Gerontology and Aging
Misconceptions About Sexual Health in Older Women: Why We Need to Talk About It
Sexual satisfaction has been linked to quality of life throughout a person’s life, and distress related to sexual dysfunction impacts the health of the individual and their relationship.1 A common misconception is that aging women are not sexually active. National representative data indicate that, while sexual activity declines with age, both men and women continue to engage in in vaginal intercourse, oral sex, and masturbation even in the eighth and ninth decades of life.1 However, patients and medical providers lack understanding about female sexual function, particularly in older women.Hormonal and Metabolic Changes of Aging and the Influence of Lifestyle Modifications
Increased life expectancy combined with the aging baby boomer generation has resulted in an unprecedented global expansion of the elderly population. The growing population of older adults and increased rate of age-related chronic illness has caused a substantial socioeconomic burden. The gradual and progressive age-related decline in hormone production and action has a detrimental impact on human health by increasing risk for chronic disease and reducing life span. This article reviews the age-related decline in hormone production, as well as age-related biochemical and body composition changes that reduce the bioavailability and actions of some hormones.Dysphagia in Older Adults
Dysphagia, which is a geriatric syndrome affecting 10% to 33% of older adults, is commonly seen in older adults who have experienced a stroke or neurodegenerative diseases such as Alzheimer or Parkinson disease. Patients diagnosed as having dysphagia can experience malnutrition, pneumonia, and dehydration. Patients can also experience increased rates of mortality and long-term care admission. Providers can identify the specific type of dysphagia for treatment in approximately 80% of patients by asking 5 questions in the patient’s history: What happens when you try to swallow? Do you have trouble chewing? Do you have difficulty swallowing solids, liquids, or both? Describe the symptom onset, duration, and frequency? What are the associated symptoms? Providers can then request a videofluoroscopic swallow study or a fiberoptic endoscopic evaluation of swallowing for further evaluation of oropharyngeal dysphagia.Polypharmacy Management in Older Patients
Medications to treat disease and extend life in our patients often amass in quantities, resulting in what has been termed “polypharmacy.” This imprecise label usually describes the accumulation of 5, and often more, medications. Polypharmacy in advancing age frequently results in drug therapy problems related to interactions, drug toxicity, falls with injury, delirium, and nonadherence. Polypharmacy is associated with resulting increased hospitalizations and higher costs of care for individuals and health care systems.Hospital to Community Transitions for Older Adults: An Update for the Practicing Clinician
Spurred by changes in both population demographics and health care reimbursement, health care providers are responding by using new models to more fully support the posthospital transition. This paper reviews common models for posthospital transition and also describes the Mayo Clinic model for care transition. Models are designed with the intent of managing the cost of health care by reducing 30-day hospital readmissions and improving management of chronic disease. Meta-analyses have proved helpful in identifying the most effective program elements designed to reduce 30-day hospital readmissions.Approach to the Older Adult With New Cognitive Symptoms
Dementia affects nearly 50 million people worldwide, translating into one new case every 3 seconds. Dementia syndrome is one of the leading causes of disability among older adults, yet it remains vastly underdiagnosed. A timely diagnosis of dementia is essential to ensuring optimal care and support of individuals and their loved ones. Although there is no single test for dementia, health care providers can use a structured approach to the workup and management of new cognitive symptoms. Comprehensive MEDLINE and PubMed searches were performed to develop an unbiased, practical diagnostic approach to these symptoms.Introduction to Thematic Reviews on Aging and Geriatric Medicine
Over the past decade, the number of publications on aging and geriatric medicine has increased dramatically, and in 2018, there were more than 27,000 and 8,000 PubMed citations, respectively. Much of this interest has been generated by a more precise understanding of the mechanisms of primary aging processes, and remarkably, the early identification of potential targets for interventions. Concomitantly, formulation of the geroscience hypothesis has created a new paradigm shift for thinking critically about the relationship between chronic diseases and aging, with the now real possibility of simultaneously treating multiple age-onset conditions with the same intervention.Prevention, Diagnosis, and Management of Chronic Wounds in Older Adults
Chronic wounds are common, disproportionately affect older adults, and are likely to be encountered by providers across all specialties and care settings. All providers should be familiar with basic wound prevention, identification, classification, and treatment approach, all of which are outlined in this article.Can Pain Management be Safely Optimized in Older Adults?
Managing chronic pain is a challenging task. Older adults (OAs) (>65 years) are the fastest growing segment of our population, and are substantially affected by chronic pain of various etiologies. Chronic pain, which affects a significant proportion of community-dwelling OAs and may be nearly universal in long-term care residents, is associated with numerous other conditions, including frailty, debility, and depression.1 Optimizing its management is critical for achieving optimal health outcomes in OAs.Assessing and Counseling the Older Driver: A Concise Review for the Generalist Clinician
Older drivers are putting more miles on the road during their “golden years” than generations prior. Many older adults have safe driving habits, but unique age-related changes increase the risk for crash-related morbidity and mortality. Generalists are poised to assess and guide older adults' driving fitness. Although there is no uniformly accepted tool for driving fitness, assessment of 5 key domains (cognition, vision, physical function, medical comorbidities, and medications) using valid tools can help clinicians stratify older drivers into low, intermediate, and high risk for unsafe driving.Exceptional Human Longevity
Exceptional longevity represents an extreme phenotype. Current centenarians are survivors of a cohort who display delayed onset of age-related diseases and/or resistance to otherwise lethal illnesses occurring earlier in life. Characteristics of aging are heterogeneous, even among long-lived individuals. Associations between specific clinical or genetic biomarkers exist, but there is unlikely to be a single biomarker predictive of long life. Careful observations in the oldest old offer some empirical strategies that favor increased health span and life span, with implications for compression of disability, identification and implementation of lifestyle behaviors that promote independence, identification and measurement of more reliable markers associated with longevity, better guidance for appropriate health screenings, and promotion of anticipatory health discussions in the setting of more accurate prognostication.
