2 results
38 - Geriatric Ear, Nose, and Throat Problems
- Edited by Christine Arenson, Jan Busby-Whitehead, University of North Carolina, Chapel Hill, Kenneth Brummel-Smith, Florida State University, James G. O'Brien, University of Louisville, Kentucky, Mary H. Palmer, University of North Carolina, Chapel Hill, William Reichel, Georgetown University, Washington DC
-
- Book:
- Reichel's Care of the Elderly
- Published online:
- 19 May 2010
- Print publication:
- 09 February 2009, pp 424-434
-
- Chapter
- Export citation
-
Summary
It is important to check carefully for a number of problems among elderly patients, who may be unaware of the insidious development of hearing loss, balance deficits, or intraoral or pharyngeal cancers. Unsuspected balance deficiencies may be putting the patient at risk for falls. Nasal obstruction may be dismissed by the patient; however, inspection may reveal easily treatable problems such as benign polyps or life-threatening disease such as a neoplasm.
OUTER EAR
The anterior and posterior surfaces of the pinna are common sites for actinic keratoses and skin cancers. The eardrum, especially the pars flaccida, is a common location for an occult cholesteatoma (see later). If cerumen obstructs the examiner's view it can be removed by direct manipulation or by irrigation with clean water at body temperature, provided there is no eardrum perforation. Alternatively, instilling mineral oil will soften and lubricate the impaction, making removal easier and more comfortable. Cerumen impaction can usually be avoided by keeping the ear oily (by adding a couple of drops of mineral oil weekly) and keeping soapy water away from the ear canal.
Swelling of the external auditory canal associated with purulent secretions indicates an external otitis. External otitis should be treated by applying eardrops containing an antibiotic (typically polymyxin and neomycin combined with hydrocortisone) in an acidic solution. Cortisporin, Coly-mycin or VoSoL are commonly used preparations. Drops should be applied three times daily. It is important that a) the canal orifice should be cleared of secretions and debris before the application and b) the patient's head must be adjusted so that the ear canal is tilted upward.
16 - Evaluation and Management of Dementia
- Edited by Christine Arenson, Jan Busby-Whitehead, University of North Carolina, Chapel Hill, Kenneth Brummel-Smith, Florida State University, James G. O'Brien, University of Louisville, Kentucky, Mary H. Palmer, University of North Carolina, Chapel Hill, William Reichel, Georgetown University, Washington DC
-
- Book:
- Reichel's Care of the Elderly
- Published online:
- 19 May 2010
- Print publication:
- 09 February 2009, pp 176-189
-
- Chapter
- Export citation
-
Summary
DEFINITION
Dementia is characterized by memory and learning impairment as well as deficits in at least one other cognitive domain. These include: impairment in communication (aphasia); impairment in recognition and manipulation of objects (agnosia and apraxia); impairment in reasoning ability; and impairment in handling complex tasks (executive function). These cognitive symptoms must represent a significant decline from a previous level of functioning and interfere with functional status and social activities. The disturbances must be insidious in onset and progressive and must not be better accounted for by another psychiatric diagnosis, such as delirium, or systemic disease.
Epidemiology
The prevalence of dementia has been estimated to be approximately 6%–10% of individuals aged 65 years or older. The prevalence of dementia increases with age, rising from 2% among those aged 65 to 74 years to more than 30% of those 85 years and older. Incidence rates of Alzheimer's disease (AD) demonstrate exponential growth, doubling every 5 years after the age of 65 years, at least until the age of 85 years.
The cost of caring for people with dementia is substantial; dementia has been estimated to increase the mean annual health care cost per older patient by $4,134, primarily as a result of increased hospitalization costs and increased expenditures on skilled nursing facilities. The current annual economic cost of dementia is approximately $100 billion. With the anticipated doubling of the population aged 65 years and older by 2030, the financial impact of dementia on our society will be even more dramatic.