Table of Contents
Dedication
Title Page
Copyright
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
Copyright
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
Suggested Reading
Chapter 120: Alcohol Consumption and Cognition
Evidence From Studies
Prospective Evidence
Conclusion
References
Chapter 121: Drug Misuse and The Older Person: A Contradiction in Terms?
Introduction
Drug Abuse
Medications and The Elderly: Geriatric Characteristics, Adverse Drug Reactions and Drug Misuse
Prevention of Iatrogenic Incidents in Practice: General Rules for Individual Prescription
Prevention of Iatrogenic Incidents in Practice: Tools for Collective Evaluation
References
Chapter 122: The Use and Abuse of Prescribed Medicines
Introduction
Use and Harmful Use
Pharmacology
Prevalence and Correlates
Benzodiazepines
Illicit Drug Misuse
Aetiology
Polysubstance Misuse
Detection
Detection of Benzodiazepine Use
Treatment
Prognosis
Conclusion
References
Chapter 123: Transportation, Driving and Older Adults
Introduction
Illness and Transportation
What do We Need to Know to Assess Our Older Patients?
Conclusion
References
Chapter 124: Smart Homes
Introduction
What is a Smart Home?
Applicability to Elderly People
Ensuring User Friendliness
Some Examples of Usage
Appropriate Design
The Difficulty of Behaviour Monitoring
The Importance of Communication with the User
Quality of Life Issues
Links with the Outside World
Experience of Usage
Infrastructure Needed for Introduction
Future Trends
Conclusion
Acknowledgements
References
Chapter 125: Skin Disorders
References
Chapter 126: The Prevention and Management of Pressure Ulcers
Clinical Staging of Pressure Ulcers
Prevention of Pressure Ulcers
Treatment of Pressure Ulcers
Conclusion
References
Chapter 127: Perioperative and Postoperative Medical Assessment
Introduction
Outcomes of Surgery in the Elderly
Ageing Physiology
Emergency Surgery
Preoperative Medical Assessment of the Geriatric Patient
Postoperative Management of the Geriatric Patient
Conclusion
References
Chapter 128: Anaesthesia
Introduction
Outcome of Surgery and Anaesthesia in the Elderly
Cardiovascular Morbidity Associated with Surgery and Anaesthesia
Respiratory Morbidity Associated with Surgery and Anaesthesia
Central Nervous System Morbidity Associated with Surgery and Anaesthesia
Renal Morbidity Associated with Surgery and Anaesthesia
Perioperative Hypothermia
Preoperative Assessment
Pain Assessment and Management in the Elderly
Ethical Considerations for Perioperative Care of the Elderly
Strategy to Reduce Postoperative Morbidity and Mortality in the Elderly
Conclusion
References
Chapter 129: Health Issues in the Ageing Female
Cancer
Menopause
Osteoporosis
References
Chapter 130: Antiageing Strategies
Introduction
The Demographic Revolution
What is Antiageing Medicine?
Can Death be Delayed?
Can the Course of Disability and Functional Dependence be Reversed?
Can Disability and Functional Dependence be Delayed?
Caloric Restriction (CR)
Epigenetics
Translation of Results into Humans
Stem Cell Ageing
The Hormonal Fountain of Youth
Preventive Gerontology
Ethical Issues
Conclusion
References
Chapter 131: Ethics in Geriatric Medicine
Scenes from Everyday Life in the Geriatrics Unit, or how do you do what's Right?
The 10-Point Approach
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
This edition first published 2012 © 2012 by John Wiley & Sons, Ltd.
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
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For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell
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.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.
Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.
The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization orWebsite is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that InternetWebsites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.
The editor and publishers have made every effort to contact all the copyright holders to obtain their permission to reproduce copyright material. However, if any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
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.
This edition first published 2012 © 2012 by John Wiley & Sons, Ltd.
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
For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell
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.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.
Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.
The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization orWebsite is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that InternetWebsites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.
The editor and publishers have made every effort to contact all the copyright holders to obtain their permission to reproduce copyright material. However, if any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
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)