Geriatric Medicine
Physician insights on aging-related care, polypharmacy management, cognitive decline, and geriatric syndromes.
Recent Discussions
How do you decide in older adults with newly diagnosed stage 2 hypertension when to start with two antihypertensive agents versus taking a more cautious approach due to concerns about potential orthostasis, frailty, or polypharmacy?
Starting Dual Therapy vs. a Staged Approach in Older Adults with Newly Diagnosed Stage 2 HypertensionThe core question isn't just how high blood pressure is; it's how much treatment this patient can safely absorb.In geriatric cardiology, cardiovascular risk reduction and treatment-related harm are t...
In an older adult hospitalized with recurrent falls, weight loss, without clear injuries, but with an inconsistent or difficult-to-reach caregiver, what findings would make you formally report suspected elder neglect and/or abuse?
I'm so glad that you're thinking about the possibility of abuse/neglect in this scenario! It's important to have it on our differential, or we'll always miss this diagnosis. First, it would be good to see if the patient can explain what is happening and provide contextual information that veers us a...
What treatment options are there for uremic pruritus in an elderly patient with risk of sundowning?
Uremic pruritus is increasingly recognized as a multifactorial condition involving peripheral neuropathy and immune dysregulation, particularly upregulation of type 2 cytokine pathways. Dysregulated opioid signaling further contributes to itch amplification. Accordingly, κ-opioid receptor agonists, ...
How do you discuss the benefits and potential risks of anticoagulation for a strong indication (e.g., atrial fibrillation with high CHA2DS2-Vasc score) with older adult patients with frequent falls?
Current guidelines from AHA/ACC emphasize that oral anticoagulants should not be withheld simply because a patient is at risk of falling.Instead, I try to manage involving shared decision-making with the patient or DPOA that weighs stroke risk against modifiable bleeding and fall risk factors( with ...
Would you start romosozumab in an active smoker?
This is not simple! But we are good at assessment of risk vs benefit (or benefit vs risk!)First I would reassess fracture risk, prior treatments, reason to consider romo. Then I would do a deep dive into risk assessment for cardiovascular disease: how much do they smoke, prior cardiovascular disease...
In an older man on tamsulosin for BPH who is presenting with recurrent falls, how do you manage the medication, in light of urinary symptom control and fall risk?
Tamsulosin carries the risk of orthostatic hypotension and falls, especially in older adults1. In the situation of an older adult man taking tamsulosin for BPH symptoms who is presenting with recurrent falls, I would first check orthostatic vitals and if positive, I would discuss this finding with t...
What are your thoughts about becoming active with national societies related to geriatric medicine and/or gerontology?
There are so many benefits to this investment. Beyond becoming part of a community and keeping up with changes in the field, it also provides opportunities for career advancement and peer mentorship. It is so valuable to know what is happening at other institutions, and so many chance meetings with ...
How do you assess the pros and cons of discontinuing a selective alpha blocker such as tamsulosin or alfuzosin in an older adult male with orthostatic hypotension and established urinary retention?
Discontinuing alpha blockers in older adults with orthostatic hypotension (OH) and urinary retention is rarely straightforward, and the decision hinges on several key points. First, it is important to understand that selective alpha-blockers (tamsulosin, alfluzosin) work by relaxing the smooth muscl...
How have the new USDA Dietary Guidelines which seem to promote several sources of saturated fat (i.e., full fat dairy products, butter, red meat) changed how you approach dietary advice with your patients?
It has not changed my recommendations at all. I still recommend a whole-food, plant-predominant eating pattern, which has been shown to improve health across a variety of chronic conditions and often can be used to treat, prevent, and sometimes reverse chronic disease. However, the new guidelines do...
What would you tell a trainee who is interested in pursuing a career in geriatric medicine but is concerned about the relatively low number of people who enter/match into the field?
A trainee who is interested in pursuing a career in geriatric medicine should consider the long-term potential of contributing meaningfully to the field and to the lives of their patients. Although there are concerns from trainees about the relatively low number of people who enter/match into the fi...