Recent research deals with disorders and deficits caused by vascular syndrome in an effort of prediction and prevention. Cardiovascular health declines with age, due to vascular risk factors, and this leads to an increasing risk of cognitive decline. Mild Cognitive Impairment (MCI) is defined as the negative cognitive changes beyond what is expected in normal aging. The purpose of the study was to compare older adults with Vascular Risk Factors (VRF), MCI patients, and healthy controls (HC) in social cognition and especially in Theory of Mind ability (ToM). The sample comprised a total of 109 adults, aged 50 to 85 years (M = 66.09, S.D. = 9.02). They were divided into three groups: (a) older adults with VRF, (b) MCI patients, and (c) healthy controls (HC). VRF and MCI did not differ significantly in age, educational level or gender as was the case with HC. Specifically, for assessing ToM, a social inference test was used, which was designed to measure sarcasm comprehension. Results showed that the performance of VRF group and MCI patients is not differentiated, while HC performed higher compared to the other two groups.  The findings may imply that the development of vascular disorder affecting vessels of the brain is associated from its “first steps” to ToM decline at least as regards specific aspects of it such as paradoxical sarcasm understanding.

Delirium is a neuropsychiatric diagnosis that is very common in general medical and surgical populations but of particular importance in palliative medicine.  The incidence is twice that of a regular nursing floor averaging 30%.  At end-of-life the percentage may be as high as 88%. Several different pathophysiologies have been investigated to define the underlying mechanisms to enable targeted therapy. The most commonly accepted cause is a decrease in acetylcholine and increased dopamine. 

Presentation:

Delirium is a syndrome with myriad presentation usually divided into motoric subtypes -hypoactive, hyperactive and mixed. It is underdiagnosed particularly the hypoactive subgroup which may be more common in the palliative medicine population and may be confused with depression. Medications are the most common causes and unfortunately, the majority of medications used in palliative medicine have the potential to cause delirium.

Treatment:

Treatment of delirium is removing the offending cause when possible. When this is not possible or while waiting for improvement, various antipsychotic medications have been used. The medication with the most data is haloperidol. No atypical antipsychotic has been found to be better that haloperidol but they may be useful if toxicity develops or there is no response. A recent article addressed the use of antipsychotics in those with mild to delirium and there was no benefit.

Consequences: 

The presence of delirium is a predictor of increased morbidity and mortality, longer hospitalization and more likely discharge to a nursing facility. This presentation will review the pathophysiology, etiology, diagnosis and treatment of delirium in palliative medicine.

Background Cannabis is emerging as a treatment for pain, but little in-depth research has been conducted since cannabis was just recently approved as a treatment. Due to the prevalence of low back pain (LBP) in aging populations, pharmaceutical cannabinoids have emerged as a possible treatment, although not without controversies.

Objective To assess the role of cannabis in the management of LBP.

Methods This article compiles global data related to the role of cannabis in the management and treatment of LBP in the aging population. A literature review was conducted based on the Cochrane Collaboration - Systematic Reviews of Health Promotion and Public Health Interventions Handbook guidelines, using predetermined keywords, inclusion and exclusion criteria.

Results Through the analysis of studies, data supporting and rejecting the use of cannabis in LBP treatment was made available so informed decisions can be made when choosing optimal management plan. Tetrahydrocannabinol (THC), the active ingredient in cannabis which plays a role in supressing acute, chronic, and neuropathic pain and can be used to manage malignant and non-malignant pain. Studies have found both significant, and insignificant decreases in lower back pain due to the use of cannabis. Similarly, studies reported contradicting evidence on the impact of cannabis to anxiety, and insomnia, both noted to be common comorbid LBP conditions.

Conclusion Overall, cannabis appears to be an effective treatment of LBP, and should be considered when other treatment methods have failed. Cannabis use in LBP is increasing in prevalence in our aging population, and should be researched further.

Causes of diabetic foot wound are multiple factors including peripheral neuropathy, decreased blood supply, high plantar pressures. Elderly diabetic foot wound may be a significant risk for morbidity, limb amputation and mortality. There is no conventional guideline regarding the selection of wound care materials in elderly diabetic foot wounds. According to the colors of the diabetic foot wound (Red-Yellow-Black wound) , it may classified in four categories.  Also, grading can be done using Wagner’s or the Texas wound classification system. Anyway, the foot is a complex structure, which acts as a foundation for the whole body, and it is important to prevent progression of diabetic foot problems. Therefore the some specialists play an important role in wound management of diabetic foot including endocrinologist, podiatrist, vascular surgeon, microbiologist, orthotist, and nutritionist. Choice of wound care in elderly diabetic foot wounds may be based on wound healing process, patient status, and anatomical changes in foot. Revascularization, debridement, offloading, antibiotic therapy, and wound care by using dressing. There are more products which help to cleaning of the wound, improve tissue granulation and wound healing. Some of them are Polyurethane films, Polyurethane foam, Hydrogel dressings, Alginate dressings, Growth factors, Honey-impregnated dressing, Topical enzymes and also Mechanical device such as Vacuum-assisted closure which generates a topical negative pressure over the wound bed. The successful management of elderly diabetic foot wounds requires the multidisciplinary teamwork of specialists. There are various topical regimes available, but the choice depends only on the treating physicians, podiatrist, or clinical care nurse.

Major Depression is common in late life.  It not only causes suffering but it contributes to disability aggravates the course of medical illness and increases mortality.  Both psychotherapy and antidepressants are effective in late life depression.  In a systematic review of older depressed adults we found 27 trials of psychotherapy with 37 comparisons and 2,245 subjects. Psychotherapy was more effective than the control condition but the effect size varied greatly with the type of control.  Trials with waitlist controls showed a large effect size while those with a supportive therapy control had a smaller effect similar to that of antidepressant treatment.  Problem Solving Therapy had the best evidence for efficacy.  We conducted a systematic review of second generation antidepressants in community dwelling adults 60 years and older with Major Depression. 10 trials with 4,165 subjects demonstrated antidepressants were more effective than placebo but the effect size was small resulting in a number-needed-to-treat of 11.  We were able to obtain individual patient data from the sponsors of each of the 10 studies with which we performed a patient level analysis of moderators of antidepressant response. Interestingly age was not a significant moderator. The primary moderator was the lifetime duration of Major Depression. The longer the duration, the lower the placebo response and the greater the drug placebo difference. The finding was replicated in a mixed age sample.