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Caring for a patient with dementia who lives at home, sometimes alone, presents a constant challenge for general practitioners. This article uses a clinical vignette to explore the initiation of medical care and treatment in an elderly patient with dementia. We specifically address how to inform the patient and family of the initial diagnosis and important issues to discuss from the start. We also examine issues such as delirium, medication adjustments, behavioral difficulties, feeding, and treatment of associated pathologies such as hypertension and diabetes.

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Among the geriatric syndromes for which hospitalized and institutionalized patients are at high risk, malnutrition is a frequent problem, and the prevalence increases with the degree of frailty. Are the treatments that are available for improving nutritional status sufficiently adaptable to the degree of frailty present in elderly patients? This article presents the findings from a literature review assessing the complications associated with tube feeding in advanced dementia. Refeeding syndrome in the fragile and elderly population is an under-recognized and poorly understood problem. Through the use of a clinical vignette which is representative of 8 cases observed in our geriatric ward, we examine the clinical warning signs, the laboratory workup, and the available treatment options.

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Hip fracture management by the geriatrician demands a close cooperation with orthopedic surgeons and a interdisciplinary approach with the implementation of protocole-driven care to standardize the care of most patients. From admission to discharge this orthogeriatric management is based on the comprehensive geriatric assessment to reduce the delays in surgery, the occurence of delirium or the most postoperative complications. This collaborative model of care seems to have the potential to improve function, admissions to nursing homes and mortality outcomes compared with usual care of geriatric patient with hip fracture.

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One hundred seventy patients (average age 79.9 years) with preserved cognitive faculties agreed to complete a questionnaire on the costs caused by their health conditions, the guilt they feel due to these costs, and their eventual resort to the Exit association. 48% answered that health care cost too much to the community, 10% reported feeling guilty about the potential costs generated by a consultation with their physician. 98 patients knew about the Exit association: 26% considered that resorting to Exit was a way to reduce health costs, 30% a way to avoid being an economic burden to their family and 34% a way to die with dignity. Our results indicate that economic pressure on medical costs is a source of guilt for older citizens, so much so that one in 10 patients considers resorting to assisted sucide for fear of costing too much to the community.

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Most of the deaths due to cancer affect the elderly population. The numerous and often underestimated co-morbidities, which weaken elderly cancer patients, interfere with the validity of medical decisions, by raising questions related to the true benefits of the suggested radiotherapy or chemotherapy, in the medium or long term. This leads, sometimes wrongly, either to an absence of oncologic treatment, or to excessive or aggressive therapeutic proposals. The review of the literature leads us to suggest that a global geriatric evaluation should systematically be done to oncologic patients over seventy, with the help of proven tools, in order to offer an appropriate and optimal oncologic treatment.

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Cervical spine fractures are not uncommon in the geriatric population. Lower energy injuries could be responsible, like a simple fall. After an injury, a fracture should always be suspected in patients who complain of cervical tenderness, until proven otherwise. Simple and easily applicable guidelines, such as the NEXUS rules that has been validated in the elderly, could help to achieve a correct diagnosis. Most often, cervical immobilization by rigid collars is an adequate therapy and allows a satisfactory functional recovery.

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Acute bacterial parotitis (ABP) in elderly is clinically described with a sudden onset of painfull swelling over the cheek and angle of the mandible. The occur of ABP is a factor of very bad prognosis, often an indicator of approaching death. In this paper we discuss eight cases observed in our geriatric clinic. To reduce the frequency of ABP in old and frail people, we must be careful about their oral hygiene and dentition, increase their hydration and reduce their use of anticholinergic drugs.

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We present the case of a end stage renal failure patient treated with haemodialysis who developed painful nodules of the subcutis which progressed to ulcerative and necrotic lesions, gradually spreading. The diagnosis of calcific uremic arteriolopathy was made, based on histologic findings showing adipose tissue with necrotic areas and calcifications of the arterioles's media. We describe the clinical presentation of this syndrome which is associated with a high mortality and resume the actual conceptions about the pathogenesis, the diagnosis, prevention and treatment.

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The post-fall syndrome is commonly observed in geriatric medicine, affecting near one out of five fallers. Left untreated, this condition can lead to a regressive syndrome, with physical, psychological and social consequences. To avoid such an evolution, specific physical therapy must be proposed as soon as possible. In this paper, clinical presentation and management of the post-fall syndrome are discussed.

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This prospective study shows key elements by grouping the opinion of 200 hospitalized patients with an average age of 78 that have conserved their cognitive faculties. 57.5% of them think that medical cost of their age group is too high for the collectivity, and brings 15% of them to hesitate before consulting their doctor. What preocupies the most is that 15 patients (7.5%) renonce due to the eventual cost of the consultation, most of them (73.35%) between 1 and 7 days, and more than one quarter (26.65%) for more than a month.

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Hypoglycaemia is often underestimated in the elderly diabetic patient, as clinical manifestations of hypoglycaemia in these patients are frequently atypical. This prospective study, enrolling 100 elderly diabetic patients (age: 79.3 years) shows a great incidence of hypoglycaemic events (24%) during the first day of hospitalisation in a geriatric unit. According to the results of this study, common risk factors for hypoglycaemia in the elderly (advanced age, insulin therapy, renal insufficiency, polymedication, fragility) have no significant predictive value. It appears that screening for risk factors is not enough to prevent hypoglycaemia in the elderly diabetic patient, thereby a careful monitoring of glycaemia during the first days (and nights) of hospitalisation is required. Renewed efforts at better defining appropriate therapeutic goals, taking into account the patient's life expectancy and comorbidities, will help prevent the occurrence of hypoglycaemia in the elderly diabetic patient.

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Constant progress in technic of biochemical measurements allow to find easier the diagnostic of primary hyperparathyroidism, which is more usual with advanced age. We're trying in this study to assess the best treatment for the old patient, often asymptomatic. We propose four clinical cases reports to illustrate the discussion.

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Normal aging is accompanied by functional decline with a loss of independence in activities of daily living. In many cases, after acute medical events, such a functional decline is observed, for which rehabilitation therapies are indicated. However, uncommon types of functional decline are also seen, without trigger event, having a particuliar clinical course: some of these are described in this paper, ranging from the "failure to thrive" to the dramatic "slipping syndrome".

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Since the duration of precordial pain plays a key role in the indication for thrombolytic treatment in acute myocardial infarction, a retrospective study was made of the last 200 infarctions at Monthey Hospital with particular reference to the factors influencing this duration (distance, type of transport, prior intervention by a physician, loss of time in hospital). These factors were compared with other studies, and ways of influencing the time factor are proposed.

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