The inability of older adults to recall their drugs and medical conditions.

BACKGROUND/OBJECTIVES: Previous research has shown that many older adults without known cognitive impairment are unable to recall basic knowledge about their medical history. We sought to determine whether older adult patients in our own clinic population were able to recall their drug regimens and medical conditions from memory. METHODS: Patients aged 65 years or older with no known cognitive impairment, dementia, or memory loss who were presenting for routine outpatient follow-up in our medical school neurology and general medicine clinics were recruited. Each patient was asked to recall the number and names of their presently prescribed drugs and their associated medical conditions. Each patient was also administered a Mini-Mental State Examination (MMSE) cognitive screening test (range 0-30). RESULTS: Most patients were unable to recall their drug regimens or their medical conditions. Of 99 patients taking drugs, only 22% correctly named their drugs from memory, and only 34% correctly named their medical conditions associated with the drugs. Fewer than half (49%) correctly recalled the number of drugs they were taking. Poor recall performance was evident even in high-cognitive (MMSE>27) patients. CONCLUSION: The accuracy of recall memory in older adults regarding their drugs and medical conditions may be poor, which has important implications towards medication reconciliation within meaningful-use doctrine. Clinicians treating older adults should be very cautious before relying on their patients' memories for accurate recall of their medical conditions, their drug regimens, and even the number of drugs they are taking.

Maximizing function and outcomes in acetabular reconstruction: segmental bony defects and pelvic discontinuity.

Acetabular reconstruction in revision total hip arthroplasty can be complicated by acetabular bone loss. In patients with severe acetabular bone deficiency with segmental bone defects or pelvic discontinuity, obtaining a stable, well-fixed acetabular component can be challenging. Although porous-coated, uncemented hemispheric cups can be used in most acetabular revisions, as the severity of acetabular deficiency increases, more complex alternatives are needed. Antiprotrusio cages have traditionally been used in the presence of acetabular columnar deficits, but higher failure rates and complications necessitated the development of alternative treatments. More recently, porous-coated acetabular augments have become an attractive alternative to structural allograft and oblong components when segmental bone loss is present. In the setting of severe bone loss or pelvic discontinuity, multiple reconstructive options are available. Depending on individual patient characteristics, plating of the pelvic discontinuity along with structural allografts, custom components, and modular or standard reconstructive cages can be used to obtain a stable acetabular component.