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Pathy's Principles and Practice of Geriatric Medicine

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Страница 1 Table of Contents List of Tables List of Illustrations Guide Pages Страница 7Страница 8Страница 9Страница 10Страница 11Страница 12Страница 13 List of Contributors Страница 15Страница 16Страница 17Страница 18 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 Third wave of geriatricians Geriatrics in the United States Geriatrics in the rest of the world Teaching geriatric medicine Achievements of geriatric medicine Gerontology: the science of the ageing process Problem areas Key points References Страница 35 CHAPTER 1 A biological perspective of ageing Introduction A populational perspective on ageing The evolutionary roots of the phenomenon of ageing The components of biological ageing Genomic instability Epigenetic changes Mitochondrial dysfunction Loss of proteostasis Metabolic dysfunction Cell senescence Stem cell exhaustion Immunosenescence Challenges for the biology of ageing and geriatric medicine Key points References CHAPTER 2 Physiology of ageing The nervous system Age‐related changes in the nervous system The cardiovascular system Age‐related changes in the cardiovascular system The endocrine system Thyroid Growth hormone Dehydroepiandrosterone (DHEA) Oestrogen Testosterone Hypothalamic‐pituitary‐adrenal (HPA) axis Arginine‐vasopressin (AVP) The gastrointestinal system Age‐related changes in the GI tract Age‐related changes in GI organs and glands The genitourinary tract Age‐related changes in the kidneys Age‐related changes in the lower urinary tract Age‐related changes in genital organs The immune system Age‐related changes in the immune system The musculoskeletal system Age‐related changes in the skeleton Age‐related changes in the muscles The respiratory system Age‐related changes in the respiratory system The skin Age‐related changes in the skin Key points References CHAPTER 3 Psychological aspects of ageing Introduction Psychological development over the lifespan Personality changes in older adulthood Normal cognitive change with age Abnormal cognitive ageing Mental health and cognition in the elderly and associated medical issues Psychological interventions in the elderly Non‐pharmacologic interventions for cognitive decline Implications for practice Key points References CHAPTER 4 Social and community aspects of ageing Introduction Demography of ageing Ageing population The causes of population ageing Old‐age dependency ratio Gender imbalance Geographic considerations: migration and immigration Relationships, viewpoints, and ageing Shifting attitudes Marriage, cohabitation, and divorce The changing family Caregiver relationships Religiousness and spirituality Community and societal structures Housing Environment Making a move Incarcerated older adults Employment and retirement The internet and social media Challenges of ageing Ageism Sensory impairments Disability Poverty Social isolation and loneliness Elder abuse Scams and fraud Natural disasters Key points References CHAPTER 5 Sexuality and ageing Introduction Sexual health in older adults Sexuality and the older woman Menopause Sexuality and the older man Andropause Sexuality and disease Dementia Sexually transmitted infections Special considerations for LGBTQ older adults Sexuality in the nursing home Conclusion Key points References CHAPTER 6 Ageing of the brain Introduction Structural age‐related brain changes Atrophy Small‐vessel disease Altered proteins Neurobiological hallmarks of brain ageing Mitochondrial dysfunction Oxidative damage Loss of proteostasis Dysregulation of calcium homeostasis Impaired adaptive cellular stress responses Inflammation Aberrant neuronal network activity and altered synaptic plasticity Impaired DNA repair Impaired neurogenesis Dysregulated energy metabolism Changes in the neurological examination with ageing Vision Hearing Taste and smell Sensation Reflexes Posture, gait, and balance Extrapyramidal signs Cognitive changes with ageing Key points References CHAPTER 7 Physical fitness and exercise Introduction What is physical activity or exercise? Physical inactivity versus exercise Inter‐individual variability in response to exercise (non‐responder phenomenon) Does exercise increase life expectancy? Physical function as a biomarker of healthy ageing and objective of exercise programmes Preserving exercise capacity with age via an active lifestyle Optimisation of body composition with ageing Role of exercise and physical activity in bone health and fracture risk Age‐related changes in bone Physical activity and bone health Exercise intervention trials in postmenopausal women and older men Optimal exercise modality and intensity for bone health Exercise in the treatment of osteoporotic fracture Role of exercise and physical activity in adipose tissue accretion and distribution Cross‐sectional studies of physical activity and fat mass Experimental studies of the influence of physical activity on abdominal fat Relationship between exercise intensity and changes in body fat Relationship between exercise modality and changes in body fat Role of exercise in preserving muscle mass with age Exercise to maintain or increase muscle mass Predictors of muscle hypertrophy after exercise Muscle power training Promotion of psychological well‐being Exercise and cognitive function Considerations regarding exercise for frail individuals with cognitive impairment Effects of exercise interventions on mobility and frailty syndromes Disease prevention through exercise Evidence for the role of exercise in the treatment of disease Mechanisms of benefit Exercise in the treatment of type 2 diabetes Evidence for exercise interventions in frail older adults with diabetes Exercise to counteract iatrogenic disease Exercise and the prevention and treatment of disability Exercise for acute hospitalised older patients Summary of exercise recommendations Resistance training recommendations Balance training recommendations Aerobic and gait training Multicomponent training Conclusions: Key points References CHAPTER 8 Health literacy and cultural sensitivity Introduction The importance of health literacy in health care Factors that influence health literacy The role of education in health literacy Educational strategies to improve health literacy Cultural sensitivity in geriatrics The need for cultural sensitivity When cultures clash Barriers to cultural understanding Common areas of conflict or misunderstanding in the clinical encounter Prior experiences Identifying the patient Communication Stereotyping Age Increasing cultural sensitivity in the clinical encounter Increase self‐awareness Improve communication Explanation Treatment Healers Negotiate Intervention Collaborate Spirituality/seniors Understand non‐verbal cues Use professional translators when possible Promote health Resources Cultural competence in health care Health promotion programs Key points References Страница 242 CHAPTER 9 Preventive geriatrics Introduction Background The Health Maintenance Clinical Glidepath Office visits Blood pressure (BP), including orthostatic measurements Weight Height Pain Medication review including over‐the‐counter (OTC) and herbal medicines Lifestyle education Maintain awareness of elder abuse Assess ADLs and IADLs Visual acuity and auditory testing Ask about urinary incontinence Males: screen for erectile dysfunction (ED) and hypogonadism Rapid Geriatric Assessment Cognitive screening Depression screening Screening for gait and balance Advance directives Influenza vaccine Pneumococcal vaccine Tetanus Zostavax and Shingrix Hepatitis C Breast cancer screening Cervical cancer screening Colon cancer screening Prostate cancer screening Lung cancer screening Osteoporosis Cholesterol screening Thyroid‐stimulating hormone (TSH) Diabetes mellitus Sleep apnoea Abdominal aortic aneurysm Key points References CHAPTER 10 Polypharmacy and deprescribing in older adults Introduction Ageing physiology affects medication efficacy and tolerance Tools for medication management Principles of appropriate prescribing Conclusion Key points References CHAPTER 11 Patient safety Introduction History and evolution of the concept of patient safety Definitions Measurement – the scale of harm Studies of errors Why do adverse events occur? Learning from other industries Human error System and organizational factors What happens after an adverse event? Reporting and learning Understanding why things go wrong Caring for patients after an adverse event Supporting staff Patient safety and older people The incidence of adverse events in older people in the hospital Re‐analysis of international adverse event studies Data from reporting systems Types of adverse events experienced by older people in the hospital The geriatric syndromes Preventable functional decline as an adverse event Adverse drug events in older people Box 11.1 Adverse events in older people. Implications Box 11.2 Common types of medication‐related problems in older people in the hospital. Why are older people more susceptible to healthcare‐associated harm than younger patients? The effects of comorbidity and frailty Decision‐making in the care of older people Multidisciplinary teams and communication Attitudes and ageism Systems and processes of care for frail older people Improving patient safety for older people Education and skills for individual practitioners Box 11.3 Some of the individual skills and behaviours that geriatricians use to maximize patient safety in older people. Design (human factors and ergonomics) and technology Improving systems of care for older people Interventions for the geriatric syndromes Hospital‐acquired infections Medication safety Patient safety issues in community settings Priorities for improving the safety and quality of care for older people Patient safety for older people across the world Improved definitions and measurement Patient safety research in non‐hospital settings Conclusion Acknowledgement Key points References Страница 333 CHAPTER 12 Nutrition and healthy ageing: Emphasis on brain, bone, and muscle Introduction Body weight and composition Body mass index, weight loss, and ageing Central adiposity and healthy ageing Fluid status, dehydration, and healthy ageing Bone loss, nutrition, and healthy ageing Energy intake, macronutrients, and satiety in ageing Determinants of dietary preference and intake among older adults Dietary patterns and nutritional status associated with healthy ageing Dietary patterns associated with healthy cognitive ageing Nutritional status and healthy ageing Micronutrients Minerals Macronutrients and omega‐3 fatty acids Dietary guidelines and clinical applications Key points References CHAPTER 13 The anorexia of aging Introduction ‘Ideal’ body weight in older people Weight loss in older people Cachexia in older people Causes of undernutrition in older people Reduced food intake Physical factors Physiological changes Loss of homeostasis The ageing gut Declining senses Hormones and neurotransmitters: a selective review Central neurotransmitters and hormones Monoamines Opioids Neuropeptide Y Galanin Orexins (hypocretins) Cocaine–amphetamine‐regulated transcript (CART) ‘Peripheral’ hormones, including gut peptides Cholecystokinin (CCK) Glucagon‐like peptide‐1 (GLP‐1) Peptide YY (PYY) Leptin Ghrelin Insulin Testosterone and other androgens Cytokines Chronic disease and anorexia in older adults Environment and social determinants of health Iatrogenic impact Conclusion Key points References CHAPTER 14 Weight loss Introduction Weight loss and frailty Weight loss and sarcopenia The relationship of weight loss to mortality Effect of weight loss on comorbid conditions Weight loss, a hallmark of malnutrition Starvation Cachexia Anorexia The use of the Mini‐Nutritional Assessment (MNA) to explore weight loss Interventions Decreased food intake The effect of exercise to improve body mass and function Palliative treatment of anorexia Conclusion Key points References CHAPTER 15 Water and electrolyte balances in ageing Introduction Normal physiology Water homeostasis in the elderly Workup and treatment of hyponatremia Workup and treatment of hypernatremia Conclusions Key points References CHAPTER 16 Vitamins and minerals Introduction Recommended intakes of vitamins and minerals Medication influences on vitamin and mineral status Vitamins and minerals – functions and characteristics Micronutrients of special concern for older adults Role of vitamin and mineral supplements in chronic disease: some reviews of the evidence Bone health, fractures, vitamin D, and calcium Prevention of fractures in high‐risk populations Prevention of fractures in healthy populations Summary Mild cognitive impairment and dementia Eye disorders – age‐related macular degeneration and age‐related cataracts Prevention of AMD Slowing the progression of AMD Prevention and slowing of age‐related cataract (ARC) development Cancer and cardiovascular diseases – selenium Cancer and cardiovascular diseases – multiple vitamins and minerals Practical implications Nutrient intake and healing of pressure injury: focus on zinc Summary Key points References Страница 435 CHAPTER 17 Changes in gastrointestinal motor and sensory function associated with ageing Introduction Control of gastrointestinal motility and sensation Pathophysiology of the ageing gut Oesophagus Changes in oesophageal motor function related to ageing Clinical presentation of disordered oesophageal motility Achalasia Distal oesophageal spasm and ‘jackhammer’ oesophagus Minor disorders of peristalsis ‘Pill esophagitis’ Non‐cardiac chest pain Gastro‐oesophageal reflux disease Stomach and duodenum Changes in gastric motor function related to ageing Small intestine Changes in small‐intestinal motor function related to ageing Postprandial hypotension Systemic disorders associated with disturbance of gastrointestinal motility Parkinson’s disease Diabetes mellitus Progressive systemic sclerosis Functional disorders Key points Acknowledgements References CHAPTER 18 The liver and gallbladder in the geriatric population Introduction Acute viral hepatitis Chronic hepatitis B and C Fatty liver disease Drug‐induced liver injury Alcoholic liver disease Primary biliary cholangitis Hemochromatosis Autoimmune hepatitis Primary sclerosing cholangitis Hepatocellular carcinoma Biliary disease Liver transplantation Conclusion Key points References CHAPTER 19 Faecal incontinence Introduction The physiology of defecation Anatomy of the lower alimentary canal Defecation Changes relating to ageing Epidemiology of faecal incontinence Prevalence Correlates and risk factors Gastrointestinal disorders Non‐GI risk factors Neurological Endocrine, diabetes, and metabolic Geriatric syndromes Medications and drugs Sequelae of faecal incontinence Assessment of faecal incontinence Investigations Management of faecal incontinence Conservative Measures Pelvic floor training and biofeedback Surgical therapy Sphincter repair Neosphincter operations Sacral neuromodulation Faecal diversion Containment Conclusions Key points References Note CHAPTER 20 Constipation Defining constipation Epidemiology, pathophysiology, and impact Aetiology of constipation Clinical approach History Physical examination Diagnostic tests Treatment Pharmacological management Bulking agents Stool softeners Osmotic laxatives Stimulant laxatives Secretagogues (prosecretory agents) Serotonin receptor agonists Opioid antagonists Enemas Miscellaneous agents Special categories of constipation Conclusion Key points References CHAPTER 21 Diseases of the pancreas The ageing pancreas Inflammatory diseases of the pancreas Acute pancreatitis Pathophysiology of acute pancreatitis Presentation of acute pancreatitis Diagnosis of acute pancreatitis Assessment of the severity of acute pancreatitis Management of acute pancreatitis Chronic pancreatitis Causes of chronic pancreatitis Clinical presentation of chronic pancreatitis Diagnosis of chronic pancreatitis Imaging procedures Complications of chronic pancreatitis Management of chronic pancreatitis Pancreatic cysts and tumours Cystic lesions of the pancreas Endocrine tumours of the pancreas Pancreatic adenocarcinoma Clinical features Diagnosis of pancreatic cancer Management of pancreatic cancer Key points References Страница 552 CHAPTER 22 Anaemia in older people Background Epidemiology Nutritional deficiencies Iron deficiency anaemia Vitamin B12 deficiency anaemia Folate deficiency anaemia Inflammatory anaemias Anaemia of chronic disease Anaemia of chronic kidney disease Anaemia of clonal disorders Conclusion Key points References CHAPTER 23 Disseminated intravascular coagulation Introduction Pathophysiology Diagnosis Management Chronic disseminated intravascular coagulation Key points References CHAPTER 24 Disorders of haemostasis Introduction Disorders of platelet number Decreased platelet production Increased peripheral destruction Increased pooling of platelets Thrombocytopenia due to drugs Functional platelet defects Hereditary coagulation defects Acquired coagulation defects Vascular disorders Thrombotic disorders Thrombophilia Lupus anticoagulant Key points References CHAPTER 25 When to anticoagulate, and which anticoagulant? Introduction The elderly are more prone to thromboembolism The elderly are more prone to haemorrhage Anticoagulant response differs in the elderly Anticoagulants are effective in the elderly Optimizing the risk‐benefit equation in the elderly Intensity of anticoagulation Age‐related factors that predispose to bleeding Tissue modifications Falls Concomitant use of antiplatelets Duration of anticoagulant therapy Start‐stop‐start anticoagulation Starting anticoagulation in elderly patients Situations that force interruption of anticoagulation Intracranial bleeding (ICB) Surgical interventions Poor control of the INR Definitive interruption of anticoagulation Key points References CHAPTER 26 Myelodysplasia Introduction Epidemiology and clinical presentation Elderly patients and risk assessment Diagnosis Blood and bone marrow examination Complete blood count Peripheral blood smear Other useful parameters of peripheral blood Bone marrow analysis Differential diagnosis Cytogenetics Other genetic events Diagnostic criteria Classification Uncertain conditions Prognosis Treatment Treatment of lower‐risk MDS Supportive measures for anaemia: erythroid‐stimulating agents Transfusion support and iron overload Alternative strategies to treat anaemia in MDS Lenalidomide Erythropoiesis maturating agents Platelet growth factors Pyridoxine, androgens, and vitamins Disease‐modifying agents for high‐risk disease Hypomethylating agents Haematopoietic stem cell transplantation Key points References {buyButton}

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