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193 results for

Failure to Thrive in the Elderly

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181. Photosensitive Eruptions (Photodermatoses)

. It presents with failure to thrive, stunted growth, small and narrow facies, sun-sensitive facial telangiectasias, immunodeficiency and increased risk of malignancies. [ ] Defective DNA repair This includes: - a collection of several genetic variants which present in childhood with severe redness and swelling up to 72 hours after sun exposure, resulting in scarring. Very rare. Other These include: Subacute cutaneous lupus erythematosus - this can occur in people with , and , or it may be drug-induced (...) a nutritional supplement containing lycopene, beta-carotene and Lactobacillus johnsonii. [ ] See also separate article . Chronic actinic dermatitis (actinic reticuloid) This is a rare condition affecting mainly middle-aged and elderly men. It often follows years of . Presentation Lichenified plaques on light-exposed skin. It is initially worse in the summer but can become perennial. There is usually little doubt about the diagnosis; however, consider the possibility of a drug-induced photodermatosis

2008 Mentor

182. Non-pulmonary Tuberculosis

before TB developed. [ ] The onset of TB is insidious. Primary infection is usually asymptomatic. The presentation of secondary infection is variable and often nonspecific. A high index of suspicion in patients from particular risk groups is essential to make a diagnosis. TB can affect all organs and body systems. Extrapulmonary TB is more common in children or in the immunosuppressed. General symptoms : fatigue, malaise, fever, weight loss, anorexia, failure to thrive and pyrexia of unknown origin (...) remaining stable at 4.1/100,000 per year. Within this population, those most at risk remain individuals from ethnic minority groups, those with social risk factors and the elderly. The proportion of TB cases with resistance to any first-line drug (7.4%) was slightly lower in 2012 than in 2011, while the proportion of multidrug-resistant (MDR) TB cases (1.6%) remained stable. About one third of the world's population has latent TB infection (LTBI). Over 95% of TB deaths occur in low- and middle-income

2008 Mentor

183. Nephrogenic Diabetes Insipidus

for each patient but polyuria is generally defined as urine output exceeding 3 litres per day in adults. [ ] Polydipsia and chronic thirst are usually a feature and there may be a predilection for very cold drinks, and usually water. Nocturia occurring several times per night is common, particularly in older adults. Children may develop nocturnal enuresis, where they have previously been continent. Infants may present with irritability, failure to thrive, protracted crying, fever, anorexia (...) . Its deficiency or failure to act causes an inability to concentrate urine in the distal renal tubules, leading to the passage of copious volumes of dilute urine. Usually the person with this condition passes >3 litres/24 hours of low osmolality (<300 mOsmol/kg) urine. There are two major forms of DI: Cranial DI: decreased secretion of ADH. Decreased secretion of ADH reduces the ability to concentrate urine and so causes polyuria and polydipsia. Nephrogenic DI: decreased ability to concentrate

2008 Mentor

184. Malnutrition

[ , ] . Nutritional support should be considered for those: With a BMI <18.5. With unintentional weight loss of >10% over the previous 3-6 months. With a BMI <20 and unintentional weight loss of >5% over the previous 3-6 months. Who have eaten little or nothing for >5 days and who are unlikely not to for the following 5 days or longer. Who have poor absorption, high nutrient losses or increased nutritional needs. Differential diagnosis Elderly failure-to-thrive (weight loss >5% of baseline, decreased appetite (...) . ; Management of acute moderate and severe childhood malnutrition. BMJ. 2008 Nov 13337:a2180. doi: 10.1136/bmj.a2180. ; British Association of Parenteral and Enteral Nutrition (BAPEN) ; Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009 Nov13(9):782-8. ; Geriatric failure to thrive. Am Fam Physician. 2004 Jul 1570(2):343-50. ; Dietary advice with or without oral nutritional supplements for disease-related

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2008 Mentor

185. Tuberculosis

before TB developed. [ ] The onset of TB is insidious. Primary infection is usually asymptomatic. The presentation of secondary infection is variable and often nonspecific. A high index of suspicion in patients from particular risk groups is essential to make a diagnosis. TB can affect all organs and body systems. Extrapulmonary TB is more common in children or in the immunosuppressed. General symptoms : fatigue, malaise, fever, weight loss, anorexia, failure to thrive and pyrexia of unknown origin (...) remaining stable at 4.1/100,000 per year. Within this population, those most at risk remain individuals from ethnic minority groups, those with social risk factors and the elderly. The proportion of TB cases with resistance to any first-line drug (7.4%) was slightly lower in 2012 than in 2011, while the proportion of multidrug-resistant (MDR) TB cases (1.6%) remained stable. About one third of the world's population has latent TB infection (LTBI). Over 95% of TB deaths occur in low- and middle-income

2008 Mentor

186. Hypervitaminosis

present with craniotabes, irritability, failure to thrive, decreased appetite and pruritus. Craniotabes is abnormally soft bones of the skull and is unrelated to tabes dorsalis. Complications include: . Hypercalciuria and . Benign intracranial hypertension. Vitamin A may be associated with increased bone fragility and an increased risk of fractures but current evidence is inconclusive. [ ] Investigation FBC. U&E, especially if there is vomiting. LFTs. Ca ++ . Dual-energy X-ray absorptiometry (DEXA (...) be harmful with unwanted consequences to our health, especially in well-nourished populations. The optimal source of antioxidants seems to come from our diet, and not from antioxidant supplements in pills or tablets. Vitamin A and vitamin E supplements may even increase mortality. [ , ] However, vitamin D3 seems to decrease mortality in elderly people living independently or in institutional care. [ ] Vitamin C supplementation has not been shown to reduce the incidence of colds in the general population

2008 Mentor

187. Homocystinuria

to tall stature (occasionally failure to thrive in infancy), fine, brittle hair, hypopigmentation, high arched palate, crowded teeth, arachnodactyly, limited joint mobility, pectus excavatum/carinatum, kyphoscoliosis. Eyes: dislocation of the lens usually downward and medially (ectopia lentis), myopia, glaucoma. CNS: general learning disability (average IQ = 80; 30% have normal IQ), seizures, cerebrovascular events, psychiatric disorders [ ] . Differential diagnosis is the main differential diagnosis (...) to consider [ ] . Marfan's syndrome Homocystinuria Autosomal dominant Aortic incompetence Upwards lens dislocation Normal mentality Scoliosis Flat feet Herniae Autosomal recessive Heart rarely affected Downwards lens dislocation General learning disability Recurrent thromboses Osteoporosis The following conditions also elevate urinary cysteine levels: Elderly Postmenopausal Renal failure Hypothyroidism Leukaemia Psoriasis Drugs - eg, methotrexate, isoniazid Investigations The cyanide-nitroprusside test

2008 Mentor

188. Cranial Diabetes Insipidus

is generally defined as urine output exceeding 3 litres per day in adults. [ ] Polydipsia and chronic thirst are usually a feature and there may be a predilection for very cold drinks, and usually water. Nocturia occurring several times per night is common, particularly in older adults. Children may develop nocturnal enuresis, where they have previously been continent. Infants may present with irritability, failure to thrive, protracted crying, fever, anorexia and fatiguability or feeding problems (...) deficiency or failure to act causes an inability to concentrate urine in the distal renal tubules, leading to the passage of copious volumes of dilute urine. Usually the person with this condition passes >3 litres/24 hours of low osmolality (<300 mOsmol/kg) urine. There are two major forms of DI: Cranial DI: decreased secretion of ADH. Decreased secretion of ADH reduces the ability to concentrate urine and so causes polyuria and polydipsia. Nephrogenic DI: decreased ability to concentrate urine because

2008 Mentor

189. Childhood Tuberculosis

before TB developed. [ ] The onset of TB is insidious. Primary infection is usually asymptomatic. The presentation of secondary infection is variable and often nonspecific. A high index of suspicion in patients from particular risk groups is essential to make a diagnosis. TB can affect all organs and body systems. Extrapulmonary TB is more common in children or in the immunosuppressed. General symptoms : fatigue, malaise, fever, weight loss, anorexia, failure to thrive and pyrexia of unknown origin (...) remaining stable at 4.1/100,000 per year. Within this population, those most at risk remain individuals from ethnic minority groups, those with social risk factors and the elderly. The proportion of TB cases with resistance to any first-line drug (7.4%) was slightly lower in 2012 than in 2011, while the proportion of multidrug-resistant (MDR) TB cases (1.6%) remained stable. About one third of the world's population has latent TB infection (LTBI). Over 95% of TB deaths occur in low- and middle-income

2008 Mentor

190. The effectiveness of domiciliary health visiting: a systematic review of international studies and a selective review of the British literature

intellectual development among children especially among children with a low birth weight or failure to thrive; a reduction in the frequency of unintentional injury as well as a reduction in the prevalence of home hazards; improvements in the detection and management of postnatal depression; enhancement of the quality of social support to mothers; and improved rates of breast-feeding. A meta-analysis of 4 RCTs indicated that intervention group mothers were significantly less likely to report problems (...) programmes were treated as a single study. The studies were divided into two sections: those assessing the outcome of home visiting to parents and young children, and those assessing the outcome to elderly people and their carers. Parents and young children (34 studies). There was evidence to suggest that home visiting was associated with improvements in parenting skills and in the quality of the home environment; amelioration of several child behavioural problems including sleeping behaviour; improved

2000 DARE.

192. Daily oral supplementation during and after a hospital stay improved nutritional status in elderly patients, but did not affect weight change

in hospital and after discharge to elderly patients improved nutritional status at 60 days more than no supplementation, but did not significantly affect percent change in weight from baseline. Commentary Malnutrition in elderly people may present as substantial loss of body weight or failure to thrive (FTT). It is often an indicator of frailty, and malnourished older patients are at particular risk of adverse outcomes, such as frequent falls, incontinence, or confusion. One feature of older patients (...) , Chung M, et al . Screening for frailty: criteria and predictors of outcomes. J Am Geriatr Soc 1991 ; 39 : 778 –84. Hildebrand JK, Joos SK, Lee MA. Use of the diagnosis “failure to thrive” in older veterans. J Am Geriatr Soc 1997 ; 45 : 1113 –7. Footnotes * Information provided by author. For correspondence: Dr C Gazzotti, Service de geriatrie CHR Citadelle, Liège, Belgium. claire.gazzottichrcitadelle.be Source of funding: not stated. Request Permissions If you wish to reuse any or all

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2005 Evidence-Based Nursing

193. Constipation Can Be Deadly: How to prevent this serious complication in the elderly (PubMed)

Constipation Can Be Deadly: How to prevent this serious complication in the elderly This article reviews two cases where severe constipation was an important factor in the patients' deaths. In the elderly, constipation can present not only with mechanical complications, such as perforation and obstruction, but with delirium and failure to thrive as well. Treatment must be aggressive and should include measures to prevent recurrence. Drugs, particularly narcotic analgesics, are important factors

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1992 Canadian Family Physician

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