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Pathy's Principles and Practice of Geriatric Medicine. Группа авторов
Читать онлайн.Название Pathy's Principles and Practice of Geriatric Medicine
Год выпуска 0
isbn 9781119484295
Автор произведения Группа авторов
Жанр Медицина
Издательство John Wiley & Sons Limited
Thyroid‐stimulating hormone (TSH)
The USPSTF does not currently recommend TSH screening of all older adults on the basis of lack of data. However, they recommend targeted TSH screening for symptomatic patients and those with certain risk factors for thyroid disease. The ACP suggests office screening of women older than 50 may be indicated. However, the evidence for treating subclinical thyroid dysfunction is inconclusive. The American Thyroid Association (ATA) issued guidelines that recommend measuring TSH levels starting at age 35 and every five years thereafter. The American Academy of Clinical Endocrinology (AACE) recommends routine TSH screening in older adults without specifying the age to start screening.47 Hypothyroidism may not be associated with adverse outcomes in the oldest individuals when detected by screening alone. A prospective study involving individuals 85 or older did not show an association of elevated TSH levels with reduction in cognitive function, mood, or performance of ADLs. Higher TSH levels were associated with lower all‐cause and cardiovascular mortality.48 Many geriatricians advocate screening high‐risk patients such as the nursing home population, frail elderly, and patients with dementia.49 The sensitive TSH assay is probably the screening test of choice
Diabetes mellitus
This recommendation is based on organizational recommendations only. The American Association of Clinical Endocrinologists recommends screening asymptomatic individuals if risk factors are present. The American Diabetes Association recommends screening asymptomatic adults with a body mass index greater than 25 kg/m2 or or more additional risk factors. The Canadian Task Force on Preventative Health Care recommends screening individuals at high risk for diabetes only every one to three years with a haemoglobin A1c. The US Preventative Services Task Force recommends screening all adults 40–70 who are overweight or obese. The diagnosis of diabetes can be made with a fasting blood sugar of 126 or greater, an A1c of 6.5% or greater, a random glucose level of 200 or greater, or an 85 g two‐hour glucose tolerance test with a plasma glucose level of 200 or greater.50
Sleep apnoea
Because of the low cost of screening (in the form of asking about symptoms of sleep apnoea during the routine history and physical or using a screening questionnaire tool such as the Epworth Sleepiness Scale)51 and the potential to miss this diagnosis among older patients, it is recommended for Robust and Frail elderly. Studies have shown some benefit of treating sleep apnoea in patients with heart failure and stroke.51,52
Abdominal aortic aneurysm
Performing a one‐time screening for abdominal aortic aneurysm (AAA) with abdominal ultrasound has been shown to reduce mortality in adults. The USPSTF recommends one‐time sonography in males between the ages of 65 and 75 who have ever smoked. The American College of Cardiology (ACC) also recommend screening male ever‐smokers ages 65–75 as well as men over 60 who are siblings or children of individuals diagnosed with an AAA. In addition, the Society of Vascular Surgery (SVS) recommends screening all men 65 or above, men 55 or older with a family history of AAA, and women 65 or above with a family history of AAA or past or present smoking use. The Canadian Cardiovascular Society has similar recommendations but recommends screening adults 50 or older with a family history of AAA.53
Key points
Health promotion and preventive medicine are key to good outcomes.
Older people with different levels of function require different approaches.
Vaccinations remain important in older people.
References
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