Geriatric Basics for the Neurohospitalist

Abstract

Due to the increasing age of the population, neurohospitalists are more frequently caring for old and very old people. Fundamental definitions and topics related to geriatric medicine are therefore of particular importance. In this review, common issues encountered in geriatric patients hospitalized on the neurology service are discussed. Focus is put on the geriatric assessment, multiprofessional diagnostic and therapeutic procedures, geriatric syndromes, pharmacotherapy of the aged, delirium, pain, and palliative management as they are relevant for the neurohospitalist. In addition, ethical questions are addressed.

Images of the month: Unexpected neurological comorbidity: Occam's razor or Hickam's dictum?

“…First, multimorbidity in the elderly concerns not only different organ systems but also isolated organs, such as the brain. 4 The three new detected conditions in our patient at her first presentation in the emergency room affect mainly elderly patients and, as the world population becomes older, the overall incidence of such findings will increase. Second, the neurological examination revealed nearly complete blindness, dysphasia and pronator drift of the right limbs.…”

Corticosteroids in patients with vestibular neuritis: An updated meta‐analysis

“…4,5 For example, in the catchment area of Landshut (Lower Bavaria) with about 200,000 inhabitants, 42 patients a year (2015) are diagnosed and treated. 6 As potential causes viral infections, vascular occlusion and immunomediated mechanisms are discussed whereby mainly the superior vestibular nerve is affected. 5 Therapeutically, corticosteroid treatment is advised in the acute phase followed by vestibular rehabilitation.…”

“…Epidemiologically, it is estimated to occur in at least 24 per 100,000 persons a year with the typical age of onset between 30 and 60 years 4,5 . For example, in the catchment area of Landshut (Lower Bavaria) with about 200,000 inhabitants, 42 patients a year (2015) are diagnosed and treated 6 . As potential causes viral infections, vascular occlusion and immunomediated mechanisms are discussed whereby mainly the superior vestibular nerve is affected 5 .…”

“…The odds ratio (OR) for good outcome in the acute phase was 3.1 (95% CI 1.2-7.8; p = .015) in favour of steroid treatment leading to the number needed to treat (NNT) = 6 (95% CI [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. The odds ratio (OR) for restoration of vestibular function in the follow-up was 2.4 (95% CI 1.3-4.4; p = .004) for the benefit of steroid treatment resulting in a NNT = 7 (95% CI [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The results of the cumulative statistics did not differ.…”