Brocklehurst's Textbook of Geriatric Medicine and Gerontology E-Book

Howard M. Fillit; Kenneth Rockwood; Kenneth Woodhouse

BOOK

Brocklehurst's Textbook of Geriatric Medicine and Gerontology E-Book

Howard M. Fillit | Kenneth Rockwood | Kenneth Woodhouse

(2010)

Additional Information

Book Details

ISBN: 978-1-4377-2075-4
Edition: 7
Language: English
Pages: 1152
Subjects: Geriatric medicine
Microbiology (non-medical)

Abstract

Popular with generations of practitioners, Brocklehurst's Textbook of Geriatric Medicine and Gerontology has been the definitive reference of choice in the field of geriatric care. The new 7th Edition, by Howard M. Fillit, MD, Kenneth Rockwood, MD, and Kenneth Woodhouse, carries on this tradition with an increased clinical focus and updated coverage to help you meet the unique challenges posed by this growing patient population. Consistent discussions of clinical manifestations, diagnosis, prevention, treatment, and more make reference quick and easy, while over 255 illustrations compliment the text to help you find what you need on a given condition. Examples of the latest imaging studies depict the effects of aging on the brain, and new algorithms further streamline decision making.

Emphasizes the clinical relevance of the latest scientific findings to help you easily apply the material to everyday practice.

Features consistent discussions of clinical manifestations, diagnosis, prevention, treatment, and more that make reference quick and easy.

Includes over 255 illustrations—including algorithms, photographs, and tables—that compliment the text to help you find what you need on a given condition.

Provides summary boxes at the end of each chapter that highlight important points.

Features the work of an expert author team, now led by Dr. Howard M. Fillit who provides an American perspective to complement the book’s traditional wealth of British expertise.

Includes an expanded use of algorithms to streamline decision making.

Presents more color images in the section on aging skin, offering a real-life perspective of conditions for enhanced diagnostic accuracy.

Includes examples of the latest imaging studies to help you detect and classify changes to the brain during aging.

Offers Grade A evidence-based references keyed to the relevant text.

Section Title	Page	Action	Price
Front Cover	Cover
Brocklehurst‘s Textbook of Geriatric Medicine and Gerontology	iii
Copyright Page	iv
Table of Contents	xxv
Contributors	v
Acknowledgments	xxi
Color Plates	Color Plate i
Section I: Gerontology	1
Introduction to Gerontology	1
Chapter 1.\rIntroduction: Aging, Frailty, and Geriatric Medicine	1
Chapter 2. The Epidemiology of Aging	3
INTRODUCTION	3
QUALITY OF LIFE AND DISABILITY	4
CONCLUSIONS	9
KEY POINTS	9
Chapter 3. The Future of Old Age	11
HISTORICAL DETERMINANTS OF THE FUTURE HEALTH OF THE ELDERLY	12
CURRENT AND FUTURE BIOMEDICAL INPUTS TO AGING	13
THE FUTURE OF AGING	15
KEY POINTS	17
Biological Gerontology	18
Chapter 4.\rEvolution Theory and the Mechanisms of Aging	18
EVOLUTION OF AGING	18
GENETICS OF LIFE SPAN	19
TESTS OF THE EVOLUTIONARY THEORIES	21
CONCLUSIONS	22
KEY POINTS	22
Chapter 5.\rMethodological Problems of Research in Older People	23
INTRODUCTION	23
KEY POINTS	28
Chapter 6.\rBiology of Aging	30
INTRODUCTION	30
THE INSULIN-SIGNALING PATHWAY AND LONGEVITY REGULATION	30
CELL PROLIFERATION, TELOMERASE, AND TELOMERE FUNCTION	32
CELL DEATH AND CELL REPLACEMENT — A CRITICAL ROLE FOR STEM CELLS?	33
PROGEROID SYNDROMES AND NORMAL AGING	33
PROTEIN DAMAGE AND SARCOPENIA—DOES PROTEIN OXIDATIVE DAMAGE PLAY A CAUSAL ROLE?	34
WHY INVEST IN BASIC AGING RESEARCH?—THE LONGEVITY DIVIDEND	35
KEY POINTS	36
Chapter 7.\rGenetic Mechanisms of Aging	38
INTRODUCTION	38
MITOCHONDRIAL GENETICS, OXIDATIVE STRESS, AND AGING	38
CHROMOSOMAL GENE MUTATIONS AND AGING	39
KEY POINTS	41
Chapter 8.\rCellular Mechanisms of Aging	42
DESTRUCTIVE AGENTS IN CELLULAR AGING	42
CELL SENESCENCE	45
PROTEIN SYNTHESIS AND DEGRADATION	48
SIGNALING PATHWAYS	49
EXTRACELLULAR MATRIX	49
KEY POINTS	49
CONCLUSION	50
Chapter 9.\rPhysiology of Aging	51
PHYSIOLOGIC DETERIORATION AND THE AGING PHENOTYPE	51
INTERSPECIES AND INTRASPECIES VARIATION IN AGE-ASSOCIATED PHYSIOLOGIC DETERIORATION	53
AGE CHANGES IN THE PHYSIOLOGY OF SPECIFIC ORGANS AND ORGAN SYSTEMS	53
AGE CHANGES IN ORGANISMIC FUNCTION	55
KEY POINTS	57
SUMMARY AND CONCLUSIONS	58
Chapter 10.\rA Clinico-Mathematical Model of Aging	59
INTRODUCTION	59
THE PHENOTYPIC DEFINITION OF FRAILTY	60
DEVELOPMENT OF A FRAILTY INDEX BASED ON COMPREHENSIVE GERIATRIC ASSESSMENT	62
KEY POINTS	65
Chapter 11.\rThe Premature Aging Syndrome Hutchinson- Gilford Progeria: Insights Into Normal Aging	66
INTRODUCTION	66
KEY POINTS	71
Medical Gerontology	73
Chapter 12.\rConnective Tissues and Aging	73
THE PROPERTIES OF CONNECTIVE TISSUES	73
BIOSYNTHESIS	74
DEGRADATION OF CONNECTIVE TISSUE COMPONENTS	74
AGING AND THE PROPERTIES OF CONNECTIVE TISSUES	77
SUMMARY	80
KEY POINTS	81
Chapter 13.\rClinical Immunology: Immune Senescence and the Acquired Immune De. ciency of Aging	82
CHANGES IN THE HUMAN IMMUNE SYSTEM WITH AGING	82
CLINICAL CONSEQUENCES OF IMMUNE SENESCENCE	85
SECONDARY CAUSES OF ACQUIRED IMMUNODEFICIENCY IN OLD AGE	88
CONCLUSIONS	90
KEY POINTS	90
Chapter 14.\rEffects of Aging on the Cardiovascular System	91
AGING-ASSOCIATED CHANGES IN VASCULAR STRUCTURE	91
ENDOTHELIAL FUNCTION IN AGING	91
ARTERIAL STIFFNESS IN AGING ARTERIES	92
EFFECT OF THE AGING PROCESS ON THE STRUCTURE OF THE HEART	93
MYOCARDIAL FUNCTION IN THE AGING HEART AT REST	94
RESPONSE OF THE AGING HEART TO EXERCISE	95
KEY POINTS	95
SUMMARY	96
Chapter 15.\rAge-Related Changes in the Respiratory System	97
RESPIRATORY FUNCTION TESTS	97
AGE-RELATED CHANGES IN THE RESPIRATORY SYSTEM	97
KEY POINTS	99
Chapter 16.\rNeurologic Signs in the Elderly	101
MENTAL STATUS	101
CRANIAL NERVE FUNCTION	101
MOTOR SIGNS	102
CHANGES IN GAIT AND STATION	103
DEEP TENDON REFLEXES	103
SENSORY SIGNS	104
PRIMITIVE REFLEXES	104
CONCLUDING COMMENTS	105
KEY POINTS	105
Chapter 17.\rGeriatric Gastroenterology: Overview	106
NORMAL PHYSIOLOGY OF AGING	106
ALTERED MANIFESTATION OF ADULT GASTROINTESTINAL DISEASES	107
GASTROINTESTINAL PROBLEMS UNIQUE TO THE ELDERLY POPULATION	109
SUMMARY	110
KEY POINTS	110
Chapter 18.\rAging of the Urinary Tract	111
INTRODUCTION	111
UPPER URINARY TRACT: KIDNEYS AND URETERS	111
LOWER URINARY TRACT: BLADDER AND OUTLET	112
KEY POINTS	115
Chapter 19.\rBone and Joint Aging	117
ARTICULAR CARTILAGE	117
THE SKELETON	119
SOFT TISSUES	121
CONSEQUENCES OF BONE AND JOINT AGING	122
THE FUTURE	122
KEY POINTS	122
Chapter 20.\rAging and the Endocrine System	123
INTRODUCTION	123
CONCLUSION	126
Chapter 21.\rAging and the Blood	127
HEMATOPOIESIS	127
SITES OF BLOOD CELL DEVELOPMENT, BONE MARROW, AND STROMA	127
HEMATOPOIETIC STEM CELLS	128
TELOMERES AND SENESCENCE	128
EPIGENETICS	128
PROGENITOR COMPARTMENT	129
CIRCULATING BLOOD CELLS	130
GRANULOCYTES	130
EOSINOPHILS, BASOPHILS, AND MAST CELLS	130
MONOCYTES AND MACROPHAGES	130
RED CELLS	130
LYMPHOID DEVELOPMENT	131
AGING AND T CELLS	131
KEY POINTS	131
AGING AND B CELLS	132
Chapter 22.\rAging and the Skin	133
INTRODUCTION	133
INTRINSIC AGING	133
EXTRINSIC AGING	133
EPIDERMIS	134
DERMIS	134
SWEAT GLANDS	135
SEBACEOUS GLANDS	135
CONCLUSION	137
KEY POINTS	137
Chapter 23.\rThe Pharmacology of Aging	138
EPIDEMIOLOGY OF DRUG USE	138
ALTERED PHARMACOKINETICS	139
ALTERED PHARMACODYNAMICS	141
DRUG INTERACTIONS	141
SUMMARY	143
KEY POINTS	144
Chapter 24.\rAntiaging Medicine	145
A BRIEF HISTORY OF ANTIAGING MEDICINE	145
THE HORMONAL FOUNTAIN OF YOUTH	147
ANTIOXIDANTS AND AGING	148
CONCLUSION	148
KEY POINTS	149
Neurogerontology	150
Chapter 25.\rThe Neurobiology of Aging: Free Radical Stress and Metabolic Pathways	150
SECTION I: NITROSATIVE AND OXIDATIVE STRESS IN THE NEUROBIOLOGY OF AGING	150
PROTEIN MISFOLDING IN NEURODEGENERATIVE DISEASES	150
GENERATION OF REACTIVE OXYGEN/ NITROGEN SPECIES (ROS/RNS)	151
PROTEIN S-NITROSYLATION AND NEURONAL CELL DEATH	152
SECTION II: METABOLIC-INSULIN SIGNALING IN THE CONTROL OF AGING AND NEURODEGENERATION	154
KEY POINTS	156
Chapter 26.\rAllostasis and Allostatic Overload in the Context of Aging	158
INTRODUCTION	158
DEFINITION OF STRESS, ALLOSTASIS, AND ALLOSTATIC LOAD	158
PROTECTION AND DAMAGE AS THE TWO SIDES OF THE RESPONSE TO STRESSORS	158
MEASUREMENT OF ALLOSTATIC LOAD	158
BEING “STRESSED OUT,” ESPECIALLY SLEEP DEPRIVATION AND ITS CONSEQUENCES	159
KEY ROLE OF THE BRAIN IN RESPONSE TO STRESS	160
TRANSLATION TO THE HUMAN BRAIN	160
POSITIVE AFFECT, SELF-ESTEEM, AND SOCIAL SUPPORT	161
DELETERIOUS ROLE OF ADVERSE EARLY LIFE EXPERIENCE	161
CONCLUSIONS	161
KEY POINTS	162
Chapter 27.\rNeuroendocrinology of Aging	163
Chapter 28.\rNormal Cognitive Aging	170
Chapter 29.\rThe Aging Personality and Self: Diversity and Health Issues	178
PERSONALITY STAGES AND EGO DEVELOPMENT	178
SOCIAL-COGNITIVE APPROACHES TO PERSONALITY	181
SYNTHESIS AND FUTURE DIRECTIONS	182
KEY POINTS	183
Social Gerontology	184
Chapter 30.\rSuccessful Aging: The Centenarians	184
DISTINGUISHING BETWEEN COMPRESSION OF MORBIDITY AND COMPRESSION OF DISABILITY AND THE ROLE OF RESILIENCE (FUNCTIONAL RESERVE AND ADAPTIVE CAPACITY)	184
KEY POINTS	186
Chapter 31.\rSocial Gerontology	187
INTRODUCTION	187
THE “PROBLEM” OF OLD AGE	187
THEORETICAL APPROACHES: FROM FUNCTIONALISM TO STRUCTURED DEPENDENCY	188
INCREASING LIFE EXPECTANCY AND COMPRESSION OF MORBIDITY— A GOLDEN AGE	188
OPPORTUNITY AGE—SUCCESSFUL AGING AND THE THIRD AGE	189
INEQUALITIES IN LATER LIFE— CONTINUITIES AND IMPACT	190
CONCLUDING COMMENTS	191
KEY POINTS	192
Chapter 32.\rProductive Aging	193
INTRODUCTION	193
DEMOGRAPHY	193
RETIREMENT	193
PAID EMPLOYMENT	194
AGEISM IN THE WORKPLACE	195
UNPAID WORK	196
JAPAN	196
DEVELOPING NATIONS	196
CONCLUSION	197
KEY POINTS	197
Chapter 33.\rSocial Vulnerability in Old Age	198
BACKGROUND AND DEFINITIONS	198
HOW CAN WE STUDY SOCIAL INFLUENCES ON HEALTH?	199
SUCCESSFUL AGING	201
ASSOCIATIONS WITH HEALTH	201
MECHANISMS	203
FRAILTY, EXCLUSION, AND “SILENCE BY PROXY”	204
POLICY RAMIFICATIONS AND POTENTIAL FOR INTERVENTIONS	204
CONCLUSIONS	204
Section II: Geriatric Medicine	205
Evaluation of the Geriatric Patient	205
Chapter 34.\rPresentation of Disease in Old Age	205
NONSPECIFIC CLINICAL PRESENTATIONS OF DISEASE IN THE OLDER POPULATION	205
COMMON DISEASES AND THEIR ATYPICAL PRESENTATION IN THE OLDER POPULATION	208
CONCLUSION	210
KEY POINTS	210
Chapter 35.\rMultidimensional Geriatric Assessment	211
BRIEF HISTORY OF GERIATRIC ASSESSMENT	211
STRUCTURE AND PROCESS OF GERIATRIC ASSESSMENT	211
EFFECTIVENESS OF GERIATRIC ASSESSMENT PROGRAMS	215
CONCLUSION	217
KEY POINTS	217
Chapter 36.\rLaboratory Medicine in Geriatrics	218
INTRODUCTION	218
CONCLUSION	222
KEY POINTS	222
Chapter 37.\rSocial Assessment of Geriatric Patients	223
SOCIAL ASSESSMENT AS PART OF COMPREHENSIVE ASSESSMENT	223
DESCRIPTIVE OVERVIEW	223
ASPECTS OF SOCIAL FUNCTIONING	224
EMERGING AREAS OF SOCIAL ASSESSMENT	228
KEY POINTS	228
Chapter 38.\rSurgery and Anesthesia in Old Age	230
TRENDS IN SURGERY AND ANESTHESIA IN OLD AGE	230
AGE, SURGERY, AND OUTCOME	230
ANESTHETIC FACTORS	231
STRATEGIES OF PREOPERATIVE ASSESSMENT	232
RESPIRATORY PROBLEMS IN THE OLDER SURGICAL PATIENT	234
CARDIAC PROBLEMS IN THE ELDERLY SURGICAL PATIENT	235
UNDERNUTRITION	237
OBESITY	239
FLUID AND ELECTROLYTE IMBALANCE	239
CENTRAL NERVOUS SYSTEM	241
ONLINE COMPUTERIZED RISK ASSESSMENT AND GUIDANCE	243
SURGICAL AND ANESTHETIC AUDITS	243
KEY POINTS	243
FUTURE TRENDS	244
Chapter 39.\rMeasuring Outcomes of Multidimensional Interventions	245
CONCLUSION	248-249
ACKNOWLEDGMENTS	248-249
Cardiovascular System	272
Chapter 40.\rChronic Cardiac Failure	272
EPIDEMIOLOGY	272
DISEASE COURSE AND PROGNOSIS	273
PATHOPHYSIOLOGY	273
THE ETIOLOGY OF HEART FAILURE	274
DIAGNOSIS OF HEART FAILURE	274
CHEST X-RAY	275
ELECTROCARDIOGRAM	276
ECHOCARDIOGRAPHY	276
TREATMENT OF HEART FAILURE	277
PROBLEMATIC DISEASE INTERACTIONS — COPD, INCONTINENCE, COGNITIVE IMPAIRMENT, DEPRESSION	283
COPD	283
CONCLUSIONS	284
KEY POINTS	285
Chapter 41.\rDiagnosis and Management of Coronary Artery Disease	286
CLINICAL MANIFESTATIONS	286
RECOGNIZED AND UNRECOGNIZED MI	286
DIAGNOSTIC TECHNIQUES	286
CORONARY RISK FACTORS	288
THERAPY OF STABLE ANGINA	290
ACUTE CORONARY SYNDROMES	290
THERAPY OF STEMI	291
THERAPY AFTER MI	291
HORMONE REPLACEMENT THERAPY	293
CORONARY REVASCULARIZATION	294
Chapter 42.\rThe Frail Elderly Patient with Heart Disease	295
INTRODUCTION	295
MAKING TREATMENT DECISIONS: SHOULD AGE MATTER?	295
HEART DISEASE, POLYPHARMACY, AND COGNITIVE IMPAIRMENT	298
CONCLUSION	299
Chapter 43.\rHypertension	300
EPIDEMIOLOGY	300
PATHOGENESIS	301
OTHER CARDIOVASCULAR RISK FACTORS	302
COMPLICATIONS OF HYPERTENSION	303
DIAGNOSIS AND EVALUATION	304
MANAGEMENT OF HYPERTENSION	305
SPECIAL CASES	309
KEY POINTS	310
SUMMARY	311
Chapter 44.\rValvular Heart Disease	312
AORTIC STENOSIS	312
AORTIC REGURGITATION	317
MITRAL ANNULAR CALCIUM	320
MITRAL STENOSIS	323
ACUTE MITRAL REGURGITATION	324
CHRONIC MITRAL REGURGITATION	324
TRICUSPID REGURGITATION	325
TRICUSPID STENOSIS	325
PULMONIC REGURGITATION	326
Chapter 45.\rCardiac Arrhythmias	327
VENTRICULAR ARRHYTHMIAS	327
ATRIAL FIBRILLATION	330
RISK FACTORS FOR THROMBOEMBOLIC STROKE	334
ATRIAL FLUTTER	335
ATRIAL PREMATURE COMPLEXES	336
SUPRAVENTRICULAR TACHYCARDIA	336
ACCELERATED ATRIOVENTRICULAR RHYTHM	336
PAROXYSMAL ATRIAL TACHYCARDIA WITH ATRIOVENTRICULAR BLOCK	336
MULTIFOCAL ATRIAL TACHYCARDIA	336
BRADYARRHYTHMIAS	336
Chapter 46.\rSyncope	338
DEFINITION	338
EPIDEMIOLOGY	338
PATHOPHYSIOLOGY	338
PRESENTATION	340
EVALUATION	340
ORTHOSTATIC HYPOTENSION	341
CAROTID SINUS SYNDROME AND CAROTID SINUS HYPERSENSITIVITY	343
VASOVAGAL SYNCOPE	345
POSTPRANDIAL HYPOTENSION	346
SUMMARY	347
Chapter 47.\rVascular Surgery	348
ARTERIAL DISEASE OF THE LIMB	348
CAROTID DISEASE	349
ABDOMINAL AORTIC ANEURYSM	352
ENDOVASCULAR TECHNIQUES	355
MANAGEMENT OF SMALL ANEURYSMS	355
CONCLUSIONS	355
KEY POINTS	355
Chapter 48.\rVenous Thromboembolism in the Elderly	356
INTRODUCTION	356
KEY POINTS	360
CONCLUSION	361
The Respiratory System	362
Chapter 49.\rAsthma and Chronic Obstructive Pulmonary Disease	362
DISEASES OF AIRFLOW OBSTRUCTION	362
ASTHMA IN THE ELDERLY	362
COPD IN THE ELDERLY	369
KEY POINTS	375
Chapter 50.\rNonobstructive Lung Disease and Thoracic Tumors	376
RESPIRATORY INFECTIONS	376
INFLUENZA	376
PNEUMONIA	376
TUBERCULOSIS	377
NONTUBERCULOUS MYCOBACTERIAL INFECTION	378
BRONCHIECTASIS	378
PLEURAL EFFUSION	379
PNEUMOTHORAX	379
DIFFUSE PARENCHYMAL LUNG DISEASE	380
IDIOPATHIC PULMONARY FIBROSIS	380
DRUG-INDUCED INTERSTITIAL LUNG DISEASE	381
CONNECTIVE TISSUE DISEASE	381
SARCOIDOSIS	381
PULMONARY VASCULITIS	381
HYPERSENSITIVITY PNEUMONITIS	382
OCCUPATIONAL LUNG DISEASE	382
LUNG CANCER	382
NON–SMALL CELL LUNG CANCER	383
SMALL CELL LUNG CANCER	383
MALIGNANT MESOTHELIOMA	384
KEY POINTS	384
The Nervous System	385
Chapter 51.\rDementia Diagnosis	385
OVERVIEW	385
LIMITATIONS OF CURRENT CLASSIFICATION	385
DEMENTIA DEFINITIONS	385
RISK FACTORS	385
DEMENTIA ASSOCIATED WITH OTHER DISORDERS	386
CLINICAL EXAMINATION FEATURES DIFFERENTIAL DIAGNOSIS	389
AUTONOMIC DYSFUNCTION	389
OCULAR AND VISUAL FINDINGS	390
PYRAMIDAL DISORDERS	390
PARKINSONIAN DISORDERS	390
CEREBELLAR SIGNS	390
NEUROPATHY AND OTHER LOWER MOTOR NEURON FINDINGS	390
GAIT IMPAIRMENT	390
SEIZURES AND MYOCLONUS	390
LABORATORY INVESTIGATIONS IN DEMENTIA	390
SUMMARY	391
KEY POINTS	391
Chapter 52.\rPresentation and Clinical Management of Dementia	392
PRESENTATION	392
DIFFERENTIAL DIAGNOSIS	394
TELLING THE DIAGNOSIS	397
MANAGEMENT	398
KEY POINTS	401
Chapter 53.\rNeuropsychology in the Diagnosis and Treatment of Dementia	402
INTRODUCTION	402
REASONS FOR NEUROPSYCHOLOGICAL ASSESSMENT	402
CHALLENGES TO NEUROPSYCHOLOGICAL ASSESSMENT IN THE ELDERLY	402
NEUROPSYCHOLOGICAL TESTS: DOMAINS OF ASSESSMENT AND NORMATIVE DATA	404
PRIMARY PROGRESSIVE APHASIAS: SEMANTIC DEMENTIA (SD) AND PROGRESSIVE NONFLUENT APHASIA (PNFA)	407
SUMMARY	410
KEY POINTS	410
Chapter 54.\rAlzheimer’s Disease	411
PATHOLOGY AND MECHANISMS OF DISEASE	411
EPIDEMIOLOGY AND GENETICS OF ALZHEIMER’S DISEASE	412
CLINICAL DIAGNOSTIC CRITERIA FOR ALZHEIMER’S DISEASE	414
CLINICAL EVALUATION FOR ALZHEIMER’S DISEASE	415
NEUROLOGIC EXAMINATION	415
LABORATORY STUDIES	416
BEHAVIORAL SYMPTOMS IN ALZHEIMER’S DISEASE	417
BIOLOGIC MARKERS OF DIAGNOSIS OF DISEASE PROGRESSION	417
TREATMENT	419
PREVIOUSLY ACCEPTED THERAPIES MAY BE INEFFECTIVE	420
MORE TARGETED THERAPEUTIC APPROACHES IN ALZHEIMER’S DISEASE THERAPY	420
KEY POINTS	420
Chapter 55. Vascular Cognitive Impairment	421
HISTORICAL OVERVIEW	421
EPIDEMIOLOGY	421
SUBTYPES OF VCI	421
ETIOLOGY AND PATHOPHYSIOLOGY OF VCI	422
DISEASE PROGRESSION	426
PREVENTION AND TREATMENT	426
KEY POINTS	426
Chapter 56. Frontotemporal Dementia	428
ETIOLOGY	428
CLINICAL PRESENTATION	429
EPIDEMIOLOGY	429
DIAGNOSIS	430
BIOMARKERS	431
TREATMENT AND STRATEGIES	432
KEY POINTS	432
Chapter 57. Functional Psychiatric Illness in Old Age	433
DEPRESSION	433
LATE LIFE PSYCHOSIS	436
MANIA	439
ANXIETY DISORDERS	440
SOMATOFORM DISORDERS	441
ALCOHOL	441
PERSONALITY DISORDERS IN OLD AGE	442
KEY POINTS	443
Chapter 58. The Older Adult with Intellectual Disability	445
DEFINITIONS AND ETIOLOGY	445
EPIDEMIOLOGY OF INTELLECTUAL DISABILITY AND AGING	445
BIOLOGIC AGING IN ID: SYNDROMIC AND NONSYNDROMIC	447
AGE-RELATED DISEASE: SYNDROMIC AND NONSYNDROMIC PATTERNS	447
ASSESSMENT OF THE HEALTH OF OLDER ADULTS WITH ID	449
COMMUNICATION	451
HEALTH PROMOTION	451
KEY POINTS	452
Chapter 59. Epilepsy	453
INTRODUCTION	453
DEFINITION	453
EPIDEMIOLOGY	453
CLASSIFICATION	453
EPILEPTIC SEIZURES	455
EPILEPSY SYNDROMES	456
MAKING THE DIAGNOSIS	457
DIFFERENTIAL DIAGNOSIS	457
OTHER CONSIDERATIONS	459
ETIOLOGY	460
INVESTIGATION	460
ANTIEPILEPTIC DRUG THERAPY	462
THE IMPACT OF EPILEPSY	464
SERVICES FOR PATIENTS WITH EPILEPSY	464
AREAS FOR RESEARCH	464
KEY POINTS	465
Chapter 60. Headache and Facial Pain	466
INTRODUCTION	466
PRIMARY HEADACHE DISORDERS	466
TREATMENT OF MIGRAINE	467
FACIAL NEURALGIAS	470
ATYPICAL FACIAL PAIN	472
HEADACHE ARISING FROM THE NECK	472
SINUS DISEASE AND DENTAL DISEASE	473
VASCULAR DISORDERS AND HEADACHE	473
INTRACRANIAL TUMORS	474
LOW-PRESSURE HEADACHE SYNDROME	475
DRUG-INDUCED HEADACHE	475
HEADACHE AND THE EYE	475
MISCELLANEOUS CAUSES OF HEAD PAIN	476
THE DIAGNOSTIC APPROACH TO HEADACHE	476
KEY POINTS	477
Chapter 61. Stroke: Epidemiology and Pathology	478
STROKE EPIDEMIOLOGY	478
PATHOLOGIC MECHANISMS UNDERLYING STROKE	482
Chapter 62. Stroke: Clinical Presentation, Management and Organization of Services	484
INTRODUCTION	484
DEFINITIONS	484
STROKE TYPES	485
CLINICAL PRESENTATION	487
INVESTIGATIONS	489
RECOVERY AND REHABILITATION	493
SECONDARY STROKE PREVENTION	495
PRIMARY STROKE PREVENTION	496
ORGANIZATION OF STROKE SERVICES	497
Chapter 63. Disorders of the Autonomic Nervous System	498
BASIC CONCEPTS OF AUTONOMIC PHYSIOLOGY	498
EFFECT OF AGING ON THE DIFFERENT COMPONENTS OF AUTONOMIC CARDIOVASCULAR CONTROL	501
EFFECT OF AGING ON AUTONOMIC RESPONSE TO STRESS	503
DISORDERS OF THE AUTONOMIC NERVOUS SYSTEM IN ELDERLY PEOPLE	504
AUTONOMIC AND NEUROENDOCRINE TESTING	506
MANAGEMENT OF ORTHOSTATIC HYPOTENSION	508
DOPS	510
SUMMARY	510
KEY POINTS	510
Chapter 64. Parkinsonism and Other Movement Disorders	511
THE AKINETIC–RIGID SYNDROMES	511
PARKINSON’S DISEASE	511
HYPERKINETIC MOVEMENT DISORDERS	518
KEY POINTS	519
Chapter 65. Neuromuscular Disorders	520
APPROACH TO THE PATIENT WITH NEUROMUSCULAR DISEASE	520
PERIPHERAL NEUROPATHIES	523
NEUROGENIC CLAUDICATION AND SPINAL STENOSIS	525
INFLAMMATORY MYOPATHY	526
INCLUSION BODY MYOSITIS	528
DRUG-INDUCED MYALGIA AND MYOPATHY	528
ENDOCRINE AND METABOLIC MYOPATHIES	529
MOTOR NEURON DISEASE (MND)	529
KEY POINTS	532
Chapter 66. Intracranial Tumors	533
CLASSIFICATION	533
EPIDEMIOLOGY	533
CLINICAL PRESENTATION	534
INVESTIGATIONS AND DIAGNOSIS	535
TREATMENTS	536
CONCLUSION	538
KEY POINTS	538
Chapter 67. Disorders of the Spinal Cord and Nerve Roots	539
CERVICAL RADICULOPATHY AND MYELOPATHY	539
CORD COMPRESSION IN RHEUMATOID ARTHRITIS	541
SPINAL CORD COMPRESSION AND THORACIC DISK PROTRUSION	541
CORD COMPRESSION FROM INTRADURAL TUMORS	542
METASTATIC SPINAL TUMORS	542
VASCULAR DISORDERS OF THE SPINAL CORD	543
SPINAL CORD INJURY	543
PAGET’S DISEASE	543
NEUROLOGIC COMPLICATIONS OF DEGENERATIVE DISEASE OF THE LUMBAR SPINE	544
KEY POINTS	545
Chapter 68. Infections of the Central Nervous System	546
FOCAL LESIONS, ENCEPHALITIS, AND CHRONIC MENINGITIS	549
KEY POINTS	552
The Nervous System	546
Chapter 69. Metabolic Bone Disease	553
INTRODUCTION	553
OSTEOPOROSIS	553
OSTEOMALACIA	558
FRACTURES IN THE ELDERLY	564
KEY POINTS	565
Chapter 70. Arthritis in the Elderly	566
DISEASE MECHANISMS	566
RHEUMATOID ARTHRITIS	570
SERONEGATIVE SPONDYLARTHRITIS	571
OSTEOARTHRITIS	572
POLYMYALGIA RHEUMATICA AND GIANT CELL ARTERITIS	573
GOUT	573
CALCIUM PYROPHOSPHATE CRYSTAL DEPOSITION (CPCD)	574
APATITE DEPOSITION DISEASE	575
KEY POINTS	576
Chapter 71. Connective Tissue Diseases	577
INTRODUCTION	577
NONMETABOLIC DISEASES OF BONE	577
CARTILAGE DISORDERS	578
DISORDERS OF FIBROUS TISSUE, LIGAMENTS, AND TENDONS	578
NEOPLASMS OF CONNECTIVE TISSUE	579
IMMUNE-MEDIATED CONNECTIVE TISSUE DISORDERS	580
METABOLIC DISORDERS	580
KEY POINTS	581
SUMMARY	582
Chapter 72. Orthopedic Geriatrics	583
INTRODUCTION	583
GERIATRIC TRAUMA	583
ANESTHETIC CONSIDERATIONS	584
FOLLOW-UP	586
GERIATRIC-ORTHOPEDIC CO-CARE	586
CONCLUSIONS	586
KEY POINTS	586
Chapter 73. Sarcopenia	587
DEFINITION	587
EPIDEMIOLOGY	587
OPERATIONAL DEFINITION OF SARCOPENIA	587
ETIOLOGY OF SARCOPENIA	588
CONSEQUENCES OF SARCOPENIA	590
CONCLUSION	593
KEY POINTS	593
Chapter 74. Podiatry	594
ORTHOPEDIC/BIOMECHANICAL DISORDERS	594
DERMATOLOGIC DISORDERS	595
NAIL DISORDERS	596
FOOT PROBLEMS IN PATIENTS WITH DIABETES	597
SUMMARY	598
KEY POINTS	598
Gastroenterology	594
Chapter 75. Geriatric Dentistry: Maintaining Oral Health in the Geriatric Population	599
INTRODUCTION	599
CONCLUSION	607
KEY POINTS	607
Chapter 76. The Upper Gastrointestinal Tract	608
THE ORAL CAVITY	608
THE OROPHARYNX	610
THE ESOPHAGUS	612
THE STOMACH	618
SYSTEMIC DISEASES	625
KEY POINTS	625
Chapter 77. The Pancreas	626
BACKGROUND	626
TUMORS OF THE PANCREAS	626
CYSTIC TUMORS	627
SOLID TUMORS	627
ACUTE PANCREATITIS	631
CONCLUSIONS	633
CHRONIC PANCREATITIS	633
KEY POINTS	633
Chapter 78. The Liver	635
STRUCTURE	635
FUNCTION	635
DRUG AND ALCOHOL METABOLISM	635
INVESTIGATIONS	636
RADIOLOGY	637
LIVER BIOPSY	637
LIVER DISEASES	638
COMPLICATIONS OF CIRRHOSIS	641
ACUTE LIVER FAILURE	643
LIVER TRANSPLANTATION	643
FOCAL LIVER LESIONS	644
KEY POINTS	644
Chapter 79. Biliary Tract Diseases	645
ISOLATED DISORDERS OF BILIRUBIN METABOLISM	645
LIVER DISEASE	645
OBSTRUCTION OF BILE DUCTS	646
INVESTIGATIONS OF THE BILIARY TRACT	649
KEY POINTS	651
Chapter 80. The Small Bowel	652
INVESTIGATION OF SMALL BOWEL DISORDERS	652
SMALL BOWEL DISEASES	653
KEY POINTS	659
Chapter 81. The Large Bowel	661
ANATOMY	661
FUNCTIONS AND SYMPTOMS	661
DIAGNOSTIC TESTING	661
IMAGING TECHNIQUES	661
COLONIC DIVERTICULOSIS	662
APPENDICITIS	664
INFECTIOUS DISEASES	664
INFLAMMATORY BOWEL DISEASE	666
ULCERATIVE COLITIS	666
SEVERE DISEASE	667
MODERATELY SEVERE DISEASE	668
MILD DISEASE	668
MAINTENANCE THERAPY	668
SURGERY	668
RISK OF COLON CANCER	668
CROHN’S DISEASE	669
ILEOCOLITIS AND COLITIS	670
PERIANAL DISEASE	670
SURGERY	670
LYMPHOCYTIC AND COLLAGENOUS COLITIS (MICROSCOPIC COLITIS)	670
COLONIC ISCHEMIA	671
COLONIC PSEUDO-OBSTRUCTION	672
VOLVULUS	672
NEOPLASTIC LESIONS	673
LOWER GASTROINTESTINAL BLEEDING	674
KEY POINTS	677
Chapter 82. Nutrition in Aging	678
NUTRITION IN AGING	678
NUTRITION SCREENING AND ASSESSMENT	678
NUTRITIONAL REQUIREMENTS	680
COMMON NUTRITIONAL PROBLEMS AND DEFICIENCIES	681
NUTRITIONAL STRATEGIES	682
NUTRITION PROGRAMS AND SERVICES	683
ETHICAL CONSIDERATIONS	684
KEY POINTS	684
Chapter 83. Obesity	685
INTRODUCTION	685
MEASUREMENT	685
OBESITY PREVALENCE	685
THE RELATIONSHIP BETWEEN BODY COMPOSITION AND AGING	685
CAUSES OF OBESITY IN THE ELDERLY	685
ADVERSE EFFECTS OF OBESITY	685
BENEFICIAL EFFECTS OF OBESITY	686
MECHANISMS BY WHICH OBESITY INCREASES MORTALITY AND MORBIDITY	686
EFFECTS OF INTENTIONAL WEIGHT LOSS IN OLDER ADULTS	687
TREATMENT	687
CONCLUSION	689
KEY POINTS	689
The Urinary Tract	690
Chapter 84. Diseases of the Aging Kidney	690
INTRODUCTION	690
DIAGNOSTIC PROBLEMS IN OLDER ADULTS	690
INFECTIONS OF THE URINARY TRACT	690
ACUTE RENAL FAILURE	691
RENAL REPLACEMENT THERAPY	694
CHRONIC KIDNEY DISEASE	694
ESTABLISHED RENAL FAILURE	696
CONCLUSION	696
KEY POINTS	696
Chapter 85. Disorders of Water, Electrolyte, and Mineral Ion Metabolism	697
INTRODUCTION	697
WATER BALANCE	697
ELECTROLYTE BALANCE	697
MINERAL ION BALANCE	698
CONCLUSION	700
Chapter 86. The Prostate	701
DEVELOPMENT	701
ASSESSMENT OF THE PROSTATE	702
SERUM MARKERS OF PROSTATIC DISEASE	704
CLINICAL ASPECTS OF PROSTATIC DISEASE	705
PROSTATE CANCER IN THE ELDERLY: A PATIENT SYNOPSIS	714
KEY POINTS	715
Women’s Health	716
Chapter 87. Gynecologic Disorders in the Elderly	716
AGE CHANGES IN THE GENITAL TRACT	716
MENOPAUSE	716
VULVAR DISORDERS	718
UTEROVAGINAL PROLAPSE	720
URINARY INCONTINENCE	721
GYNECOLOGIC CANCER IN THE ELDERLY	721
SEXUALITY AND AGING	724
KEY POINTS	725
Chapter 88. Cancer of the Breast in the Elderly	726
INTRODUCTION	726
BREAST CANCER PRESENTATION: DIAGNOSIS AND STAGING	726
PATHOLOGY OF BREAST CANCER AND MOLECULAR MARKERS OF CLINICAL INTEREST	726
MANAGEMENT OF BREAST CANCER	727
CONCLUSIONS	729
KEY POINTS	729
Endocrinology	730
Chapter 89. Adrenal and Pituitary Disorders	730
DISORDERS OF THE ADRENAL CORTEX	730
CLINICAL PATTERNS OF ADRENAL DISORDERS	733
PITUITARY DISORDERS	735
KEY POINTS	735
Chapter 90. Disorders of the Thyroid	737
MORPHOLOGY	737
ASSESSMENT OF THYROID FUNCTION	738
SCREENING FOR THYROID DYSFUNCTION	740
HYPERTHYROIDISM	740
ACUTE HYPERTHYROIDISM	743
SUBCLINICAL HYPERTHYROIDISM	743
HYPOTHYROIDISM	745
SUBCLINICAL HYPOTHYROIDISM	748
NODULAR THYROID DISEASE AND NEOPLASIA	750
KEY POINTS	754
Chapter 91. Disorders of the Parathyroid Glands	755
INTRODUCTION	755
PHYSIOLOGY OF PARATHYROID HORMONE	755
CALCIUM HOMEOSTASIS AND CHANGES WITH AGE	755
SECONDARY HYPERPARATHYROIDISM	756
PRIMARY HYPERPARATHYROIDISM	756
LITHIUM	758
TERTIARY HYPERPARATHYROIDISM	758
HYPOPARATHYROIDISM	759
KEY POINTS	759
Chapter 92. Diabetes Mellitus	760
DIABETES DEFINITION, CLASSIFICATION, AND DIAGNOSIS	760
IMPAIRMENT OF GLUCOSE TOLERANCE WITH AGING	761
EPIDEMIOLOGY OF DIABETES MELLITUS IN THE ELDERLY POPULATION	761
IMPACT OF DIABETES MELLITUS IN THE ELDERLY POPULATION	762
RESIDENTIAL CARE AND THE HOUSEBOUND	766
GLUCOSE CONTROL IN DIABETES MELLITUS	767
SULFONYLUREAS	768
INSULIN	770
HOME MONITORING OF DIABETIC CONTROL	771
HYPOGLYCEMIA IN THE ELDERLY PATIENT	771
HYPERGLYCEMIC COMA	771
BLOOD PRESSURE CONTROL IN DIABETES MELLITUS	772
LIPID CONTROL IN DIABETES MELLITUS	772
VASCULAR PROPHYLAXIS	773
CARE ISSUES AND FUTURE INITIATIVES	773
KEY POINTS	774
Hematology and Oncology	775
Chapter 93. Blood Disorders in the Elderly	775
ANEMIA	775
MYELODYSPLASIA	777
MYELOPROLIFERATIVE DISORDERS	779
OTHER HEMATOLOGIC MALIGNANCIES COMMON TO OLDER PATIENTS	781
CLINICAL FEATURES, PROGNOSIS, AND MANAGEMENT	784
DISORDERS OF HEMOSTASIS	789
KEY POINTS	790
Chapter 94. Geriatric Oncology	791
CANCER AND AGING	791
CANCER PREVENTION	792
PREVENTION STRATEGIES	792
INCIDENCE	795
DIAGNOSIS	795
STAGE OF DISEASE	795
TREATMENT	796
SURGERY	797
DRUG THERAPY	797
CHEMOTHERAPY	798
HORMONAL THERAPIES	798
RADIOTHERAPY	799
NURSING CARE	799
REHABILITATION	800
SURVIVAL	800
KEY POINTS	800
Skin and Special Senses	801
Chapter 95. Skin Disease and Old Age	801
INTRODUCTION	801
EPIDEMIOLOGY	801
APPROACH TO THE PATIENT	801
SELECTED SKIN CONDITIONS	801
KEY POINTS	801
KEY POINTS	805
Chapter 96. Aging and Disorders of the Eye	810
EYELIDS	810
LACRIMAL APPARATUS	810
CONJUNCTIVA	811
CORNEA	811
UVEAL TRACT	812
GLAUCOMA	813
CRYSTALLINE LENS	814
RETINA AND VITREOUS	815
OPTIC NERVE	819
NEURO-OPHTHALMOLOGY	819
ORBIT	819
OPHTHALMIC COMPLICATIONS OF SYSTEMIC DISEASES	819
OPHTHALMIC COMPLICATIONS OF SYSTEMIC MEDICATIONS	819
SYSTEMIC COMPLICATIONS OF OPHTHALMIC MEDICATIONS	820
LOW-VISION REHABILITATION	820
KEY POINTS	821
Chapter 97. Disorders of Hearing	822
DEMOGRAPHICS OF AGING AND HEARING LOSS	822
AGE-RELATED CHANGES WITHIN THE AUDITORY SYSTEM	822
BEHAVIORAL IMPLICATIONS OF ANATOMIC AND PHYSIOLOGIC CHANGES	824
PSYCHOSOCIAL CONSEQUENCES OF DECREMENTS IN PURE-TONE SENSITIVITY AND SPEECH UNDERSTANDING	825
HEARING TECHNOLOGIES	826
SCREENING PROTOCOLS	832
WHEN AND TO WHOM TO REFER	833
KEY POINTS	833
CONCLUDING REMARKS	834
Section III: Problem-Based Geriatric Medicine	835
Prevention and Health Promotion	835
Chapter 98. Health Promotion for the Community-Living Older Adult	835
INTRODUCTION	835
THE HETEROGENEITY OF OLDER ADULTS AND THE NEED FOR HEALTH PROMOTION	836
CONCEPTUAL FRAMEWORK FOR HEALTH PROMOTION AND PREVENTIVE CARE FOR FRAIL OLDER ADULTS	837
FRAMEWORK FOR ECONOMIC EVALUATION	838
SCREENING AND ASSESSMENT: IDENTIFYING OLDER ADULTS WHO COULD BENEFIT FROM HEALTH PROMOTION AND PREVENTIVE CARE EFFORTS	838
PROMOTING HEALTH IN COMMUNITYLIVING OLDER ADULTS: LESSONS FROM FIVE INTERVENTION STUDIES	842
THE NEED FOR LEGISLATION AND POLICY	845
THE NEED FOR MORE RESEARCH	846
Chapter 99. Preventive and Anticipatory Care	848
DISEASE PREVENTION	848
PREVENTION OF FRAILTY	849
PREVENTION OF ACCIDENTS	850
PREVENTION OF IATROGENIC PROBLEMS	851
PREVENTION OF PSYCHOSOCIAL ILLNESSES	851
INDIVIDUALIZING PREVENTION	852
PREVENTIVE PRACTICE SYSTEMS	852
SUMMARY	853
KEY POINTS	853
Chapter 100. Sexuality in Old Age	854
MISINFORMATION, MYTHS, AND PREJUDICES	854
NORMAL AGING AND CHANGES IN SEXUALITY	854
EXAMINATION AND EVALUATION OF THE PATIENT	855
EFFECTS OF MEDICAL PROBLEMS, SURGERY, AND MEDICATIONS	855
ERECTILE DYSFUNCTION	855
THE “SECOND LANGUAGE OF SEX”	858
SUMMARY	858
KEY POINTS	858
Chapter 101. Exercise for Successful Aging	859
INTRODUCTION	859
AEROBIC EXERCISE	859
STRENGTH TRAINING	861
OTHER EFFECTS OF EXERCISE	863
SUMMARY	864
KEY POINTS	864
Chapter 102. Injury in Older People	865
PHYSIOLOGIC CHANGES IN OLDER VICTIMS OF TRAUMA	865
DOES RECOVERY OCCUR IN OLDER VICTIMS OF TRAUMA?	866
HOW TO ASSESS INJURY AND MEASURE OUTCOME?	867
INJURY PATTERNS IN OLDER PEOPLE	867
CONCLUSIONS	869
KEY POINTS	869
Chapter 103. Rehabilitation: Therapy Techniques	870
OCCUPATIONAL THERAPY AND PHYSIOTHERAPY	870
THE THERAPY PROCESS	872
SOME SPECIFIC THERAPY TECHNIQUES	873
FUTURE DIRECTIONS	879
KEY POINTS	879
Chapter 103B. Rehabilitation: General Principles	Chapter 103-1
DEFINITIONS OF REHABILITATION	Chapter 103-1
OLDER AGE AND REHABILITATION NEED	Chapter 103-2
PREVENTION OF DISABLEMENT	Chapter 103-2
POLICY FRAMEWORK FOR REHABILITATION SERVICES FOR ELDERLY PEOPLE IN THE UNITED KINGDOM	Chapter 103-3
UNDERSTANDING DISABILITY	Chapter 103-5
ASSESSMENT AND REHABILITATION POTENTIAL	Chapter 103-7
DETECTION OF DEPRESSION AND DEMENTIA	Chapter 103-9
ASSESSMENT OF MOBILITY	Chapter 103-9
ASSESSMENT OF DISABILITY	Chapter 103-10
TEAMWORK IN REHABILITATION	Chapter 103-11
THE CONTENT OF REHABILITATION	Chapter 103-13
REHABILITATION SERVICES	Chapter 103-15
CONCLUSION	Chapter 103-17
KEY POINTS	Chapter 103-17
Geriatric Syndromes	880
Chapter 104. Geriatric Pharmacotherapy and Polypharmacy	880
INTRODUCTION	880
EFFICACY AND SAFETY OF PHARMACOTHERAPY FOR ELDERLY PATIENTS	880
MEDICATION-RELATED PROBLEMS IN ELDERLY PATIENTS	880
EPIDEMIOLOGY OF ADVERSE DRUG REACTIONS	881
ADVERSE DRUG REACTION RISK FACTORS	881
EPIDEMIOLOGY OF ADVERSE DRUG WITHDRAWAL EVENTS	882
ADVERSE DRUG WITHDRAWAL RISK FACTORS	882
EPIDEMIOLOGY OF THERAPEUTIC FAILURE	882
THERAPEUTIC FAILURE RISK FACTORS	882
MEASURES TO REDUCE MEDICATION- RELATED PROBLEMS IN ELDERLY PATIENTS	883
PRINCIPLES OF GERIATRIC PHARMACOTHERAPY	884
SUMMARY	885
KEY POINTS	885
Chapter 105. Impaired Mobility	886
INTRODUCTION	886
AGE-RELATED CHANGES IN MOBILITY	886
COMMON DISORDERS OF GAIT	887
CLINICAL ASSESSMENT OF BALANCE AND MOBILITY	888
IMMOBILITY IN OLDER PEOPLE: IMPACT AND INTERVENTIONS	889
IMPAIRED MOBILITY AND FRAILTY	892
CONCLUSION	893
KEY POINTS	893
Chapter 106. Falls	894
INTRODUCTION	894
EPIDEMIOLOGY	894
CAUSATION	894
SCREENING	897
EVALUATION AND MANAGEMENT	898
SYSTEMWIDE IMPLEMENTATION	902
SUMMARY	902
KEY POINTS	902
Chapter 107. Delirium	903
INTRODUCTION	903
KEY POINTS	908
Chapter 108. Constipation and Fecal Incontinence in Old Age	909
INTRODUCTION	909
DEFINITIONS	909
PREVALENCE OF CONSTIPATION AND CONSTIPATION-RELATED SYMPTOMS	909
PREVALENCE OF FECAL INCONTINENCE IN OLDER PEOPLE	910
RISK FACTORS FOR FI AND CONSTIPATION IN OLDER PEOPLE	911
PATHOPHYSIOLOGY OF CONSTIPATION AND FI IN OLDER PEOPLE	914
CLINICAL EVALUATION	915
TREATMENT OF CONSTIPATION IN OLDER PEOPLE	918
PHARMACOLOGIC TREATMENT	920
TREATMENT OF FECAL INCONTINENCE IN OLDER ADULTS	921
KEY POINTS	925
FURTHER RESEARCH	925
Chapter 109. Urinary Incontinence	926
ANATOMY AND PHYSIOLOGY	926
PRESENTATION	927
MULTICHANNEL CYSTOMETRY	928
AGE-RELATED PATHOPHYSIOLOGY	929
ASSESMENT OF THE ELDERY INCONTINENT PATIENT	931
THE TREATMENT OF URINARY INCONTINENCE	934
OTHER PHARMACOLOGIC MEASURES	936
FLAVOXATE HYDROCHLORIDE (URISPAS)	936
INDWELLING CATHETERS	938
EXTERNAL SHEATH DRAINAGE	938
KEY POINTS	938
Chapter 110. Pressure Sores	939
NORMAL AGING	939
PATHOPHYSIOLOGY OF PRESSURE ULCERS	939
RISK ASSESSMENT	940
PRESSURE ULCER CLASSIFICATION	940
MANAGEMENT AND TREATMENT	940
QUALITY INIDICATOR AND LITIGATION	941
CONCLUSION	941
KEY POINTS	942
Chapter 111. Sleep, Aging, and Late-Life Insomnia	943
INSOMNIA	943
SUMMARY	948
KEY POINTS	948
Chapter 112. Malnutrition in Older Adults	949
Chapter 113. The Mistreatment and Neglect of Older People	959
HISTORICAL DEVELOPMENT	959
DEFINITIONS	959
PREVALENCE AND INCIDENCE	960
RISK FACTORS	961
IDENTIFICATION	962
PREVENTION, TREATMENT, AND MANAGEMENT	963
SUMMARY AND CONCLUSION	963
KEY POINTS	963
Chapter 114. Pain in the Older Adult	965
COMPONENTS OF PAIN	965
TYPES OF PAIN	965
PATHOPHYSIOLOGIC PERSPECTIVE	966
EVALUATION	966
MANAGEMENT	968
CONCLUDING REMARKS	972
KEY POINTS	972
Chapter 115. Palliative Medicine for the Elderly Patient	973
INTRODUCTION	973
SYMPTOM CONTROL	975
KEY POINTS	982
Chapter 116. Ethical Issues in Geriatric Medicine	983
KEY POINTS	987
Section IV: Health Systems and Geriatric Medicine	988
Chapter 117. The Elderly in Society: An International Perspective	988
INTRODUCTION	988
CONCLUSION: THE GERIATRICIAN’S ROLE	995
KEY POINTS	995
Chapter 118. Geriatrics in Europe	997
AGING IN EUROPE	997
THE DEVELOPMENT OF GERIATRIC MEDICINE	997
GERIATRIC MEDICINE IN SELECTED COUNTRIES TODAY	998
GERIATRIC MEDICINE IN OTHER EUROPEAN COUNTRIES	999
GERIATRIC MEDICINE ORGANIZATIONS IN EUROPE	1000
IAGG	1000
EUGMS	1001
EUMS - Geriatric Medicine Section	1001
COLLABORATIVE RESEARCH IN EUROPE	1004
CONCLUSIONS	1004
Chapter 119. Geriatrics in North America	1005
INTRODUCTION	1005
KEY POINTS	1009
Chapter 120. Geriatrics in the Rest of the World	1010
CONCLUSION	1015
KEY POINTS	1015
Chapter 121. Geriatrics in Latin America	1016
INTRODUCTION	1016
KEY POINTS	1020
Chapter 122. Long-Term Care in the United Kingdom	1021
LONG-TERM CARE IN THE UNITED KINGDOM	1021
KEY POINTS	1025
Chapter 123. Institutional Long-Term Care in the United States	1026
HISTORY OF INSTITUTIONAL LONG-TERM CARE	1026
DEMOGRAPHICS AND ECONOMIC CONSIDERATIONS	1026
CULTURE CHANGE IN U.S. NURSING HOMES	1030
FUTURE PERSPECTIVES	1030
Chapter 124. Education in Geriatric Medicine	1032
INTRODUCTION	1032
SUMMARY	1035
CONCLUSION	1036
KEY POINTS	1036
Chapter 125. Improving Quality of Care in the United Kingdom	1038
WHAT IS QUALITY?	1038
MEASURING QUALITY OF CARE	1039
RECENT QUALITY IMPROVEMENT INITIATIVES IN THE UNITED KINGDOM	1039
LESSONS FROM INDUSTRY ON QUALITY MANAGEMENT	1041
THE CURRENT NHS APPROACH	1043
KEY POINTS	1045
Chapter 126. Preserving Medicare Through a “Quality” Focus	1046
MEDICARE’S NEW FOCUS ON QUALITY	1046
MEASURING QUALITY	1048
COST EFFECTIVE QUALITY	1052
RESOURCES: “QUALITY” ORGANIZATIONS	1054
THE FUTURE OF “QUALITY”	1056
KEY POINTS	1056
Chapter 127. Managed Care for Older Americans	1057
MANAGED CARE TIMELINE	1057
MEDICARE MANAGED CARE IN FEE-FOR-SERVICE	1057
MANAGED CARE PRINCIPLES	1059
PLAN REIMBURSEMENT	1060
CAPITATION AND PAY-FORPERFORMANCE	1060
MEASURING QUALITY OF CARE	1061
A VISION FOR CARE IN THE FUTURE	1062
KEY POINTS	1063
Chapter 128. Telemedicine Applications in Geriatrics	1064
BACKGROUND	1064
CARE COORDINATION IN CHRONIC DISEASE MANAGEMENT	1064
CARE COORDINATION IN THE MANAGEMENT OF THE FRAIL OLDER ADULT	1064
BASIC PRINCIPLES OF TELEMEDICINE/TELEHEALTH	1064
APPLICATIONS OF HOME TELEMEDICINE/TELEHEALTH IN THE ELDERLY	1065
USABILITY ISSUES IN THE ELDERLY	1067
BARRIERS TO WIDESPREAD USE OF TELEMEDICNE	1067
FUTURE DIRECTIONS	1068
KEY POINTS	1069
Index	1071

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