment?
It is important to recognize that decision-making capacity in hospitalized older adults with cognitive impairment is both decision-specific and time-specific. Assessment should focus on the patient’s ability to demonstrate the four elements described by Appelbaum and Grisso: understanding, appreciat...
What are your preferred treatment options for patients with chronic non-healing leg ulcers?
In addition to all the typical things (decreasing edema with meds, compression, etc + treating superinfection, critical colonization, or debriding eschars), there is some evidence for pentoxifylline 400 mg TID or 800 BID in ulcerations of any etiology. There is also newer evidence for using topical ...
What are some practical tips in distinguishing between metabolic bone disease due to chronic kidney disease and osteoporosis?
The biggest difference between osteoporosis and CKD-MBD has to do with the underlying bone mineral laboratories. Generally, with osteoporosis, bone chemistries are relatively normal; there may be a decrease in Vit D. However, with CKD-MBD, there is usually an increase in PTH, potentially abnormaliti...
Does global brain atrophy increase risk for intracranial bleed after fall in older adults?
It depends on the location of the hemorrhage. Subdural bleeding/hematoma is much more likely in elderly people with brain atrophy and a fall. Epidural hemorrhage is much more common in young patients. Intracerebral hemorrhage is more related to risk factors such as hypertension in middle age and amy...
What is your approach to picking a dose/formulation of Vitamin D for a community-dwelling older adult found to have Vitamin D deficiency?
Supplementation with cholecalciferol (vitamin D3) 1000–2000 IU daily would be my choice for community-dwelling older adults with documented deficiency, and is preferred over ergocalciferol (vitamin D2). I would also co-administer calcium (1000–1200 mg/day) to support fracture prevention. Routine lab...
What is your approach to antibiotic selection for bacterial species that demonstrate susceptibility to penicillins or cephalosporins on testing, but are known to harbor inducible AmpC resistance?
I will assess how long I am treating the person/infection, and go from there in terms of how likely I am to induce the AmpC based on the duration of treatment. For example, if it's a 7-day course for UTI or GN bacteremia, I may risk the penicillin/cephalosporin (based on susceptibilities, of course)...