Jicht in de wervelkolom: een zeldzame presentatie van een veelvoorkomende aandoening

A 92-year old woman was admitted to the geriatric department because of a confusional state due to a urinary tract infection, a severe dermatitis and gout. An incomplete tetraplegia was found on physical examination. Radiological examination showed a large gouty tophus causing spinal cord compression and destruction of the dens. Gouty involvement of the spine is a less common complication of the disease. Optimal treatment of gout is important to prevent the development of such severe complications.     

Oud en een biertje! De praktijk van een aan alcohol verslaafde 65-jarige man

Alcohol abuse and addiction in The Netherlands among the older adults aged 65 and over has increased in the last decade. Outreaching care is important as most of the elderly do not receive the care they need. We discuss the detoxification and group therapy of an elderly alcoholic. Issues that will be discussed are potential risks and choices that need to be made.     

Benzodiazepineverslaving; een stille verslaving onder ouderen

Benzodiazepines are frequently prescribed for a longer period of time for anxiety disorders and insomnia in spite of the many guidelines to prescribe these drugs only short-term. These guidelines are based on the risk-benefit balance between long-term effectiveness and side effects like addiction, anterograde amnesia, and increased risk on falling (resulting in hip fractures), traffic accidents and even mortality. Also low-dose benzodiazepine use can lead to benzodiazepine dependence. Although initially most attention has been paid to the physical withdrawal syndrome, psychological aspects of benzodiazepine dependence have received more and more attention in the past decades. Recently, a relationship between the brain-reward system, involved in addiction, and benzodiazepine use, was demonstrated. When long-term benzodiazepine use is recognised as problematic by both physician and patient, different treatment modalities are available to support patients in achieving abstinence. One of every four patients is able to stop by themselves with the aid of a minimal intervention providing psychoeducation and encouragement. Two out of three long-term uses are able to stop their usage with the aid of systematic tapering protocols guided by a physician or psychologist. In case of an underlying insomnia or anxiety disorder, cognitive-behavioural therapy should be added to the tapering protocol. In contrast to the general opinion, advanced old age has no negative impact on the treatment response.     

Ichthyosis generalis,een geval van geslachtsgebonden erfelijkheid

Resumé Ichthyosis generalis: a case of sex-limited inheritance in man with recessiveness of the anomaly. The case can be understood from the pedigree.     

Geriatrisch spreekuur door een specialist ouderengeneeskunde in de huisartspraktijk

An innovative project is presented, in which general practitioners, an elderly care physician and specialized nurses work together. The primary aim of the project was early detecting of frail community dwelling elderly and to give them adequate treatment and support, to enable them to stay in their own home situation as long as possible. The detection of frail elderly was performed by mean of the Easycare instrument. Results collected from October 2007 - July 2009 are presented in this article. The findings show that particularly elderly with symptoms of dementia have been detected. The main actions were provision of integrated psychogeriatric care according to a tailormade integral care plan and starting or extending home care. Elderly with somatic problems were seen mostly in one time consultations. The satisfaction about the care provided in the project was high, both for participating patients and professionals. In the pilot a tendency was also found towards fewer referrals to hospital (specialists) and towards a reduction of the number of acute admissions to the nursing home.