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It has been well documented that lithium decreases the risk for suicide [30–33]. Fewer physicians are using lithium, however, secondary to its narrow therapeutic index, need for close monitoring of levels especially in the setting of renal dysfunction or dehydration, and more common neurotoxicity in the geriatric population. Several other mood stabilizers are effective for the treatment of bipolar disorder. Each carries different advantages and disadvantages and risks for side effects. To date, there have been no randomized, double-blind, placebo-controlled trials looking at the use of anticonvulsants or mood stabilizers in older patients who have BAD.

It usually resolves in an hour but may take longer in the elderly. Anterograde amnesia usually resolves in 1 to 3 weeks after treatment, whereas retrograde amnesia, the most serious and rare of the three, takes a longer time to resolve. Patients are maintained on antidepressant medication after ECT to prevent relapse and maintain remission. Vagus nerve stimulation VNS initially was used and finally approved for treatment-refractory epilepsy in 1997. Noticing its mood-brightening effect on epilepsy patients, anatomic afferent connections of the left vagus nerve to the CNS and to structures relevant to mood regulation lead to studies being conducted to determine its effectiveness for depression [47].

Gehlsen and Whaley [27] reported that healthy older persons with a history of falling had significantly weaker leg strength than did nonfallers. Whipple and colleagues [28] FALLS & THEIR PREVENTION IN THE ELDERLY 813 examined knee and ankle strength, and reported that weakness at both joints was significantly more common among institutionalized fallers than nonfallers. They also performed gait analysis of 49 nursing home patients, and found that fallers had significantly slower gait speed and shorter stride length than did nonfallers [29].

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