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Your search term(s) "older adults" returned 12 results.

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Biliary Diseases in the Elderly. Practical Gastroenterology. 32(9): 14-26. September 2008.

This article reviews the diagnosis and management of biliary diseases in older adults, specifically those older than 65. The authors note that pancreatobiliary disorders represent some of the most common and feared conditions that affect the elderly. They emphasize the need to conceptualize interventions by how they will affect the patient’s independence and quality of life, with an endpoint often being improvement rather than cure. Topics covered include biliary tract morphology and physiology in aging, cholelithiasis or gallstones, choledocholithiasis or bile duct stones, acute calculous cholecystitis, acute acalculous cholecystitis, cancer of the biliary tract, gallbladder carcinoma, cholangiocarcinoma (CCA), benign strictures, hemobilia, and biliary papillomatosis. For each condition, the authors review diagnostic testing, symptoms, treatment approaches, possible complications of disease and treatment, and prognosis. The authors conclude by noting that technological advances in imaging and therapeutics allow more aggressive clinical care plans in patients who as recently as 5 years ago would have been deemed suitable only for palliation. 1 table. 110 references.

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Celiac Disease Management for Older Adults. Today’s Dietitian. 10(5):22-24. May 2008.

This article helps dietitians understand strategies to help their older clients follow a gluten-free diet to manage their celiac disease. The author notes that although a gluten-free diet is a successful way to treat celiac disease, the process of following a restrictive diet can be cumbersome, particularly for older adults, who may have additional dietary concerns such as chewing and swallowing difficulties, diabetes, or other conditions that complicate eating. The author explains the importance of focusing on allowable foods, discussing safe food alternatives, providing resources, and being realistic with clients. Resources that can be useful include where clients can find gluten-free foods locally, Internet sites for products and support groups, and local restaurants that will offer gluten-free meals. A final section discusses some additional concerns about the higher carbohydrate and fat content of some commercially available gluten-free foods. The author encourages dietitians to help their clients include the use of gluten-free, high-fiber grains in their diet plans. References are available online (references@gvpubcom).

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Colorectal Cancer (CRC) Screening in the Geriatric Population: Factors in Risk Assessment And Outcome Benefits. Practical Gastroenterology. 32(2): 17-36. February 2008.

This article explores factors in risk assessment and outcome benefits associated with colorectal cancer screening (CRC) in the geriatric population. CRC screening is the search for polyps and cancer in individuals who have not been previously diagnosed with colonic neoplasms; surveillance refers to follow-up of patients who have already received a diagnosis of colonic neoplasms. The authors review the literature, report on the current status of CRC screening, and then analyze certain controversies in discontinuing screening colonoscopy after a certain age. Topics include the epidemiology of CRC in the United States, particularly in relation to age groups, racial factors, and ethnic groups; the prevalence of CRC in different groups; current recommendations for CRC screening, including risk stratification, recommendations for the average risk population and for those deemed at higher risk; the role of diagnostic tests, including fecal occult blood testing (FOBT), sigmoidoscopy, colonoscopy, and double contrast barium enema (DCBE); future alternatives to traditional colonoscopy, including virtual colonoscopy, stool DNA tests for colon cancer, and wireless capsule endoscopy; the effect of aging on the incidence of CRC; colonoscopy complications in older patients compared with those in younger patients; and cost factors. The authors note that many debates on screening colonoscopy in older adults are prompted by a desire to free up endoscopic resources to screen younger individuals with a longer life expectancy. The demand for screening colonoscopy continues to strain the U.S. health care system, despite overall low participation rates. The authors conclude that CRC screening should be individualized based on quality of life of the patient, comorbid situations, and a rough estimate of the individual’s life expectancy. 1 figure. 2 tables. 88 references.

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Concerned About Constipation?.

This fact sheet from the National Institute on Aging provides basic information about constipation. Readers are reassured that there is no correct number of daily or weekly bowel movements and being “regular” is different for each person. The fact sheet lists recommended questions to help readers determine whether they might have a constipation problem. These questions consider symptoms such as bowel movements fewer than three times per week, difficulty passing stools, lumpy or hard stools, and a feeling of being blocked or of not having fully emptied the bowels. The fact sheet discusses the causes of constipation, including diet; using too many laxatives or enemas; lack of exercise; holding back bowel movements; some medical conditions; some medications; treatment approaches such as adding fiber to the diet, drinking adequate fluids, and getting enough physical activity; and how to know when to consult a health care provider about constipation concerns. Readers are referred to three resource organizations for more information: the National Digestive Diseases Information Clearinghouse (www.niddk.nih.gov or 1–800–891–5389), the National Library of Medicine Medline Plus (www.medlineplus.gov), and the National Institute on Aging Information Center (www.nia.nih.gov or 1–800–222–2225). Readers are encouraged to go online to NIHSeniorHealth (www.nihseniorhealth.gov), a senior-friendly website that has health information for older adults.

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Bacteria and Foodborne Illness. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2007. 8 p.

Foodborne illness results from eating food contaminated with bacteria—or their toxins—or other pathogens such as parasites or viruses. The resulting illnesses range from upset stomach to more serious symptoms, including diarrhea, fever, vomiting, abdominal cramps, and dehydration. This fact sheet reviews the causes, symptoms, risk factors, complications, diagnosis, treatment, and prevention of foodborne illness. People at greater risk for foodborne illness include young children, pregnant women and their fetuses, older adults, and people with lowered immunity. Symptoms usually resemble intestinal flu. Treatment may range from replacement of lost fluids and electrolytes for mild cases of foodborne illness, to hospitalization for severe conditions such as hemolytic uremic syndrome (HUS). Prevention strategies include adequate hand washing; keeping raw meat, poultry and seafood separate from other foods; cooking foods properly; using adequate refrigeration; and cleaning surfaces well before and after using them to prepare foods. One section describes the use of food irradiation as a means of cold pasteurization, which destroys living bacteria, to control foodborne disease A final section considers recent evidence that foodborne pathogens are linked to chronic disorders, including arthritis, inflammatory bowel disease, kidney failure, Guillain-Barre syndrome, and autoimmune disorders. One sidebar reviews common sources of foodborne illness, including the bacteria that are usually responsible. The fact sheet concludes with contact information for nine resource organizations, including government agencies and a brief description of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC). 1 table.

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Epstein-Barr Virus: An Unusual Cause of Cholestatic Hepatitis in Older Adults. Gastroenterology and Hepatology. 3(2): 101-107. February 2007.

Epstein-Barr virus (EBV) frequently causes acute infection or infectious mononucleosis (IM) in adolescents. However, in the older adult population, acute EBV infection is a rare occurrence and may present with atypical signs and symptoms, making the diagnosis an elusive one. This article presents two cases of older adult patients with acute EBV infection, cholestatic hepatitis, and neurologic symptoms. For each patient, the authors describe presenting symptoms, diagnostic tests that were conducted, results of those tests, diagnosis, and course of the disease. In both patients, the liver chemistry tests normalized over the several months following the acute disease episode. The authors remind readers that the diagnosis of acute EBV in older patients requires recognition of potentially atypical laboratory findings. The pathogenesis of EBV-associated neurologic disorders is not completely understood, but direct viral invasion of the central nervous system is a possible mechanism. Although many adult patients with acute EBV are hospitalized for the evaluation of their presenting symptoms, treatment remains supportive. Antiviral agents, such as acyclovir, have not been found to affect the severity or duration of IM, but they do appear to reduce oropharyngeal shedding of the virus. The authors conclude that, in older adult patients presenting with nonspecific symptoms, including fever, liver chemistry test abnormalities, and neurologic symptoms, IM should be considered in the differential diagnosis. Costly and invasive procedures can be avoided if an appropriate diagnosis is achieved earlier in the course of the illness. Appended to the article is a peer review by Mendez-Sanchez et al. 3 tables. 45 references.

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Food Safety for the Senior Set. Today's Dietitian. 9(6): 24-27. June 2007.

Many foodborne illnesses cause only mild symptoms in the general population. They can, however, be associated with severe infections, serious complications, and death in high-risk populations such as preschool-aged children, older adults, and those with impaired immune systems. This article considers food safety for older adults, focusing on those seniors who are residents in long-term care (LTC) facilities. The author reviews some of the reasons for renewed interest in this topic, including newly identified pathogens and vehicles of transmission, the threat of bioterrorism, changes in methods of food production, and increasingly international sources of the food supply. The author then briefly reviews the 10 most common causes of foodborne illnesses, which include improper cooling, 12 or more hours between preparation and eating, infected people handling food, inadequate reheating, improper hot-holding temperatures, contaminated ingredients, food from unsafe sources, improper cleaning, cross-contamination from raw foods, and inadequate cooking. The author encourages dietitians to familiarize themselves with certain foods that may pose a significant health hazard to older adults in an LTC setting. In addition, dietitians must manage the safety of food by controlling the food supply, maintaining sanitary facilities, and training employees to know how to work safely with food. 5 references.

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Gallstones. Bethesda, MD: National Digestive Diseases Information Clearinghouse. July 2007. 8 p.

This fact sheet provides a wealth of information about gallstones, which are small, pebble-like substances that develop in the gallbladder. Gallstones form when liquid bile stored in the gallbladder hardens. Bile is made in the liver and stored in the gallbladder until the body needs it. The fact sheet describes the different types of gallstones, symptoms and complications of gallstones, the causes of gallstones, diagnostic tests that may be used to confirm the presence of gallstones, and treatment strategies including surgery and nonsurgical therapies such as oral dissolution therapy and contact dissolution therapy. Gallstones are more common among older adults; women; American Indians; Mexican Americans; people with diabetes; those with a family history of gallstones; people who are overweight, obese, or who undergo rapid weight loss; and those taking cholesterol-lowering drugs. Gallbladder attacks often occur after eating a meal, especially one high in fat. The symptoms of gallstones may mimic those of other problems, including a heart attack, so an accurate diagnosis is important. Laparoscopic surgery to remove the gallbladder is the most common treatment. A final brief section describes the research aims in this area. The fact sheet concludes with a list of resource organizations through which readers can obtain additional information, and a description of the goals and activities of the National Digestive Diseases Information Clearinghouse. 1 figure. 1 table. 3 references.

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Hepatitis A. Practical Gastroenterology. 31(10): 37-38, 40-42. October 2007.

This article reviews hepatitis A, an important illness to consider in the evaluation of patients presenting with acute hepatitis. The authors cover virology, epidemiology, clinical features, diagnosis, treatment, and prevention strategies. Hepatitis A is an acute disease, with uncommon but well-documented relapses that typically occur 30 to 90 days after the primary episode. Rarely, extrahepatic manifestations can occur. The authors caution that older adults and patients with chronic liver disease are patient groups in which hepatitis A virus (HAV) can have a severe clinical course. They conclude that universal childhood immunization against HAV in all regions of the country, as recently recommended by the Centers for Disease Control and Prevention (CDC), may help decrease the incidence and impact of HAV in this country. 2 tables. 26 references.

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Lactose Intolerance: Testing and Challenges. Today's Dietitian. 9(7): 24, 26. July 2007.

Older adults generally have decreased levels of lactase, which can result in increased frequency of suspected lactose intolerance among long-term care (LTC) residents. In addition, there are some differences in prevalence in different groups: lactose intolerance affects 80 percent of African Americans, 80 to 100 percent of American Indians, and 90 to 100 percent of Asians. This article reviews the diagnostic and screening tests that may be used to diagnose lactose intolerance. Lactose intolerance is often characterized by bloating, flatulence, abdominal pain, and diarrhea. The tests reviewed include the hydrogen breath test, the lactose tolerance test, and the stool acidity test. A final section considers the interplay between osteoporosis and lactose intolerance, focusing on the need for a diet that is adequate in calcium and vitamin D without including milk and dairy products. One sidebar lists recommended steps to the successful control of lactose intolerance. 3 references.

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