Diabetes mellitus (DM) is common in older adults and frequently affects residents of nursing homes (NH). Most have complex health status owing to comorbid illness, frailty, and the presence of geriatric syndromes. This complexity increases the risk of adverse events related to treatment. As a result, management of DM in the NH setting requires supreme clinical judgment that balances an understanding of the effects of comorbidity, functional disability, and geriatric syndromes with the resident’s healthcare preferences and estimated life expectancy. Developing goals of care and implementing treatment plans requires knowledge of the balance of potential benefits and burdens of certain treatments, including lifestyle modification and pharmacotherapy. Prevention of macrovascular complications through intensive blood pressure and lipid management is achievable in a much shorter time period than the prevention of microvascular complications through intensive glycemic control. Furthermore, it

Diagnosis and management of gout in the long-term care (LTC) setting requires special considerations. Presentation of gout is different in elderly than in middle-aged men and women. It is important not to label coincidental hyperuricemia and osteoarthritis as gout. Treatment of asymptomatic hyperuricemia is not recommended. In the LTC setting, attempts to change a diet to one that is purine-free may be challenging and of limited benefit in lowering serum urate levels over a long period of time. Side effects of nonsteroidal anti-inflammatory drugs in the elderly limit their use in LTC residents. Colchicine is best avoided as well. Corticosteroids--both systemic and intra-articular--can be used as effective alternatives for acute gouty arthritis in elderly residents. Use of uricosuric drugs is limited by its poor tolerance and limited renal reserve. Allopurinol, when indicated, should be started at the lowest possible dose and increased cautiously over weeks with close monitoring. (Annal