Introduction: Cancer-screening decisions for older adults should be individualized. However, conducting such complex shared decisions may be challenging for primary care providers (PCPs). Additionally, there is little information on how PCPs make these decisions. This study consisted of a provider survey and chart review to assess current PCP approaches to breast and colorectal cancer (CRC) screening with patients age ≥75. Methods: PCP survey questions: panel age, comfort with discussion of screening harms and benefits, screening decision-making process, and discussion style. One Hundred charts were chosen from a random sample of male and female patients ≥75 with a recent office visit. Chart reviews assessed whether providers recommended screening for breast and/or colon cancer in patients ≥75, if there was a documented screening discussion, and if screening was completed. Results: Fifty-one PCPs completed the survey. PCPs varied in the proportions of older adults they recommended for breast and CRC screening. 90.2% reported feeling very (43.1%) or somewhat (47.1%) comfortable discussing reasons for/against screening with older patients. Top screening considerations: life expectancy (84.3%), patient preference (82.4%), and severity of medical conditions (70.6%). Three-quarters (74.55%) reported a shared decision-making approach with discussion of harms/ benefits. Of 61 eligible patients, 8(13.1%) had a documented discussion regarding mammography. Of 58 patients eligible for CRC screening, 7(12.1%) had a documented discussion. Discussion: Findings showed inconsistency in PCP approaches to cancer screening in older adults and in discussion documentation. There is ample room for improvement in standardizing approaches and documentation of cancer screening discussions with older patients.

Diabetes mellitus is a prevalent chronic health condition associated with significant morbidity and mortality. Those with diabetes must acquire self-efficacy in the tasks necessary for them to successfully manage their disease. In this study, a controlled pre-and post-design was used to determine the effect of an adult support and education group visit program embedded in an urban academic family medicine practice on weight and the achievement of treatment goals for hemoglobin A1C, low-density lipoprotein (LDL) blood concentration, and blood pressure (BP) several months after it was implemented. Participants in the program were matched to a comparison group based on age, gender, race/ethnicity, and zip code group, a surrogate marker for socioeconomic status. The distribution of demographic characteristics and co-morbidities was similar between the groups. Significant increases occurred in the proportion of participants achieving both an A1C concentration G7% (CMH=4.6613, p=0.0309) while controlling for baseline AIC concentration, and a BPG140/90 mm Hg (CMH=5.61, p=0.018) controlling for baseline BP compared to the comparison group. The hemoglobin A1C concentration declined in 76.9% of the participants in the group visit program compared to 54.3% in the comparison group (CMH=8.9911, p=0.0027). The increase in the proportion of group visit participants achieving the target LDL concentrations did not achieve statistical significance. The proportion of participants who lost weight was similar to that in the comparison group. Early experience with the program was encouraging and suggested it may improve patients' management of their diabetes mellitus in an urban, predominantly African American population.

As the aging population expands, it will become increasingly important for health care providers to become aware of and sensitive to the needs and concerns of older adults. Ageism is a term that describes negative stereotyping of older adults and discrimination because of older age. Health concerns and symptoms in the elderly may be overlooked or dismissed as part of the normal aging process. Consequently, several conditions in olders adults are significantly underdiagnosed and undertreated Misconceptions about aging frequently encountered in medicine and in society at large include issues involving sexuality, sleep disturbance, depression, cognitive impairment, and substance abuse. We can learn to recognize ageist notions that influence medical practice. Perhaps by becoming more aware of myths and realities of aging, we can improve the health and quality of life of our elderly patients.

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