Case Study Discussion – Geriatric Chronic Condition

Case Study Discussion – Geriatric Chronic Condition

Geriatric is a branch of medicine whose main focus is management of the older adults by preventing disease, treating diseases and preventing complications or disabilities, and promoting health through nutritional and psychological support (Randhawa & Varghese, 2022). From the patient’s history presented in the case scenario, several differential diagnoses might be formed based on the clinical presentation and the predisposing factors exhibited in the patient’s history and lifestyle.

To begin with, the patient has a history of chronic cough and risky behavior of smoking, which predisposes him to a possible diagnosis of Chronic obstructive pulmonary disease (COPD), which is presented through long-term coughing (Agarwal et al., 2023). Secondly, a nagging dry cough in long-term smokers can not only be associated with COPD but also with lung cancer due to the increased risk brought about by smoking. Thirdly, long-term smoking serves as a risk factor for other lung diseases secondary to the damage caused by chronic smoke and the conditions present with chronic coughs, such as bronchitis. The other possible diagnosis for this patient might be characterized by chronic cough and hypertension management. This is known to be a common side effect to users of the ACE class of antihypertensives, which is unlikely in our scenario but serves as an important parameter to consider.  The symptoms of polyuria, the age of the patient, and the medical history of chronic hypertension may justify the probability of having diabetes and benign prostatic hyperplasia (BPH) among the differential diagnoses (Ng & Baradhi, 2021).

Despite having numerous differential diagnoses, the most likely diagnoses include COPD, benign prostatic hyperplasia, and diabetes. These diagnoses are justified by the patient’s history of chronic smoking, chronic hypertension, old age, and his clinical presentations of polyuria and persistent cough.

Plan of Care

Before initiating any treatment for the patient, I would opt to do a couple of diagnostic tests to come up with an actual diagnosis. Therefore, the priority management step will be diagnostics, such as the spirometry (GOLD Guidelines for COPD) test, to assess lung function and confirm the likelihood of COPD. Imaging tests, particularly on the chest, will be done to establish the possible lung pathology that might be responsible for the chronic cough (Agarwal et al., 2023). Prostate-specific antigen (PSA) is another vital test in this case due to the prevalence of BPH among males of a similar age to the client, along with the increased frequency of urination. Lastly, with the history of hypertension and now the rise in recent polyuria, the suspicion of diabetes justifies the need to do an HbA1c test to screen for diabetes.

The treatment of the patient will be based on the findings from the tests that will guide the selection of the therapy to use. For instance, if COPD is confirmed, the pharmacologic management according to the clinical guidelines (Javier De Miguel-Díez et al., 2024) for COPD involves initiation with short-acting bronchodilators such as albuterol; when the symptoms persist, long-acting bronchodilators such as salmeterol and tiotropium are considered. Lastly, inhaled corticosteroids are considered in cases of frequent exacerbations. Also, it is important to assist the patient in stopping smoking through the use of nicotine replacement patches and behavioral support. Use the clinical guidelines for BPH management that state the use of alpha-blockers such as tamsulosin to increase urine flow and ease the symptoms of BPH (Ng et al., 2024). 5-alpha-reductase inhibitors such as finasteride are used to shrink the benign and prevent progression (Ng & Baradhi, 2024). Lastly, a combined therapy might be used if symptoms persist. Another therapy approach is the continuous monitoring of the hypertension status and managing the blood pressure appropriately.

Referrals, Education, and Follow-Up

Referral of the patient to other specialized centers is of great importance to him. For instance, the patient can be referred to a pulmonologist for the management of COPD symptoms; a urologist can help the patient by offering more specialized care concerning frequent urination (Ohishi et al., 2021); and a psychologist to help the patient stop smoking through behavioral therapy. Thirdly, I would educate the patient on the best lifestyle modifications, such as avoidance of respiratory irritants like smoke, the health hazards of smoking, and how to stop it. Lastly, I would discuss the follow-up sessions with the patient to monitor his progress. The aim of follow-up will be assessing the effectiveness of the prescribed medication, checking the progress of smoking cessation, reviewing the results of spirometry, assessing the blood pressure control, encouraging the patient to quit smoking, and lastly, considering repeating the diagnostic tests.

References

Agarwal, A. K., Raja, A., & Brown, B. D. (2023). Chronic obstructive pulmonary disease (COPD). National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559281/

Ng, M., & Baradhi, K. M. (2021). Benign Prostatic Hyperplasia. PubMed; StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/32644346/

Ng, M., & Baradhi, K. M. (2024, January 11). Benign prostatic hyperplasia. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558920/

Ohishi, M., Kubozono, T., Higuchi, K., & Akasaki, Y. (2021). Hypertension, cardiovascular disease, and nocturia: A systematic review of the pathophysiological mechanisms. Hypertension Research, 44. https://doi.org/10.1038/s41440-021-00634-0

Randhawa, S. S., & Varghese, D. (2022). Geriatric Evaluation and Treatment of Age-Related Cognitive Decline. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK580536/

Javier De Miguel-Díez, Fernández-Villar, A., Esperanza Doña Díaz, Marta Padilla Bernáldez, Trillo-Calvo, E., Jesús Molina París, Barrecheguren, M., Valero, M., & Ramírez, T. (2024). Chronic Obstructive Lung Disease: Treatment Guidelines and Recommendations for Referral and Multidisciplinary Continuity of Care. Journal of Clinical Medicine, 13(2), 303–303. https://doi.org/10.3390/jcm13020303

Ng, M., Leslie, S. W., & Baradhi, K. M. (2024). Benign Prostatic Hyperplasia. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558920/#:~:text=Standard%20investigation%20of%20BPH%20includes

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Case Study Discussion – Geriatric Chronic Condition

Discussion Prompt
A 68-year-old male presents to your clinic today. He complains of a dry cough for the last two (2) months that will not go away. He also complains of frequent urination for the last four (4) months. His past medical history includes hypertension diagnosed five years ago, treated with 120 mg of valsartan only. He does not know his family history since he was adopted. He has smoked ½ pack of cigarettes daily for the last 40 years and has had trouble quitting in the past.
What are your differentials and most likely diagnosis or diagonses? What specific resources and support groups exist in your own clinic’s community for referral, should he chose to quit smoking? What will be your plan of care for your patient including diagnostics, treatment/prescribing, referrals, education, and follow-up?

Expectations
Initial Post:
• Length: A minimum of 500 words, not including references
• Citations: At least one high-level scholarly reference in APA from within the last 5 years
Please please use clinical guidelines as a reference to the plan of care based on the scenario.