Current Diagnosis & Treatment: Geriatrics

CURRENT Diagnosis & Treatment Geriatrics Second Edition......Page 2
Copyright Page......Page 3
Contents......Page 6
Authors......Page 23
Preface......Page 58
Section I. Principles of Geriatric Care......Page 60
1. Transforming the Care of Older Adults: Knowledge, Skills, & System Change......Page 61
Guiding Principles......Page 62
Geriatric Principles......Page 66
Epidemiology of Functional Limitations......Page 69
Assessment of Functional Status......Page 72
Risk Factors for Functional Decline......Page 74
Prevention of Functional Decline......Page 75
Rehabilitation: The Treatment of Functional Decline......Page 76
Goals of Care Discussions......Page 81
A Practical Guide to Goals of Care Discussions......Page 82
Prognostication......Page 86
Prognosis Related to Specific Diseases......Page 90
Communicating Prognosis to Patient or Surrogate......Page 96
4. The Social Context of Older Adults......Page 100
Financial Issues in the Third Age......Page 101
Food Insecurity and Older Adults......Page 102
Medicare......Page 103
Housing and Long-Term Care......Page 105
Caregiving......Page 107
Recommendations for Clinicians......Page 108
5. The Interprofessional Team......Page 110
Key Definitions and Concepts......Page 111
Interprofessional Team Innovations in Geriatrics......Page 113
Evidence of Interprofessional Teams in the Care of Older Adults......Page 115
Resources and Tools for Teamwork......Page 117
Barriers to the Advancement of Teamwork......Page 119
Future Steps......Page 120
Teams and Clinical Sites of Care......Page 122
Prognosis......Page 123
Patient Goals......Page 124
Functional Assessment......Page 125
Falls and Gait Impairment......Page 126
Vision Impairment......Page 127
Dementia......Page 128
Nutrition......Page 129
Financial, Environmental and Social Resources......Page 130
Geriatric Assessment in Primary Care......Page 131
7. Atypical Presentations of Illness in Older Adults......Page 137
Identifying Patients at Risk......Page 138
Screening Issues for the Geriatric Population......Page 149
Geriatric Syndromes......Page 154
Health-Related Behaviors......Page 159
Immunizations......Page 162
Endocrine Disorders......Page 165
Cardiovascular Disease......Page 167
Cancer......Page 171
Geriatric Principles......Page 177
Drug Metabolism and Physiologic Effects in Older Adults......Page 178
Geriatric Therapeutics......Page 180
Prescribing for Older Adults......Page 198
Adherence......Page 204
Managing Complexity......Page 205
Prescribing Across the Care Continuum......Page 208
Background and Definitions......Page 213
Clinician Challenges in the Care of Older Adults with Multimorbidity......Page 214
General Considerations in the Care of Multimorbid Older Adults......Page 215
Overview of Palliative Care......Page 223
Psychological, Spiritual, and Social Issues......Page 225
Communication, Decision Making, and Advance Care Planning......Page 226
Challenges to Providing Palliative Care in Long-Term Care Settings......Page 227
Caring for Family Members: Grief and Bereavement......Page 236
12. Ethics & Informed Decision Making......Page 239
Ethical Issues in the Care of Older Adults......Page 240
Decision-Making Capacity and Informed Decision Making......Page 243
Advance Care Planning and Advance Directives......Page 244
Surrogate Decision Making......Page 245
Balancing Promotion of Independence and Patient Safety......Page 247
Section II. Care Settings......Page 250
Definitions......Page 251
Background......Page 252
Adverse Events During Transitions......Page 253
Barriers to Successful Care Transitions......Page 254
Overcoming the Barriers: Best Practices......Page 256
Evidence-Based Interventions......Page 258
Conclusion......Page 259
General Principles in Older Adults......Page 263
Personal Physician......Page 264
Physician Directed Medical Practice......Page 265
Care Coordination and Integration......Page 266
Quality and Safety......Page 267
Enhanced Access......Page 268
General Principles......Page 270
Models of Emergency Care......Page 272
Clinical Care......Page 273
Future of Emergency Care......Page 277
General Principles in Older Adults: Hazards of Hospitalization......Page 281
Successful Models of Care......Page 285
Approach to the Hospitalized Older Adult......Page 287
Therapy......Page 292
Prevention......Page 293
Transitioning from Hospital to Home......Page 295
Surgical Risk in the Older Adult......Page 300
Clinical Care......Page 302
Models of Surgical Care......Page 308
General Principles in Older Adults......Page 310
Long-Term Care in the Community......Page 312
Institutional Long-Term Care......Page 314
Hospice and End-of-Life Care......Page 320
Preventive Home Care/ Geriatric Assessment......Page 324
Posthospitalization Case Management & Transitional Care Models......Page 325
Eligibility Requirements......Page 326
Innovations in Care Delivery......Page 330
Area Agencies on Aging......Page 332
Postacute Hospitalization & Home Rehabilitation Care......Page 333
House Calls & Home-Based Primary Care......Page 334
Overview of Travel Problems......Page 338
Risk of Venous Thromboembolism Due to Travel......Page 340
Resources About Travel Risks......Page 341
Ship Travel......Page 342
Air Travel......Page 343
Section III. Common Conditions in Geriatrics......Page 350
21. Delirium......Page 351
22. Cognitive Impairment & Dementia......Page 371
23. Cerebrovascular Disease......Page 403
Parkinson Disease......Page 422
Essential Tremor......Page 440
25. Falls & Mobility Disorders......Page 445
26. Osteoarthritis......Page 466
27. Osteoporosis & Hip Fractures......Page 492
28. Coronary Disease......Page 518
Acute Coronary Syndrome......Page 524
Chronic Coronary Heart Disease......Page 539
Heart Failure......Page 552
Bradyarrhythmias......Page 569
Tachyarrhythmias—Atrial Fibrillation & Atrial Flutter......Page 572
Ventricular Arrhythmias......Page 580
30. Hypertension......Page 587
31. Valvular Disease......Page 616
Aortic Stenosis......Page 617
Aortic Insufficiency......Page 624
Mitral Stenosis......Page 628
Mitral Regurgitation......Page 633
Peripheral Arterial Disease......Page 642
Venous Thromboembolism......Page 655
Chronic Venous Insufficiency......Page 667
Lymphedema......Page 676
34. Chronic Obstructive Pulmonary Disease......Page 684
35. Gastrointestinal & Abdominal Complaints......Page 707
Gastroesophageal Reflux Disease......Page 708
Dysphagia......Page 712
Motility Disorders......Page 717
Peptic Ulcer Disease......Page 719
Dyspepsia......Page 721
Diarrhea......Page 723
Diverticular Disease......Page 727
Inflammatory Bowel Disease......Page 729
Fecal Incontinence......Page 730
Colonic Ischemia......Page 733
Abdominal Pain......Page 735
36. Constipation......Page 741
37. Fluid & Electrolyte Abnormalities......Page 756
Hyponatremia......Page 757
Hypernatremia......Page 763
Potassium Disorders......Page 765
Hypokalemia......Page 766
Hyperkalemia......Page 770
Nocturnal Polyuria......Page 776
38. Chronic Kidney Disease......Page 779
39. Urinary Incontinence......Page 793
Benign Prostatic Hyperplasia......Page 819
Prostate Cancer......Page 827
Subclinical Hypothyroidism......Page 838
Subclinical Hyperthyroidism......Page 840
Hypothyroidism......Page 842
Myxedema Coma......Page 845
Hyperthyroidism......Page 848
Nodular Thyroid Disease & Neoplasia......Page 856
Acute Adrenal Insufficiency......Page 863
Cushing Syndrome......Page 866
Hyperparathyroidism......Page 869
42. Diabetes......Page 875
43. Anemia......Page 899
44. Common Cancers......Page 915
Breast Cancer......Page 917
Lung Cancer......Page 920
Colorectal Cancer......Page 922
Pancreatic Cancer......Page 925
Leukemia......Page 926
Lymphoma......Page 927
Depression......Page 933
Suicide......Page 947
Bipolar Disorder......Page 948
Anxiety & Stress Disorders......Page 951
Schizophrenia & Psychotic Disorders......Page 959
46. Sexual Health & Dysfunction......Page 967
47. Common Infections......Page 985
Urinary Tract Infections......Page 994
Respiratory Tract Infections......Page 997
Gastrointestinal Infections......Page 1001
Skin and Soft-Tissue Infections......Page 1002
Prosthetic Joint Infections and Osteomyelitis......Page 1006
HIV/AIDS......Page 1008
48. Pressure Ulcers......Page 1015
49. Common Skin Disorders......Page 1037
Seborrheic Keratosis......Page 1038
Epidermal Inclusion Cyst......Page 1041
Warts (Verruca Vulgaris & Verruca Plantaris)......Page 1043
Onychomycosis......Page 1045
Dry Skin, Pruritus, & Asteatotic Dermatitis......Page 1050
Seborrheic Dermatitis......Page 1055
Stasis Dermatitis......Page 1058
Psoriasis......Page 1060
Rosacea......Page 1064
Contact Dermatitis......Page 1067
Drug Eruption (Morbilliform)......Page 1072
Herpes Zoster......Page 1074
Scabies......Page 1079
Bullous Pemphigoid......Page 1085
Actinic Keratosis......Page 1089
Basal Cell Carcinoma......Page 1092
Squamous Cell Carcinoma......Page 1094
Melanoma......Page 1098
50. Sleep Disorders......Page 1103
Insomnia......Page 1106
Sleep Apnea......Page 1112
Periodic Limb Movement During Sleep & Restless Legs Syndrome......Page 1115
Narcolepsy......Page 1117
Circadian Rhythm Sleep Disorders......Page 1118
REM Behavior Disorder......Page 1119
Sleep Problems in Special Populations......Page 1120
51. Oral Diseases & Disorders......Page 1123
Section IV. Common Clinical Scenarios in Geriatrics......Page 1139
52. Evaluating Confusion in Older Adults......Page 1140
53. Addressing Polypharmacy & Improving Medication Adherence in Older Adults......Page 1152
Problems Caused by Polypharmacy......Page 1153
Unprescribing: Intervening to Reduce Polypharmacy......Page 1154
Adherence......Page 1159
54. Managing Persistent Pain in Older Adults......Page 1165
55. Considering Anticoagulation in Older Adults......Page 1183
Available Classes of Anticoagulant Therapy......Page 1184
Management of Bleeding in Older Patients on Anticoagulants......Page 1200
Antiaging Therapies......Page 1203
Ethical and Legal Issues with Antiaging Therapies......Page 1204
57. Considering Complementary & Alternative Medicines for Older Adults......Page 1216
Massage and Chiropractic Therapy......Page 1218
Herbs & Supplements......Page 1220
Other Forms of Alternative or Complementary Medicine......Page 1229
58. Managing Misuse of Alcohol & Psychoactive Prescription Medications in Older Adults......Page 1233
Health Risks Associated with Hazardous and Harmful Use in Older Adults......Page 1234
Psychoactive Medications......Page 1235
Definitions to Guide Screening and Interventions......Page 1236
Brief Interventions......Page 1246
59. Assessing Older Adults for Syncope Following a Fall......Page 1250
General Approach to the Patient with Falls or Syncope......Page 1251
How Falls and Syncope Overlap......Page 1254
When to Consider Syncope as a Cause of Falls......Page 1255
Common Diagnostic Categories to Consider......Page 1256
60. Treating Headaches in Older Adults......Page 1261
61. Managing Vision Impairment in Older Adults......Page 1272
Normal Changes in the Aging Eye......Page 1273
Cataracts......Page 1275
Age-Related Macular Degeneration......Page 1279
Diabetic Retinopathy......Page 1281
Glaucoma......Page 1284
Systemic Medications and Glaucoma......Page 1290
Visual Symptoms Indicating Need for Urgent Referral to an Eye-Care Specialist......Page 1291
62. Managing Hearing Impairment in Older Adults......Page 1295
63. Addressing Chest Pain in Older Adults......Page 1313
64. Addressing Dyspnea in Older Adults......Page 1321
Gout......Page 1338
Calcium Pyrophosphate Crystal Disease......Page 1342
Polymyalgia Rheumatica......Page 1345
66. Managing Back Pain in Older Adults......Page 1348
67. Determining the Appropriate Use of Exercise for Older Adults......Page 1361
68. Defining Adequate Nutrition for Older Adults......Page 1381
69. Helping Older Adults with Low Health Literacy......Page 1400
Unique Health Literacy Considerations in Older Adults......Page 1401
Clear Health Communication Strategies......Page 1407
Systems Approaches......Page 1412
70. Understanding the Effects of Homelessness and Housing Instability on Older Adults......Page 1415
Pathways to Homelessness Among Older Adults......Page 1417
Strategies to Prevent Homelessness Among Older Adults......Page 1418
Health Status of Older Homeless Adults......Page 1421
Interaction Between Health Status and Environment......Page 1422
Conclusions & Next Steps......Page 1428
71. Understanding the Effects of Criminal Justice Involvement on Older Adults......Page 1430
Epidemiology......Page 1431
The Clinical Encounter......Page 1433
72. Detecting, Assessing, & Responding to Elder Mistreatment......Page 1439
73. Meeting the Unique Needs of LGBT Older Adults......Page 1457
Definitions......Page 1458
Health Issues for LGBT Older Adults......Page 1462
Biopsychosocial Aspects of Care......Page 1466
Conclusion......Page 1469
Section V. Broadening Clinical Practice......Page 1471
The Challenges with Current Evidence......Page 1472
Applying the Evidence to Your Older Patients......Page 1476
75. International Perspectives in Geriatric Care......Page 1479
Challenges for the Future of China’s Aging Population......Page 1493
76. Public Policy Intersecting with an Aging Society......Page 1510
Three Spheres of Aging with Dignity and Independence......Page 1512
Key Programs and Services for Older Adults......Page 1514
Opportunities in the Patient Protection and Affordable Care Act......Page 1520
Where Do We Go from Here?......Page 1521
Index......Page 1527