Julie K. Gammack

Diabetes mellitus in older men

Most persons with diabetes mellitus are over the age of 60 years. Males develop diabetes more commonly than females. Older diabetics tend to have both impaired insulin release as well as insulin resistance. In older persons diabetes mellitus is associated with decreased functional status and cognitive dysfunction. In general, older persons with diabetes are inclined to be underdiagnosed and undertreated. Managing diabetes in older persons requires special considerations because of their differences in pathophysiology of diabetes and strong association with functional, cognitive impairments and comorbidities. The use of strict therapeutic diets is not recommended in older persons. Treatment of hypertension and hyperglycemia can improve outcomes in older persons. The interdisciplinary team approach is important for care of older diabetic persons.

Falls, osteoporosis, and hip fractures

Osteoporosis and falls are distinct conditions that share the potential clinical endpoint of fracture. This article explores the associations between osteoporosis and falls by examining the epidemiology, risk factors, risk prevention, and treatments. It outlines the evidence on falls prevention, osteoporosis diagnosis, and fracture risk assessment. It includes several studies that challenge the common view on the use of fall prevention tools, dual energy X-ray absorptiometry testing, and postfracture bisphosphonate treatment. By understanding the evidence, it becomes clearer how to target populations at risk, interpret screening methods, and promote disease prevention and treatment.

Lower Urinary Tract Symptoms

Lower urinary tract symptoms (LUTS) occur commonly in older men and can have a significant effect on quality of life. Symptoms can be categorized as voiding, storage, or postvoiding in nature. A variety of symptom screening scales are available to categorize the nature and severity of the urinary symptoms. Erectile dysfunction (ED) symptoms frequently overlap with LUTS and treatment must address both conditions. Initial evaluation for LUTS and ED includes extensive questioning about symptoms, medication use, and medical history, followed by a targeted physical examination and basic laboratory testing. Treatment is focused on the origin of symptoms, which are frequently bladder hyperactivity, urinary retention, or prostatic hypertrophy. Common medication classes used to treat LUTS and ED include alpha-1 adrenergic blockers, anticholinergics, 5alpha-reductase inhibitors, and phosphodiesterase inhibitors. Combination medication therapy has been studied and is providing benefit in patients with more than one type of urinary dysfunction.

Nursing education and improvement in oral care delivery in long-term care.

OBJECTIVE To determine if a facility-wide oral care educational program will improve the quality of routine oral care provided to nursing home residents. DESIGN Single-blind, pre-post observational study of direct caregivers providing routine oral care to residents in 2 nursing homes. INTERVENTION A 30-minute oral care program including lecture, demonstration, and hands-on skill training led by a research-trained dental hygienist. RESULTS Twenty-eight subjects were observed during 110 pre- and 119 posteducation oral care encounters. One third of the subjects attended the facility-wide oral education program. Most facility residents were cooperative during oral care delivery. The average length of brushing to the teeth or dentures was 52 seconds and total time for oral care delivery was 2minutes after the educational program. Approximately half of the residents received tooth or denture care with both toothbrush and paste, half had tongue cleansing performed and half received oral rinsing with water. One resident received flossing of the teeth. One third of the oral care encounters were performed without the use of gloves. There were no significant changes in any oral care activities after the educational intervention. CONCLUSION The oral care educational program did not result in improvement in the delivery of routine oral care to nursing home residents.

Natural Light Exposure Improves Subjective Sleep Quality in Nursing Home Residents

To the Editor: Sleep disturbance in the nursing home is common and includes frequent nocturnal awakening, increased sleep latency, and prolonged time spent in bed. This can lead to confusion, poor control of medical illnesses, and impaired rehabilitation. Studies on artificial light therapy in nursing home residents have demonstrated improvement in sleep as measured by polysomnography, nursing observation, and patient selfreport. We hypothesize that natural light exposure can provide similar sleep benefits. In this investigation, self-reported sleep quality was measured in nursing home residents using a sunlight exposure protocol.

Cancer in older men: A gender-based review

Cancer is a common condition of the older male. Risk factors for developing a malignancy include genetic, environmental and life style features. Cancer epidemiology and prognosis differ depending on the age and gender of the population being studied. In the group of men older than 65 years, the most common malignant tumors are prostate, lung, colon and pancreatic cancer. Treatment options vary depending on the stage of the tumor when it is diagnosed, and the decision for therapeutic versus palliative interventions will depend upon the functional status, comorbidity and personal wishes of the patients.

Home Hospitalization Service for Acute Uncomplicated First Ischemic Stroke in Elderly Patients

1. Disability and functional impairment, using the activity of daily living (ADL) scale and the seven-item Functional Impairment Measure. 2. Mental status and severity of stroke-related neurologic deficit using the Canadian Neurological Scale and modified National Institutes of Health Stroke Scale. 3. Depression using the Geriatric Depression Scale (GDS). Patients were evaluated at baseline and after 6 months.

Physician Judgments and the Burden of Chronic Pain

Objective In a moderated mediation model, this study examined the interaction effect of pain severity and medical evidence on physician judgments of chronic pain. The effects of higher pain severity on physician judgments were expected to be mediated through anticipated clinical burden, but only when medical evidence was low. Design Participants were randomly assigned to one of six case descriptions of a chronic pain patient in a 3 × 2 design that varied by reported pain severity (4, 6, 8/10) and medical evidence (low vs high). Setting An academic training program for medical residents/fellows. Subjects Residents/fellows in clinical departments at postgraduate year 2 or higher (N = 109). Methods Participants read case descriptions and then made judgments about the patient and rated the level of burden they expected to assume in treating the patient. Results Higher pain severity occasioned greater pain discounting and higher likelihood of prescribing opioid medication. When medical evidence was low, participants had less trust in the patients pain report, attributed pain more to psychosocial than medical factors, and were less likely to refer for possible surgery. Analyses yielded no support for moderated mediation as expected burden was high across all conditions. Significant associations were found between expected burden and multiple clinical judgments. Conclusions Results did not support the proposed moderated mediation model as all patients were expected to be burdensome across clinical presentations, reflecting negative expectations of patients with chronic pain. Such expectations can have adverse implications for patient-provider communication, shared decision-making, and the delivery of personalized care.