CME : Your SA Journal of CPD - Volume 25, Issue 9, 2007
Volume 25, Issue 9, 2007
Source: CME : Your SA Journal of CPD 25 (2007)More Less
This issue of CME is about elderly medicine - called geriatrics when I was a student. Elderly medicine is often regarded as the care of frail, old people, with multiple pathologies, poor cognition and an increasingly poor quality of life. But, as many populations in the world age, it is becoming clear that this picture of old age could become outdated.
Author B. CassimSource: CME : Your SA Journal of CPD 25, pp 414 –416 (2007)More Less
Author S. LipschitzSource: CME : Your SA Journal of CPD 25, pp 418 –420 (2007)More Less
With increasing age, there is an age-related increase in co-morbidity and disability. Ageing is a process that steadily reduces physiological reserve, resulting in diminished ability to compensate for the toll of illness. Illnesses accumulate with age and increase in severity and number. Frailty (a complex interplay of health and illness, attitudes, resources and dependence on others, leading to a decreased ability to withstand illness without loss of function) increases with age. A double burden of physiological decline and disease is associated with excess morbidity and resultant disability, i.e. difficulty performing simple physical and mental tasks necessary for daily life.
Author S.Z. KalulaSource: CME : Your SA Journal of CPD 25, pp 422 –425 (2007)More Less
Persons aged 60 years and over are the main consumers of drugs because of increased pathology requiring multiple medications. No local data are available but USA data show that while older persons constitute 13% of that country's total population, they consume approximately 35% of all medications used. Ageing alters pharmacokinetics (absorption, distribution, metabolism and elimination) and pharmacodynamics (drug-receptor or drug-organ interactions), which affects choice, dose and dosing frequency of many drugs.
Source: CME : Your SA Journal of CPD 25, pp 426 –429 (2007)More Less
Urinary incontinence (UI) is an involuntary loss of urine that occurs when bladder pressure exceeds resistance to outflow. The International Continence Society defines it as 'urine loss, which is objectively demonstrable and is a social or hygienic problem'. It has all the characteristics of a typical 'geriatric syndrome' in that it is prevalent and costly, hidden, related to frailty, with multifactorial causation and a marked impact on quality of life (QoL). The mechanisms of continence are not all understood, but the effects of UI on health (e.g. development of skin irritation, contribution to pressure ulcers, nocturia leading to insomnia, falls (20 - 30%), psychological wellbeing (embarrassment, frustration, social isolation, depression) and costs involved (currently exceeding $20 billion per year in the USA) are well documented. A variety of effective treatments are known, but invariably underutilised.
Author D. WeichSource: CME : Your SA Journal of CPD 25, pp 430 –431 (2007)More Less
Although falls in the elderly have been recognised as one of the 'giants of geriatrics' by geriatricians, they remain a problem area - possibly because there are many reasons for falling and it is often time consuming to elicit the specific causes in a patient. The elderly do not report falls if they have not injured themselves.
Author P. LabanSource: CME : Your SA Journal of CPD 25, pp 432 –437 (2007)More Less
Author B. TippingSource: CME : Your SA Journal of CPD 25, pp 438 –439 (2007)More Less
Delirium is a poorly understood, complex multifactorial syndrome characterised by impaired consciousness, impaired cognition, a rapid onset, a fluctuating course and external causation. It represents an adverse interaction between a vulnerable patient, disease, medical therapy and the care environment.
Author H. DawoodSource: CME : Your SA Journal of CPD 25, pp 440 –441 (2007)More Less
The provision of highly active antiretroviral therapy (HAART) has transformed HIV / AIDS from an acute / subacute disease to a controllable chronic disease. HIV-infected individuals now live longer and grow old. Furthermore, a number of older patients become infected later in life and are not aware of their HIV status. The prevalence of HIV infection in individuals older than 55 years is growing and HIV infection can no longer be thought of as a 'young person's disease'.
Author K. RossSource: CME : Your SA Journal of CPD 25, pp 441 –442 (2007)More Less
Family physicians play an important role in addressing the driving ability and safety of their older patients. No test can directly predict crash risk in an individual. Instead, physicians can test patients indirectly by assessing the functions that are necessary for safe driving.
Source: CME : Your SA Journal of CPD 25, pp 444 –446 (2007)More Less
Hypertension is a common disease of the elderly (older than 65 years), with a prevalence of between 60% and 80%. It is more often isolated systolic hypertension with a relative fall in diastolic pressure, resulting in an increased pulse pressure. Isolated systolic hypertension is caused by age-related increases in arterial stiffness. Cardiovascular risk factors such as diabetes, hyperlipidaemia, sedentary lifestyle and obesity, are more common in the elderly. For these reasons, the elderly population with hypertension is at increased risk of cardiovascular morbidity and mortality.
Author Pieter JordaanSource: CME : Your SA Journal of CPD 25 (2007)More Less
Recently my wife and I used an agency to go to Ireland to work there and learnt a very expensive lesson. It was an obvious mistake we made, but one that is so easy to make. It cost us R25 000 excluding accommodation and food.
My reason for this warning is that in this day and age it is getting more difficult for South African doctors, especially junior doctors, to work overseas. As we do not have the knowledge of how a foreign country's health system works, we rely on agencies to assist us in working abroad.