Geriatric Medicine
Physician insights on aging-related care, polypharmacy management, cognitive decline, and geriatric syndromes.
Recent Discussions
Have you used lithium for agitation in dementia?
Non-pharmacologic approaches are first indicated. If they fail, then a psychotropic treatment algorithm is indicated, which generally starts with a serotonin reuptake inhibitor. Lithium would not be considered standard or first-line treatment for agitation in Alzheimer's disease, and in most other m...
How do you advocate for geriatric-focused care models, such as age-friendly health systems, ACE units, or inpatient delirium programs, in institutions that don't have a strong geriatrics infrastructure?
As they say, culture eats strategy for breakfast. And most care for older adults will be delivered in places with minimal infrastructure for older adults, so you are in good company. So, with that in mind, some ideas that might be helpful: Get to know the decision makers and people who can be effec...
Do you recommend vitamin K2 supplements in patients with osteoporosis?
The answer, as with most vitamin supplementations, cannot be answered with high-level evidence to support a "yes or no". A bit of background and then a brief review of available evidence.Vitamin K is thought to be important for bone health because it activates several proteins involved in bone forma...
How do you advise older adult patients with cognitive impairment and/or caregivers who inquire about commercial cognitive apps/games for the prevention of cognitive decline?
There is no data that suggests that participating in cognitive apps/games can help patients who already have cognitive impairment. That said, my bias is that doing something is better than doing nothing, so any cognitive challenge is better than just watching TV.There is some data that cognitive sti...
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?
For someone in his 80s who has received good screening and never had polyps, continuing colonoscopy brings little benefit. The risks and difficulties from the procedure become greater with age, so, for most older adults, stopping routine screening is usually the better option for geriatric care. Whe...
Has the April 2026 Cochrane review on anti-amyloid antibodies changed how you counsel older adults with early Alzheimer's disease about whether to pursue treatment with lecanemab or donanemab?
The April 2026 Cochrane review has not fundamentally changed my counseling, but it has strengthened my caution. It reinforces that lecanemab and donanemab clearly remove amyloid, yet any average clinical benefit appears small and remains difficult to interpret confidently given the numerous threats ...
How have you refined your approach to disclosing a new diagnosis of dementia to a patient and their family?
I tend to think about this disclosure as layers of an onion. My general layers are: Explain what dementia is (and is not) and how we got to that diagnosis. Something like "You and your family have noticed memory problems, and the testing we just did confirms that. The memory problem appears signifi...
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...
When diuretics or lactulose are newly started or uptitrated at discharge, what clinical factors make you schedule follow-up within 72–96 hours rather than the usual 7–14 days?
In reality, follow-up in 72-96 hours is quite difficult to achieve, so we do rely a bit on nursing check-ins as opposed to clinic follow-up. But clinical factors such as severity of VOL or HE, suspected compliance, out-of-hospital discharge setting (home vs shelter), support structure for patient, a...
In a frail older adult with moderate-to-severe lower urinary tract symptoms, when do you start a beta-3 agonist like vibegron over an anticholinergic?
In a frail older adult with OAB-predominant moderate-to-severe LUTS, I generally start a β3 agonist (vibegron or mirabegron) as the first-line pharmacologic option once behavioral interventions are insufficient. Behavioral therapies may include fluid management, bladder retraining, pelvic floor exer...