Geriatrics/Aging

More than 30 years after the Nursing Home Reform Act, the United States still fails to protect nursing home residents and provide them with high-quality care. The Covid-19 pandemic’s devastating effect on nursing homes reminds us that further reforms are sorely needed.

This interactive feature about the use of bisphosphonates to treat osteoporosis offers a case vignette accompanied by two essays, one supporting continuation of bisphosphonate therapy beyond 5 years and the other supporting a “drug holiday.”

An 80-year-old woman was admitted with pancytopenia. Five weeks earlier, nausea, vomiting, diarrhea, chills, and fever had developed. CT revealed bilateral pelvic masses; examination of a peripheral-blood smear revealed schistocytes, anisocytosis, and a low platelet count. A diagnostic test was performed, and management decisions were made.

The patient’s eyes close as his diagnosis sinks in. The resident sits with him in a silence filled with racing fears of the unknown. It’s that moment when everything has changed for this man: he’s gone from before to after. The resident knows this moment all too well.

The perception that a good death is one that occurs at home is ingrained in our cultural and social history. But palliative care clinicians have begun to question this idea. What is needed is high-quality end-of-life care that aligns with individual goals and needs.

ECT is effective for several disorders, particularly severe or treatment-resistant depression, with a rapid response, but stigma has impeded its use. The mechanism is not known, but a seizure is required for efficacy. Effects on memory are prominent though usually transient.

When her mother is discharged from rehab after a fall that caused multiple pelvic fractures, a doctor experiences first-hand the frustrations of getting the requisite home help up and running. Even in a generous health system, time, advocacy, and resources are required.

A majority of persons in whom a femoral neck fracture occurs have physical impairment, cognitive impairment, or both. For these patients, a hemiarthroplasty is considered to be the most suitable treatment; bone cement may or may not be used for fixation of the prosthesis. Using an uncemented stem reduces both...

In this multicenter, randomized trial comparing cemented with modern uncemented hemiarthroplasty in persons 60 years of age or older with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and a lower risk of periprosthetic fracture than uncemented hemiarthroplasty.

After her grandmother attempts suicide, a physician finds that the medical team’s avoidance of honest conversation about her grandmother’s reality and desires creates a chasm between the clinicians and the family that is counterproductive and painful.

The Covid-19 pandemic has deepened commitments to enhancing the diversity of the populations participating in research studies. But people with disabilities have been left out of most of these initiatives.

The traditional model of autonomy sees patients as atomistic, and the clinician’s duty as providing information and protecting the patient from undue influence. But people are interconnected and interdependent, shaped by communities and relationships with loved ones.

Aducanumab’s price can inform the drug-pricing policy debate because it responds to key features of the market environment for physician-administered drugs: Medicare’s reimbursement formula, payment to physicians for infused drugs, and cost-sharing requirements.

General anesthesia, a state of reversible unconsciousness, is one of the most important advances in medicine, enabling more than 300 million people annually to safely undergo invasive procedures. Concern has emerged that the effects of general anesthesia may not be transient, especially in patients with underlying neurologic disorders. In 1955,...

CMS is considering whether and under what circumstances Medicare will pay for aducanumab for Alzheimer’s disease. A restrictive coverage determination could save the federal government money, but it would also shift substantial costs to states.