Foot Examination for Older Adults

The foot changes with age. Foot disorders in older adults are associated with falls, lower limb ulcers, and pain. Physical examination of the feet as part of the routine assessment of older adults is imperative to detect foot problems. Foot pain and pathologies are common in older adults. Regular foot care is important to prevent these issues. However, some older adults may find it difficult to complete foot care, including cutting toenails. Regular foot examination can detect common foot problems, functional decline, and is recommended for preventing falls. We describe a technique for performing a focused examination of the feet for older adults. This review addresses current podiatric issues in older patient populations and describes a method for foot examination to address the needs of older adults that can be incorporated into patient assessments in any clinical setting.     

Falls in older adults: risk assessment, management and prevention

Falls are a common and serious problem for older adults. This article reviews practical aspects of the evaluation and management of this disorder in the ambulatory setting. Older patients should be screened for falls or changes in mobility as part of their annual health maintenance examination. Most falls are due to multiple factors, including disorders of gait, balance, strength, and vision. Polypharmacy and certain medications contribute to falls in many patients and can be a remediable factor. Many falls can be prevented through individualized multicomponent interventions. Exercise programs, rehabilitation, medication management, and treatment of vitamin D deficiency are the most effective single interventions. Referral to a geriatrician should be considered for patients with other common geriatric syndromes, such as cognitive impairment, incontinence, or depression.     

Psychotherapeutic Treatment Levels for Personality Disorders in Older Adults

Treatment of personality disorders (PDs) in older adults is a highly underexplored topic. In this article clinical applicability of the findings from a recent Delphi study regarding treatment aspects of PDs in older adults is explored. This concerns the relevance of three psychotherapeutic treatment levels for PDs in later life: (a) personality-changing treatment, (b) adaptation-enhancing treatment, and (c) supportive-structuring treatment. By means of three cases concerning the three levels, all from a cognitive behavioral perspective, namely (a) schema therapy, (b) cognitive behavioral therapy, and (c) behavioral therapy, we illustrate the usefulness of the different levels in the selection of treatment for older adults with PDs. Throughout all treatment levels, attention to specific age-related psychotherapeutic topics—such as loss of health and autonomy, cohort beliefs, sociocultural context, beliefs about and consequences of somatic comorbidity, intergenerational linkages, and changing life perspectives—is crucial, as they often cause an exacerbation of personality pathology in later life. Suggestions as to how to adapt existing treatments within a cognitive behavioral framework in order to better mold them to the needs and experiences of older adults with PDs are discussed.     

Nocturia and its clinical implications in older women

The aim of this study is to demonstrate the relationship between nocturia and geriatric syndromes, and comprehensive geriatric assessment parameters (CGA) in older women. 858 older outpatient women were included in this cross-sectional study. For the nocturia variable, the question, “Generally, during the past 30 days, how many times did you usually urinate after you have gone to sleep at night until the time you got up in the morning?’’ was used. The relationships between nocturia status and common geriatric syndromes, and CGA parameters were determined. The mean age of patients was 74.1 ± 8.0 years. The prevalence of patients who reported average of 0, ≥1, ≥2, ≥3, and ≥4 nocturnal episodes was 14.7%, 85.3%, 66.3%, 42.13%, and 24.1%, respectively. When all the covariates including age, education, Charlson Comorbidities Index score, glomerular filtration rate, antimuscarinic drugs and alpha-blockers use, diabetes mellitus, chronic obstructive pulmonary disease, and incontinence were adjusted, there were higher rates of insomnia, recurrent falls and higher scores of Timed Up-Go test in older women with ≥2 nocturia episodes (p < 0.05). There was a significant correlation between ≥3 nocturia episodes and lower Instrumental Activities of Daily Living scores and a significant correlation between ≥4 nocturnal episodes and frailty and polypharmacy (p < 0.05). Nocturia is quite common and associated with insomnia, frailty, polypharmacy, incontinence, falls, lower gait speed, and functionality in older women.Therefore, nocturia is very important for geriatric practice and ≥2 nocturia episodes can be a marker of poor health status in older women.