Review an approach to history and physical exam for Parkinson’s Disease, including practicing screening neurological examination. A 70yo F presents to neurology clinic, referred for tremor and falls.

Mr. Guiseppe (Joe) Russo is an 81-year-old man who returns to see you, his new Family Physician, regarding cognitive concerns. He is accompanied by his wife of 60 years, Maria Russo. Mr. Russo is a retired Crane Operator, who was born in Southern Italy, and who worked in the steel industry after immigrating with Maria to Canada at the age of 20. As a child, he completed 6 years of formal education; later he became fluent in English while working in Canada. He and Maria have three adult children, two sons and one daughter, and live in a bungalow in the city of your practice. He is otherwise physically well, with well-controlled hypertension, dyslipidemia, and DMII, as well as osteoarthritis of the knees. His medications are provided to you in a list. He is a lifelong non-smoker who consumes one glass of wine with dinner each night. Mr. Russo was diagnosed with early-stage Alzheimer’s disease (versus Mixed Dementia) by his prior physician, Dr. Retired, approximately 2 years ago. At that time, Mr. Russo presented with approximately 2 years of gradually progressive decline in short-term memory and executive function, that was impacting his ability to pay bills on time. His SMME score at that time was 21/30, with 0/3 on delayed recall and difficulty with orientation (year incorrect). He was unable to draw a clock correctly (CDT), but Dr. Retired suspected that language and education impacted Mr. Russo’s performance on both the SMMSE and the CDT.

Novak B. is now 68 years old. He comes to the office today complaining of shortness of breath and fatigue on exertion. While Novak B. denies chest pain, over the last 3-4 weeks he has been getting more short of breath. He first noticed this when he was playing golf with his friends a few weeks ago. He wasn't able to finish his 18-hole game, despite using a cart. He walks his dog about 1 km every evening and usually stops every 250 m due to leg cramps. Lately, however, he has needed to stop every 100 m due to leg cramps as well as at the half-way mark due to fatigue. For the last week, he has been increasingly sleeping in his recliner rather than his bed due to difficulty breathing; however, he denies waking up gasping for air when you ask. He is still struggling with a burning sensation in his feet and legs and wakes up at night to “shake it off”. His once thin legs are becoming increasingly swollen as the day progresses. He denies any cough, fever or night sweats. He feels his heart is running faster at times, especially when physically active. You know that his spouse passed away last year after a long battle with cancer. He has 2 children who live out West. When questioned about alcohol intake, he admits that he has been drinking more alcohol since his spouse passed away.

Ms. Sara Yamata is a well 79-year-old woman, currently living alone in a condominium in your community, who attends an appointment with you, her longstanding Family Physician, for the purpose of a periodic health examination. Ms. Yamato is a retired High School English Teacher, who was widowed three years ago. She has one daughter, Elizabeth, and two grandchildren, all of whom live nearby. She is unaccompanied at the visit. Ms. Yamato reports that she has been doing well since you last saw her (for a blood pressure check six months ago), with no interim illnesses or admissions to hospital. Her chronic diseases remain well-managed. She reports having sustained at least one fall over the past 12 months (on the ice, when shoveling her driveway), but fortunately did not sustain any injuries. She remains independent with her ADLs and most of her IADLs; her daughter, Elizabeth, assists her with larger shopping trips and with preparation of her taxes. Her condominium performs the outdoor maintenance for its residents. Ms. Yamata continues to drive, with no reported difficulties, and remains active in her community by volunteering in the gift shop at her local hospital and attending a weekly social group at the Community Centre. With this information, you think about Ms. Yamato’s frailty status using a frailty model with which you are familiar. You review her past medical history and corresponding treatments, as listed in your EMR. Ms. Yamato brings her current prescription medications, in their original bottles from the pharmacy, to the appointment. At your request, she has also brought with her the multiple over-the-counter (OTC) and herbal medications that she is taking at home. She recognizes that she has “many bottles of pills” with her, and wishes to discuss which ones could be discontinued, if any. You spend some time thinking about approaches to deprescribing and approaching “polypharmacy” in older adults.

This session will provide a population health overview of the key issues related to the aging population as well as highlight the knowledge and skills that physicians need to deal ethically and professionally with older adults.

Mr. Guiseppe (Joe) Russo is an 81-year-old man who returns to see you, his new Family Physician, regarding cognitive concerns. He is accompanied by his wife of 60 years, Maria Russo. Mr. Russo is a retired Crane Operator, who was born in Southern Italy, and who worked in the steel industry after immigrating with Maria to Canada at the age of 20. As a child, he completed 6 years of formal education; later he became fluent in English while working in Canada. He and Maria have three adult children, two sons and one daughter, and live in a bungalow in the city of your practice. He is otherwise physically well, with well-controlled hypertension, dyslipidemia, and DMII, as well as osteoarthritis of the knees. His medications are provided to you in a list. He is a lifelong non-smoker who consumes one glass of wine with dinner each night. Mr. Russo was diagnosed with early-stage Alzheimer’s disease (versus Mixed Dementia) by his prior physician, Dr. Retired, approximately 2 years ago. At that time, Mr. Russo presented with approximately 2 years of gradually progressive decline in short-term memory and executive function, that was impacting his ability to pay bills on time. His SMME score at that time was 21/30, with 0/3 on delayed recall and difficulty with orientation (year incorrect). He was unable to draw a clock correctly (CDT), but Dr. Retired suspected that language and education impacted Mr. Russo’s performance on both the SMMSE and the CDT.

Mr. Guiseppe (Joe) Russo is an 81-year-old man who returns to see you, his new Family Physician, regarding cognitive concerns. He is accompanied by his wife of 60 years, Maria Russo. Mr. Russo is a retired Crane Operator, who was born in Southern Italy, and who worked in the steel industry after immigrating with Maria to Canada at the age of 20. As a child, he completed 6 years of formal education; later he became fluent in English while working in Canada. He and Maria have three adult children, two sons and one daughter, and live in a bungalow in the city of your practice. He is otherwise physically well, with well-controlled hypertension, dyslipidemia, and DMII, as well as osteoarthritis of the knees. His medications are provided to you in a list. He is a lifelong non-smoker who consumes one glass of wine with dinner each night. Mr. Russo was diagnosed with early-stage Alzheimer’s disease (versus Mixed Dementia) by his prior physician, Dr. Retired, approximately 2 years ago. At that time, Mr. Russo presented with approximately 2 years of gradually progressive decline in short-term memory and executive function, that was impacting his ability to pay bills on time. His SMME score at that time was 21/30, with 0/3 on delayed recall and difficulty with orientation (year incorrect). He was unable to draw a clock correctly (CDT), but Dr. Retired suspected that language and education impacted Mr. Russo’s performance on both the SMMSE and the CDT.

This session will provide a population health overview of the key issues related to the aging population as well as highlight the knowledge and skills that physicians need to deal ethically and professionally with older adults.

Mr. Guiseppe (Joe) Russo is an 81-year-old man who returns to see you, his new Family Physician, regarding cognitive concerns. He is accompanied by his wife of 60 years, Maria Russo. Mr. Russo is a retired Crane Operator, who was born in Southern Italy, and who worked in the steel industry after immigrating with Maria to Canada at the age of 20. As a child, he completed 6 years of formal education; later he became fluent in English while working in Canada. He and Maria have three adult children, two sons and one daughter, and live in a bungalow in the city of your practice. He is otherwise physically well, with well-controlled hypertension, dyslipidemia, and DMII, as well as osteoarthritis of the knees. His medications are provided to you in a list. He is a lifelong non-smoker who consumes one glass of wine with dinner each night. Mr. Russo was diagnosed with early-stage Alzheimer’s disease (versus Mixed Dementia) by his prior physician, Dr. Retired, approximately 2 years ago. At that time, Mr. Russo presented with approximately 2 years of gradually progressive decline in short-term memory and executive function, that was impacting his ability to pay bills on time. His SMME score at that time was 21/30, with 0/3 on delayed recall and difficulty with orientation (year incorrect). He was unable to draw a clock correctly (CDT), but Dr. Retired suspected that language and education impacted Mr. Russo’s performance on both the SMMSE and the CDT.

Ms. Sara Yamata is a well 79-year-old woman, currently living alone in a condominium in your community, who attends an appointment with you, her longstanding Family Physician, for the purpose of a periodic health examination. Ms. Yamato is a retired High School English Teacher, who was widowed three years ago. She has one daughter, Elizabeth, and two grandchildren, all of whom live nearby. She is unaccompanied at the visit. Ms. Yamato reports that she has been doing well since you last saw her (for a blood pressure check six months ago), with no interim illnesses or admissions to hospital. Her chronic diseases remain well-managed. She reports having sustained at least one fall over the past 12 months (on the ice, when shoveling her driveway), but fortunately did not sustain any injuries. She remains independent with her ADLs and most of her IADLs; her daughter, Elizabeth, assists her with larger shopping trips and with preparation of her taxes. Her condominium performs the outdoor maintenance for its residents. Ms. Yamata continues to drive, with no reported difficulties, and remains active in her community by volunteering in the gift shop at her local hospital and attending a weekly social group at the Community Centre. With this information, you think about Ms. Yamato’s frailty status using a frailty model with which you are familiar. You review her past medical history and corresponding treatments, as listed in your EMR. Ms. Yamato brings her current prescription medications, in their original bottles from the pharmacy, to the appointment. At your request, she has also brought with her the multiple over-the-counter (OTC) and herbal medications that she is taking at home. She recognizes that she has “many bottles of pills” with her, and wishes to discuss which ones could be discontinued, if any. You spend some time thinking about approaches to deprescribing and approaching “polypharmacy” in older adults.

This session will provide a population health overview of the key issues related to the aging population as well as highlight the knowledge and skills that physicians need to deal ethically and professionally with older adults.

Mr. Guiseppe (Joe) Russo is an 81-year-old man who returns to see you, his new Family Physician, regarding cognitive concerns. He is accompanied by his wife of 60 years, Maria Russo. Mr. Russo is a retired Crane Operator, who was born in Southern Italy, and who worked in the steel industry after immigrating with Maria to Canada at the age of 20. As a child, he completed 6 years of formal education; later he became fluent in English while working in Canada. He and Maria have three adult children, two sons and one daughter, and live in a bungalow in the city of your practice. He is otherwise physically well, with well-controlled hypertension, dyslipidemia, and DMII, as well as osteoarthritis of the knees. His medications are provided to you in a list. He is a lifelong non-smoker who consumes one glass of wine with dinner each night. Mr. Russo was diagnosed with early-stage Alzheimer’s disease (versus Mixed Dementia) by his prior physician, Dr. Retired, approximately 2 years ago. At that time, Mr. Russo presented with approximately 2 years of gradually progressive decline in short-term memory and executive function, that was impacting his ability to pay bills on time. His SMME score at that time was 21/30, with 0/3 on delayed recall and difficulty with orientation (year incorrect). He was unable to draw a clock correctly (CDT), but Dr. Retired suspected that language and education impacted Mr. Russo’s performance on both the SMMSE and the CDT.

Ms. Sara Yamata is a well 79-year-old woman, currently living alone in a condominium in your community, who attends an appointment with you, her longstanding Family Physician, for the purpose of a periodic health examination. Ms. Yamato is a retired High School English Teacher, who was widowed three years ago. She has one daughter, Elizabeth, and two grandchildren, all of whom live nearby. She is unaccompanied at the visit. Ms. Yamato reports that she has been doing well since you last saw her (for a blood pressure check six months ago), with no interim illnesses or admissions to hospital. Her chronic diseases remain well-managed. She reports having sustained at least one fall over the past 12 months (on the ice, when shoveling her driveway), but fortunately did not sustain any injuries. She remains independent with her ADLs and most of her IADLs; her daughter, Elizabeth, assists her with larger shopping trips and with preparation of her taxes. Her condominium performs the outdoor maintenance for its residents. Ms. Yamata continues to drive, with no reported difficulties, and remains active in her community by volunteering in the gift shop at her local hospital and attending a weekly social group at the Community Centre. With this information, you think about Ms. Yamato’s frailty status using a frailty model with which you are familiar. You review her past medical history and corresponding treatments, as listed in your EMR. Ms. Yamato brings her current prescription medications, in their original bottles from the pharmacy, to the appointment. At your request, she has also brought with her the multiple over-the-counter (OTC) and herbal medications that she is taking at home. She recognizes that she has “many bottles of pills” with her, and wishes to discuss which ones could be discontinued, if any. You spend some time thinking about approaches to deprescribing and approaching “polypharmacy” in older adults.