Biomedical subjects
Publications and source records attributed to Syed H Tariq.
Testosterone deficiency occurs commonly in men as they grow older. This deficiency often is associated with a decline in sexual activity and a loss of muscle mass. Testosterone replacement can reverse many of these effects. At present, no ideal form of testosterone replacement is available. Like the phosphodiesterase-5 inhibitors, testosterone replacement in older men is a quality of life issue.
CONTEXT: The Mini-Mental State Examination (MMSE) is commonly used as a screening tool to detect dementia. However, it performs poorly in identifying persons with mild neurocognitive disorder. The Saint Louis University Mental Status (SLUMS) examination is a 30-point screening questionnaire that tests for orientation, memory, attention, and executive functions. OBJECTIVE: The objective of this study was to compare SLUMS and the MMSE for detecting dementia and mild neurocognitive disorder (MNCD) using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. METHODS: Patients at the Veterans' Affairs Geriatric Research, Education and Clinical Center, St. Louis, MO (N = 702) were clinically classified as having normal cognitive functioning, MNCD, or dementia based on DSM-IV criteria. The SLUMS and MMSE were administered for comparison. RESULTS: Mean age was 75.3 years (standard deviation: 5.5). Regarding education, 62.4% of the sample had at least completed high school and 30.6% had not. Sensitivity and specificity were calculated and receiver operator curves (ROCs) generated for SLUMS and MMSE as a function of diagnosis (MCND versus dementia) and education. Both the SLUMS and MMSE produced acceptable ROCs for the diagnosis of dementia, but the ROCs for SLUMS were better than the MMSE for the diagnosis of MNCD in both education groups. CONCLUSION: These results suggest that the SLUMS and MMSE have comparable sensitivities, specificities, and area under the curve in detecting dementia. Although the definition of MNCD is controversial, the authors believe that the SLUMS is possibly better at detecting mild neurocognitive disorder, which the MMSE failed to detect, but this needs to be further investigated.
In summary, herbs are commonly used, and it is the physician's responsibility to have better documentation of this practice by encouraging patients to report use of herbs, and to look for any unusual side effects that can occur in terms of herb-drug or herb-herb interactions.
Urinary incontinence is common in the elderly population;however, less than half the people who have this problem are examined or treated. The Agency for Health Care Policy and Research recommends behavioral interventions before other forms of treatment in patients who are diagnosed with stress, urge, or mixed incontinence after a basic evaluation. Behavioral treatments are safe, effective, and low risk and have no documented side effects. They also can be used as an adjunct to other therapies, such as pharmacologic and surgical interventions.
Fecal incontinence is a common problem in the elderly population,particularly in nursing homes, and is one of the common reasons for nursing home placement. In addition to the inconvenience of the incontinence for the patient and caregiver, it is associated with increased mortality. Identifiable physiologic changes in the anorectal region may contribute to the development of fecal incontinence.Fecal incontinence is a disorder of men and women, with an equal or greater prevalence in men in advancing years. All patients who have fecal incontinence warrant an initial medical evaluation,including the exclusion of fecal impaction. Cognitively impaired patients benefit most from habit training. Selected elderly patients who have fecal incontinence may benefit from biofeedback and surgical intervention.
Fecal incontinence is an underreported problem in the general population; it is especially common in elderly persons (aged >or=65 years) residing in the community or in long-term care settings. It affects more women than men during younger years, but this differential narrows with age. Physiological changes such as sphincter muscle and sensory abnormalities in the anorectal region contribute to this problem, as do factors such as dementia, physical disability, and fecal impaction. Treatment with biofeedback is feasible in many elderly patients. Those with advanced dementia or physical disability may benefit from a bowel habit training program. Selected patients may require surgical sphincter repair. Minimally invasive techniques such as radiofrequency energy application offer promising future treatment options. The purpose of this review is to provide current information on fecal incontinence and its management in the elderly.
Disease is commonly associated with sexual dysfunction in both men and women. In many cases, effective treatments are available that can improve libido, erectile dysfunction, and vaginal dryness. Sexual problems in older persons with disease often lead to anxiety, marital discord, and withdrawal. It is the responsibility of all health care professionals to inquire about sexuality in all patients, no matter what the patient's age, and to be aware that frailty [79-81] is not, in itself, a barrier to sexuality. Health professionals need to give education, support, and counseling on sexuality for patients with disease.
This study shows that endocrine and vascular etiologies of erectile dysfunction are more common in the older age group, whereas depression and marital discord are more common in the younger age group. There is considerable overlap between various factors pointing to the multifactorial nature of erectile dysfunction. Review of the treatment option chosen reveals that the invasive modalities were least common as compared with the popular vacuum tumescence device (although cumbersome) and testosterone replacement. Persons with low testosterone have an improved efficacy of sildenafil when hypogonadism is treated. Sildenafil with its ease of administration and high efficacy seems to be the logical first choice for most of the patients. If contraindications exist or treatment failures occur, other treatment options should be offered to patients.
Although multiple models of care exist to prevent the development of delirium in hospitalized patients, models for the management of patients for whom delirium is unpreventable or who already have delirium on admission to the hospital are needed. This article describes the development, management, and economics of a new model of care for patients with delirium, called the Delirium Room (DR). The DR is a specialized 4-bed unit that provides 24-hour intensive nursing care and is completely free of physical restraints. Another important feature of the 4-bed DR is that it is an integral part of a 22-bed acute care for the elderly (ACE) unit. As such, patients in the DR benefit from features of the ACE unit: a change in the physical environment of the medical floor to promote mobility and function and discourage bedrest, comprehensive geriatric care that identifies and addresses problems that can lead to a decline in function, and use of a daily multidisciplinary team meeting. This article also presents descriptive data on a group of delirious patients managed in the DR with the intention of giving baseline data for other ACE units that are considering opening a DR or for future prospective studies in this area.
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INTRODUCTION: Dehydration is a difficult clinical diagnosis in older adults because the physical signs of dehydration are often confusing. The clinical consequences of a diagnosis of dehydration are critical, since dehydration implies increased morbidity and mortality and aggressive rehydration can improve clinical outcome. The diagnosis is a sentinel event for nursing homes, and often is made at transfer to a hospital. OBJECTIVE: To define the accuracy of the clinical diagnosis of dehydration during hospital admission, and to observe persons admitted from long-term care. METHODS: A total of 102 consecutive medical admissions in persons older than 65 years with a diagnostic coding for dehydration either on admission or during the course of hospitalization over a 3-month period at a university teaching hospital were reviewed. The diagnosis of dehydration was considered confirmed if the calculated serum osmolarity was greater than 295 milliosmols (mOsmol). Subjects were considered to have intravascular volume depletion if the ratio of blood urea nitrogen (BUN) to serum creatinine was greater than 20 or the serum sodium was greater than 145 milligrams per deciliter. Subjects were considered to have hypovolemia if the serum osmolarity was greater than 295 and the BUN/creatinine ratio was greater than 20. RESULTS: Among subjects with a clinical diagnosis of dehydration, only 17% had a serum osmolarity >295 mOsm, and only 11% had a serum sodium greater than 145. A BUN/creatinine ratio greater than 20 was present in 68% of the subjects. Clinicians appear to be using the term dehydration synonymously with intravascular volume depletion. Even so, at least a third of the diagnoses of intravascular volume depletion in older adults were incorrect based on laboratory data. CONCLUSION: Physicians who diagnose dehydration during hospital admission may be relying more on physical signs than laboratory data. Little change in laboratory markers for hydration status occurs from the time of diagnosis to hospital discharge, suggesting that the clinical diagnosis does not affect fluid management. The data suggest a need for improvement in the differential diagnosis and management of volume changes in older persons.