Treatment of Behaviorally Disturbed Elderly Patients: A Clinical Approach

Background: Assessment and management of pain in elderly people with cognitive impairment is particularly challenging. Physiological changes due to aging as well as comorbidities and polypharmacy are responsible for a complex clinical approach. Concomitantly, in cognitive impairment, including advanced dementia, changes in central nervous system along with changes in the peripheral nervous system due to aging have a significant impact in pain perception. Often clinicians decide to prescribe opioids in order to relief pain, also without a clear indication. Aim: This review aims to investigate the effect of opioids in elderly patients with cognitive impairment. Methods: A literature search of PubMed/Medline, Scopus, and Cochrane databases was conducted using keyword searches to generate lists of articles which were screened for relevance by title and abstract to give a final list of articles for full-text review. Further articles were identified by snowballing from the reference lists of the full-text articles. Results: This review discuss the complex physiological and pharmacological changes in elderly as well as the neurological changes that affect pain perception in this population. Additionally, it focuses on cognitive impairment and pain in Alzheimer’s disease and other dementias, the pain assessment in the elderly with cognitive impairment as well as the safety of opioid use in elderly. Information regarding opioid prescription in nursing homes as well as recorded indications for opioids use, type and dosing of opioid and compliance of treatment in advanced dementia are also provided. Conclusions: Opioid prescription in elderly population with cognitive impairment is particularly complex. All healthcare professionals involved in the care of such patients, need to be aware of the challenges and strive to ensure analgesic use is guided by appropriate and accurate pain assessment.

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Geriatric oncology: Comprehensive geriatric assessment tools (CGA) implementation and interdisciplinary clinical approach for elderly patients (pts) in AC Camargo Cancer Center (ACCCC), Sao Paulo, Brazil.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.15_suppl.9549 ◽

2014 ◽

Vol 32 (15_suppl) ◽

pp. 9549-9549

Author(s):

Aldo A. Dettino ◽

Barbara C M Figueroa ◽

Ana M M Leite ◽

Ludmilla T.D. Chinen ◽

Ulisses Ribaldo Nicolau ◽

...

Keyword(s):

Elderly Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Geriatric Oncology ◽

Sao Paulo ◽

Assessment Tools ◽

Cancer Center ◽

Clinical Approach ◽

São Paulo

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Oxidative stress mediated electrolyte imbalance in 30 known cases of knee osteoarthritis patients: A clinical approach

Asian Journal of Medical Sciences ◽

10.3126/ajms.v6i5.12274 ◽

2015 ◽

Vol 6 (5) ◽

pp. 26-30

Author(s):

Jusmita Dutta ◽

Dilutpal Sharma ◽

Rahul Saxena

Keyword(s):

Oxidative Stress ◽

Elderly Patients ◽

Electrolyte Imbalance ◽

Clinical Approach ◽

Dietary Salt ◽

Medical Sciences ◽

Chronic Disability ◽

Normal Individuals ◽

Total Antioxidant ◽

Altered Serum

Background: Osteoarthritis (OA), also known as degenerative arthritis, is the leading cause of chronic disability in elderly. Although, it is a process of progressive deterioration of articular cartilage with ageing which involves numerous risk factors, it is conceivable that oxidative stress mediated electrolyte imbalance may have a crucial role in the development of hypertension risk in OA elderly. Aims & objective: The present study was designed to assess the association of oxidative stress and altered serum electrolyte levels in OA elderly patients and to determine their effect in predicting hypertension (HT) risk. Methods: Total antioxidant activity (TAA), lipid peroxidation (malondialdehyde; MDA) and serum mineral (Na+, K+, Mg2+ and Ca2+) levels were estimated in 40 OA elderly patients by using standard methods and statistically compared it with that of 40 healthy normal individuals of same age group (55-70 years). Result: Plasma TAA, serum potassium, magnesium and calcium levels were significantly low in patient group (p<0.05) as compared to healthy controls whereas erythrocyte MDA levels were significantly high in OA subjects. However, serum sodium levels were increased insignificantly (p<0.1) in OA subjects. Conclusion: Our findings indicate that oxidative stress plays a significant role in shaping the OA older population to develop future hypertension, characterized by altered serum minerals levels. Therefore, consumption of diet rich in antioxidants, proteins and minerals with low dietary salt should be increased with senescence in order to prevent disease complexity.DOI: http://dx.doi.org/10.3126/ajms.v6i5.12274 Asian Journal of Medical Sciences Vol.6(5) 2015 26-30

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Hyponatremia: A clinical approach

Terapevticheskii arkhiv ◽

10.17116/terarkh2017898134-140 ◽

2017 ◽

Vol 89 (8) ◽

pp. 134-140 ◽

Cited By ~ 1

Author(s):

D Yu Shchekochikhin ◽

N L Kozlovskaya ◽

F Yu Kopylov ◽

A L Syrkin ◽

E M Shilov

Keyword(s):

Clinical Practice ◽

Elderly Patients ◽

Individual Case ◽

Clinical Analysis ◽

Clinical Approach ◽

Severe Hyponatremia ◽

Chronic Hyponatremia ◽

Life Threatening ◽

Appropriate Therapy ◽

Balance Problems

Hyponatremia is the most common electrolyte metabolic abnormality in clinical practice. The unfavorable course of many diseases is associated with hyponatremia. Acute severe hyponatremia is life-threatening because cerebral edema may develop. Less obvious chronic hyponatremia increases the risk of balance problems, falls and fractures, especially in elderly patients. In any occasion, hyponatremia should not be now regarded only as a laboratory phenomenon in critically ill patients, but it necessitates a thorough clinical analysis of each individual case and appropriate therapy. The paper presents approaches to diagnosing and treating hyponatremia in various clinical situations.

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