Geriatric Medicine
Physician insights on aging-related care, polypharmacy management, cognitive decline, and geriatric syndromes.
Recent Discussions
What is the role for checking uric acid levels in evaluation of SIADH in hospitalized older adults?
Uric acid is typically not a first-line test for evaluation of hyponatremia. It's usually used when trying to differentiate between hypovolemic states (not SIADH by definition) and euvolemic states (including SIADH). The utility stems from how uric acid is handled in the nephron, i.e., it's reabsorb...
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...
How does premorbid dementia affect your decision to offer acute stroke intervention?
Patients with dementia can still benefit from endovascular thrombectomy. Of course, they can at best be restored to their previous level of function, including their cognitive deficits. If the quality of life of the patient is still satisfactory, however, this treatment is justified. This position i...
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...
How do you approach treatment of hypersomnolence in dementia?
To state the obvious first that you will have had to exclude a hypoactive delirium. And then, considerations: 1. What stage of dementia is the person in? If severe or later stages, this could be normal and physiologic given the level of cerebral atrophy and damage. 2. What type of dementia? If you t...
What is your approach to a newly diagnosed LBBB in individuals >70 years old who are free of any signs or symptoms of heart disease and without other significant ASCVD risk factors besides age?
The presence of BBB; whether IVCD or RBBB or LBBB, signifies infranodal conduction delay from a myopathy. That myopathy may be hypertensive (LVH) or ischemic (LAD disease) or something less common (inflammatory etc). The ideal test would evaluate anterior septal LV thickness and vascular flow; it’s ...
In light of recent measles outbreaks in the US, would you recommend an MMR booster for immunocompetent patients born before 1957?
I would not recommend a measles vaccine for a person born before 1957. This year has been chosen because people before born before 1957 have a very very high likelihood of having had measles because virtually all children got this highly contagious disease. On the other hand, there is no harm to get...
Is there any benefit in maintaining statin or aspirin therapy in patients >75 years old with stable, multivessel ischemic heart disease in light of challenges encountered with polypharmacy?
This is a great geriatric cardiology question because it acknowledges that guidelines may not apply in an older patient with multiple medical problems and a complex medication regimen. The question further implies that treatment should be individualized and patient-centered. I agree with the questio...
How have you developed your approach to delivering a new serious diagnosis such as cancer, diabetes, or a chronic progressive condition in the primary care setting, where the relationship is longitudinal and the follow-up is yours to carry?
I think the Primary Care physician is in a unique position to deliver difficult news to their patient. Given our long-term relationship with the patient and often with their family, there is an element of trust and familiarity that can provide a measure of stability and security in the midst of the ...
Do you recommend the use of portable high-efficiency particulate absolute air cleaners to former smokers with moderate to severe COPD?
This is a regional decision that is based upon ambient air pollution, such as wildfire smoke in the Southwest, and can be trialed before purchase to evaluate symptomatic efficacy. The CLEAN AIR STUDY (Hansel et al., PMID 34449285) did not validate improvement in total St George's Respiratory Questio...