We seek to explain how the treatment of non-melanoma skin cancer (NMSC) should differ in certain geriatric patients. Our goal is to provide primary care physicians with a comprehensive methodology for approaching the evaluation and management of these patients. Recent retrospective studies have revealed that the rates of aggressive surgical treatment of NMSCs are equivalent in non-age restricted and geriatric populations, including those with limited life expectancy. Geriatric patients have higher rates of post-operative complications without affecting disease specific survival. These studies suggest that we must carefully consider how we counsel and treat elderly patients with NMSC. There are many surgical and non-surgical treatment modalities for NMSC that offer varying cure rates. Given the non-lethal nature of many of these tumors, active surveillance is another viable treatment alternative especially in patients with limited life expectancy. Ultimately, we must engage in shared decision-making with our patients to develop treatment plans that best align with each patient’s overall goals of care.

Purpose of Review Vaccinations are a preventative health priority for older adults. The purpose of this paper is to review recent publications on this topic and to provide updates on current research involving recommended vaccines.

Over half of the older adults in U.S. have multimorbidity, defined broadly as the presence of 2 or more chronic diseases in an individual. Multimorbidity has significant overlap with disability and frailty. In this review, we broadly review the concepts of multimorbidity, disability, and frailty, as well as their interrelationships, and ability to predict future adverse health outcomes in older adults. Depending on the study, the prevalence of individuals with all three of multimorbidity, disability, and frailty ranges from 2-20%. Multimorbidity and patterns of multimorbidity are predictive of functional limitations, disability, health care usage, and mortality. The degree to which multimorbidity predicts these outcomes depends on many factors but partly upon the population examined and the presence of frailty and disability. Multimorbidity is an emerging public health concern that is observed with and predictive of disability and frailty.

Periprosthetic fractures (PPF) of the lower extremity are increasing as the population ages, as the number of joint replacement increases, and patients remain active. The management of PPFs is challenging because of implant and cement obstruction within the bone, poor bone quality, and limited availability of bone stock for screw purchase. Historically, they have been associated with high rates of nonunion, infection, and fixation failure. Minimally invasive osteosynthesis (MIO) has reduced complications and improved union rates compared to conventional open plating of fractures. This paper reviews the principles of treatment, implant choices, and technical challenges of MIO for PPF in the lower extremity. In recent series, PPF for the lower extremity has shown reduced complication rates, improved union, and early mobilization compared prior open treatment. MIO for PPF is technically challenging but promising method of treatment for PPF.

Purpose of ReviewThis review broadly discusses the consequences of inadequate consumption, by deficit or excess, of selected micronutrients on the quality of life and morbidity during aging, specifically considering increases in life expectancy and the costs of care in the older persons.Recent FindingsA literature review of the periods 2012 to 2018, focusing on vitamins A, B12, and D, calcium, iron and folate, was completed as these micronutrients are found to significantly affect the aging process. Causation and application of these micronutrients to disorders related to aging are controversial and mixed. This review highlights research needs and controversial points on the role of these micronutrients.SummaryMicronutrient deficiencies are a common and avoidable contributor to decreased quality of life and healthcare costs in the older persons. Further research is needed to determine adequate intakes and innovative uses, including appropriate thresholds for improved health outcomes for this population.

Purpose of ReviewThe purpose of this review is to summarize the current data for comparative effectiveness of glycemic control in older adults.Recent FindingsIn the last several years, professional societies have released guidelines for glycemic control in older adults, generally recommending individualized HbA1c goals. However, recent observational studies demonstrate that many older adults remain aggressively managed and are at increased risk of hypoglycemia. Large randomized trials of older adults with diabetes have failed to show convincing cardiovascular benefit from intensive glycemic control and suggest some microvascular benefit. Additionally, a few studies suggest that suboptimal glycemic control can increase the risk for geriatric syndromes. Emerging research suggests similar safety and efficacy of glucose-lowering therapies in older versus younger adults.SummaryOverall, there is a paucity of data supporting the benefit of intensive glycemic control in older adults. More research is needed in this vulnerable population.

Type 2 diabetes mellitus (T2DM) is a major risk factor for falls and frailty in older adults. The purpose of this review was to survey, the current literature on risk factors and interventions for prevention of falls and frailty in older adults with T2DM. Screening for falls and frailty in the clinical setting is recommended. Exercise to improve balance, strength, and mobility; health education; and diabetes self-management are potential interventions for falls and frailty in older adults with T2DM. Pharmacologic agents are the focus of current studies which may lead to potential future interventions for both falls and frailty. Evidence-based guidelines and tools for prevention and management of falls and frailty have been developed for clinicians caring for older adults. Because of the reciprocal relationship between falls and frailty, interventions to prevent one may also improve the other geriatric syndrome.

Urgency urinary incontinence (UUI) has a significant impact on the physical function and quality of life of women. When conservative treatments fail, procedure-based management can be used to treat refractory symptoms. We review recent updates on the efficacy and complications of these interventions with focus on older adults. In high quality studies, intradetrusor botulinum toxin injections and sacral neuromodulation (SNM) result in improvement in frequency of UUI episodes. Adverse effects are slightly elevated in older women, but benefits generally outweigh risks. More evidence is needed to help inform the choice between botulinum toxin injections and SNM with regard to safety and efficacy. Percutaneous tibial nerve stimulation (PTNS) shows efficacy and low adverse events, though high quality studies are few. More evidence is needed to support its use as a first-line intervention for refractory UUI, especially in older women. Surgical intervention is associated with significant complications and is only an option in those who have failed all other interventions. Procedure-based interventions are effective in addressing UUI. Botulinum toxin injections and SNM should be considered after conservative management has failed. PTNS, with its low morbidity, could be considered before botulinum toxin and SNM if future studies support its efficacy, especially in older women. Future directions should aim to examine patient-reported long-term outcomes, especially in older adults, and decrease morbidity, which may increase the safety profile in older adults.

Purpose of Review Pelvic organ prolapse (POP) is a common condition that can adversely affect quality of life in older women. With the current trend in longevity, the number of women with this problem will exceed the availability of subspecialists in Female Pelvic Medicine and Reconstructive Surgery. The purpose of this paper is to aid primary care physicians, geriatricians, and general gynecologists in the evaluation, referral, and treatment of women with POP. Women can be quickly evaluated and offered therapy prior to referral to a subspecialist.

Purpose of Review Fragility fractures have become a worldwide epidemic that has necessitated a paradigm shift in how we approach the care for elderly orthopaedic patients. There is a great need for subspecialty trained orthopaedic surgeons to help bridge the gap and help with transition of care in geriatric orthopaedic patients.