Pages: 58

No chapter abstract available.

Pages: 3

The shift in the prevalence from acute and communicable diseases to multiple chronic diseases calls for a realignment of the healthcare system that was previously organized to treat acute conditions. The term “geriatric” refers to old age that in most advanced societies has been set arbitrarily at 65 years. The solution resides in an integrated and coordinated system that is more expensive than one dealing with short-term interventions, although many inefficiencies in care delivery and inappropriate interventions contribute to heighten the cost. The net effect of this increased longevity combined with the decline of birth rates is practically a doubling of the percentage of older adults, to reach about 25% of the population by 2030 in most developed countries. The solution resides in an integrated and coordinated system that is more expensive than one dealing with short-term interventions, although many inefficiencies in care delivery and inappropriate interventions contribute to heighten the cost.

Pages: 4

Caring for the Older Person (by Abraham Fuks, MD) This chapter, by one of the prominent medical educators active today, focuses “attention to chronic illnesses and the needs of the older person whose ailments need a more deliberate, longer-term horizon with different goals and aspirations.” Dr. Fuks observes that it is the obligation of the caregiver who has been entrusted with the care of the person to fulfill that duty, provided that consent has been given. The patient is to be valued. A proper relationship between patient and caregiver is central. Time, sympathy, and understanding, not only of the person, but of the person in the context of her/his life and surroundings, is important. There is no clear line of division between those who are old and those who are not. Emphasis on acute illness with inadequate attention to chronic illness is discussed. Dr Fuks espouses a proactive and expansive vision of health care. The current state of care is discussed. The importance of language, with the elimination of condescending “elderspeak” is explained.

Pages: 3

Frailty (by Sathya Karunananthan, PhD and Howard Bergman, MD) Like many chapters, the Frailty chapter begins with a hypothetical vignette exemplifying the problem to be considered, in this case, frailty. The resolution of the vignette is at the end of the chapter. The very definition of frailty is a matter of some debate, and this is covered. There is general agreement that frailty in older persons refers to a state of vulnerability to adverse health outcomes. Definitions and conceptualizations of frailty are discussed. The chapter explores the increasing vulnerability of our bodies and organs as we age and what care providers can do to diagnose and treat individuals. Frailty is a risk factor for poor health outcomes in a variety of conditions. Possible interventions are discussed. Instrumental and basic activities of daily living are referred to. The meaning of frailty to older persons is significant. Stereotypes of aging can be internalized, and impact health.

Pages: 6

Physical Activity as a Countermeasure to Frailty (by Guy Hajj Boutros, MSc and Antony D. Karelis, PhD) This chapter, deliberately placed after the chapter on frailty, makes a compelling case for avoiding the sedentary state when possible, and demonstrates interventions that can potentially reverse frailty.

Pages: 2

“Doctor, My Spouse Is Getting Forgetful” (by Serge Gauthier, MD) explores the natural decline in memory, and how to diagnose and address dementia in your patients, clients, or family.

Pages: 4

Update on Alzheimer’s Disease Diagnosis and Management (by Serge Gauthier, MD) is a synopsis of the diagnosis and management of AD, as well as its natural history and progression, by one of the acknowledged leaders in the field.

Pages: 4

Navigating the Journey of Dementia as a Caregiver (by Claire Webster, CPCA) identifies who caregivers are, their demanding roles and the toll the caregiving may take on them.

Pages: 5

How to Diagnose and Manage Delirium (by Haibin Yin, MD). Among elderly patients who come into the ER, 15% suffer from delirium or “acute brain failure.” This chapter explores the signs and treatments.

Pages: 5

Why Does My Patient Have Gait and Balance Disorders? (by Olivier Beauchet, MD, PhD) explores the main causes and best treatments for the broad category of walking and balance problems.

Pages: 6

Could My Patient Be Malnourished? (by Jose Morais, MD) explores the prevalence of malnutrition in older populations, how to diagnose it, and how to treat it.

Pages: 4

Dental Care in Older Persons (by Michael Wiseman, DDS) Dr. Wiseman makes the point that periodontal disease is a prominent chronic infection of older persons that can be associated with systemic health. The importance of dental hygiene is stressed. The DNA of oral bacteria has been identified in atheromatous plaques. Considerations in tooth replacement are discussed, as are difficulty in swallowing and aspiration pneumonia.

Pages: 11

Eating, Drinking and Swallowing Problems of Vulnerable Older Adults (by Heather C. Lambert, PhD) Possibly up to 38% of older adults living in the community and an even higher percentage of those in long-term care have a loss of skills related to swallowing. This loss of ingestive skills is explored in detail. The risk of aspiration, the root cause of which is a failure of airway protection, is discussed. Interventions and prevention, including dietary modifications, are explained. A team approach in managing these conditions may be optimal.

Pages: 35

No chapter abstract available.

Pages: 12

Architecture and the Aging (by Julia Gersovitz, O.C., OAQ, QAA, AANB FIRAC/FRAIC, FAPT, CAHP and Boris Morin-Defoy, M.Arch) The acclaimed, internationally recognized architect, Julia Gersovitz, along with her co-contributor, Boris Morin-Defoy, start out with a stark assessment of the state of nursing homes and the disproportionate death rate of residents within them during the COVID-19 pandemic. This laid bare the deficiencies of the nursing home concept and its inadequacies, which Professor Gersovitz elucidates here. She goes back further in history to explain how the present system evolved. The extensively researched work then goes on to explain how most people would prefer to age at home, rather than be in a facility. Strategies for accomplishing that are discussed. The concept of physical and cognitive autonomy is introduced and is put forward as a method to evaluate older persons. Various intermediate housing solutions that already exist, including naturally occurring retirement communities and active adult communities, are discussed. It is suggested that new facilities should ideally be located in urban centers, and interaction with the surrounding population be encouraged. The abandonment of the hospital model in construction of new facilities is advocated. Better models that are properly scaled and amenable to a more normal and familiar lifestyle, are delved into at length.

Pages: 6

Are the Immunizations of My Patient up to Date? (by Dominique Tessier, MD) stresses the importance of immunizations in our vulnerable older population, with details of the various immunizations that may be necessary.

Pages: 4

Management of Older Patients in the Emergency Department (By Cyrille Launay, MD, PhD) provides an overview of the unique challenges facing ER staff in diagnosing and working with older patients.

Pages: 5

Critical Care of the Older Person (by Astrid F. Pilgrim, MD, and Michael R. Pinsky, MD) is a comprehensive look at the important differences seen in the critically ill older person, and how to efficiently respond to these issues and counteract them.

Pages: 7

COVID-19 in Long-Term Care (by Julia Chabot, MD, Philippe Desmarais, MD, and Michael Stiffel, MD) addresses the particularly onerous effects of the global pandemic on older persons, particularly those in long-term care facilities.

Pages: 68

No chapter abstract available.

Pages: 10

Arthritis in the Older Person (by Linda Yue, MD, Kevin Yip, MD and Joseph A. Markenson, MD) The noted rheumatologist Joseph A. Markenson MD, Hospital for Special Surgery in New York, Professor of Clinical Medicine, Weill Cornell Medical College, Attending Physician, Memorial Sloan-Kettering Cancer Center, along with Drs Linda Yue and Kevin Yip, have written a comprehensive chapter on arthritis, and how it specifically impacts the older person. The various forms of arthritis that afflict older persons, and the management of those conditions, are discussed. This highly researched chapter has concluding take home points. There are two major forms of arthritis, degenerative (or mechanical) and inflammatory. Although both can result in joint pain, damage and signs of local inflammation, the underlying mechanism leading to the manifestations is different. The management of both degenerative and inflammatory arthritis should consist of a multidisciplinary approach. Treatment should involve a combination of pharmacologic therapy, physical and/or occupational therapy, and rheumatology or orthopedic specialty co-management.

Pages: 4

Stroke Prevention in the Elderly (by Liam Durcan, MD) emphasizes the need to identify predisposing causes of this major cause of death and disability, and to modify those risks before serious harm occurs.

Pages: 11

Advances in Cardiac Care for Older Persons (by P. David Myerowitz, MD) is a detailed chronicle of medical problems encountered with the aging heart, and state of the art measures to deal with each of those problems.

Pages: 6

Could My Patient Be at Risk of Orthostatic Hypotension? (by Eric T. Hedge, MSc and Carmelo Mastrandrea, MD, PhD) Orthostatic hypotension is the inability of the body to maintain adequate blood pressure during movement to an upright position because of gravity. The condition may be as prevalent as one in five for community-living individuals 60 years of age or older. Falls induced by orthostatic hypotension can result in significant trauma. Risk factors, diagnosis, non-pharmacologic and pharmacological interventions are all discussed.

Pages: 7

The Care of Chronic Obstructive Pulmonary Disease in Older Adults (by Bryan Ross, MD and Jean Bourbeau, MD) COPD, a very common and often preventable condition affecting many older adults, encompasses both emphysema and chronic bronchitis. Internationally recognized Dr Jean Bourbeau and Dr Bryan Ross elaborate on the nature of the condition, the risk factors, and treatments.

Pages: 8

How Do I Manage My Patient with Peripheral Arterial Disease? (by Oren K. Steinmetz, MD and Anna Kinio, MD) Dr Oren K. Steinmetz, the former Chief of the Division of Vascular Surgery at McGill, along with Dr Anna Eva Kinio, define peripheral arterial disease as chronic occlusive disease of the lower extremities secondary to atherosclerosis. The epidemiology of PAD is discussed, noting that the aging of the population has contributed to PAD becoming a global health concern. It is noted that some risk factors are modifiable, and strategies for modification are presented. Diagnosis and Grading of PAD are covered. It is noted that even in asymptomatic individuals, the presence of PAD is associated with physical decline, with a high risk of cardiovascular events and mortality. Intermittent claudication is discussed. Compromised limb perfusion is a danger. The ankle-brachial index is explained, as are duplex ultrasound imaging, computed tomography angiography, and digital subtraction angiography. Treatment possibilities are presented, including lifestyle and risk factor modification, antiplatelet agents, and anticoagulation. Endovascular treatment, open surgical revascularization, and amputation are discussed.

Pages: 6

How to Manage Type 2 Diabetes in Frail Elderly Patients (by Young-Sang Kim, MD, PhD, and Jose A. Morais, MD) explores this important disease condition that is highly prevalent in older adults, and stresses the differences in treatment and approach that are necessary in the older population.

Pages: 11

Hepatobiliary Considerations, Including Cancer (by Erica C. Roth, MD, Sunil Karhadkar, MD and Antonio di Carlo, MD) As the life expectancy of the general population continues to increase, physicians are increasingly caring for older patients. With the evolution of perioperative care, minimally invasive techniques and improved health of older patients, considering an octogenarian for a major hepatobiliary operation is not that unusual. Immune related and hepatobiliary changes are elucidated. Gallbladder conditions including cholelithiasis, acute cholecystitis, choledocholithiasis, acute cholangitis and gallbladder cancer are all discussed. Benign liver lesions, including hepatic cysts, hemangiomas and the premalignant biliary cystadenoma are discussed, as are cholangiocarcinoma and hepatocellular carcinoma. Pancreatitis and pancreatic carcinoma are among the pancreatic disease entities considered here. A good deal of attention is given to state of the art perioperative care.

Pages: 4

Abdominal Organ Transplantation in the Older Person: (by Antonio di Carlo, MD and Sunil Karhadkar, MD) Antonio di Carlo, MD, Professor and Chief, abdominal organ transplantation, Lewis Katz School of Medicine, Temple University, along with Associate Professor Sunil Karhadkar, MD, cover the important issues in the transplantation of kidneys and livers into older persons. In North America there are no unified criteria for transplanting older patients for any organ. Of all the potential abdominal organs that can be transplanted, the kidney is the one that older patients need most. There have been anecdotal reports of kidney transplantation in octogenarians, with the oldest patient in personal experience being 85 years old. Pancreas and intestinal transplantation is usually limited to recipients younger than 60 to 65 and liver transplantation to those below 70 years. When being considered for an organ transplant, older patients frequently encounter discrimination and selection bias. Organ transplantation for end-stage disease is limited by a global shortage of organs. Allocation of scarce organs to older recipients raises ethical questions. The living donor option is discussed. In comparison to staying on dialysis, there is data to suggest that the life expectancy of an older patient is better with a kidney transplant. Rigorous evaluation must be undertaken prior to surgery to assess survivability, as well as immunosuppression tolerance.

Pages: 30

No chapter abstract available.

Pages: 4

Cancer in Older Adults (by Doreen Wan-Chow-Wah, MD) brings the relatively young subspecialty of Geriatric Oncology to the forefront. Particularities of older persons with cancer are noted, including fitness for treatment. Life expectancy is factored in.

Pages: 10

Cancer Screening in the Older Adult (by Catalina Hernandez-Torres, MD, and Tina Hsu, MD) discusses the sometimes controversial role of cancer screening in older adults. Screening recommendations are covered in the light of treatment options and patient preference.

Pages: 8

Diagnosis and Management of Bowel Cancer (by Jessica Holland, MD and Barry L. Stein, MD) Dr. Holland, along with Dr. Stein, Director, Center for Colon and Rectal Surgery, McGill University, point out that colorectal cancer has the third highest cancer incidence worldwide, along with the second highest mortality. Screening techniques including colonoscopy are discussed. Diagnosis and staging investigations are elucidated, as well as surveillance and treatment options including chemotherapy, radiation, and surgery. Prehabilitation, the process of improving the functional capacity of a patient prior to surgery, is stressed. Metastatic disease is discussed, as is survival. Challenges of managing with an ostomy are covered.

Pages: 4

Precision Medicine and Care of the Older Patient (by Anne Croudass, RN, MSc and Donald White, PhD) The eminent Dr Donald White, who manages the Stratified Medicine Program at Cancer Research UK, has delivered the largest genetic screening program for molecular aberrations of non-small cell lung cancer of its type in the world. He and his co-author, Anne Croudass, the lead research nurse at Cancer Research UK, have contributed a chapter that begins with an illustrative vignette that describes the symptoms of NSCLC, leading to diagnosis and ultimately chemotherapy with its side effects, and the emotional, psychological, social, and financial toll. This vignette is astutely contrasted with a follow-up in which the patient is placed on a compound designed to target specific molecular changes within his cancer cells. The target was the Epidermal Growth Factor Receptor (EGFR). A mutation in EGFR had been identified in the tumour by sequencing DNA from the biopsy. The emergence and delivery of precision medicine is discussed, including the monitoring of disease by blood test, detecting DNA fragments from residual tumour. Precision medicine is transformative, having the potential to revolutionize the impact of cancer treatments for elderly patients and their families, who often reside in fragile, co-dependent relationships, relying on each other for aspects of care and activities of daily living.

Pages: 3

Psycho Oncology: Living with the Fear of Death (by Norman Straker, MD) is a discussion of the emotional and psychiatric care of cancer patients and their families by one of the originators of the subspecialty. The relationship between various psychiatric disorders and cancer is examined.

Pages: 53

No chapter abstract available.

Pages: 7

Incontinence in Older Adults (by Samer Shamout MD and Lysanne Campeau, MD) explores the risks, diagnosis, and treatment of urinary incontinence.

Pages: 8

Sleep Disorders in Older Persons (by Shachi Tyagi, MD) Poor sleep is one of the most prevalent health concerns encountered in older adults. Changes in sleep with aging and common sleep complaints in older adults are discussed. Insomnia, with difficulty in falling asleep or maintaining sleep, is delved into, as well as contributing or associated medical and psychiatric conditions. Diagnosis and treatment, including psychological interventions and pharmacotherapy, are elucidated. Sleep-disordered breathing, sleep-related movement disorders, and parasomnia are all explained and discussed.

Pages: 6

Polypharmacy and Deprescribing in the Elderly (by Louise Mallet, Pharm.D.). Polypharmacy is taking multiple medicines for chronic issues at the same time and is common among the elderly. This chapter explores the risks of polypharmacy and how to “deprescribe” unnecessary medications.

Pages: 6

After Menopause (by Ronald M. Caplan, MD) brings to the fore the fact that, with dramatically increasing lifespan, the postmenopausal years represent a very significant proportion of a woman’s productive life. Physiologic changes, screening for possible problems, prevention and possible treatments are discussed.

Pages: 4

The Senior Adult Eye (by Peter M. Odell, MD) Dr. Odell, Clinical Professor of Ophthalmology, Weill Cornell Medical College, notes that the frequency of eye problems increases as people age, increasing the need for regular follow up. Cataracts, glaucoma, and macular degeneration are all elucidated and management discussed. Other common ocular disorders are covered as well.

Pages: 8

Hearing Loss and Aging (by Joseph J. Montano, Ed.D) Dr. Montano, Professor of Audiology, Weill Cornell Medical College, makes the point that hearing loss is an invisible condition with no obvious outward indications. The early signs of hearing loss are discussed, as is the relationship between hearing loss and cognition. Types of hearing loss include conductive, sensorineural and mixed. Amelioration and management are discussed. The role of amplification devices—hearing aids and hearing assistive technology systems—is explained. Communication strategies are elucidated.

Pages: 6

Skin Care of the Older Person: The Skin and Its Associated Changes (by Aziz Khan, MD, and Hao Feng, MD) comprehensively details disorders of the skin in older persons and the management of those conditions.

Pages: 7

Caring for the Older Person Undergoing Plastic Surgery (by Subhas Gupta, MD and Erin O’Rorke, MD) Subhas Gupta, MD, Chairman and Professor, The Department of Plastic Surgery, Loma Linda University Medical Center, along with Erin O’Rorke, MD, focus on patient selection and state of the art methods of optimally readying patients for surgery. The 15% of the U.S. population that is 65 years of age or older accounts for over 40% of surgical cases. Case selection is very important in this older population. Prehabilitation techniques, improving the functional capability of the patient to better withstand the stress of the procedure, are explained. Common plastic surgery procedures amongst older patients involving the hand, breast, trunk and face, and malignancy reconstructions are all discussed.

Pages: 44

No chapter abstract available.

Pages: 6

Elder Abuse (by Mark J. Yaffe, MD). Unfortunately, elder abuse is far too common in our society, and takes on many forms. This chapter helps care providers to identify elder abuse and learn how to address it.

Pages: 6

Late-Life Anxiety (by Jess Friedland, MD, Paulina Bajsarowicz, MD, and Philippe Desmarais, MD) describes the risk and predisposing factors for the development of anxiety disorders in older persons and the treatments of those disorders.

Pages: 5

An Overview of Late-Life Depression (by Artin Mahdanian, MD, and Silvia Monti De Flores, MD) explores the importance of understanding late-life depression for care professionals, including tools for diagnosis and treatment.

Pages: 5

Assessment of Decision-Making Capacity (by Catherine Ferrier, MD) provides an important analysis of how to determine a patient’s ability to make key decisions about their medical treatment, living situation, finances, and more.

Pages: 6

How Can Older People Be Protected? (by Randy S. Perskin, Esq., JD) explores the important legal issues facing elderly patients and how care providers can best support them.

Pages: 11

Financial Guidance for Seniors (by Karen C. Altfest, PhD, CFP) recognizes that among the paramount concerns of older persons is financial stability. Financial concerns can affect mental and physical health, wellbeing, and even lifespan. Advice is offered to caregivers, including family, and to the older individual on how to anticipate and overcome these problems.

Pages: 4

The Role of Religious Belief in the End-of-Life Care of Older Persons (by A. Mark Clarfield, MD) compassionately shows that we cannot treat older persons near the end of life, and their families, without an understanding of their religious beliefs, and appropriately responding to their needs and concerns in ways that respect those beliefs.

Pages: 46

No chapter abstract available.

Pages: 44

Medical Terms and Their Meaning (by Ronald M. Caplan, MD). A highly researched glossary of medical definitions that will help you to understand what you’re reading and navigate the often-confusing world of scientific terminology. Includes forward-looking research that gives you a sense of where the advances in medicine are going in the future.

Pages: 1

End of Each Chapter