Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 139: First Time Visit for a 73-Year-Old Man
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Mar 27, 2025 A primary care review focused on the first visit for a 73-year-old new patient. Discussion covers aging physiology and demographic trends. They debate individualized goals of care, medication choices like statins, and screening decisions such as colon cancer checks. Blood pressure, anemia workup, and diabetes A1c targets for older adults are highlighted.
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Aging Narrows Physiologic Reserve
- Aging is a physiological process that increases disease susceptibility without being a disease itself.
- Reduced physiologic reserve or homeostenosis raises risk for illness and iatrogenic harm like adverse drug reactions and deconditioning.
Individualize Glycemic Targets For Older Adults
- Individualize goals of care for older adults based on function, cognition, comorbidities, and patient goals.
- For this 73-year-old with intact function and few comorbidities, target hemoglobin A1c <7.5% to balance benefit and hypoglycemia risk.
Function Trumps Chronologic Age
- Not all people of the same chronological age are equivalent; clinicians must assess lifestyle, function, and goals.
- Overmedicalization causes harm, so balance interventions with patient priorities and likely benefit.
