This case report details the diagnostic challenge and management of an 88-year-old man who presented to a rural Japanese community hospital with sepsis-like symptoms, initially suspected of acute bacterial cholangitis based on his physical and laboratory findings. Despite the antibiotic treatment of tazobactam and piperacillin, the patient\'s symptoms persisted, leading to further investigations that revealed no signs of infection but notable aortic arch wall thickening on contrast-enhanced computed tomography scans. These findings, combined with the patient\'s clinical presentation and lack of antibiotic response, redirected the diagnosis toward giant cell arteritis (GCA). The administration of prednisolone of 60 mg daily significantly alleviated symptoms and prevented potential severe complications such as blindness and irreversible neurological damage. This case underscores the importance of considering GCA in elderly patients presenting with systemic inflammatory symptoms and the necessity of timely intervention. It also highlights the challenges in managing high-dose steroid therapy in elderly patients and suggests the potential benefits of integrating immunosuppressants to reduce steroid dependency. This report emphasizes the need for heightened awareness and a comprehensive diagnostic approach in atypical presentations of GCA, particularly in geriatric populations within resource-limited healthcare settings.

Malnutrition, inflammation, comorbid diseases, and inactivity are known causes of sarcopenia. It results in clinical consequences like fractures, falls, low quality of life, cognitive dysfunction, and mortality. Especially in the treatment of patients with prolonged immobilization syndrome, management should not only focus on functional limitations but patients should also be evaluated and followed up for sarcopenia. In this case report, we present the management of probable secondary sarcopenia in the intensive care unit as a result of urosepsis and discuss it in the light of the literature.

Hypothermia is defined as a core body temperature of less than 35°C. This report centers on the case of an older adult who presented to the emergency department (ED) with mild hypothermia, bradycardia, and electrolyte abnormalities during the summer in a warm climate. The patient was an 82-year-old man who was found to be hypothermic (33.6°C rectally), hypotensive, and bradycardic. He was treated with intravenous (IV) fluid resuscitation, active external rewarming (AER), and empiric antibiotics for his left lower lobe pneumonia. He was admitted to the intensive care unit and ultimately discharged home with physical therapy. Older adults are at an increased risk for hypothermia, even in a tropical climate. Early recognition of hypothermia is essential to achieve good outcomes.

This case report details the assessment and interdisciplinary collaboration in the management of an 81-year-old patient presenting with acute visual impairment, dizziness, general weakness, gait disturbances and fear of falling. A holistic geriatric evaluation revealed orthostatic dysregulation and an underlying multifactorial gait disorder exacerbated by visual impairment. Ophthalmological findings included left central retinal artery branch occlusion and cataracts. A comprehensive geriatric assessment showed frailty, impaired mobility and decreased functional abilities. Subsequent patient-centered interdisciplinary approaches included treatment for retinal ischemia, orthostatic testing, medication reconciliation, physiotherapy and occupational therapy. This case emphasizes how interdisciplinary collaboration between ophthalmology and geriatrics enables proactive assessment and intervention to reduce the risk of functional decline and loss of autonomy in visually impaired patients, which is of particular relevance considering the increasing prevalence of visual impairment in the ageing population.
UNASSIGNED: Dieser Fallbericht beschreibt einen 81-jährigen Patienten, der aufgrund akuter Visusminderung, Schwindel, allgemeiner Schwäche, Gangstörung und Sturzangst in eine Klinik für Augenheilkunde aufgenommen wurde. Zu den ophthalmologischen Befunden gehörten ein reperfundierter Arterienastverschluss links und eine Cataracta corticonuclearis provecta beidseits. Ein umfassendes geriatrisches Assessment ergab zusätzlich geringgradige Frailty, eingeschränkte Mobilität und verringerte Selbsthilfefähigkeit. Die interdisziplinäre Behandlung erfolgte patientenzentriert und umfasste neben der Behandlung und Abklärung der retinalen Ischämie u. a. eine Schwindelabklärung, Medikationsanalyse und -änderung, Physio- sowie Ergotherapie. Sehkraftminderungen gehen bei älteren Menschen mit erhöhtem Risiko für Autonomieverlust, Mobilitätseinschränkung, funktionellen Abbau und verminderter Lebensqualität einher. Das Sturzrisiko und die Mortalität sind erhöht. Dieser Fallbericht verdeutlicht, wie interdisziplinäre Zusammenarbeit zwischen Augenheilkunde und Geriatrie eine frühzeitige Identifikation des individuellen Risikos und geeigneter Interventionen ermöglicht.

UNASSIGNED: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the end of 2019 caused the global pandemic. Oral and dermatological manifestations of coronavirus disease 2019 (COVID-19) such as xerostomia, aphthous-like lesions, ulcers, tongue depapillation, necrotizing gingivitis, and taste disorders, including the loss of taste and salivary gland infections are being reported. This study aims to describe a case of oral ulcers following COVID-19 infection.
UNASSIGNED: We present the case of a 95-year-old male patient hospitalized in follow-up care and rehabilitation unit, of Minimes Geriatric Clinic, Toulouse, France. He had an alteration in his general health in the context of COVID-19 infection detected by reverse transcription polymerase chain reaction (RT-PCR). Six days after the admission, the patient complained of a strong burning sensation of the mouth, especially on the tongue and the lips\' mucosa. Intraoral examination revealed painful erosive areas on the lateral edges of the tongue and the mucous side of the lower lip. The proposed treatment to reduce the burning sensation was based on general analgesics (morphine sulfate), mouthwash with sodium bicarbonate, the application of a lidocaine-based oral anesthetic and healing gel and a comfort-oriented diet. Thirteen days later, the patient reported a gradual improvement.
UNASSIGNED: A diverse range of oral manifestations has been observed in patients with a history of COVID-19 infection. These oral ulcers significantly impact the quality of life of the individual, causing intense pain, stress, and difficulties in eating, with repercussions on nutritional status, especially in older individuals. Our case underscores the importance of oral examinations and the role of dentists in the management of patients with SARS-CoV-2.

OBJECTIVE: To conduct a business case analysis for Department of Veterans Affairs (VA) program STRIDE (ASsisTed EaRly MobIlization for hospitalizeD older VEterans), which was designed to address immobility for hospitalized older adults.
METHODS: This was a secondary analysis of primary data from a VA 8-hospital implementation trial conducted by the Function and Independence Quality Enhancement Research Initiative (QUERI). In partnership with VA operational partners, we estimated resources needed for program delivery in and out of the VA as well as national implementation facilitation in the VA. A scenario analysis using wage data from the Bureau of Labor Statistics informs implementation decisions outside the VA.
METHODS: This budget impact analysis compared delivery and implementation costs for two implementation strategies (Replicating Effective Programs [REP]+CONNECT and REP-only). To simulate national budget scenarios for implementation, we estimated the number of eligible hospitalizations nationally and varied key parameters (e.g., enrollment rates) to evaluate the impact of uncertainty.
METHODS: Personnel time and implementation outcomes were collected from hospitals (2017-2019). Hospital average daily census and wage data were estimated as of 2022 to improve relevance to future implementation.
RESULTS: Average implementation costs were $9450 for REP+CONNECT and $5622 for REP-only; average program delivery costs were less than $30 per participant in both VA and non-VA hospital settings. Number of walks had the most impact on delivery costs and ranged from 1 to 5 walks per participant. In sensitivity analyses, cost increased to $35 per participant if a physical therapist assistant conducts the walks. Among study hospitals, mean enrollment rates were higher among the REP+CONNECT hospitals (12%) than the REP-only hospitals (4%) and VA implementation costs ranged from $66 to $100 per enrolled.
CONCLUSIONS: STRIDE is a low-cost intervention, and program participation has the biggest impact on the resources needed for delivering STRIDE.
BACKGROUND: ClinicalsTrials.gov NCT03300336. Prospectively registered on 3 October 2017.

Development of competencies related to care of older adults is necessary in pharmacy education. Skills laboratories as an essential part of the curriculum represent an important setting to teach geriatrics. The purpose of this research was to describe geriatrics cases in skills/simulation activities of an undergraduate pharmacy program.
A retrospective review of one academic year of skills laboratories from the pharmacy program at the Faculty of Pharmacy of University of Montreal was performed. Sessions including cases aged ≥65 years were selected. Content was extracted for characteristics relating to the patient, health, medications, and care context. A framework including geriatric considerations such as geriatric syndromes, frailty status, and potentially inappropriate medications was developed for data collection.
In total, 210 patient cases were extracted. Older adults (≥ 65 years) were represented in 51 cases (24%), with 8 cases (4%) aged ≥80 years. Geriatric syndromes were documented in 8%, functional status in 10%, and mobility in 12% of the cases. The median number of comorbidities and medications were 4 and 7, respectively. Regarding polypharmacy, only 10 cases had >10 medications, and none had >15 medications. Potentially inappropriate medications were found in 47% (n = 24) of the cases but were addressed in only 14% (n = 7) cases.
This mapping of skills laboratories highlights gaps in geriatrics content. Inclusion of the oldest patients and geriatrics issues were incorporated in a minority of cases and lacked many characteristics essential for geriatrics care.

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This case report describes an 86-year-old female patient who presented with complex post-surgical complications following orthopedic surgery for a femoral neck fracture. Initially diagnosed with septic shock due to methicillin-resistant Staphylococcus aureus (MRSA) bacteremia at the surgical site, the patient\'s treatment course was complicated, involving multiple hospital transfers and varying treatments, including antibiotics and surgical drainage. Despite the absence of infection indicators post treatment, the patient later developed severe thigh pain and was found to have migratory pseudogout, an unusual diagnosis in the context of MRSA and post-surgical complications. This report emphasizes the diagnostic challenges in distinguishing between surgical site infections and other inflammatory conditions like migratory pseudogout, particularly in older patients with comorbidities. It underscores the importance of comprehensive evaluations and the need for general physicians to maintain a broad differential diagnosis when managing post-surgical infections. The case highlights the persistence and recurrence risk of MRSA infections, even post-appropriate antibiotic therapy, and the necessity of considering migratory pseudogout in patients with recurrent infections and systemic soft tissue involvement. The insights from this case contribute to the understanding of complex post-surgical complications and advocate for meticulous assessment and tailored treatment strategies in similar clinical scenarios.