CME : Your SA Journal of CPD - Volume 22, Issue 11, 2004
Volume 22, Issue 11, 2004
Author Tobie J. De VilliersSource: CME : Your SA Journal of CPD 22, pp 609 –612 (2004)More Less
HT is the only proven therapy for the treatment of vasomotor symptoms of menopause. <br>Systemic or local HT prevents and treats urogenital atrophy. <br>HT prevents the early bone loss of menopause and associated fractures. <br>HT is associated with a lowered risk of colorectal cancer. <br>HT increases the risk of VTE and stroke. <br>HT should not be used for the prevention of CAD. <br>EPT is associated with an increased risk of invasive breast cancer after 5 years of therapy. <br>Progestogen is only added in the presence of a uterus in order to protect against endometrial cancer. <br>Use the lowest dose of HT for the shortest period of time.
Author Christianne BouwensSource: CME : Your SA Journal of CPD 22, pp 614 –618 (2004)More Less
Geriatric assessment (GA) is a multidimensional screening tool. <br>GA serves to detect overlooked areas of importance for the older person. <br>GA is also used to detect the presence of geriatric syndromes and non-medical issues of relevance to elderly. <br>Pre-visit self-rating questionnaires (e.g. Barthel index) are time saving and useful. <br>A standard questionnaire during consultation will cover the majority of the needs of the older individual. <br>Use of a limited number of standardised rating scales will enable the practitioner to screen effectively. <br>In-home assessment can reveal crucial information that would not otherwise have been procured. <br>Quality of life issues are of prime importance for all older individuals and should always be taken into account.
Author Dora WynchankSource: CME : Your SA Journal of CPD 22, pp 619 –622 (2004)More Less
Depression is a common illness that is under-recognised and undertreated in the elderly population. <br>Major depression is not simply a natural outcome of ageing. <br>Elderly depressed patients present with a typical clinical picture. <br>Memory loss, mental confusion, social withdrawal, and neurovegetative symptoms are common. <br>The elderly patient may not admit to depressed mood but will have numerous somatic complaints. <br>Suicide is commonest in elderly white men. <br>SSRIs are preferred over older antidepressants because of milder side-effects, safety in overdose and limited drug-drug interactions. <br>Nausea, agitation, insomnia, and sexual dysfunction are the commonest side effects of SSRIs. <br>Doses should initially be low, with slow upward titration and a treatment trial duration of 9 weeks. <br>ECT and psychotherapy are alternative treatment options.
Source: CME : Your SA Journal of CPD 22, pp 623 –628 (2004)More Less
In the elderly: <br>Common endocrine conditions (presenting to the GP) are more prevalent. <br>Thyroid dysfunction and type 2 diabetes mellitus often have subtle or unusual presentations and demand a low threshold for screening. <br>Goals of diabetic therapy need to be individualised; insulin is not contraindicated. <br>Hypoglycaemia in patients on diabetic therapy must be avoided. <br>Initiating thyroxine replacement: start low, go slow. <br>Prevalent fragility fracture is a better predictor than BMD for future osteoporotic fracture. <br>Hip and vertebral fractures are associated with a high morbidity and mortality. <br>HRT prevents osteoporotic fractures, but should only be used if there are significant menopausal symptoms, and then only in the short term. <br>BPs are the first-choice agents for reducing both spine and hip fracture rates. <br>A degree of OM commonly accompanies OP. <br>Most cases of Paget's disease are discovered incidentally and usually do not require specific therapy.
Source: CME : Your SA Journal of CPD 22, pp 629 –635 (2004)More Less
The health care professional in the care of the older adult is often associated with the treatment of diseases in the elderly. <br>An equally important role is that played in enhancing the functional status and quality of life of the older adult. <br>This role is examined with regard to exercise therapy, prevention and treatment of falls and in the education of the elderly. <br>Physiotherapists, biokineticists and exercise scientists are encouraged to participate in multidisciplinary health care teams. <br>Together they should recognise the significant opportunity to advance 'successful aging' by prescribing exercise to delay the onset of infirmity and to compress morbidity.