Geriatric Medicine
Physician insights on aging-related care, polypharmacy management, cognitive decline, and geriatric syndromes.
Recent Discussions
What are your preferred treatment options for patients with chronic non-healing leg ulcers?
While the approach will differ depending on the underlying wound etiology, some basic principles are applicable across wound types. Compression can help heal all lower extremity wounds, with the exception of moderate to severe peripheral arterial disease. Compression is not just for venous leg ulcer...
How are you incorporating the newer RCT data suggesting no mortality benefit to indefinite beta-blocker therapy for patients who are several years out from an MI with preserved LVEF and no angina or arrhythmia?
I have been de-prescribing after counseling once the patient is a couple of years out. This reduces symptoms, pill burden, drug interactions, etc., so I see an active benefit even if the patient seems to be tolerating medication. Obviously, they would have no other indication for BB, mainly arrhythm...
How do you manage sleep disturbances in patients with Alzheimer’s disease without relying heavily on deliriogenic medications?
Sleep disturbances are common in older people and in those with Alzheimer’s disease (AD) in particular, and there are often multiple etiologies. Whether sleep disturbances increase the risk for AD, or are a result, metanalyses have suggested that the magnitude of sleep impairment correlates with the...
Under what circumstances would you consider low-dose radiation therapy for osteoarthritis in an older adult patient?
Here is a recent expert consensus by Joel Block on the use of low-dose radiation therapy in OA: Some highlights: "Placebo-controlled randomized clinical trials have now been reported using LDRT for OA of the knees and of the hands. Taken together, they do not show benefit beyond placebo... While a d...
How do you decide when to formally re-assess and document decisional capacity in a hospitalized patient who initially lacks it?
This is a great question and tricky to answer in every scenario. In general, we should be reassessing decisional capacity with each clinical encounter, though formal documentation may not be necessary each time. My approach is based on considering several factors: What is the underlying cause of th...
How do you prioritize and sequence interventions when multiple fall risk factors are identified in an older adult after an interdisciplinary fall clinic visit?
In our Fall Prevention Clinic, our team consists of a geriatrician, physical therapist, and a psychologist (different from most other clinics, which include a nurse or OT). When evaluating patients, we work collaboratively on setting three specific goals with our patients. Additionally, our patients...
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 ...
What has been your approach to using buprenorphine patches for treatment of chronic pain in older adults with dementia?
It is a partial µ-agonist, which I can explain to families, allowing for safer titration with a ceiling effect that limits respiratory depression. This partial agonism also produces less euphoria than full agonists. Additionally, κ-receptor antagonism reduces dysphoria and may have antidepressant pr...
What has your geriatrics practice taught you about aging well?
After every clinic, I feel that I have learned something on "how to age well" from my patients. My top takeaways - Positive attitude tops all other coping skills. Two different patients with similar age, similar comorbidity burden, and similar social circumstances will have opposite views simply ba...
What is your approach to using coronary calcium scoring to select older adults for statins in primary prevention without diabetes or known ASCVD?
A definition of older adults needs to be made. If greater than 75, it’s a class IIb indication and of limited value. Risk score, also in patients under 75, should be at least 5%, preferably closer to 7.5%. I tend to give the patients the data and let them make the decision; it’s definitely not a mus...