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1 Chapter 1Figure 1.1 A Gompertz curve showing the increase in the incidence of death w...Figure 1.2 The ‘non‐Gompertzian’ curve of the incidence of death in the nake...Figure 1.3 The rectangularization or compression of mortality (dotted line) ...

2 Chapter 4Figure 4.1 The societal and community factors that influence an older adult'...Figure 4.2 United States population separated by age and gender in 2020 and ...Figure 4.3 Trends in the relationship status of adults over age 50 in the US...Figure 4.4 A summary of suboptimal and ideal reasons for older adults to con...Figure 4.5 Risk factors, possible adverse events, and possible treatment opt...

3 Chapter 6Figure 6.1 The hallmarks of brain ageing.

4 Chapter 10Figure 10.1 The Eight C considerations of appropriate prescribing.

5 Chapter 11Figure 11.1 Reason’s Swiss cheese model.Figure 11.2 A proposed scheme for the effects of hospitalization on frail ol...Figure 11.3 Three common clinical scenarios where delirium, incontinence, an...

6 Chapter 12Figure 12.1 Decline in olfaction with age. University of Pennsylvania Smell ...

7 Chapter 13Figure 13.1 Overview of the mechanisms involved in appetite regulation.Figure 13.2 The stimulatory and inhibitory effects of hormones.Figure 13.3 Anorexia as a multifactorial geriatric syndrome with poor outcom...

8 Chapter 14Figure 14.1 Malnutrition clinical presentations according to inflammation in...Figure 14.2 Mini‐Nutritional Assessment (MNA).

9 Chapter 15Figure 15.1 Osmotic control of water balance. The hypothalamus supraoptic (S...Figure 15.2 Pressure‐volume control of water and sodium balance. Barorecepto...Figure 15.3 Renal action of ADH in water conservation.Figure 15.4 Comparisons of disorders of thirst. Serum ADH levels increase wi...Figure 15.5 Algorithm of workup and therapy for hyponatremia. Review medicat...

10 Chapter 17Figure 17.1 Normal oesophageal manometry displayed as a pressure topography ...Figure 17.2 Barium swallow in a patient with achalasia, demonstrating a dila...Figure 17.3 Oesophageal manometry in achalasia (type 2), displayed as a pres...Figure 17.4 Manometry recording in distal oesophageal spasm, displayed as a ...Figure 17.5 Barium swallow in a patient with distal oesophageal spasm, demon...Figure 17.6 Scintigraphic gastric emptying study. Part of the radiolabelled ...

11 Chapter 20Figure 20.1 Illustration of the defecatory process.Figure 20.2 An abdominal radiograph obtained 5 days after ingestion of a cap...

12 Chapter 21Figure 21.1 Acute necrotizing pancreatitis, with a bilobed walled‐off necros...Figure 21.2 Atrophied pancreas with dilated, irregular pancreatic duct and i...Figure 21.3 Hypoenhancing lesion with a central cystic component at the panc...

13 Chapter 22Figure 22.1 Aetiology of anaemia.Figure 22.2 Most prevalent types of anaemia in older adults.Figure 22.3 Diagnostic laboratory values for iron deficiency anaemia, anaemi...Figure 22.4 Diagnostic laboratory values for vitamin B12 deficiency anaemia....Figure 22.5 Key mechanisms for anaemia of chronic disease.

14 Chapter 23Figure 23.1 Mechanism of microvascular thrombosis and bleeding in DIC. Broke...

15 Chapter 24Figure 24.1 Coagulation cascade.Figure 24.2 The natural anticoagulant pathway directly inhibits and negative...

16 Chapter 25Figure 25.1 Relationship between the intensity of anticoagulation and the ri...

17 Chapter 28Figure 28.1 Overlap between frailty, comorbidity, and disability. ADL, activ...Figure 28.2 (a) Unadjusted Kaplan‐Meier cumulative probability of incident f...Figure 28.3 Hazard ratios for mortality by BMI after adjustment for age, his...Figure 28.4 Epidemiology of heart failure. AMI, acute myocardial infarction;...

18 Chapter 29Figure 29.1 Junctional bradycardia: failure of sinus beats has resulted in a...Figure 29.2 Rhythm strip showing advanced second‐degree heart block. The sec...Figure 29.3 Complete heart block. Rhythm strip showing P waves (arrows) that...Figure 29.4 Atrial tachycardia. Abnormal, inverted P waves are seen (arrows)...Figure 29.5 Twelve‐lead ECG of typical atrial flutter with variable AV block...Figure 29.6 Rhythm strip of a patient in AF with a slow ventricular response...Figure 29.7 Lead II rhythm strip of a patient with chronic AF who presented ...Figure 29.8 Rhythm strip showing single and paired ventricular ectopic beats...Figure 29.9 Rhythm strip showing non‐sustained ventricular tachycardia.Figure 29.10 Rhythm strip showing an episode of ventricular fibrillation wit...Figure 29.11 Chest X‐ray of a patient with an ICD (atrial and ventricular le...

19 Chapter 30Figure 30.1 Schematic presentation of the main factors involved in the patho...Figure 30.2 Main outlines of the treatment of stable and decompensated ischa...Figure 30.3 Types of myocardial infarctions. Type 1, infarction related to c...

20 Chapter 31Figure 31.1 Total cholesterol, high‐density lipoprotein cholesterol (HDL‐C),...Figure 31.2 Regression estimates of mean plasma lipid values by age for male...Figure 31.3 Modification of lipid patterns by lifestyle change and drugs. Li...Figure 31.4 Effects on major vascular events per mmol/L reduction in LDL cho...Figure 31.5 Secondary prevention in patients with clinical ASCVD. ‘Very high...Figure 31.6 Flowchart for hepatotoxicity evaluation in patients on statin th...Figure 31.7 Flowchart for myopathy evaluation in patients on statin therapy....

21 Chapter 33Figure 33.1 Pathophysiology of hypertension in older people. Age‐related vas...Figure 33.2 Suggested dynamic targets that are based on and change with pati...

22 Chapter 34Figure 34.1 Schematic presentation of the pathophysiology of heart failure. ...Figure 34.2 Schematic presentation of the principles of heart failure manage...Figure 34.3 Nonpharmacological approaches in the management of heart failure...Figure 34.4 Treatment approach for symptomatic heart failure with reduced ej...

23 Chapter 35Figure 35.1 Age distribution of cardiac procedures (2009–2018) in adult pati...Figure 35.2 Isolated aortic valve replacement by conventional cardiac surger...Figure 35.3 Type of cardiac surgery done in 185,013 patients undergoing hear...Figure 35.4 The rate of complications. In‐hospital mortality (circles and do...Figure 35.5 Management of STEMI patients within 12 hours of first medical co...Figure 35.6 Actuarial survival rate of 474 patients 80 years of age or older...Figure 35.7 Comparative data between an unselected population of 80‐year‐old...Figure 35.8 Choice of TAVI versus surgical AVR in the patient with severe sy...Figure 35.9 Change in procedure volume for aortic valve replacement (AVR; br...Figure 35.10 Survival following transcatheter aortic valve implantation depe...Figure 35.11 Long‐term survival of 614 consecutive patients who underwent ei...Figure 35.12 The therapeutic International Normalised Ratio (INR) window is ...Figure 35.13 Trends of surgical ablation in the US by operative procedure, 2...Figure 35.14 Adult and paediatric heart transplants according to median dono...Figure 35.15 The average yearly rate (during the first five years after pres...

24 Chapter 36Figure 36.1 Mechanisms of endothelial dysfunction and atherosclerosis in age...Figure 36.2 Measurement and diagnostic characteristics of the ankle‐brachial...

25 Chapter 37Figure 37.1 Diagnostic algorithm for lower‐limb DVT. DVT, deep vein thrombos...Figure 37.2 Diagnostic algorithm for PE without haemodynamic instability. PE...

26 Chapter 39Figure 39.1 Decision tree for hospitalization of frail elderly patients with...

27 Chapter 40Figure 40.1 Possible mechanism for the development of aspiration pneumonia i...

28 Chapter 41Figure 41.1 Main risk factors and vulnerable groups of older people for COVI...

29 Chapter 42Figure 42.1 Inhaled medication in COPD. ICS, inhaled corticosteroid; LABA, l...

30 Chapter 45Figure 45.1 Sleep hypnogram for a young adult and an 80‐year‐old. Horizontal...

31 Chapter 46Figure 46.1 the interplay of different pathogenetic mechanisms in NPH.Figure 46.2 CT scan showing typical features of NPH, with ventricular enlarg...Figure 46.3 T1‐weighted axial view showing the maximum diameter of the horns...Figure 46.4 Coronal T1‐weighted views showing enlarged ventricles (*) and DE...Figure 46.5 T1‐weighted sagittal view through the midline showing the narrow...Figure 46.6 T1‐weighted coronal view through the posterior commissure, perpe...Figure 46.7 Idiopathic normal‐pressure hydrocephalus grading scale (iNPHGS)....Figure 46.8 Schema for predicting shunt responsiveness. A positive response ...Figure 46.9 Diagnostic criteria according to the Japanese Guidelines, 2012....Figure 46.10 Diagram of a ventriculoperitoneal shunt system.Figure 46.11 Valve pressure programming for the Codman–Hakim shunt. A built‐...Figure 46.12 Ventricles do not necessarily shrink after successful shunting....Figure 46.13 Subdural effusion. (a) Note the hypodense collection in the sub...

32 Chapter 47Figure 47.1 (a) Early changes of right MCA territory infarction on CT scan; ...Figure 47.2 Multiple areas of hyperintense wedge‐shaped cerebral infarction ...Figure 47.3 Carotid artery dissection on MR imaging. There is left carotid d...Figure 47.4 Carotid artery stenosis.Figure 47.5 Effect of surgery on the absolute risk of main trial outcomes at...

33 Chapter 48Figure 48.1 Activation on functional MRI during a choice reaction task in a ...Figure 48.2 Functional MRI on a choice reaction task using the affected hand...Figure 48.3 Functional MRI on a choice reaction task using the affected hand...

34 Chapter 49Figure 49.1 Normal swallowing process.

35 Chapter 50Figure 50.1 Schematic representation of a subdural hematoma. The dura has tw...Figure 50.2 CT scan of a left acute SDH (hyperdensity) with associated midli...Figure 50.3 Head CT showing (a) bilateral chronic SDH (hypodensities) and (b...Figure 50.4 (a) T2‐weighted MRI showing bilateral chronic SDH; (b) T1‐weight...

36 Chapter 53Figure 53.1 MRI showing a convex aspect of the midbrain, indicating atrophy ...

37 Chapter 55Figure 55.1 Schematic presentation of the main lines of the pathogenesis of ...

38 Chapter 57Figure 57.1 Dermatomyositis. Note the erythema over the knuckles (Gottron’s ...Figure 57.2 Dermatomyositis. Muscle biopsy (Haematoxylin & Eosin stain [H&E]...Figure 57.3 Polymyositis. Muscle biopsy (H&E, ×115). Note the endomysial inf...Figure 57.4 Inclusion body myositis. Muscle biopsy (H&E, ×460). Note the two...Figure 57.5 Inclusion body myositis. Muscle biopsy (electron micrograph, ×13...Figure 57.6 Type II fibre atrophy. Muscle biopsy (ATPase, pH 9.4, ×30). The ...Figure 57.7 Facioscapulohumeral muscular dystrophy (see text).Figure 57.8 Facioscapulohumeral muscular dystrophy (see text).Figure 57.9 Facioscapulohumeral muscular dystrophy (see text).Figure 57.10 Oculopharyngeal muscular dystrophy (see text).Figure 57.11 Myotonic dystrophy. Characteristic facial appearance. Note the ...Figure 57.12 Mitochondrial cytopathy. Muscle biopsy (modified Gomori trichro...

39 Chapter 63Figure 63.1 Evolution of Alzheimer’s disease diagnosis criteria over the pas...

40 Chapter 65Figure 65.1 The pyramid of vascular cognitive impairment vs. vascular dement...

41 Chapter 66Figure 66.1 Cognitive reserve.

42 Chapter 67Figure 67.1 Alzheimer’s disease and the potential roles of physical activity...

43 Chapter 68Figure 68.1 Main results of clinical trials for Alzheimer’s disease over tim...

44 Chapter 69Figure 69.1 Schematic diagram depicting the spectrum of vascular cognitive i...Figure 69.2 Differentiation of clinical features of vascular dementia by ves...Figure 69.3 Schematic representation depicting how Lewy bodies (DLB) and Par...Figure 69.4 Clinico‐pathologic correlation of the clinical subtypes of front...

45 Chapter 70Figure 70.1 Conceptual model describing interactions of individuals with dem...

46 Chapter 71Figure 71.1 In this model, changes in functional connectivity, inflammation,...

47 Chapter 73Figure 73.1 Outline of the life cycle for an individual. At each stage, mult...Figure 73.2 The pyramid of services for people with mental health problems i...

48 Chapter 75Figure 75.1 Mechanisms subserving balance in humans.Figure 75.2 Normal sequence of events leading to recovery from a peripheral ...Figure 75.3 Head thrust test: normal to the left (a) and (b), abnormal to th...Figure 75.4 The Dix‐Hallpike manoeuvre for inducing positional nystagmus.Figure 75.5 Pathophysiological mechanisms of cupulolithiasis and canalithias...Figure 75.6 Particle repositioning procedure for canalithiasis of the left p...Figure 75.7 Factors predisposing to decompensation.

49 Chapter 76Figure 76.1 Schematic drawing of the major layers of the olfactory bulb and ...Figure 76.2 Scores on the University of Pennsylvania Smell Identification Te...Figure 76.3 Male normative data for the University of Pennsylvania Smell Ide...Figure 76.4 Prevalence of smell impairment in men and women by age group usi...Figure 76.5 (a) and (b) Distribution of taste buds on the human tongue. Tast...

50 Chapter 77Figure 77.1 Algorithm for the diagnosis and management of osteoporosis in po...Figure 77.2 Treatment pathways according to the categorisation of fracture r...

51 Chapter 78Figure 78.1 The 30‐Second Chair Stand assessment.Figure 78.2 The 4‐Stage Balance Test assessment.Figure 78.3 The Berg Balance Scale.Figure 78.4 (a) The walking gait cycle. During double stance, the weight is ...Figure 78.5 The Get Up and Go Test.Figure 78.6 The Stopping Elderly Accidents, Deaths & Injuries (STEADI) algor...

52 Chapter 79Figure 79.1 Classification of hip fractures by Parker and Johansen.Figure 79.2 Intracapsular fracture fixed with three screws.Figure 79.3 Fracture treated with an uncemented Moore hemiarthroplasty.Figure 79.4 Fracture treated with a cemented total arthroplasty.Figure 79.5 Bipolar hemiarthroplasty.Figure 79.6 Trochanteric fracture fixed by dynamic hip screw.Figure 79.7 Trochanteric fracture fixed by gamma nail.

53 Chapter 80Figure 80.1 Common foot problems in older people. (a) Onychomycosis; (b) dia...

54 Chapter 81Figure 81.1 Classical feedback loop between glucose and pancreatic secretion...Figure 81.2 Effects of disease on feedback among hypothalamus, pituitary, an...Figure 81.3 Effects of aging on feedback among hypothalamus, pituitary, and ...Figure 81.4 Differences in protein binding of testosterone between young and...

55 Chapter 82Figure 82.1 Hormones produced by the anterior pituitary and its hypothalamic...

56 Chapter 83Figure 83.1 Algorithm for diagnosing thyroid disorders in the presence of an...Figure 83.2 Algorithm for diagnosing thyroid disorders in the presence of re...Figure 83.3 Algorithm for diagnosing and managing thyroid nodule in the pres...Figure 83.4 Algorithm for diagnosing and managing thyroid nodule in the pres...

57 Chapter 84Figure 84.1 The follicular content of the ovary determines two different sce...Figure 84.2 The ovary of a young woman, replete with follicles, and that of ...Figure 84.3 The Study of Women Across the Nation found that ethnic origin in...Figure 84.4 The Women’s Health Initiative (WHI) study found a reduction of 3...Figure 84.5 Trunk obesity increases the release of free fatty acids (FFA) to...

58 Chapter 85Figure 85.1 Diagnosis of hypogonadism.

59 Chapter 89Figure 89.1 Algorithm for evaluating and managing prostate cancer in the eld...

60 Chapter 92Figure 92.1 (a) Cancer incidence rates in men; (b) cancer incidence rates in...Figure 92.2 Guideline for the management of senior adult oncology patients....

61 Chapter 95Figure 95.1 Matching the complexity of clinical decision‐making to the decis...Figure 95.2 Nausea and vomiting pathways.Figure 95.3 Comparing the course of chronic disease to cancer. The y‐axis is...

62 Chapter 97Figure 97.1 The pathway from frailty to death.Figure 97.2 The frailty threshold.Figure 97.3 The major causes of frailty.Figure 97.4 The pathogenesis of frailty in congestive heart failure.Figure 97.5 Frailty and diabetes mellitus.Figure 97.6 Frailty and anaemia.Figure 97.7 Schematic view of the biochemistry of sarcopenia.

63 Chapter 98Figure 98.1 The complex interaction between health status, activity, and par...Figure 98.2 Honda’s experimental Walking Assist Device with Body Weight Supp...Figure 98.3 Rocker‐bottom shoe with an insole.Figure 98.4 Two types of lower limb prostheses are shown, with a solid ankle...

64 Chapter 100Figure 100.1 WHO ICOPE care pathways. (a) Cognitive capacity care pathways t...Figure 100.2 WHO ICOPE handbook app.

65 Chapter 101Figure 101.1 The rising prevalence of VHD according to age. Frequency in (a)...Figure 101.2 (a) Transoesophageal echocardiogram (TOE) demonstrating severe ...Figure 101.3 Chest X‐ray demonstrating pulmonary oedema: cardiomegaly, alveo...Figure 101.4 (a) Parasternal long‐axis transthoracic echocardiogram (TTE) de...Figure 101.5 Cardiac magnetic resonance imaging in aortic stenosis. (a) A na...Figure 101.6 The natural history of aortic stenosis demonstrating a long asy...Figure 101.7 Continuous‐wave Doppler profile in severe aortic stenosis. The ...Figure 101.8 Indications for intervention in patients with severe aortic ste...Figure 101.9 Contemporary transcatheter aortic valve implantation devices: (...Figure 101.10 Selection of an aortic valve management strategy in elderly pa...Figure 101.11 Transthoracic echo views: (a and b) rheumatic mitral stenosis ...Figure 101.12 (a) The Inoue balloon used during percutaneous balloon mitral ...Figure 101.13 Schematic of the carrying aetiologies of mitral regurgitation ...Figure 101.14 Representative echocardiogram images of an elderly patient wit...Figure 101.15 The percutaneous MitraClip device (inset) provides a central t...Figure 101.16 (a) TTE showing vegetations on aortic valve leaflets; (b) TTE ...Figure 101.17 Proposed modifications to the Duke criteria for the diagnosis ...

66 Chapter 106Figure 106.1 Different types of suboptimal prescription.

67 Chapter 108Figure 108.1 Scheme for a generic healthcare‐enabled Smart Home.Figure 108.2 Four‐layer logical architecture for a Smart Home.Figure 108.3 Properties for a Smart Home to be a u‐Home.Figure 108.4 Man‐in‐the‐middle attack.

68 Chapter 110Figure 110.1 Histologic changes in elderly skin (H&E 100× magnification). (a...Figure 110.2 (a) Asteatotic eczema. Note the eczematous dermatitis in a dist...Figure 110.3 Bullous pemphigoid. Note the tense bullae and erosions secondar...

69 Chapter 112Figure 112.1 The 5 Ms framework for care of older adults. In this model, eac...

70 Chapter 113Figure 113.1 Mortality associated with surgery and anaesthesia.Figure 113.2 Revised Cardiac Risk Index.

71 Chapter 115Figure 115.1 Mechanisms investigated as the fundaments of the ageing process...Figure 115.2 Effects and proposed mechanisms of physical exercise on cogniti...

72 Chapter 117Figure 117.1 Participation of older adults in RCTs published in PubMed 1990–...Figure 117.2 Number of RCTs published in PubMed involving the oldest old (ag...Figure 117.3 Number (blue bars) and percentage (orange line) of intervention...Figure 117.4 Primary conditions targeted by the 3520 clinical trials specifi...Figure 117.5 Number of currently recruiting (as of 22/01/2020) trials specif...

73 Chapter 119Figure 119.1 Estimated and forecast world numbers of centenarians from 1990 ...

74 Chapter 120Figure 120.1 Palliative care is most effective for patients and their famili...Figure 120.2 The Serious illness Conversation Guide uses a checklist approac...

75 Chapter 122Figure 122.1 Continuous Quality Improvement Model.

76 Chapter 123Figure 123.1 The audit cycle.

77 Chapter 126Figure 126.1 Person–Environment–Occupation–Performance/Participation (PEOP) ...Figure 126.2 WHO ICF model.Figure 126.3 Continuum of geriatric OT services.Figure 126.4 Geriatric OT services.Figure 126.5 Geriatric OT service settings.Figure 126.6 OT process.Figure 126.7 OT assessment and intervention components.

78 Chapter 128Figure 128.1 Medicare inpatient discharges per beneficiary and outpatient vi...

79 Chapter 130Figure 130.1 Training structure for medicine in the UK.

80 Chapter 134Figure 134.1 The whole spectrum of research on ageing.Figure 134.2 Changes in telomere length with cell divisions.