Insomnia in the geriatric patient

Insomnia in the geriatric patient is unique and complex, requiring a comprehensive and careful evaluation. Insomnia is the most common sleep complaint reported by persons > 60 years. It is defined as the inability to initiate or maintain sleep, and the etiology can be multifactorial. Insomnia in the geriatric patient may be due to a primary sleep disorder, such as obstructive sleep apnea, periodic limb movements in sleep, circadian rhythm disorders, or restless legs syndrome, or it may be secondary to underlying medical or psychiatric conditions, medication effects, or psychosocial factors. When insomnia becomes chronic, it may exacerbate medical and psychiatric illnesses. Insomnia can lead to excessive daytime sleepiness, which may result in disturbed intellect, impaired cognition, confusion, psychomotor retardation, or increased risk of injury, any of which can compromise the patient's quality of life and create social and economic burdens for caregivers. This article discusses the recommended diagnostic and treatment approaches that may be used by the clinician in treating the geriatric patient. Case studies are presented to illustrate diagnoses of insomnia and therapeutic interventions.     

Rehabilitation and the geriatric patient

The true challenge in the care of the elderly is to keep people at home, in the community, with a high degree of functional ability. This is beneficial to the individual and, from a financial point of view, to the community and public. Maintenance and restoration of function are best accomplished within a framework that considers the psychosocial and developmental needs of the geriatric patient and in a setting specifically intended for the geriatric rehabilitation patient. Unlike the rehabilitation process in younger age groups, which is often dramatic, successful work with geriatric patients is likely to be subtle, but it will result in a return to the community and allow patients to experience a higher level of satisfaction (both emotional and functional) at the end of their lives. The needs of this population are many, and the health care provider must consider disease, physiologic changes associated with aging, and developmental needs when planning and implementing care. Initial research has pointed to the efficacy of geriatric rehabilitation programs; this would seem to indicate a need for a true specialization in geriatrics within the field of rehabilitation.     

伪聋及夸大性耳聋患者听力检查的护理

目的 针对伪聋及夸大性耳聋患者心理特点进行护理，最终对其听力作出正确评估。方法 对初次检查结果可疑者，分析其行为动机，进行正确有效的思想疏导工作，使患者以积极的态度接受检查。结果 经说服教育和心理护理。所有病例均获得满意检查结果。确定初诊为伪聋者58例，夸大性耳聋者67例。动机包括为获取经济赔偿或诉讼优势；工伤评残或老兵退役评残；逃避工作或训练；医疗纠纷等。结论 伪聋和夸大性耳聋有其复杂的主观动机，通过正确引导和心理护理，最终均能获得真实听力结果。     

Management of the patient with tinnitus

Management of the patient with tinnitus is an extremely perplexing problem. This article discusses the evaluation and therapeutic considerations currently used.     

Clinical pharmacology in the geriatric patient

Geriatric patients are a subset of older people with multiple comorbidities that usually have significant functional implications. Geriatric patients have impaired homeostasis and wide inter-individual variability. Comprehensive geriatric assessment captures the complexity of the problems that characterize frail older patients and can be used to guide management, including prescribing. Prescribing for geriatric patients requires an understanding of the efficacy of the medication in frail older people, assessment of the risk of adverse drug events, discussion of the harm:benefit ratio with the patient, a decision about the dose regime and careful monitoring of the patient's response. This requires evaluation of evidence from clinical trials, application of the evidence to frail older people through an understanding of changes in pharmacokinetics and pharmacodynamics, and attention to medication management issues. Given that most disease occurs in older people, and that older people are the major recipients of drug therapy in the Western world, increased research and a better evidence base is essential to guide clinicians who manage geriatric patients.     

Preoperative considerations in the geriatric patient

Because of the "graying" of the population, the increasing availability of surgeons, and the improvement of surgical techniques and intensive care, more and more surgery will be done on geriatric patients. Sometimes, however, surgery will not be considered in a geriatric patient because of mistaken underestimation of life expectancy. The medical consultant is charged with confirming that surgery represents the consequence of the patient's informed decision, a task that is usually time consuming and often difficult. The medical consultant next identifies patient-related and procedure-related factors that affect surgical morbidity and mortality. General physiologic declines in all organ systems are characteristic of aging, but the most important ones affecting surgical risk are those of cardiovascular, pulmonary, immunologic, and central nervous systems. These systems must be assessed by an orderly preoperative evaluation that aims to optimize the patient's status and anticipate and minimize postoperative complication.     

声信息治疗神经性耳鸣患者的护理

目的观察声信息治疗神经性耳鸣患者的临床应用效果,总结其护理要点。方法选择65例神经性耳呜患者,随机分为2组,实验组35例,42耳,在常规改善微循环、营养耳神经等处理的基础上采用声信息治疗,其中4名患者因不能坚持治疗而剔除;对照组30例,41耳,采用常规改善微循环、营养耳神经等处理。治疗时间均为10d。记录比较两组患者治疗前、后的耳鸣程度及疗效。结果实验组对神经性耳呜的疗效与对照组相比较差异有统计学意义（P〈0．05）。结论利用声信息治疗神经性耳鸣患者疗效值得肯定;声信息治疗的护理要点为：熟练掌握S9818声信息治疗仪的操作方法和注意事项,加强对患者的健康教育,提高其遵医行为。     

Sudden sensorineural hearing loss in a post‐COVID‐19 patient

A detailed history and diagnostic evaluation for recent or past COVID‐19 infection is vital in patients presenting with Sudden Sensorineural Hearing Loss (SSNHL) since SSNHL could be a sequelae of COVID‐19 and timely diagnosis and intervention could significantly improve hearing and quality of life.