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Update in Geriatrics
- William J. Hall, MD
- 1998-99 Series; John Roberts, MD, Editor From University of Rochester School of Medicine and Dentistry, Rochester, New York. For current author addresses, see end of text. Requests for Reprints: William J. Hall, MD, Department of Medicine, Box MED, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642. Current Author Addresses: Dr. Hall: Department of Medicine, Box MED, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642. Dr. Roberts (Series Editor): Madrona Medical Group, 3199 Steller Court, Bellingham, WA 98226.
Geriatrics received much attention in 1997-almost 100 journals in 31 countries published theme issues on the topic late in the year. As a result, 1997 provided the most new articles on geriatrics ever published in a single year.
However, many of the articles published in the theme issues were reviews. In this Update, emphasis is placed on well-done, original clinical research that affects the practice of every general internist. In preparing this Update, I reviewed the articles in 30 English-language peer-reviewed journals published in 1997. Given that most elderly persons live outside long-term care institutions and are cared for by practicing internists, this Update focuses on two general topics: common office problems and issues that arise in the course of routine hospitalization.
Common Office Problems
The management of medications in elderly patients is an everyday office issue. Polypharmacy is a common problem, and therapy with most, but not all, drugs can apparently be safely discontinued. Benzodiazepines are especially problematic and may actually increase the prevalence of insomnia. Isolated systolic hypertension continues to be a difficult problem, and appropriate therapy decreases symptomatic episodes of heart failure. Some data suggest the interesting possibility that treatment of hypertension may actually mitigate orthostatic hypotension. Finally, an ancient herbal remedy was found to improve the course of some patients with dementia, and the recognition of the role of various micronutrients in maintaining health was enhanced.
Therapy with Most Drugs Can Be Safely Stopped
Graves T, Hanlon JT, Schmader KE, et al. Adverse events after discontinuing medications in elderly outpatients. Arch Intern Med. 1997; 157:2205-10.
Patients in their eighties are commonly prescribed 8 to 12 medications, and the potential dangers of adverse effects with such polypharmacy are well known. Elderly persons taking more than 5 medications simultaneously have about a 35% chance of developing an adverse drug reaction per year. About 70% of these persons will require …
