Cassio Lynm

Falls and Older Adults

Falls are the leading cause of deaths related to injury among people 65 years and older. More than one-third will fall each year; two-thirds of those who fall will fall again within 6 months. Although falling is not normal, older people are more likely to fall because of sensory changes, bones that are less dense, slower reflexes, and reduced strength. These changes affect walking and balance. The January 20, 2010, issue of JAMA includes an article about care of older adults who fall.

Cancer: The Basics

Cancer is a word applied to different types of abnormal, unhealthy cells that grow in an uncontrolled way in the body’s tissues. Cancer causes malignant tumors (abnormal growths) and loss of normal body organ function. The cancer cells can metastasize (spread) to nearby organs or can spread through the bloodstream or lymph system to other areas of the body, depending on the type of cancer involved and the severity of the disease. In addition to causing changes in and damaging the area where it started, cancer often causes other symptoms, such as fatigue, weight loss, anemia (low blood count), pain, weakness, depression, and shortness of breath, and it can be associated with infection. More than 11 million persons in the United States have cancer. Worldwide, more than 12 million individuals are diagnosed with cancer every year. Health care professionals involved in cancer care include oncologists and hematologists (doctors with specialized education and training in treating cancer and diseases of the bloodstream), surgeons of different specialties including surgical oncologists (who focus on surgical management of cancer), radiation oncologists (doctors with specialized training in using x-ray therapy to treat cancer), and nurses with special expertise in cancer care. The March 17, 2010, issue of JAMA is a theme issue devoted to articles about cancer.

Mild Cognitive Impairment

Concerns about memory, word-finding, or other cognitive (mental function) problems are common among older adults. A mild cognitive problem is different from dementia, however, because dementia is diagnosed only when both memory and another cognitive function are each affected severely enough to interfere with a persons ability to carry out routine daily activities. Dementia is much more severe than a mild memory problem such as difficulty recalling names. The October 1, 2008, issue of JAMA includes an article about mild cognitive impairment.

Intensive Care Units

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JAMA patient page. Cystic fibrosis.

C ystic fibrosis (CF) is a genetic (inherited) disease that affects mainly the lungs, the pancreas, and the sweat glands. Some CF patients develop serious liver disease. The abnormal CF gene changes the makeup of mucus in the airways, making it thick and sticky. The body cannot clear this thick mucus from the airways, leading to recurrent lung infections that are difficult to treat. Thick secretions also block other glands, causing them to function poorly. About 30 000 persons in the United States have CF and more than 10 million carry the gene for CF. Carriers of the gene do not have symptoms of CF, but if they have a child who inherits 2 copies (one from each biological parent) of the CF gene, that child will develop cystic fibrosis and can also pass the CF gene on to any children he or she may have. In the past, most persons with CF found out about their condition when they had symptoms in childhood. Newborn screening programs can now lead to earlier diagnosis and therapy to limit the impact of the disease. The September 9, 2009, issue of JAMA includes an article about genetic variations that contribute to the development of serious liver disease in cystic fibrosis.

JAMA patient page. Ulcerative colitis.

Small intestine Inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn disease make the bowel (intestine) inflamed, irritated, swollen, and unable to function in a healthy way. Ulcerative colitis affects the large intestine (the colon) and the rectum but does not involve the small intestine (the part of the bowel that connects the stomach to the colon and that is responsible for almost all the body’s food digestion and absorption of nutrition). Crohn disease affects both the small intestine and the colon.

Urinary Incontinence in Older Women

Urinary incontinence (involuntary loss of urine) is twice as common in women as in men and affects at least 1 in 3 older women. Urinary incontinence is not a normal result of aging; it is a medical problem that is often curable and should be treated. Urine is stored in the bladder and emptied via a tube called the urethra. During urination, muscles of the bladder wall contract, forcing urine from the bladder into the urethra. Sphincter muscles surrounding the urethra relax, releasing urine from the body. Incontinence occurs if bladder muscles suddenly contract or sphincter muscles are not strong enough to contain urine. The June 2, 2010, issue of JAMA includes an article about incontinence in older women.

JAMA patient page. Uterine fibroids.

U terine fibroids are benign (noncancerous) tumors of the uterus (womb) that occur in about 66% of women by the time they reach the age of 50. Fibroids are tumors of the smooth muscle cells of the uterus. The collagen content of the tumor gives it a hard, fibrous texture, thus the name fibroid. These tumors are also called leiomyomata or myomas. The cause of uterine fibroids is unknown. There is a familial predisposition, with a 2to 3-fold increased risk if a mother or sister is affected. African American women are 3 times more likely to be affected than other women. In African American women these tumors can occur at an earlier age and are often larger and more symptomatic. In some women fibroids do not cause symptoms and do not require any treatment. In many women fibroids cause abnormal uterine bleeding and pelvic discomfort. The January 7, 2009, issue of JAMA includes an article about a woman with uterine fibroids.

Treatment of Varicose Veins

The initial evaluation includes taking a history and performing a physical examination. A duplex scan, a type of ultrasound, is the most common and preferred test to evaluate the vascular system. A duplex scan is performed by a vascular technologist and allows doctors to look at the blood flow within veins. This is a painless test performed with a probe and the application of gel. This test is not needed in all patients, especially when there are no symptoms or they are mild. Laboratory blood tests are not needed in patients with varicose veins unless they have ulcers or a history of phlebitis or deep vein thrombosis.

Traveling to High Altitude When You Have Sleep Apnea

How can sleep apnea be treated? The most effective treatment for obstructive sleep apnea is continuous positive airway pressure (CPAP). CPAP machines apply air under gentle pressure to a patient’s airway during sleep (see illustration). A special dental appliance that is snapped onto the teeth during sleep to hold the lower jaw in an advanced position is also effective and may be used if CPAP is not feasible (such as during mountain travel when there is no electricity). The temporary cessation of airflow in sleep apnea may be due either to collapse of the throat (obstructive form of sleep apnea) or to a loss of the drive to breathe (central form of sleep apnea). What is the best way to manage sleep apnea when traveling to high altitude? A study published in the December 12, 2012, issue of JAMA reports treatments to minimize the risk of altitude-related illness for patients with sleep apnea. At altitude, the reduced oxygen content of the blood induces breathing instability, with periods of deep and rapid breathing alternating with central apnea. This breathing pattern is called high-altitude periodic breathing. It occurs even in healthy persons at altitudes above 6000 ft. It may lead to sleep disturbances with frequent awakenings and a feeling of lack of air. High-altitude periodic breathing in healthy mountain travelers and in patients with preexisting obstructive sleep apnea can be prevented or treated with acetazolamide, a drug that is also used for acute mountain sickness.