Cover

cover_image

Table of Contents

Dedication

Title Page

About the Editors

List of Contributors

Preface to the Fourth Edition

Preface to the Fifth Edition

Foreword

Introduction: Historical Perspectives

Introduction

The Earlier Writers on Old Age

The Birth of Modern Geriatric Medicine

British Developments

An Overview of Early Geriatric Medicine in the United Kingdom

The Early Pioneers in Geriatric Medicine

The Second Wave of Geriatricians

Geriatrics in the United States

Geriatrics in the Rest of the World

Teaching Geriatric Medicine

Achievements of Geriatric Medicine

Problem Areas

References

Part 1: Ageing: Biological, Social and Community Perspectives

Chapter 1: A Biological Perspective of Ageing

Introduction

Ageing Populations

Why do We Grow Old?

The Evolutionary Perspective of Ageing—Key Concepts

Changing Concepts in the Biology of Ageing

The ‘Theories of Ageing’

Subcellular Components of Ageing

Cellular Components of Ageing

Systemic Components of Ageing

The Biology of Ageing and Geriatric Medicine

References

Chapter 2: The Demography of Ageing

Introduction

Models of Chronic Disease and Mortality Trends

Mortality Selection and Trajectories

Discussion

References

Chapter 3: The Physiology of Ageing

Ageing of Organs

References

Chapter 4: Psychological Aspects of Ageing

Introduction

Life Stage Perspective

What do We Know?

Age-Related Psychological Changes

Chapter 5: Ageing of the Brain

Is there Physiological Ageing for the Brain?

Pathological Ageing: Proposed Cellular and Molecular Mechanisms

Changes in Large Neuroendocrine Systems and in General Behaviour During Ageing

Assessing Age-Related Physiological and Pathological Changes in Brain Anatomy and Function: The Input of Brain Imaging

References

Chapter 6: Epidemiology of Ageing and Disability

Ageing and Chronic Disease Epidemiology

Disability and Ageing

Decision-making

The Interprofessional Care Team

Conclusion

References

Chapter 7: Social and Community Aspects of Ageing

Introduction

Demography of Ageing

Growing Older—The Social Process

Poverty

Housing Problems

Retirement

The ‘Golden Age’ Myth

Ageism

The Effect of Social Factors on the Aging Process

Lifestyle, Nutrition and Healthy Ageing: Lessons from the SENECA Study

Religion and Spirituality

Anti-ageing Medicine

The Environment and the Genome

Elder Abuse

The Internet

Cultural Competency

Disasters

References

Chapter 8: The Developmental Origins of Ageing

Introduction

Developmental Plasticity

Developmental Influences and Mortality

Developmental Influences and Age-Related Disease

Developmental Influences and Ageing of the Musculoskeletal System

Developmental Influences and Ageing at the Cellular and Molecular Level

A Life Course Approach to Ageing and its Relevance to Clinical Practice

References

Chapter 9: Sexuality and Ageing

Introduction

Sexual Health

Sexuality and the Older Woman

Erectile Dysfunction

Andropause

Sexuality and Disease

The Older Homosexual

Paraphilias

Sexuality in the Nursing Home

Conclusion

References

Chapter 10: Physical Fitness and Exercise

Introduction

What is Exercise?

Does Exercise Increase Life Expectancy?

Preserving Exercise Capacity with Age via An Active Lifestyle

Optimization of Body Composition with Ageing

Promotion of Psychological Well-Being

Exercise and Cognitive Function

Disease Prevention Through Exercise

Evidence for the Role of Exercise in the Treatment of Disease

Exercise and the Prevention and Treatment of Disability

Conclusion and Directions for Future Research

References

Chapter 11: Health Literacy and Cultural Sensitivity

Introduction

The Importance of Health Literacy in Health Care

Cultural Sensitivity in Geriatrics

Resources

References

Part 2: Medicine and Prescribing in Old Age

Chapter 12: Preventive Geriatrics

Introduction

Background

The Health Maintenance Clinical Glidepath

References

Chapter 13: Polypharmacy

Introduction

Pharmacokinetics

Metabolism and Drug Clearance

Elimination and Renal Excretion

Pharmacodynamics

Pharmacogenetics

Prescribing for Geriatric Patients

References

Chapter 14: Patient Safety

Introduction

Patient Safety and Older People

Why are Older People More Susceptible to Healthcare-Associated Harm than Younger Patients?

Improving Patient Safety for Older People

Priorities for Improving the Safety and Quality of Care for Older People

Conclusion

References

Section 1: Eating Disorders and Nutritional Health

Chapter 15: Epidemiology of Nutrition and Ageing

Introduction

Body Weight, Body Composition and Health

Dietary Intake, Dietary Patterns, Diet Scores in Relation to Mortality: Differences Within and Between Populations

Determinants of Food Choice and Vulnerable Groups

Effect of Nutritional Supplements on Health Indices in Frail Elderly People

Dietary Guidelines

References

Chapter 16: The Anorexia of Ageing

The ‘Paradox’ of Undernutrition in Older People

‘Ideal’ Body Weight in Older People

Weight Loss in Older People

Cachexia in Older People

Undernutrition in Older People

Causes of Undernutrition in Older People

Causes of the Physiological Anorexia of Ageing

Hormones and Neurotransmitters: a Selective Review (Table 16.3)

Diagnoses and Treatment of Undernutrition in Older People

References

Chapter 17: Weight Loss

Introduction

The Relationship of Weight Loss to Mortality

Effect of Weight Loss on Comorbid Conditions

Causes of Weight Loss

Evaluation of Weight Loss

Interventions

For Sarcopenia

Conclusion

References

Chapter 18: Dehydration

Introduction

Water Loss

Regulation of Water Balance

Water Regulation in Older Adults

Dehydration, Intravascular Fluid Loss and Hypovolaemia

Diagnosis of Dehydration

Urine Colour

Problems with the Diagnosis of Dehydration

Consequences of Dehydration

Treatment of Dehydration

Prevention of Dehydration

Conclusion

References

Chapter 19: Vitamins and Minerals

Introduction

Prevalence/Scope of the Problem

Dietary Reference Intakes

Factors Affecting Nutrient Intake in the Elderly

The Antioxidants

Vitamin D

Vitamin K

Folate

Vitamin B12

Vitamin B6

Zinc

Copper

Chromium

Conclusion

References

Chapter 20: Obesity

Age-related Changes in Body Composition

Assessment of Obesity with Increasing Age

Prevalence of Obesity in Older People

Consequences of Obesity in the Elderly

Management of Obesity in the Elderly

Multidisciplinary Management of the Obese Elderly

Conclusion

References

Section 2: Gastro Disorders

Chapter 21: Changes in Gastrointestinal Motor and Sensory Function Associated with Ageing

Introduction

Control of Gastrointestinal Motility and Sensation

Pathophysiology of the Ageing Gut

Oesophagus

Stomach and Duodenum

Small Intestine

Systemic Disorders Associated with Disturbance of Gastrointestinal Motility

Functional Disorders

References

Chapter 22: Gastrointestinal Bleeding

Introduction

Economic Impact

Clinical Presentation

Clinical Course

Causes of GI Bleeding

Evaluation and Management of GI Bleeding

Conclusion

References

Chapter 23: Liver and Gall Bladder

Age-Related Hepatobiliary Changes

Hepatic Diseases of the Elderly

Diseases of the Gallbladder and Biliary Tract

References

Chapter 24: Sphincter function

Introduction

Anatomy and Physiology of the Anal Canal and Rectum

Prevalence and Importance

Risk Factors and Causes of Faecal Incontinence

Clinical Subgroups

Evaluation of Faecal Incontinence

Treatment

Conclusion

References

Chapter 25: Constipation

Defining Constipation

Epidemiology, Pathophysiology and Impact

Aetiology of Constipation

Clinical Approach

Treatment

Special Categories of Constipation

Conclusion

References

Chapter 26: Management of Diarrhoea

Overview of Diarrhoeal Illness

Acute Diarrhoea

Chronic Diarrhoea

Conclusion

References

Chapter 27: Diseases of the Pancreas

The Ageing Pancreas

Inflammatory Diseases of the Pancreas

Pancreatic Tumours

References

Section 3: Haematological Disorders

Chapter 28: Anaemia

Introduction

Definition and Prevalence

Differential Diagnosis

Management

Conclusion

References

Chapter 29: Disorders of haemostasis

Introduction

Disorders of Platelet Number

Hereditary Coagulation Defects

Acquired Coagulation Defects

Vascular Disorders

Thrombotic Disorders

Thrombophilia

References

Chapter 30: Disseminated Intravascular Coagulation

Introduction

Pathophysiology

Diagnosis

Management

Chronic Disseminated Intravascular Coagulation

References

Chapter 31: Anticoagulants

Introduction

The Elderly are more Prone to Thromboembolism

Anticoagulant Response Differs in the Elderly

The Elderly are more Prone to Haemorrhage

Anticoagulants are Effective in the Elderly

The Risk–Benefit Equation: How to Optimize it in the Elderly

Conclusions

References

Chapter 32: Myelodysplasia

Introduction

Epidemiology and Clinical Presentation

Diagnosis

Classification

Prognosis

Treatment

Supportive Care

References

Chapter 33: Management of Myelodysplastic Syndromes and Acute Leukaemia

Introduction

Myelodysplastic Syndromes

Acute Myelogenous Leukaemia (AML)

Acute Lymphoblastic Leukaemia (ALL)

Conclusion

References

Section 4: Cardiovascular Diseases and Health

Chapter 34: Epidemiology of Heart Disease

Introduction

Coronary Heart Disease

Heart Failure

Valvular Heart Disease

Rhythm Disorders

Conclusion

References

Chapter 35: Cardiac Ageing and Systemic Disorders

Introduction

Changes in Cardiac Structure with Ageing

Changes in Cardiac Physiology with Ageing

Cardiac Manifestations of Non-Cardiac Disease

Endocrine Abnormalities and the Cardiovascular System

Conclusions

References

Chapter 36: Arrhythmias

The Elderly Heart

Symptomatic Bradycardias

Atrial Tachyarrhythmias

Atrial Fibrillation

Anticoagulation

Ventricular Arrhythmias

References

Chapter 37: Ischaemic Heart Disease

Introduction

Clinical Manifestations

Recognized and Unrecognized MI

Diagnostic Techniques

Coronary Risk Factors

Therapy of Stable Angina

Acute Coronary Syndromes

Therapy of STEMI

Therapy After MI

Hormone Replacement Therapy

Revascularization

References

Chapter 38: Lipid Management

Introduction

Cholesterol in the Elderly

Clinical Signs

Lipoproteins and Their Measurement

Diagnosis

LDL-C as a Target of Therapy with Statins

Specific Prescribing Points in the Elderly

HDL-Cholesterol

Patients Older than 80 years

Conclusion

References

Chapter 39: Hypotension

Orthostatic Hypotension

Postprandial Hypotension

Post-Exercise Hypotension (PEH)

References

Chapter 40: Hypertension

Definition and Prevalence

Pathophysiology

Related Clinical Entities

The Effect of Treating Hypertension in the Elderly—An Overview of Clinical Trials

Clinical Assessment and Diagnosis2

Management

Conclusion

Acknowledgement

References

Chapter 41: Heart Failure

Introduction

Pathophysiology

Clinical Features

Management

Prevention

Future Directions

References

Chapter 42: Cardiac Surgery

Introduction

Cardiac Surgery Outcomes in the Elderly

Assessment of the Elderly Patient for Cardiac Surgery

Coronary Artery Bypass Graft Surgery

Valve Surgery

Combined Coronary Artery Bypass Graft and Valve Surgery in the Elderly

Anticoagulation Management in the Elderly

Non-Pharmacological Curative Therapy for Atrial Fibrillation

Thoracic Aortic Surgery

Cardiac Transplantation

Conclusions

References

Chapter 43: Peripheral Arterial Disease

Introduction

Epidemiology

Pathophysiology

Diagnosis

Treatment

Acknowledgments

References

Chapter 44: Venous Thromboembolism

Epidemiology and Pathogenesis

Primary Prophylaxis of VTE

Management of Suspected DVT or PE

References

Chapter 45: Cardiac Rehabilitation

Cardiac Diseases and Rehabilitation Services

Cardiac Rehabilitation: Definition and Aims

The Structure of Cardiac Rehabilitation Programmes

The Physiological Effects of Aerobic Training

Evidence-Based Results of Cardiac Rehabilitation in Different Cardiac Conditions

References

Section 5: Respiratory Diseases

Chapter 46: Epidemiology of Respiratory Infection

Community-Acquired Pneumonia

Nursing Home-Acquired Pneumonia

Hospital-Acquired Pneumonia

Tuberculosis

Non-Influenza Viral Respiratory Infection

References

Chapter 47: Pneumonia

Introduction

Causative Agents

Clinical Presentation of Pneumonia in the Elderly

Differential Diagnosis of Lower Respiratory Tract Infection

Hospitalization and Further Investigations in Elderly Persons with a Suspected Diagnosis of Community-Acquired Pneumonia

Therapy of Pneumonia in the Elderly

Further Reading

Chapter 48: Aspiration Pneumonia

Aspiration Pneumonia and Aspiration Pneumonitis

Mechanisms for Development of Aspiration Pneumonia or Aspiration Pneumonitis

Treatments for Aspiration Pneumonia and Aspiration Pneumonitis

Strategies for the Prevention of Aspiration Pneumonia (Figure 48.2)

Prevention of Pneumonia Among the Elderly by Vaccines

Conclusion

References

Chapter 49: Interstitial Lung Disease and Lung Cancer

Interstitial Lung Disease

Lung Cancer

References

Chapter 50: Chronic Obstructive Pulmonary Disease and Asthma

Chronic Obstructive Pulmonary Disease (COPD)

Asthma

References

Chapter 51: Pulmonary Hypertension

Introduction

Definition

Classification of Pulmonary Hypertension

Epidemiology of Pulmonary Hypertension

Common Features of Pulmonary Hypertension

Pathology and Pathophysiology of Pulmonary Hypertension

Clinical Aspects of Subgroups of Pulmonary Hypertension

Conclusion

References

Chapter 52: Pulmonary Rehabilitation

Introduction

Organization

Patient Selection

Components of Pulmonary Rehabilitation

Outcomes

Maintenance Following Pulmonary Rehabilitation

Conclusion

References

Section 6: CNS Disorders

Chapter 53: Neurological Signs of Ageing

Introduction

Neurological Signs of Ageing

Cognitive Function

Cranial Nerves, Including Special Senses

Sensorimotor Function: Motor Systems

Sensorimotor Function: Sensory Systems

Conclusion

References

Chapter 54: Sleep Apnoea and Sleep Disorders

Background

Assessment

Diagnosis and Treatment

References

Chapter 55: Headache

Introduction

Diagnosis and Clinical Description of Headaches

Primary Headaches in the Elderly

Secondary Headache Disorders

Other Head and Facial Pain Syndromes Affecting the Elderly

References

Chapter 56: Normal Pressure Hydrocephalus

Introduction

Aetiology and Pathophysiology

Clinical Presentation

Differential Diagnosis

Diagnostic Modalities

Treatment

Outcome and Prognosis

Long-Term Care and Follow-Up

References

Chapter 57: Acute Stroke Care and Management of Carotid Artery Stenosis

Introduction

Stroke Aetiology

Prognosis of Stroke

Clinical Evaluation and Stroke Syndromes

Prehospital Care

Initial Investigations and Imaging

In-Hospital Care

Thrombolysis and Recanalization

Neuroprotective Drugs

Neurosurgery for Ischaemic Stroke

Palliative Care

Stroke Units

Secondary Prevention

Carotid Artery Stenosis

Carotid Artery Stenting

Vertebral and Intracranial Arterial Stenting

Intracranial and Subarachnoid Haemorrhage

Discussion

References

Chapter 58: Stroke and Stroke Rehabilitation

Introduction

The Neurological Basis of Recovery

Patterns of Recovery

Objectives of Rehabilitation

Process of Rehabilitation

Common Problems in Stroke Rehabilitation

Conclusion

References

Chapter 59: Communication Disorders and Dysphagia

Communication

Ageing and Communication

Diagnosis and Assessment of Communication Disorders

Swallowing

Dysphagia

References

Chapter 60: Acute and Chronic Subdural Haematoma

Introduction

Acute Subdural Haematoma

Chronic Subdural Haematoma

Subdural Hygroma

References

Chapter 61: Epilepsy

Introduction

Aetiology

Diagnosis

Differential Diagnosis

Seizure Classification

Investigations (Table 61.4)

Treatments

Status Epilepticus

Driving

References

Chapter 62: Syncope and Non-Epileptic Attacks

Introduction

Syncope

Other Non-Epileptic Attack Disorders

References

Chapter 63: Parkinson's Disease

Introduction

Signs and Symptoms of Very Late-Onset Parkinson's Disease

Differential Diagnosis of Parkinson's Disease

Advanced Parkinson's Disease

Management of Parkinson's Disease in the Elderly

Further Reading

Chapter 64: Non-Parkinsonian Movement Disorders

Introduction

Chorea

Restless Legs Syndrome and Periodic Limb Movements During Sleep and While Awake

Dystonia

Tremor

Chapter 65: Diabetic Neuropathy

Introduction

Pathogenic Mechanisms

Clinical Presentation and Diagnosis

Conclusion

References

Chapter 66: Disorders of the Neuromuscular Junction

Introduction

Myasthenia Gravis

Diagnostic Investigations: Bedside

Diagnostic Investigations: Laboratory

Management

Lambert–Eaton Myasthenic Syndrome

Peripheral Nerve Hyperexcitability

Acknowledgement

References

Chapter 67: Muscle Disorders

Introduction

Clinical Assessment

Laboratory Investigations

Acquired Myopathies

Inherited Myopathies

Acknowledgements

References

Chapter 68: Motor Neurone Disease

Introduction

Definition and Terminology

Clinical Features

Clinical Course

Differential Diagnosis and Diagnostic Pitfalls

Cervical and/or Lumbar Spondylosis

Other Spinal Pathology

Inflammatory Lower Motor Neurone Disorders

Other Neuropathies

Differential Diagnosis of Bulbar MND

Investigations that Aid Diagnosis

Diagnosis of MND

Epidemiology

Pathology of MND

Aetiology and Pathophysiology

Symptomatic Treatment

Advances in Drug Treatment

Multidisciplinary Team Approach

References

Chapter 69: Control of Chronic Pain

Introduction

Age-Related Changes in the Nociceptive System

Assessment

Management Strategies

References

Chapter 70: Multiple Sclerosis

Introduction

Pathophysiology, Aetiology and Epidemiology

Clinical Spectrum, Diagnosis and Treatment

Prognosis

Comorbidities

Complementary and Alternative Medicine (CAM)

Access to Healthcare

Fostering Healthy Living and Resilience

References

Title Page

Section 7: Dementia and Cognitive Disorders

Chapter 71: Delirium

Overview

History and Pathophysiology

Prevalence and Incidence for Various Sites and Situations

Associated Adverse Outcomes

The Comprehensive Approach to Delirium

Physical Restraints

Pharmacological Restraints

References

Chapter 72: Memory Clinics

Introduction

Developments Around The World

Why The Need?

Are They Effective?

The Memory Clinic Team

What Happens in a Memory Clinic?

What Interventions can be Offered?

The Memory Clinic as Part of Local Dementia Services

References

Chapter 73: Alzheimer's Disease

Introduction

Neuropathology

Epidemiology and Genetics

Diagnostic Criteria

Evaluation of the AD Patient

Management

Future Therapies

Conclusion

Acknowledgements

References

Chapter 74: Mild Cognitive Impairment

Introduction

History

Definitions and Terminology

Case Examples

Why Does it Matter?

Epidemiology

Neuropathology

Approaching The Patient and Their Caregiver

Natural Progression of Disease and Outcomes

Treatment

Advance Care Planning

Future Directions

Conclusion

References

Chapter 75: Vascular Dementia

Introduction

Definition, Physiopathology and Classification

Diagnosis

Epidemiology

Clinical and Neuropsychological Features

Preventive and Curative Therapies

Conclusion

References

Chapter 76: Mental Stimulation and Dementia

Introduction

Cognitive (Mental) Interventions

Supporting Evidence

Mechanisms

Targets of Intervention

Implementing Interventions

Conclusion

Acknowledgement

References

Chapter 77: Exercise and Dementia

Introduction

Physical Activity and The Prevention of Dementia in Clinical Research

Physical Activity and Executive Function

Frailty, Physical Activity and Cognitive Reserve

Biological Mechanisms of Physical Activity in Preventing Cognitive Decline

Clinical Practical Applications: Physical Activity and Prevention of AD

Physical Activity in AD Populations

Practical Clinical Applications: Physical Activity for Demented Patients

Conclusion

References

Chapter 78: Drug Development and Alzheimer's Disease

Introduction

Impact on Cholinergic Deficit

Anti-Amyloid Therapies

Drugs to Target Tau Protein

Neuroprotective Agents

Neurorestorative Approaches

Other Potential Therapeutic Strategies

Non-Pharmaceutical Therapies

Prevention and AD

Conclusion

References

Chapter 79: Other Dementias

Introduction

Vascular Cognitive Impairment/Vascular Dementia

Lewy Body Disease

Dementia with Lewy Bodies

Progressive Supranuclear Palsy

Corticobasal Degeneration

Multiple System Atrophy

Frontotemporal Lobar Degeneration

Depression

Medications

Dementia with Parkinsonism

Conclusion

References

Chapter 80: Treatment of Behavioural Disorders

Introduction

Physical Causes of Behavioural Symptoms

Conceptual Framework of Behavioural Symptoms of Dementia

Dementia and Personality

Functional Impairment

Mood Disorders

Delusions and Hallucinations

Dependence in Activities of Daily Living (ADLs)

Inability to Initiate Meaningful Activities

Anxiety

Spatial Disorientation

Rejection of Care

Food Refusal

Insomnia

Apathy and Agitation

Elopement and Interference with Others

Environmental Factors

References

Chapter 81: Geriatric Psychiatry

Introduction

Epidemiology

Challenges in Geriatric Psychiatry

The Psychiatric Interview of an Older Adult

Work-Up

Interdisciplinary Approach and Individualized Care Plan

Depression

Bereavement

Severe Mental Illness

Bipolar Affective Disorder and Late-Onset Mania

Schizophrenia

Late-Life Psychosis

Cognitive Disorders

Substance Abuse

Anxiety Disorders

Geriatric Psychiatry Emergencies

Other Common Mental Health Problems in Older Adults

Special Populations in Geriatric Psychiatry

Palliative and End-of-Life Care

Geriatric Psychopharmacology

Electroconvulsive Therapy

Psychotherapy and Other Psychosocial Interventions

Spirituality and Geriatric Psychiatry

Prevention in Geriatric Psychiatry

Best Practice Models for Geriatric Psychiatry Services

Long-Term Care Homes

Geriatric Psychiatry in Primary Care Offices

Successful Ageing

Future Research

References

Chapter 82: Organization of Services in Geriatric Psychiatry

Introduction

Developments in the UK 2005–2010

Services

Patients' Views and Involvement

Carers

Additional Responsibilities for Geriatric Psychiatry Services

Other Issues

An International Perspective

Conclusion

References

Chapter 83: Depression in Later Life: Aetiology, Epidemiology, Assessment, Diagnosis and Treatment

Introduction

Varieties of Late-Life Depression

Epidemiology of Late-Life Depression

Course of Late-Life Depression

Non-Suicide Mortality

Suicide

Aetiology

Diagnosis

Treatment

Conclusion

References

Chapter 84: The Older Patient with Down Syndrome

Introduction

Genes and Down Syndrome

The Physician, and The Patient with Down Syndrome

Disorders Associated with Down Syndrome

Conclusion

References

Section 8: Special Senses

Chapter 85: Disorders of The Eye

Introduction

Definitions, Treatments, and Risk Factors

Summary

References

Chapter 86: The ageing auditory system—pathology and epidemiology of age-related hearing loss

The auditory system

Epidemiology of hearing

Conclusion and the future

References

Chapter 87: Disorders of the Vestibular System

Introduction

Vestibular Anatomy

Physiology and Ageing of the Vestibular Apparatus

Clinical Aspects and Diagnostic Strategy

Peripheral Vestibular Disorders

Central Vestibular Disorders

Management

References

Chapter 88: Smell and Taste

Introduction

Characterization of Chemosensory Problems

Anatomy of The Olfactory System

Anatomy of The Gustatory System

Clinical Tests of Olfactory and Gustatory Function

Age-Related Changes in Olfactory Function

Age-Related Changes in Gustatory Function

Causes of Smell Dysfunction in the Elderly

Causes of Taste Dysfunction in The Elderly

Evaluating and Managing Elderly Patients with Chemosensory Dysfunction

Acknowledgments

References

Section 9: Bone and Joint Health

Chapter 89: Paget's Disease of Bone

Introduction

Pathology of Paget's Disease

Sequelae of Paget's Disease

Presentation of Paget's Disease

Epidemiology of Paget's Disease

Aetiology of Paget's Disease

Treatment of Paget's Disease

Final Considerations in Paget's Disease

References

Chapter 90: Management of Osteoporosis; Its Consequences: A Major Threat to Quality of Life

Introduction

Epidemiology of Osteoporosis and Fractures

Bone Remodelling Throughout Life

Pathogenesis of Osteoporosis and Fractures

Diagnosis of Osteoporosis

Fracture Risk Assessment

Investigation

Lifestyle Measures

Drug Treatment

Future Treatments

References

Chapter 91: Gait, Balance and Falls

Introduction

Balance

Gait

Falls

Clinical Presentation of Falls

Consequences of Falls

Diagnostic Assessment

Therapeutic Approach

Prevention

Acknowledgment

Appendix 91.1

Appendix 91.2

Appendix 91.3

References

Chapter 92: Foot Problems

Introduction

Risk Disorders with Pedal Manifestations

Keratotic Lesions

Ulcers

Toenails

Bursitis

Scarring

Fissures

Management Considerations

Foot Care

Footwear

Orthotics

References

Chapter 93: Hip Fracture and Orthogeriatrics

Background

Diagnosis and Classification

Preoperative Care

Fracture Repair and Perioperative Care

Postoperative Care

Surgical Complications

Secondary Fracture Prevention

Orthogeriatric Collaboration and Orthogeriatric Models

References

Chapter 94: Diseases of the Joints

Introduction

Osteoarthritis

Rheumatoid Arthritis

Gout

Calcium Pyrophosphate Deposition Disease

Connective Tissue Disease

Infectious Arthritis

Treatment

Physical Therapy

Medications

Surgery

References

Section 10: Endocrine and Metabolic Disorders

Chapter 95: Endocrinology of Ageing

Introduction

Hormonal Regulation and Ageing

Effects of Ageing and Related Diseases on Endocrine Diseases

Insulin Resistance Syndrome and Ageing

The Hormonal Fountain of Youth

References

Chapter 96: Water and Electrolyte Balances in Ageing

Introduction

Normal Physiology

Water Homeostasis in the Elderly

Workup and Treatment of Hyponatraemia

Workup and Treatment of Hypernatraemia

Conclusion

References

Chapter 97: The Pituitary Gland

Introduction

Anatomy

Anterior Pituitary Disorders—Clinical Manifestations

Anterior Pituitary Disorders—Treatment

Anterior Pituitary Hormone Secretion—Functional Changes With Age

Posterior Pituitary Gland

References

Chapter 98: Thyroid Disorders

Introduction

Age-Related Modifications in Thyroid Function

Prevalence of Thyroid Disease in Older Populations

Hypothyroidism

Hyperthyroidism

Non-Thyroidal Illness (NTI)

Thyroid Nodules and Nodular Goitre

Conclusion

References

Chapter 99: Ovarian Function and Menopause

Introduction and Definitions

Epidemiology

Endocrinology and Neuroendocrinology of Menopause

Ovarian Ageing and Sex Steroids Changes

Specific Healthcare Problems in Relation to The Menopause

Hormone Therapy in Postmenopausal Women

Androgen Therapy in Postmenopausal Women

Conclusion

Further Reading

Chapter 100: Testicular Function

Introduction

Ageing and Testicular Function

Diagnosis of Late-Onset Hypogonadism

Treatment of Late-Onset Hypogonadism

Benefits of Testosterone Replacement Therapy

Risks of Testosterone Replacement Therapy

Symptom Relief

Monitoring Patients on TRT

Precautions and Contraindications for TRT

Conclusion and Recommendations

References

Chapter 101: Diabetes Mellitus

Introduction

Epidemiology, Pathogenesis and Modes of Presentation

Impact of Diabetes Mellitus

Care Home Diabetes

Prevention

Conclusion

References

Chapter 102: New Therapies for Diabetes Mellitus

Why Do We Need New Antiglycaemic Medications and the ‘Diabetes Conundrum’?

Definition of Type 2 Diabetes Mellitus: Disease or Risk Factor?

Current Adjunctive Therapies for T2DM

Currently Approved Antiglycaemic Therapies

Metformin: Life Begins at 50

Sulfonylureas (SUs)

Meglitinides (Glinides): Faster is not Always Better

Thiazolidinediones (TZDs): The Bloom is Off the Rose and the Pie is in the Sky (Rosiglitazone and Pioglitazone)—Downsizing Expectations

α-Glucosidase Inhibitors (AGIs)—the Drugs that Get no Respect

Colesevelam: LDL and A1c Lowering—a Match Made in Heaven

Bromocriptine: Born Again

Incretin Therapies: The New Kid on the Block

Amylin Analogues—Pramlintide

Emerging but not Yet Approved Antiglycaemics

Conclusion

References

Section 11: Urogenital Disorders

Chapter 103: Gynaecology and The Older Patient

Introduction

Effect of Ageing on the Genital Tract

Hormonal Changes

The Menopause and HRT (Hormone Replacement Therapy)

Common Symptoms in the Elderly

Postmenopausal Bleeding (PMB)

Discharge Per Vagina

Uterovaginal Prolapse

Urinary Incontinence

Sexuality and Old Age

Vulval Disorders

Gynaecological Cancer

HIV and Old Age

Conclusion

References

Chapter 104: The Ageing Bladder

Introduction

Anatomy of the Ageing Bladder

Bladder Physiology and Correlation to Anatomy of the Ageing Bladder

Special Disease States

Pharmacology as it Relates to the Ageing Bladder

Surgical Disease of the Ageing Bladder

Conclusion

References

Chapter 105: Prostate Diseases

Introduction

Benign Prostatic Hyperplasia

Prostate Cancer

Prostatitis

References

Chapter 106: Urinary Incontinence

Introduction

Pathophysiology and Types of Urinary Incontinence

Complications and Impact of Incontinence

Diagnosis and Assessment of Urinary Incontinence

Management of Urinary Incontinence

References

Chapter 107: Geriatric Nephrology

Introduction

Normal Ageing: Glomerular Level

Diseases: At the Glomerular Level

Normal Ageing: Renovascular Level

Diseases: Reno-Vascular Level

Normal Ageing: Tubular-Interstitial Level

Diseases: Tubular-Interstitial Level

Acute Kidney Injury (AKI)

Chronic Kidney Disease (CKD)

Renal Pharmacology

References

Section 12: Cancer

Chapter 108: Cancer and Ageing

Introduction

Epidemiology and Disparities

Ageing and Tumour Development

Cancer Prevention

Cancer Screening

Cancer Treatment

Supportive Care

Multidisciplinary Care Models

Survivorship

Conclusion

References

Chapter 109: Oncological Emergencies

Introduction

Haematological Emergencies

Metabolic Emergencies

Cardiovascular Emergencies

Neurological Emergencies

Structural Emergencies

Acute Pain Emergencies

The Role of Geriatric Evaluation in the Prediction of Oncological Emergencies

Conclusion

References

Chapter 110: Breast Cancer

The Presentation

Stage of Presentation

Variation in Care and Undertreatment in the Elderly

Screening in the Elderly

Risk Factors in the Elderly

Natural History of Breast Cancer in the Elderly

Treatment of Operable Disease

Role of Radiotherapy

Adjuvant Endocrine Therapy

Chemotherapy

Treatment of Advanced Disease

Prognostic Factors in Elderly Breast Cancer

Quality of Life Issues

Conclusion

Guidelines for Therapy

References

Chapter 111: Maintaining Functional Status

Introduction

A Role for Geriatricians in Cancer Care

Staging the Ageing of the Elderly Cancer Patient

Exercise

Conclusion

References

Section 13: Functional Disorders and Rehabilitation

Chapter 112: Multidimensional Geriatric Assessment

Introduction

Components of Geriatric Assessment

Settings of Geriatric Assessment

Effectiveness of Geriatric Assessment Programmes

Conclusion

References

Chapter 113: Frailty

Introduction

Pathophysiology of Frailty

Conclusion

References

Chapter 114: Rehabilitation

Introduction

Terminology and Classifications

Determinants of Activity and Participation Restrictions

Principles of Rehabilitation

The Rehabilitation Process

The Rehabilitation Setting

Emerging Technologies and Rehabilitation

Specific Rehabilitation Problems

Future Challenges

References

Section 14: Iatrogenic Infections

Chapter 115: Tuberculosis

Introduction

Epidemiology

Pathogenesis

Clinical Characteristics

Diagnosis

Treatment

Infection Control Issues

References

Chapter 116: Valvular Heart Disease and Infective Endocarditis

Introduction

Epidemiology and Pathophysiology

History and Clinical Assessment

Aortic Stenosis

Aortic Regurgitation

Mitral Stenosis

Mitral Regurgitation

Mixed Valve Disease

Interventional Treatment in the Elderly

Prosthetic Valves in the Elderly

Infective Endocarditis

Prosthetic Valve Endocarditis

Conclusion

Chapter 117: Infections of the Central Nervous System

Meningitis

Focal Central Nervous System Infections

Encephalitis

Postpolio Syndrome

Creutzfeldt–Jakob Disease

References

Section 15: Special Issues

Chapter 118: Elder Abuse: A UK Perspective

History of Elder Abuse Management in the UK

Defining Elder Abuse

Prevalence of Elder Abuse

Risk Factors for Elder Abuse

Abuse in Institutions

Detecting Abuse

Management of Abuse

Preventing Abuse

Conclusion

References

Chapter 119: Good Quality Care: Abuse

Definitions

A Reminder of the Main Ethical Principles

Multidimensional Aspects of Abuse

But Who Abuses?

Conduct to Embrace

Article 434-3 of the Penal Code

The Laws

Other Contributions

MobiQual—Mobilization for the Improvement of the Quality of Professional Practices

Further Comments

Conclusion

Further Reading

Chapter 132: Participation of Older People in Clinical Trials

Introduction

Summary of Existing Clinical Trials Involving Older People

Determinants of Participation of Older People in Clinical Trials

Facilitating the Access of Older People to Clinical Trials

Conclusion

References

Chapter 133: Restraints and Immobility

Introduction

Immobility

Physical Restraints

Siderails

Risk Factors and Justification

Complications

Outcomes of Restrictive Device Reduction

Approaches to Reduce Restrictive Device Usage

Conclusion

References

Chapter 134: Centenarians

An Optimistic View

Compression of Morbidity Versus Disability

Nature Versus Nurture

Centenarian Offspring: Following in the Footsteps of Their Parents

Genetic Findings

A Proposed Multifactorial Model for Exceptional Longevity and Exceptional Survival Phenotypes

Conclusion

References

Chapter 135: End-of-Life and Palliative Care

Introduction

Palliative and Hospice Care

Symptom Assessment and Treatment

Communication

Psychosocial and Spiritual Domains

Cross-Cultural Issues

Care Transitions in End-of-Life Care

References

Chapter 136: End-of-Life Care: Special Issues

Palliative Care

Withholding and Withdrawing Treatment

Care Planning

Terminal Care

Assisted Dying

Bereavement

Conclusion

References

Part 3: Global Healthcare Systems

Chapter 137: Improving Quality of Care

Introduction

The History of Quality

Quality in the Nursing Home

Quality in Acute Care Practices

Quality in the Community Setting

Future Initiatives in Healthcare Quality

Conclusion

Appendix 137.1 Healthcare quality organizations

References

Chapter 138: Clinical Audit of Healthcare

Definition

Background

The Audit Cycle

Planning an Audit

Determining Standards

Determining Audit Criteria

Collecting Data

Dissemination and Change

Re-Audit and Sustaining Improvement

Conclusion

References

Chapter 139: Carers and the Role of the Family

Introduction

Definitions of Caring

Assessment of Family Carers

Arranging Services to Support Carers

Discussion

References

Chapter 140: Nursing Home Care

Introduction

Comparison of Nursing Homes in Different Countries

References

Chapter 141: Geriatric Occupational Therapy: Achieving Quality in Daily Living

Overview

Conceptual Foundations of Geriatric Occupational Therapy

Scope of Occupational Therapy Services

Occupational Therapy Process

Conclusion

References

Chapter 142: Geriatric Medicine Education in Europe and the United States

Introduction

Geriatric Education in Europe

Undergraduate Geriatric Medicine Education in Europe

Geriatric Medicine Teaching at the Postgraduate Level

Continuing Medical Education

Undergraduate Geriatric Education in the United States

Postgraduate Geriatric Education in USA

Initiatives for Improving Undergraduate and Postgraduate Geriatric Education: United States

Conclusion

References

Chapter 143: Systems of Healthcare: The United States

Introduction

Overview of Healthcare Demographics

Development of Geriatric Medicine

Home Healthcare

Nursing Home Care

Hospital Care

Academic Geriatrics

Conclusion

References

Chapter 144: Systems of Healthcare: Australia

Overview of Healthcare Demographics

Development of Geriatric Medicine

Home Healthcare

Nursing Home Care

Hospital Care

Academic Geriatrics

References

Chapter 145: Systems of Healthcare: The United Kingdom

Introduction

Overview of Healthcare Demographics

Development of Geriatric Medicine

Home Healthcare

Nursing Home Care

Hospital Care

Academic Geriatrics

Conclusion

References

Chapter 146: Geriatric Medicine in China

Introduction

The Elderly Population in Hong Kong SAR, Macau SAR and Taiwan

Policies toward Ageing in Mainland China

Health of the Elderly in Mainland China and Hong Kong SAR

Geriatric Medicine in China and Hong Kong SAR

The Health and Long-Term Care System for the Elderly in Hong Kong SAR

History of the Development of Geriatric Medicine in Hong Kong SAR

Lack of a Systematic Approach in Acute Geriatrics Care in Hong Kong SAR

Issues in Primary Healthcare for the Elderly in Hong Kong SAR

Geriatric Healthcare at Residential Care Homes for the Elderly (RCHES) in Hong Kong SAR

Service Gap and Duplication Issues for Health and Long-Term Care of the Elderly

Recommendation for an Integrated Health and Social Care Delivery System in Hong Kong SAR

Conclusions

References

Chapter 147: Ageing in Developing Countries

Introduction

Ageing and Health

Health Care and Geriatric Medicine

References

Chapter 148: Geriatric Medicine in the European Union: Towards Unification of Diversity

Introduction

Demography

Healthcare and Health Systems

Health and Ageing Trends

Geriatric Medicine

Geriatric Organizations

Recent Developments in EU Policy

Acknowledgements

References

Appendix: Function assessment scales

Components of the geriatric assessment

Activities of daily living (ADLs) and instrumental activities of daily living (IADLs)

Dental

Hallpike Manoeuvre

Osler Manoeuvre for pseudohypertension

Simplified Nutrition Assessment Questionnaire (SNAQ)

The Mini-Nutritional Assessment (MNA) Scale

Saint Louis University social activities assessment

The Confusion Assessment Method (CAM) diagnostic algorithm

Index

To my mother, Ivy, and father, Radovan, for giving me the opportunity.

–Alan J. Sinclair

To all my older friends and patients who have taught me geriatrics, to my wife Pat and my children Robert, Susan and Jacqueline who have supported me throughout my career, and to my grandchildren Amanda, Conor, Katelyn, Nicole, Paige and John who are my eternal joy and hope for my future of elder care.

–John E. Morley

To all the teams working at the Gérontopôle, to my father Professor Pierre Vellas who created the Universities of the Third Age, and to Professor J.L. Albarede, our mentor.

–Bruno Vellas

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Library of Congress Cataloging-in-Publication Data

Pathy's principles and practice of geriatric medicine / edited by Alan J. Sinclair, John E. Morley, Bruno Vellas.–5th ed.

p. ; cm.

Principles and practice of geriatric medicine

Rev. ed. of: Principles and practice of geriatric medicine. 4th ed. c2006.

Includes bibliographical references and index.

ISBN 978-0-470-68393-4 (cloth)

I. Sinclair, Alan (Alan J.) II. Morley, John E. III. Vellas, B. J. (Bruno J.) IV. Pathy, M. S. J. V. Principles and practice of geriatric medicine. VI. Title: Principles and practice of geriatric medicine.

[DNLM: 1. Geriatrics–methods.WT 100]

LC classification not assigned

618.97–dc23

2011032652

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley's global Scientific, Technical and Medical business with Blackwell Publishing.

Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK

The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

111 River Street, Hoboken, NJ 07030-5774, USA

The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

Library of Congress Cataloging-in-Publication Data

Pathy's principles and practice of geriatric medicine / edited by Alan J. Sinclair, John E. Morley, Bruno Vellas.–5th ed.

p. ; cm.

Principles and practice of geriatric medicine

Rev. ed. of: Principles and practice of geriatric medicine. 4th ed. c2006.

Includes bibliographical references and index.

ISBN 978-0-470-68393-4 (cloth)