Dementia – Other considerations/mimics
Prior to proceeding with a full evaluation of suspected cognitive impairment, it is important to perform a quick review of the patient’s problem list/PMH in their medical record to identify if they have been previously …
Dementia – Screening
PEARL: The USPSTF has found that screening instruments are adequate to detect cognitive impairment. However, they concluded that there is insufficient evidence to assess the balance of benefits or harms of screening because the current …
Dementia – Suspicion in Older Adult
New cognitive impairment is defined by a decline in one or more cognitive domains: Learning and memory: Ability to encode, retrieve, store, and make new memories Language: Ability to understand and produce language Executive function: Ability to reason and …
UTI: Evaluate for non UTI causes
Antibiotics for the urinary tract are not indicated See AGS Choosing Wisely, consider printing patient information If a urinalysis and culture were obtained: PEARL – The presence of pyuria does not diagnose an infection and …
UTI: Diagnosis, monitoring, prophylaxis
Pearl: A non catheter associated UTI is defined as the presence of signs or symptoms compatible with UTI and significant bacteriuria* with no more than 2 species. *“Significant” bacteriuria varies and is arbitrary. Cutoffs of …
UTI: Treatment
Initiate supportive cares. Specifically, encourage hydration If with severe symptoms, start broad-spectrum antibiotics (see chart below). Then narrow based on culture and sensitivities If with mild symptoms: Review previous organisms and susceptibilities If not available, …
UTI: No signs/symptoms localizing to urinary tract
Pearl: In the absence of localizing signs/symptoms, the likelihood of a true UTI is low. If there are no localizing signs/symptoms of a UTI, the likelihood of a true UTI is probably low Remember that …
UTI: Localizing Signs and Symptoms
Pearl: Symptoms such as change in cognition, agitation/aggression, decreased appetite, nausea +/- vomiting, syncope and falls are NOT symptoms of UTI in older adults in the absence of genitourinary tract specific signs and symptoms. Localizing …
CA-UTI: Treatment
Selection of antibiotics should be tailored to the typical organisms and severity of illness. In CA-UTI with severe symptoms, start broad-spectrum antibiotics (see chart below). Then narrow based on culture and sensitivities In CA-UTI with …
CA-UTI: Evaluate for non UTI causes
Antibiotics for the urinary tract are not indicated if other localizing symptoms are present If a urinalysis and culture are obtained, remember the presence of bacteriuria or pyuria alone does not differentiate between CA-UTI and …