Geriatric Medicine: A Person Centered Evidence Based Approach

Preface to the Fifth Edition
Preface to the Fourth Edition
Preface to the Third Edition
Preface to the Second Edition
Preface to the First Edition
Contents
About the Editors
Contributors
Part I: What´s Different About Geriatric Medicine
	1 The Geriatrics Approach to Care
		Introduction
		The 5Ms
			What Matters
			Medications
			Mobility
			Mentation
			Multimorbidity
		Case Study
		Conclusion/Summary
		Learning Objectives
		References
	2 Collaborative Decision-Making
		Introduction
		Success and Challenges of Chronic Illness Care for Older Adults
			Elderhood Today
				Epidemiology of Multiple Morbidity
				Understanding Multimorbidity Through Mrs. Jones
			Disease-Oriented Approach to Medical Decision-Making
				How Clinicians Make Treatment Decisions
				How Practice Guidelines Are Translated into Health Outcomes in Usual Care
			Challenges of the Single-Disease Approach in the Care of Older Adults
				Costs Outweigh Benefits of Single-Disease Guidelines for Older Adults with Multimorbidity
				Understanding the Relevant Outcome Goals for Older Adults with Multimorbidity
				Burdensome Treatments and Care as a Meaningful Variable in Clinical Decision-Making
				Need for Trade-Offs in Multimorbidity Care
			Satisfactory Trade-Offs Require a Process of Collaborative Decision-Making
				Patients´ Perspectives on What Is High-Quality Healthcare
				Collaborative Decision-Making to Address Clinical Equipoise
		Model of Collaborative Decision-Making for Older Adults with Multiple Morbidities
			Key Concepts Related to Collaborative Decision-Making
				When to Use the Model for Collaborative Decision-Making
			An Overview of the Model for Collaborative Decision-Making
			A Pathway for Identifying Health Outcome Goals
				Describing What Matters Most: Health Values
				An Empirically Grounded Set of Health Value Dimensions Among Older, Multimorbid Adults
				Placing Broad Values Within the Context and Realities of Patients´ Health and Lives
				Arriving at Collaborative Health Outcome Goals
			The Pathway for Aligning Care with Health Outcome Goals
				Identifying Care Options that May Facilitate Goal Attainment
				Patients´ Care Preferences Modify Selection of Care Options
				Revisit Care Options Based on Goal Attainment
		What Most Matters: Building an Evidence-Base for Collaborative Decision-Making
			The Patient Priorities Care Approach
				Patient´s Health Priorities Are What Matters to Older Adults
				Overview of the Patient Priorities Care Approach
				Identifying Health Priorities Core Component of PPC
				Aligning Care with Health Priorities Core Component of PPC
			Examples and Evidence of Patient Priorities Care in Action
				Patient Priorities Care Case Study
				Benefit of Aligning Health Care with Health Priorities
				Evidence Supporting the Effectiveness of Patient Priorities Care
				Lessons Learned
		Summary
		References
	3 Caring for Patients in an Evidence-Limited World
		Introduction
		Internal Validity
		Clinically Meaningful Results
		Applicability
		Treatment Studies: Applying Results to Older Adults
		Patient-Disease Interactions
		Disease Differences
		Patient Differences
		Treatment Differences
		Patient-Treatment Interactions
		Diagnosis Studies - Diagnostic Tests, Differential Diagnosis, Screening, and Clinical Prediction Rules: Applying Results to Ol...
		Prognosis Studies: Applying Results to Older Adults
		Clinical Trials and Older Adults
		Case Study
		Conclusion/Summary
		References
	4 Geriatric Prescribing Principles and Interprofessional Healthcare Team Leadership
		Introduction
		Systemic Changes in Normal Aging
		Pharmacokinetic and Pharmacodynamic Changes with Aging
			Pharmacodynamics
			Pharmacokinetics
				Drug Absorption
				Drug Distribution
				Protein Binding
				Metabolism
				Excretion
			Failure to Thrive
			Protein Malnutrition
			Role of Prealbumin in Tube Feeding Decisions
				Wound Healing
			Herbal Supplements
			Adverse Drug Reactions in the Elderly
			Polypharmacy and the Prescribing Cascade
			Deprescribing
			Special Considerations for Persons Over 80 Years Old
			Deprescribing During Common Chronic Disease States
		Case Presentation
		Case Follow-Up
			Rationale for the Recommendations
		Advantages of Interdisciplinary Teams in Geriatric Patients´ Decision-Making
		Leadership Model for Healthcare Teams
		Common Goals and Benefits of an Interprofessional Care Team
		Challenges of Interprofessional Care Teams
			Emotional Intelligence Discussion
		Summary
		References
	5 Social Determinants of Health
		Introduction
		Social Determinants of Health in Older Persons
			Social Isolation and Loneliness
			Screening for Loneliness and Social Isolation
			Interventions for Loneliness and Social Isolation
			Cultural Determinants of Loneliness
		Food Insecurity in Older Adults
			Screening for Food Insecurity
			Health Consequences of Food Insecurity
			Interventions for Food Insecurity
		Access to Transportation Among Older Adults
			Driving and Older Adults
			Community Transportation Resources
		Financial Insecurity in Older Adults
			Screening for Financial Insecurity
		Housing Insecurity in Older Adults
		Ageism in Older Adults
		Conclusion/Summary
		References
	6 Legal Aspects of Geriatric Medicine
		Introduction
		Informed Consent
		Implied Consent
		Decision-Making Capacity (DMC)
		Sexuality and Dementia: Balancing Patient Rights with Patient Safety
		Surrogate Decision Making
		Power of Attorney
		Guardian
		Conservator
		Resident´s Representative
		Advance Directives
		Do Not Resuscitate (DNR) Orders
		Medical Orders for Life-Sustaining Treatment (MOLST) and Physician Orders for Life-Sustaining Treatment (POLST)
		Off-Label Prescribing and Antipsychotics
		Advance Care Planning
		Home Care and Hospice
		End of Life Options Acts (EOLOA)
		Effective Pain Management Versus Elder Abuse
		Medical Marijuana and Geriatric Medicine
		Collateral Legal Actions
		Legal Theories of Liability
			Negligence
			Malpractice
			Medical Malpractice
			Res Ipsa Loquitor
			Stark Law
			Anti-kickback Statute (AKS)
		Medical Errors and Extreme Honesty
		Documentation
		Conclusion
		Dedication
		References
	7 Ethical Issues in the Care of Older Adults
		Introduction
			Learning Objectives
		General Principles of Bioethics
		What Is Different About Geriatric Ethics?
		New Challenges Facing Geriatric Bioethics
			Justice and Access to Healthcare for Health Disparity Populations
			The Growing Threat of Social Isolation and Loneliness
		Case Studies
			Case 1: Dignity and Moral Distress
			Case 2: Withholding Medically Effective Treatment
			Case 3: Withholding Medically Futile Interventions
		Conclusion
		References
	8 Policy Issues in the Care of Older Adults
		Introduction
		Policy Issues in the Care of Older Adults
			Case Study #1: CA AB 749
				Policy Pearls
			Key Policy Issues
			Future Trends
		Conclusions and Recommendations
		References
	9 Age-Friendly Health Systems in an Ecosystem Perspective
		Age-Friendly Health Systems
		Evidence for the 4Ms
		Geriatric Care Models
		Acute Care for Elders Unit
			Geriatric Emergency Department Collaborative
			Hospital-at-Home
			Hospital Elder Life Program
			Interventions to Reduce Acute Care Transfers
			Nurses Improving Care for Healthsystem Elders
			Palliative Care
			Program of All-Inclusive Care for the Elderly
			Transitional Care Model (TCM)
			UCLA Alzheimer´s and Dementia Care
		Age-Friendly Ecosystem
			Age-Friendly Cities and Communities
			Age-Friendly Public Health Systems
			Age-Friendly Universities
			Measuring an Age-Friendly Ecosystem
		Disease Prevention and Health Promotion: Continuity of Care with a 4Ms Framework and Ecosystem Approach
		Case Study
			The Cambridge Health Alliance, Cambridge, Massachusetts
		Conclusion
		References
	10 WHO Approach to Healthy Aging
		The Concept of Healthy Aging
		The World Report on Aging and Health and the Concept of Intrinsic Capacity
			The Five Domains of Intrinsic Capacity
			The Predictive Value of Intrinsic Capacity
			Differences Between Intrinsic Capacity and Other Constructs
			The Expected Impact on the Healthcare Systems
		Toward the Integration of Care
			Generic Care Pathway for Older People by ICOPE
			The Care Pathway for Each Domain of Intrinsic Capacity
				Cognition
				Locomotion
				Psychological
				Sensory
				Vitality
			The Impact of Polypharmacy on Intrinsic Capacity
			The Impact of Social Care and Caregivers on Intrinsic Capacity
			Accessibility of Healthcare Services
		Planning to Integrate the ICOPE Approach into Health and Long-Term Care Systems
		Innovation and Technologies
		Conclusions
		References
	11 Ethnogeriatrics
		Important Concepts and Definitions
		Learning Objectives
		Introduction
		Healthy Aging
		Comprehensive Geriatric Assessment
		The ADDRESSING Model
		Health Literacy
			Verbal and Nonverbal Communication
			Selecting Interpreters
			The Physical Exam
			Family and Caregiver Involvement
			Advance Care Planning and Decision-Making
		Race, Ethnicity, and Culture: Clinical Considerations
			Mental Health
			Elder Abuse
		Settings of Care
			Outpatient Clinical Care
			Inpatient Clinical Care
			Long-Term Care (Alf, Nursing Home, and SNF)
			Serious Illness and End-of-Life Care
			Serious Illness and Religion
			Hospice and Palliative Care (at Home)
			Cognitive Evaluation and Cognitive Impairment
			Cognitive Evaluation Tools
			Ethnogeriatrics Research
		Conclusion/Summary
		References
	12 Caregiving (in the Twenty-First Century)
		Introduction
		Changing Landscape of Aging
		Caregiving Epidemiology
			The Care-Recipient
			The Caregiver
		Caregiving Tasks: What Do Caregivers  Do?
			Tasks
			Duration of Care
		Impact of Caregiving on Health of Recipient and Caregiver
			Care-Recipient Outcomes
			Caregiver Outcomes
		Caregiving and Elder Abuse
		Role of the Interdisciplinary Team
			Care-Recipient Assessment
			Caregiver Assessment
			Interdisciplinary Management
		Caregiver-Specific Education and Support Resources
		Advance Care Planning as Part of Caregiving
		Goals of Caregiving: The Ideal
		Gaps in Knowledge and Research
		Joy in Caregiving
		Case Study
		Conclusion
		Clinical Pearls
		References
	13 Comprehensive Geriatric Assessment
		Introduction
		Medical Assessment
			Falls/Gait Disorder
			Vision Impairment
			Hearing Impairment
			Malnutrition
			Urinary Incontinence
			Polypharmacy
		Cognitive Assessment
		Psychologic Assessment
		Functional Assessment
		Driving Assessment
		Social Assessment
			Patient´s Goals and Preferences
		Welcome to Medicare Visit
		Annual Wellness Visit
		Conclusion
		References
	14 Determination of Decision-Making Capacity
		Introduction
		Definitions of Capacity
		Differentiating Capacity from Competence
		Components of Valid Informed Consent and Making a Decision
		Capacity to Make Medical Decisions
		Capacity to Consent or Refuse Psychiatric Treatment
		Capacity to Choose Where to Live
		Capacity to Refuse Assistance
		Contractual Capacity
		Testamentary Capacity
		Capacity to Marry
		Capacity to Consent to Sexual Relations
		Financial Capacity
		Capacity to Consent for Research
		Special Considerations
			Evolution Within Gillick´s Stratification Model (Robust, Frail, Moderately Demented, and End of Life)
			Delirium and Fluctuating Capacity
			End-of-Life Decision-Making
			Aphasia
			Undue Influence
		Tools to Aid Determining Capacity
		International Considerations
		Case Example
		References
	15 Physical Exercise
		Introduction
		Exercise for Independent Living and Health Aging
		Preserving Exercise Capacity with Age Via an Active Lifestyle
		Physical Function as a Real Biomarker of Healthy Aging and Objective of Exercise Programs
		Interindividual Variability in Response to Exercise (Nonresponder Phenomenon)
		Exercise for Frail Individuals with Cognitive Impairment
		Effects of Exercise Interventions on Muscle Strength, Incidence of Falls, and Gait Ability
		Exercise for Acute Hospitalized Older Patients
		Multicomponent Tailored-Exercise Program Vivifrail
		Conclusion/Summary
			Key Points
		References
	16 Nutrition in Older Adults
		Introduction
		Learning Objectives
		Gastrointestinal Tract (GI) Changes with Aging
		Nutrient Requirements and Intake
		Calorie Requirements
		Protein Requirements
		Malnutrition in Older People
		Nutrition Screening and Assessment in Older People
		Nutritional Intervention
		Enteral Nutrition
		Parenteral Nutrition
			Reimbursement and Home Nutrition Support
		Conclusion
		References
	17 Health Maintenance and Prevention
		Introduction
			Person-Centered Health Maintenance
		Considerations in Person-Centered Health Maintenance in Older Adults
			Limited Evidence
			Lag Time to Benefit
			Life Expectancy and Prognosis
			Functional Status
			Cognitive Impairment
		Sources for Health Maintenance Recommendations in Older Adults
			Clinical Glidepaths Based on Gillick´s Stratification Model
			ACOVE
			The US Preventive Services Task Force
		Health Counselling Recommendations
			Nutrition
			Physical Activity
			Smoking Cessation
			Unhealthy Alcohol Use
		Cancer Screening
			Colorectal Cancer
			Breast Cancer
			Prostate Cancer
			Lung Cancer
			Cervical Cancer
		Immunizations
		Disease Prevention Recommendations
			Hypertension
			Abdominal Aortic Aneurysm
			Dyslipidemia
			Diabetes
			Osteoporosis
		Geriatric Syndromes
			Baseline Function Assessment
			Cognitive Impairment and Dementia
			Falls
			Urinary Incontinence
			Depression
			Hearing and Vision Screening
			Medication Management
			Advance Care Planning
		Case Studies
		Conclusions
		References
	18 Frailty
		Introduction
		Frailty: What Is It?
		The Operationalization of Frailty
			The Frailty Phenotype
			The Frailty Index
			Other Models and Instruments
			The Physical Frailty and Sarcopenia (PF&S Model)
		Interventions Against Frailty
			Comprehensive Geriatric Assessment
			Other Interventions
				Nutritional Intervention
				Physical Activity and Physical Exercise Interventions
				Pharmacological Agents
		Conclusion
		References
Part II: Medical Care
	19 Management of Cardiovascular Disease in the Elderly
		Cardiac Arrhythmias
			Introduction
				Supraventricular Tachycardia
					Atrial Fibrillation
					Atrial Flutter
					AV Reentrant (Accessory Pathway), AV Node Reentrant, and Atrial Tachycardia
			Bradyarrhythmia
			Ventricular Arrhythmias and Sudden Cardiac Death
		Stable Ischemic Heart Disease and Acute Coronary Syndromes
			Introduction
			Pathophysiology of Myocardial Ischemia
			Established Risk Factors for Atherosclerotic CAD
			Clinical Presentation and Diagnosis
			Spectrum of Coronary Artery Disease
			Stable Ischemic Heart Disease and Subclinical Atherosclerosis in Older Adults
			Acute Coronary Syndrome in Older Adult Patients
				Diagnosis
				Risk Stratification
				Treatment Strategies
				Medications
				Coronary Revascularization Strategies in Older Adults
		Dyslipidemia
			Introduction
			Pathophysiology
			Dyslipidemia Interventions in Elderly Adults
				Lifestyle Modification
				Statin Therapy
					Statin Therapy Studies
						Statin in Primary Prevention
					Evaluation and Risk Assessment
					Statins in Secondary Prevention
					High-Risk Group
					Side Effects Associated with Statin
				Other Lipid-Lowering Agents (Nonstatin Drugs)
			Lipid-Lowering Therapy and Frailty
			Clinical Management Consideration/Implication
		Heart Failure with Preserved Ejection Fraction
			Introduction
			Definition and Diagnosis
			HFpEF and Multimorbidity
			Treatment
				Pharmacological Treatment for Symptomatic HFpEF (See Update)
				Treatment of Underlying Comorbidities
				HFpEF Management Based on Clinical Phenotypes
				Intervention
		Aortic Stenosis
			Introduction
			Pathology and Epidemiology
			Clinical Manifestations
			Diagnostic Modalities
			Treatment Indications and Aortic Stenosis Therapy
		Venous Thromboembolism in the Elderly
			Introduction
				Epidemiology
				Etiology and Risk Factors
					Immobilization
					Malignancy
					Comorbidities
					Hormone Replacement Therapy (HRT)
					Genetic Risk Factors
				Age-Specific Risk Factors
					Frailty
					Sarcopenia
					Endothelial Dysfunction
					Venous Insufficiency
					Nursing Home Residence
				Prevention and Prophylaxis of Venous Thromboembolism
					Risk Stratification
					Pharmacological Thromboprophylaxis
					Mechanical Thromboprophylaxis
				Diagnosis
					Clinical Prediction Rules
					Electrocardiogram
					Laboratory Tests
					Radiological Workup
				Treatment
		Conclusion
		References
	20 Hypertension
		Introduction
		Diagnosis
		Evaluation
		Evidence for Treatment
		Goals of Treatment
		Considerations for Determining Individual Goals
		Quality of Life in Hypertension Management
		Treatment
			Nonpharmacologic Approaches
			Pharmacologic Treatment
			Combination Therapy
			Monitoring of Treatment and for Side Effects
			When to Consider Discontinuation/Deprescribing
			Resistant Hypertension
			Severe Asymptomatic Hypertension and Hypertensive Emergency
			Therapies to Be Used with Caution
			High-Value Care
		Patient and Family Education
		Social Determinants of Health
		Case Studies
		Conclusion
		References
	21 Orthostatic (Postural) and Postprandial Hypotension in Older Adults
		Introduction
		Epidemiology
		Pathophysiology
		Diagnosis
		Etiology
			Orthostatic Hypotension
			Postprandial Hypotension
		Symptoms
			Orthostatic hypotension
			Postprandial Hypotension
		Evaluation and Assessment
			Orthostatic Hypotension
			Postprandial Hypotension
		Management
			Nonpharmacologic Treatment of Orthostatic Hypotension
			Pharmacologic Treatment of Orthostatic Hypotension
			Nonpharmacological Treatment of Postpradial Hypotension
			Pharmacologic Management of PPH
		Prognosis
		Conclusions
		References
	22 Syncope
		Introduction
		Pathophysiology of Syncope
		Syncope Etiology
			Neurally Mediated or Reflex Syncope
				Vasovagal Syncope
				Carotid Sinus Syncope
			Orthostatic Syncope
			Cardiac Syncope
		Diagnosing Syncope in the Older Patient
			Initial Evaluation
			Carotid Sinus Massage
			Additional Tests
			Tilt Testing
			Blood Pressure Monitoring
			Autonomic Function Tests
			Electrocardiographic Monitoring
		Treatment
			Treating Reflex Syncope
			Treating Orthostatic Syncope
		Special Population
			Syncope and Falls in the Older Patient
			Syncope and Dementia
		Case Study
			Male, 86 Years Old
			Proximate Medical History
		Conclusion/Summary
		References
	23 Peripheral Arterial Disease
		Key Points
		Epidemiology, Anatomy, and Pathophysiology
			Epidemiology
			Pathogenesis
			Anatomy
		Risk Factors
			Demographics
			Diabetes, Hypertension, and Dyslipidemia
			Tobacco Use
			Socioeconomic Status, Race, and Ethnicity
			Brief Overview of Uncommon Risk Factors
		Clinical Presentation and Diagnosis
			History
			Physical Exam
			Ankle Brachial Index
			Toe Brachial Index
			Other Measures of Perfusion
			Diagnostic Imaging
		Person-Centered Focus on Approach to Diagnosis, Treatment, and Management
			General Principles
			Asymptomatic PAD
			Intermittent Claudication
				Patient History
				Neurogenic Claudication
			Chronic Limb Threatening Ischemia
		Treatment and Medical Management
			Medical Management
				Risk Factor Modification
				Glucose Control
				Antiplatelet Therapy
				Cilostazol
			Exercise Therapy
				Revascularization
				Femoral-Popliteal Disease
				Operative Techniques
			Person-Centered Approach
		Multidisciplinary Approach
		Patient and Family Education (Health Literacy)
		Emergencies
		Quality and Safety Alerts
		Social Determinants of Health
		Ethical Dilemmas
		Cost Implications
		Conclusion Summary
		References
	24 Diabetes
		Introduction
		Evaluation and Care of Older Adults with Diabetes
			Pathogenesis
			Clinical Features and Recognition
			Diagnosis
				Factors that Affect A1C and Pitfalls in Its Interpretation
			Clinical Burden of Diabetes
			Challenges of Managing Diabetes
		Optimal Care for Older Adults with Type 1 Diabetes
		Assessment of Patients
			Person-Centered Approach
			Treatment Goals for Glycemia in Older Adults
			Management
			Control of Cardiovascular Risk
		Hyperglycemia Management: A Case-Based Approach
			Case Study
			Case Discussion
			Case Discussion with Concurrent CKD Stage 4
			Diabetes Management in the COVID-19 Pandemic
			Reducing Hypoglycemia
			Hospital Care
		Improving Care Transitions: Appropriate Information Sharing and Integrated Communication
			Care of Patients with Diabetes at the End of Life
			The Interprofessional Team and Key Supportive Services
			Diabetes Technology in Older Adults
			Clinical Pearls
		Conclusion
		References
	25 Thyroid Disorders in Older Adults
		Introduction
			Learning Objectives
		Etiology, Anatomy, and Pathophysiology of Thyroid Disorders
			Epidemiology and Risk Factors
			Evaluation of Thyroid Function
			Medications that Interfere with Laboratory Tests of Thyroid Function in Euthyroid Individuals
			Hypothyroidism
				Definitions
				Signs and Symptoms of Hypothyroidism in Older Adults
				Secondary Hypothyroidism
				Diagnosis of Hypothyroidism
				Management of Hypothyroidism
			Subclinical Hypothyroidism
				Definition
				Diagnosis
				Signs and Symptoms
				Clinical Impact
				Management of Subclinical Hypothyroidism
			Hyperthyroidism
				Definitions
				Signs and Symptoms of Hyperthyroidism in Older Adults
			Subclinical Hyperthyroidism
				Diagnosis of Hyperthyroidism
				Management of Hyperthyroidism
			Thyroid Nodules and Thyroid Cancer
			Diagnostic Approach to Thyroid Nodules
			Ultrasound Features of Malignancy
			Thyroid Biopsy
			Evaluation and Management of Thyroid Nodules
			Thyroid Cancer Treatment
			The Safety of Thyroid Surgery in Older Adults
			Follow-Up of Patients with a History of Thyroid Cancer
			Clinical Pearls
		Case Study
			Management
		Conclusion/Summary
		References
			Epidemiology
			Drugs and Thyroid Hormone Action
			Thyroid Nodules and Thyroid Cancer
			Thyroid Surgery
	26 Infectious Diseases in Older Persons
		Introduction
		Aging and Host Defenses
		Clinical Features of Infection in Older Persons
		Pneumonia
			Introduction
			Pathogenesis
			Etiology
			Diagnosis
			Management
			Prevention
		Urinary Tract Infection
			Introduction
			Pathogenesis/Risk Factors for UTI
			Etiology
			Diagnosis
			Management
			Prevention
			Summary
		Clostridioides difficile
			Introduction
			Diagnosis
			Management
		Coronavirus Disease 2019 (COVID-19)
		References
	27 Hematologic Disorders
		Introduction
		Anemias
			Definition of Anemia in an Older Adult
			Epidemiology of Anemia in an Older Adult
			Diagnosis of Anemia in an Older Adult
			Consequences of Anemia in an Older Adult
			Anemia of Inflammation
			Laboratory Findings Associated with Anemia of Inflammation
			Approach to Treatment of Anemia of Inflammation
			Use of Erythropoiesis-Stimulating Agents to Treat Anemia of Inflammation
			Use of Iron in Patients with Anemia of Inflammation
		Anemia due to Vitamin B12 Deficiency
			Clinical Presentation
			Laboratory Testing
			Management of Vitamin B12 Deficiency Anemia and Pernicious Anemia
			Assessing and Monitoring Response to Treatment
		Iron-Deficiency Anemia and the Older Adult
			Diagnosis of Iron-Deficiency Anemia
			Management of Iron-Deficiency Anemia
		Hematological Malignancies
			Myelodysplastic Syndromes
			Clinical Manifestations and Diagnosis of MDS
			Classification
			Management of MDS
		Myeloproliferative Neoplasms
			Chronic Myelogenous Leukemia
			Clinical and Diagnostic Features of CML
			Management of CML for Older Adults
		Polycythemia Vera
			Management of PV
		Essential Thrombocythemia
			Management of ET
		Primary Myelofibrosis
			Management of PMF
		Multiple Myeloma
			The Role of Geriatric Assessments and Frailty Scales in Multiple Myeloma
			Developing a Personalized Approach for the Management of Adults with Multiple Myeloma
		Conclusion/Summary
		References
	28 Gastrointestinal Disorders in Older Patients
		Introduction
		Disorders of Swallowing and the Esophagus
			Overview of Common Conditions Associated with Dysphagia
			Diagnostic Testing to Consider in Geriatric Patients with Dysphagia
			Treatment Options
		Gastroesophageal Reflux Disease
			Overview
			Diagnostic Testing to Consider in Geriatric Patients with GERD
			Treatment
		Disorders of the Stomach
			Overview of Common Gastric Conditions
		Peptic Ulcer Disease
			Overview
			Diagnosis
			Treatment
		Gastrointestinal Bleeding
			Clinical Approach to GI Bleeding
			Presentation
			Evaluation
			Endoscopy
			Imaging
			Medical Therapy
			Surgical Intervention
		Common Causes of Gastrointestinal Bleeding in the Older Population
			Peptic Ulcer Disease
			Diverticular Bleeding
			Ischemic Bowel Disease
			Vascular Ectasias
			Radiation Proctitis
		Small Intestine Diseases
			Overview
			Celiac Disease
			Mesenteric Ischemia
			Small Bowel Bleeding
			Small Intestinal Bacterial Overgrowth (SIBO)
		Disorders of the Colon
			Constipation
			Irritable Bowel Syndrome
			Diverticulosis and Diverticulitis
			Inflammatory Bowel Disease
			Pseudomembranous colitis
		Liver Disorders
			Drug-Induced Liver Injury
			Autoimmune Liver Disease
			Cirrhosis in the Older Population
		Gallstone Disorders
		Pancreatic Disorders
			Pancreatic Cancer
			Treatment Approaches to Pancreatic Cancer
		Conclusions
		References
	29 Pulmonary Disease
		Introduction
			Learning Objectives
		The Aging Lung
		Asthma in the Elderly
			Definition and Epidemiology
			Pathophysiology
			Clinical Presentation and Diagnosis
			Management
				Pharmacologic Therapies
				Non-pharmacologic Therapies
				Additional Therapies
		COPD in the Elderly
			Definition and Epidemiology
			Pathophysiology
			Clinical Presentation and Diagnosis
			Management
				Pharmacologic Therapies
				Non-pharmacologic Therapies
				Acute Exacerbations of COPD
				Advanced Therapies
		Idiopathic Pulmonary Fibrosis
			Definition and Epidemiology
			Pathophysiology
			Clinical Presentation and Diagnosis
			Management
		Other Pulmonary Conditions
			Obstructive Sleep Apnea
			Lung Cancer
			Neuromuscular Disease
		Conclusion
		Clinical Cases
			Case 1
				History
				Discussion
			Case 2
				History
				Discussion
			Case 3
				History
				Discussion
		References
	30 Kidney Disorders
		Introduction
		Epidemiology of Chronic Kidney Disease
		Kidney Anatomy, Physiology, and Senescence
		Assessing Kidney Function
		Chronic Kidney Disease Management Considerations
			Specialist Referral
		Glomerular Syndromes
			Immunosuppression Considerations
			Membranous Nephropathy
			Minimal Change Disease
		Kidney in Systemic Disease
			Infection-Associated Glomerulonephritis
			ANCA-Associated Glomerulonephritis
			Paraproteinemia
			Hypertensive Nephrosclerosis
			Cardiorenal Syndrome
		Diabetic Kidney Disease
		Analgesic Nephropathy
		Obstructive Uropathy
		Acute Kidney Injury
			Acute Interstitial Nephritis
		Disorders of Sodium and Fluid Balance
			Hyponatremia
			Hypernatremia
		Kidney Toxicity and Drug Dosing
			Drug Dosing
		Conclusion
		References
	31 End-Stage Kidney Disease in the Elderly Population
		Case Study
		Introduction and Epidemiology
			Severe Acute Kidney Injury in Critically Ill Elderly Patients
		End-Stage Kidney Disease in the Elderly
			Life Expectancy
			Approach to Decision-Making: Kidney Replacement Therapy Versus Conservative Management
		Optimal Timing of Dialysis Initiation
		Comparison of Hemodialysis Versus Peritoneal Dialysis
		Hemodialysis in the Elderly
			Is Incremental HD a Good Choice in the Elderly?
			Home Hemodialysis in the Elderly
			Optimal Vascular Access
		Peritoneal Dialysis in the Elderly
			Transplantation in the Elderly Population
			Conservative Management in ESKD/Hospice and Palliative Care
			Case Study Follow-Up
		Conclusion
		References
	32 Dermatologic and Mucocutaneous Disorders
		Introduction
		The Hair and Scalp
			Aging of the Hair
			Common Geriatric Conditions of the Hair and Scalp
			Non-Scarring Alopecias
			Scarring Alopecias
			Acquired Hair Shaft Disorder
			Other Treatments
		The Nail Apparatus
			Aging of the Nails
			Common Geriatric Diseases of the Nails
				Infections of the Nail
			Onychodystrophy
				Tumors and Pigmented Lesions of the Nail
				Nails and Systemic Disease
		The Skin
			Aging of the Skin
			Common Geriatric Conditions of the Skin
				Decubitus Ulcers
				Fungal Infections of the Skin
				Bacterial Infections of the Skin
				Viral Infections of the Skin
				Parasitic Infections of the Skin
				Benign Neoplastic Conditions of the Skin
				Malignant Neoplastic Conditions of the Skin
		Cutaneous Drug Eruptions
			Elder Abuse
			Physical Abuse
			Sexual Abuse
			Neglect
			Management of Elder Abuse
		Conclusion
		References
	33 Changes and Diseases of the Aging Eye
		Basic Parts of an Eye Examination
		Refractive Error
		Dry Eye Syndrome and Ocular Surface Disease [7]
			Pathophysiology
				Evaporative Dry Eye
				Aqueous Deficient Dry Eye
				Eyelid Malposition and Dry Eye
				Blepharitis
			Management
		Cataract [8, 9]
			Pathophysiology
			Management
				Nonsurgical Management
				Surgical Management
				Preoperative Evaluation
				Surgical Phase
				Post-surgical Phase
		Glaucoma [10-13]
			Pathophysiology
				Diagnostic Tools
			Management
		Age-Related Macular Degeneration [14-19]
			Pathophysiology
				Diagnostic Tools
			Management
		Diabetic Retinopathy [20, 21]
			Pathophysiology
				Diagnostic Tools
			Management
		Summary
		References
	34 Otologic Changes and Disorders
		Introduction
		Presbycusis (Age-Related Hearing Loss)
			Anatomy and Pathophysiology
			Definitions
				Sensory Presbycusis (Outer Hair Cell Loss)
				Metabolic Presbycusis (Strial Atrophy)
				Neural Presbycusis (Ganglion Cell Loss)
			Pathogenesis of Presbycusis
			Clinical Presentation
			Risk Factors
				Cochlear Age
				Genetic Predisposition
				Noise Exposure and Environment
				Comorbidities
			Hearing Loss and Cognition
			Clinical Evaluation of Hearing Loss
				History and Risk Factor Assessment
				The Physical Examination
				Screening Tests and Audiometry
				Imaging Studies
			Management
				Prevention
				Rehabilitation
					Communication Courtesy
					Speech Reading
					Auditory Training
					Information Counseling and Support
				Amplification
					Assisted Listening Devices
					Conventional Hearing Aids
					Middle Ear Implants and Bone Conduction Implants
				Cochlear Implantation
		Presbystasis
			Pathophysiology, Risk Factors, and Etiology
			Clinical Evaluation of Imbalance
				History and Risk Factor Assessment
				The Physical Examination and Work-Up
			Management
				Vestibular Rehabilitation
				Fall Prevention
		Future Directions and Conclusions
		References
	35 Aging and the Oral Cavity
		Introduction
		Learning Objectives
		Why Does the Oral Health of Older People Matter?
		Which Are the Most Frequent Oral Conditions Among the Older People?
			Dental Decay (Caries)
			Periodontal Diseases (Gingivitis and Periodontitis)
			Tooth Loss
				Decay-Tooth Loss
					Root Remnants
				Periodontitis-Tooth Loss
			Dry Mouth
			Mucosal Disorders
			Dental Prostheses
		Which Are the Consequences of These Oral Conditions?
			Nonverbal Communication
			Verbal Communication
			Eating
			Pain
		Which Are the Implications of Older peoples Oral Conditions?
			Social Functioning
			Diet
			Physiology and Biology
		Conclusion
		References
	36 Bone and Joint Disorders
		Introduction
		Osteoporosis
			Epidemiology
			Pathophysiology
			Person-Centered Approach in Older Adults
				To Treat or Not to Treat
				Individualized Fracture Risk Assessment Tools
				Shared Decision-Making
			Diagnosis
				Diagnostic Criteria
				Differential Diagnosis and Work-Up for Secondary Causes
				Screening and Case Finding
			Treatment
				Non-pharmacological Measures
				Calcium and Vitamin D
					Physiology
					Recommended Calcium Intake and Vitamin D Levels
					Calcium Supplements: Pharmacology
					Pharmacology of Vitamin D Supplements
					Role of Calcium and Vitamin D Supplements in Osteoporosis
					Safety of Calcium and Vitamin D Supplements
				Osteoporosis Drugs and Treatment Algorithms
					Estrogen Replacement Therapy and SERMs
					Bisphosphonates
					Denosumab
					Medication-Related Osteonecrosis of the Jaw (MRONJ) and Atypical Femoral Fractures
					Bone Anabolic Drugs
			Follow-Up
		Osteoarthritis
			Epidemiology and Pathophysiology
			Diagnosis
			Person-Centered Approach in Older Adults
			Treatment
				Treating Pain and Inflammatory Flares
				Physical and Occupational Therapy
				Disease-Modifying OA Drugs
				Joint Prosthesis Surgery
			Follow-Up
		Gout
			Epidemiology
			Pathophysiology
			Person-Centered Approach in Older Adults
			Diagnosis
			Treatment
				Patient Education and Lifestyle Measures
				Treatment for Gout Flares
				Urate-Lowering Therapies
					Indications and Treatment Target
					Allopurinol
					Febuxostat
					Uricosuric Drugs
					Pegloticase
					Prophylactic Therapy to Prevent Flares During Initiation of Urate-Lowering Therapy
				Treatment for CPPD
			Follow-Up
		Polymyalgia Rheumatica and Giant Cell Arteritis
			Epidemiology
			Pathophysiology
			Person-Centered Approach in Older Adults
			Diagnosis
				Symptoms and Signs
				Laboratory Tests
				Imaging
				Temporal Artery Biopsy
			Treatment
				Patient Education and Lifestyle Measures
				Glucocorticoids
				Glucocorticoid-Sparing Drugs
			Follow-Up
		References
	37 COVID-19 in Older Adults
		Introduction
		Learning Objectives
		Overview and Epidemiology
		Diagnosis
		Treatment
		Vaccines
		Continuum of Care Challenges
			Acute Care Setting
			Long-Term Care Facilities
			Outpatient
			Home Setting
		Clinical Pearls
		Social Determinants of Health
		Case Studies
			Case Study 1
			Case Study 2
			Case Study 3
		Conclusion
		References
Part III: Cancer in Older Adults: An Overview
	38 Cancer and Older Adults: The Introduction
		Introduction
		Epidemiology
		Global Aging, Global Geriatric Oncology, and Global Effort
		Disparity in Cancer Outcomes Based on Age
		Frailty
		Assessing Frailty
		Frailty and Cancer Outcomes
		Benefits of Frailty Assessment
		Interventions Following Frailty Assessment
			The Role of Geriatricians and Geriatric Care Providers in Geriatric Oncology
		Quality Versus Quantity of Life
		Digital Health Technologies and Geriatric Oncology
			Electronic Patient Reported Solutions
		Handheld and Wearable Technologies
		A Case of an Older Patient with Colon Cancer
		Conclusion
		References
	39 Cancer Screening in the Older Adult
		Introduction
			Historical Perspective on Cancer
			Emergence of Screening and Prevention
			Considerations for Screening: Balance Between Benefits and Risks
			Consideration in Older Adults- Individualized Decision-Making
		Cancer Screening Guidelines for Older Adults
			Breast Cancer
				Risk Factors
					Nonmodifiable
					Modifiable
				Primary Prevention
				Screening
			Lung Cancer
				Risk Factors
					Nonmodifiable
					Modifiable Risk Factors
				Primary Prevention
				Screening
			Colorectal Cancer
				Risk Factors
					Nonmodifiable
					Modifiable Risk Factors
				Primary Prevention
				Screening
			Cervical Cancer
				Risk Factors
				Primary Prevention
				Screening
			Uterine Cancer
				Risk Factors
				Primary Prevention
				Screening
			Ovarian Cancer
				Risk Factors
					Genetic Factors
					Nongenetic Factors
				Screening
			Vulvar and Vaginal Cancers
			Prostate Cancer
				Risk Factors
					Nonmodifiable Risk Factors
					Modifiable Risk Factors
				Primary Prevention
				Screening
					Risks Associated with Prostate Cancer Tests and Treatments
			Bladder Cancer
				Risk Factors
					Nonmodifiable Risk Factors
					Modifiable Risk Factors
				Primary Prevention
				Screening
			Skin Cancer
				Risk Factors
					Nonmodifiable
					Modifiable
				Primary Prevention
				Screening
		Conclusion
		References
	40 Breast Cancer
		Introduction
		The Female Breast
		Aging and the Breast
		Epidemiology of Breast Cancer in Older Adults
		Breast Cancer Subtypes in Older Adults
		Person-Centered Focus on Approach to Diagnosis, Treatment, and Management
		Breast Cancer Screening in Older Adults
		Approach to Palpable Breast Masses in Older Adults
		Breast Cancer Staging and Workup
		Therapeutic Approach to Breast Cancer in Older Women
			Surgery
			Radiotherapy
			Systemic Treatment
				Neoadjuvant/Adjuvant Cytotoxic Chemotherapy
				Neoadjuvant/Adjuvant Endocrine Therapy
				Neoadjuvant/Adjuvant Targeted Therapy
				Treatment Considerations in Older Women with Metastatic Disease
				Primary Endocrine Therapy
				Novel Therapeutic Options
		Patient and Family Education
		Emergencies
		Clinical Pearls
		Social Determinants of Health
		Cost Implications
		Case Study Vignette
		Conclusions
		References
	41 Colorectal Cancer in Older Adults
		Epidemiology
		Transitioning from Age to Frailty
		Assessing Frailty
		Borrowing From Frailty to Create Predictive Models for Outcomes of Older Adults with Cancer
		Frailty Management
		What Geriatricians Need to Know About Colorectal Cancer Treatment
		References
	42 Lung Cancer in Elderly: Patient-Centered Approach for Optimal Delivery of Care
		Introduction
			Overview of Lung Cancer in Geriatric Patients
			Significance of Geriatric Focus
			Risk Factors
			Screening Guidelines for Older Adults
		Treatment Approaches in Older Adults with Lung Cancer
			Management of Early-Stage Lung Cancer
				Surgical Resection
				Non-Surgical Local Treatment
					NSCLC
					Small Cell Lung Cancer (SCLC)
				Adjuvant Treatment After Surgery
				Locally Advanced Lung Cancer: Role of Chemoradiation Therapy
			Management of Metastatic Lung Cancer
		Emerging Trends for Treatment
		Geriatric Consideration
			Frailty
		Clinical Vignettes
		Palliative Care and Symptom Management for Elderly Patients
		Conclusion
		References
	43 Prostate Cancer
		Demographics of Prostate Cancer in the Elder Population
		Risk Factors for Prostate Cancer Development
			Germline Mutations
			Black Race
		Screening and Diagnosis
			Prostate-Specific Antigen
			Prostate Cancer Diagnosis (Prostate Biopsy)
			ISUP Grade Group
			Prostate Cancer Risk Categories and Stage Classification
		Age-Related Considerations, Frailty, and Treatment Evaluation
		Therapeutic Options
			Treatment Decision-Making in Older Men
				Interprofessional Team
			Localized Prostate Cancer
				Active Surveillance and Watchful Waiting
				Radical Prostatectomy
				Radiation Therapy
				Androgen Deprivation Therapy
				Focal Therapies
				Follow-Up
			Advanced Prostate Cancer
				Non-metastatic Castration-Resistant Prostate cancer, Metastatic Hormone-Sensitive Prostate Cancer, and Metastatic Castration-R...
				Docetaxel
				Abiraterone Plus Prednisone
				Enzalutamide
				Apalutamide
				Darolutamide
				Sipuleucel T
				Radium 223 Dichloride
				Cabazitaxel
				Poly(adenosine diphosphate ribose) Polymerase Inhibitors
			Metastasis-Directed Therapy
			Emergency situations
				Acute Urinary Retention
				Imminent Fractures/Spinal Cord Compression
				Radiation Cystitis
		Conclusions
		References
	44 Gynecologic Oncology
		Introduction
		Overview of Gynecologic Malignancies
		Symptoms at Presentation
		Screening
		Treatment
		Disparities in Care of Older Adults with Gynecologic Malignancies
		Individualized Care for Older Adults
		Conclusions
		References
	45 Hematologic Malignancies
		Introduction
		Learning Objectives
		Benign and Malignant Hematological Diseases
			Incidence, Etiology, and Risk Factors
			Common Hematological Malignancies of Older Adults
			Geriatric Assessment in Hematologic Malignancies
			Risk-Adapted Approaches to Management
			Patient Education, Communication, and Prognosis
			Integrated Care Delivery, Quality and Safety, Cost Implications
		Case Study
			Case 1
			Case 1 Discussion
			Case 2
			Case 2 Discussion
			Case 3
			Case 3 Discussion
		Conclusion/Summary
		References
Part IV: Sexuality and the Genitourinary System
	46 Gynecologic and Urologic Problems in Older Women
		Introduction
			Learning Objectives
		Urogenital Changes in the Older Woman
			Effects of Aging on Female Urogenital Tract
			Gynecologic Evaluation
			General Principle of Gynecologic Examination
			System-Based Gynecologic Examination
				External Genitalia
				Clitoris
				Vagina
				Cervix
				Uterus
				Ovaries/Adnexa
				Urethra
				Bartholin´s Glands
		Common Urogynecologic Problems of the Older Woman
			Genitourinary Syndrome of Menopause
				General Definition
				Manifestations of Genitourinary Syndrome of Menopause (GSM)
				Epidemiology
				Pathophysiology
				Clinical Evaluation
				Differential Diagnosis
				Laboratory Evaluation
				Treatment
					First-Line Treatment
					Vulvovaginal Care
					Nonhormonal Products
					Second-Line Treatment
					Opposed Progestin in Vaginal Estrogen Therapy
				Special Considerations
					Cancer Risks
					Estrogen Exposure to Male Partner
				Other Available Treatment Options for GSM
					Dehydroepiandrosterone (DHEA)
					Ospemifene
					Testosterone
					Probiotics
					Energy-Based Therapies
					Pelvic Floor Therapy: Dilators
			Vulvar Disorders
				Lichen Simplex Chronicum
				Lichen Sclerosus
					Medical Management
				Lichen Planus
			Urethra
				Urethral Caruncle
				Urethral Prolapse
			Other Gynecologic Problems in Older Women
				Postmenopausal Bleeding
			Pelvic Floor Disorders
				Pelvic Organ Prolapse
				Management of Pelvic Organ Prolapse
					Evaluation
					Prolapse Classification Systems
					Prolapse Examination
					Treatment
					Nonsurgical Treatment Approaches
					Pelvic Floor Muscle Exercises
					Pessaries
					Surgical Management
					Reconstructive Versus Obliterative Procedures
				Common Co-existing Pelvic Floor Disorders
					Urinary Incontinence
					Fecal Incontinence
		Case Study
		Conclusion/Summary
		References
	47 Sexuality and Aging
		Learning Objectives
		Introduction
		Sexuality and Aging
		Sexual Dysfunction in Older Men
		Sexual Dysfunction in Older Women
		Menopause
		Sexually Transmitted Infections and Older Adults
		Impact of Chronic Disease on Sexual Function
		Urinary Incontinence
		Sexuality in Long-Term Care Settings
		Sexuality in Persons with Dementia
		LGBTQ-Identifying Older Adults
		Intimacy at the End of Life
		Conclusion/Summary
		References
	48 BPH and Male Lower Urinary Tract Symptoms
		Introduction
		Etiology, Anatomy, and Pathophysiology
		Epidemiology
		Risk Factors
		Person-Centered Focus on Approach to Diagnosis, Treatment, and Management
		Management
		Clinical Pearls
		Conclusion/Summary
		References
	49 Voiding Problems and Urinary Incontinence in the Geriatric Patient
		Introduction
		Understanding Incontinence Means Understanding Continence
		It´s Not Just the Aging Bladder and Sphincter
		Incontinence Does Not Occur in Isolation
		Why Is This Patient Incontinent?
			Bladder Diaries
			Postvoid Residual Volume
			Cough Stress Test
			Laboratory and Radiographic Testing
			Office Cystometry
			Urodynamics
		Managing Urinary Incontinence
			Patient Centered Approach to Urinary Incontinence
				Highly Functional Older Adults
				Older Adults with Physical or Cognitive Impairments
				End of Life
				Conservative Management
				Lifestyle Modification
				Behavioral Management
				Bladder Training
				Some Bladder Control Strategies Include
				Prompted Voiding
				Timed Voiding
				Habit Training
				Pharmacotherapy
				Anticholinergics
				Beta 3-adrenoceptor Agonist
			Incontinence Due to an Impaired Urinary Sphincter
		Alternative Treatments
			Social Determinants of Health
		Appendix A
		Appendix B
		Appendix C: Office Cystometry Procedure and Interpretation
			Procedure
			Interpretation
		References
Part V: Disorders of the Brain
	50 Alzheimer´s Disease and Other Dementias
		Introduction
		Alzheimer´s Disease and Other Dementias
			Epidemiology
			Etiology and Pathophysiology
			Alzheimer´s Disease Risk Factors and Genetics
			Diagnosis
				Screening Visit
				Diagnostic Assessment
			Treatment
				Pharmacologic Therapies
				Nonpharmacologic Therapies
				Management of Behavioral and Psychological Symptoms of Dementia
		Case Study (Evidence-Based Practice Case Studies or Vignette Which Highlights the Concept of Person-Centered Care in Order to ...
			Case 1: Alzheimer´s Disease Genetics
			Case 2: Alzheimer´s Diagnosis
		Conclusion/Summary
		Cross-References
		References
	51 Cerebrovascular Disease and Stroke
		Introduction
		Ischemic Stroke
		Cardioembolic Stroke
		Large Artery Atherosclerosis
		Small Vessel Occlusive Disease
		Embolic Stroke of Undetermined Source
		Diagnosis and Acute Treatment
			Intravenous Thrombolytic Therapy
			Endovascular Intervention
			Antiplatelet Therapy
			Neuroprotection
			Acute Stroke Units
		Stroke Prevention
		Stroke Risk Factors
			Hypertension
			Dyslipidemia
			Other Factors
		Conditions Requiring Treatment
			Atrial Fibrillation
			Carotid Stenosis
		Post-Stroke Depression
		Hemorrhagic Stroke
			Subarachnoid Hemorrhage
			Diagnosis of SAH
			Treatment
			Intracerebral Hemorrhage
			Epidemiology
			Pathophysiology
			Clinical Features
			Diagnostic Investigations
			Management
			Management of Blood Pressure
			Ventricular Blood and Hydrocephalus
			Surgical Evacuation
			Seizures and Epilepsy
			Cerebral Amyloid Angiopathy
		Conclusion
		References
	52 Parkinson´s Disease and Other Movement Disorders
		Introduction
			Learning Objectives
		Parkinson´s Disease
			Pathophysiology
			Risk Factors
			Diagnosis
			Prognosis/Progression
			Symptoms and Management
				Motor Symptoms: Tremor, Rigidity, and Bradykinesia
				Gait
				Nonmotor Symptoms
			Inpatient Management
		Atypical, Neurodegenerative, Parkinsonism
			Pathophysiology
			Diagnosis
			Prognosis
			Management
		Secondary Parkinsonism
			Drug-Induced Parkinsonism
			Vascular Parkinsonism
			Head Trauma
			Other Causes of Secondary Parkinsonism
		Essential Tremor
			Diagnosis
			Treatment
		Drug-Induced and Enhanced Physiologic Tremor
			Diagnosis
			Treatment
		Dystonia
			Epidemiology and Risk Factors
			Diagnosis
			Management
			Secondary Dystonia and Acute Dystonic Reaction
		Other Hyperkinetic Movement Disorders
			Chorea
			Tardive Syndromes: Dyskinesia, Dystonia, and Akathisia
			Myoclonus
		Other Notable Movement Disorders in Older Adults
			Ataxia
			Restless Leg Syndrome
		Conclusion/Summary
		Cross-References
		References
	53 Schizophrenia and Other Late-Life Psychoses
		Introduction
		Aetiology and Risk Factors of Schizophrenia
		Pathophysiology of Schizophrenia
		Clinical Presentation of Schizophrenia
		Psychotic Symptoms in Older Adults Emerging in the Context of Pathological Conditions Different from Schizophrenia
		Diagnosis of Schizophrenia and Differential Diagnosis of Psychotic Symptoms in Older Adults
		Treatment and Management of Schizophrenia
			Pharmacological Treatment of Schizophrenia
			Safety Alerts
			Non-pharmacological Treatment of Schizophrenia
			Treatment of Psychoses in Late Life
		Conclusions
		Cross-References
		References
Part VI: Diagnosis and Management of Geriatric Syndromes
	54 Depression, Anxiety, and Other Mood Disorders
		Introduction
		Depression
		Anxiety
			Comorbidity of Anxiety Disorders and Late-Life Depression
			Comorbidity of Anxiety Disorder and Substance Use
			Comorbidity of Anxiety Disorders and Medical Illness
			Anxiety Disorders and Neurocognitive Impairment
		Other Mood Disorders
		Case Study
		Conclusion/Summary
		References
	55 Delirium
		Introduction
		Main Text (Disease and Syndrome Related Chapters)
			Delirium: A Typical Syndrome of Older Adults
				Epidemiology and Outcomes of Delirium
				Causes of Delirium
				Pathophysiology of Delirium
				Delirium and Frailty: A Complex Relationship
				Diagnosis of Delirium
				The Diagnosis of Delirium Superimposed on Dementia (DSD): A Clinical Challenge
				Prevention of Delirium
				Treatment of Delirium
		Case Study (Evidence-Based Practice Case Studies or Vignette Which Highlights the Concept of Person-Centered Care in Order to ...
		Conclusion/Summary
		References
	56 Pain Management in the Older Adult
		Introduction
		The Under Recognition of Pain in Older Adults
		Effects of Chronic Pain in Older Adults
		Commonly Occurring Disease States in Older Adults
		Familiar Challenges in Pain Management When Treating Older Adults
			Pain Assessment
				Assessment Scales
				Pain Assessment in the Setting of Dementia
			Pharmacological Management
		Age-Related Changes to Drug Metabolism
		Nonopioid Analgesics
			Nonsteroidal Anti-Inflammatory Drugs (NSAID)
			Antidepressants
			Gabapentinoids
			Muscle Relaxants
		Opioid Analgesics
			Full Agonists
			Partial Agonists
			Adverse Events Related to Opioids
		Nonpharmacological Strategies to Treat Pain
			Physical Therapy
			Behavioral Therapy
			Acupuncture
			Interventional Pain Medicine
		Conclusion
			Patient Case
				Analgesics
				What Analgesic Options May Be Appropriate?
		References
	57 Pressure Injury and Chronic Wounds
		Introduction
		Aging Skin
		Wound Healing Overview
		Psychosocial Aspects of Chronic Wounds
		Nutritional Aspects of Wound Care
			Infectious Aspects of Chronic Wounds
			Osteomyelitis
			Necrotizing Soft Tissue Infections
			Cutaneous Candidiasis
		Pressure Injuries
		Lower Extremity Wounds
			Venous Ulcers
			Arterial Ulcers
			Diabetic Ulcers
			Leg Ulcers from Sickle Cell Disease
			Pyoderma Gangrenosum
			Martorell´s Hypertensive Ischemic Ulcer
			Calciphylaxis
			Wounds Related to Vasculitis
		Lymphedema
		Nonhealing Surgical Wounds
		Traumatic Wounds
			Lacerations
			Skin Tears
			Burns
			Factitious (Self-inflicted) Wounds
		Wounds Related to Malignancy
		Moisture Associated Skin Damage (MASD)
		Principles of Chronic Wound Management
		Palliative Care for Chronic Wounds
		Conclusions/Summary
		References
	58 Sarcopenia
		Introduction
		Diagnosis
			The European Working Group on Sarcopenia in Older People
			The Foundation for the National Institutes of Health (FNIH) Sarcopenia Project
			The European Working Group on Sarcopenia in Older People 2
			Physical Frailty and Sarcopenia, According to SPRINTT Consortium
		Pathophysiology
		Risk Factors
		Outcomes
		Muscle Mass Assessment
			Body Imaging Techniques
				Magnetic Resonance Imaging
				Computed Tomography
				Dual Energy X-ray Absorptiometry
				Bioelectric Impedance Analysis (BIA)
				Muscle Ultrasonography
			Anthropometric Measures
				Calf Circumference
				Mid-Arm Muscle Circumference
			Biochemical Markers for Muscle Mass Estimation
				Total or Partial Body Potassium
				Circulating Creatinine and Deuterated Creatine (D3-Creatine) Dilution Method
		Assessment of Muscle Strength and Muscle Function
			Handgrip Strength
			The Chair Stand Test
			Knee Flexion/Extension
			Short Physical Performance Battery
			Timed Get-Up-and-Go Test
			400-m Walk Test
		Treatment
			Non-pharmacological Approaches
			Pharmacological Approaches
		Conclusion/Summary
		References
	59 Falls in Older Adults
		Introduction
		Falls in Older Adults: Pathophysiology, Screening, and Prevention
			Treatments for Falls Prevention
			Social Determinants of Health
		Case Study
		Conclusion/Summary
		References
	60 Sleep and Sleep Disorders
		Introduction
		Sleep and Aging
			Physiologic Changes
			Sleep Architecture
			Circadian Rhythms
		Sleep and Comorbidities in Older Adults
		Sleep Among Older Adults in Special Settings
			Long-Term Care
			Acute Hospitalization
		Sleep Disorders
			Insomnia
				Behavioral Treatment of Insomnia
				Pharmacologic Options
			Sleep-Related Breathing Disorders
				Epidemiology of Sleep Apnea Syndromes
				Obstructive Sleep Apnea
				Central Sleep Apnea
				Consequences of Sleep Apnea
				Diagnosis of Sleep Apnea
				Treatment of Sleep Apnea and Common Barriers to Success
			Sleep-Related Movement Disorders
				Periodic Limb Movement Disorder
				Restless Legs Syndrome
			Parasomnias
				REM Sleep Behavior Disorder
				Other Parasomnias
		Conclusions/Summary
		References
	61 Elder Mistreatment and Abuse
		Introduction
			Definitions
				Epidemiological Trends and Clinical Consequences
			Screening and Diagnosis
				Clinical and Ethical Challenges
		Conclusions
		References
Part VII: Care Delivery and Systems Approaches to Geriatric Care
	62 Primary Care
		Introduction
		Primary Care Defined
		Focus on Function
		Focus on Purpose
			Focus on Managing Chronic Disease(s) and Developing Chronic Care Treatment Models
			Identify and Manage Psychological and Social Aspects of Care
			Respect a Person´s Dignity and Autonomy
			Respect Cultural and Spiritual Beliefs
			Be Sensitive to the Person´s Financial Condition
		Promote Wellness
			Listen and Communicate Effectively
			Person-Centered Approach to Care
			Realistically Promote Optimism and Hope
			Team Approach to Care
		Primary Care Models
			Patient-Centered Medical Home (PCMH)
			Guided Care
			Comprehensive Primary Care Plus (CPC+)
			Primary Care First
		Geriatrics Models in Primary Care
			Program of All-Inclusive Care of the Elderly (PACE)
			Geriatric Resources for Assessment and Care of Elders (GRACE)
			The Independence at Home Demonstration
			Patient-Aligned Care Teams (PACT)
			Aging Brain Care (ABC) Program
		Conclusion/Summary
		References
	63 Emergency Medicine and the Person-Centered Approach to the Older Adult
		The 4M Framework
		Geriatric Emergency Department Accreditation
		A Person-Centered Approach in the ED
			Triage
				Geriatric-Specific Triage and Screening
			Special Considerations in Triage
				Delirium
				Falls
			Waiting Room
		The Patient Encounter
			The Emergency Department (ED) Experience
				Emergency Department Referral
				The Geriatric Emergency Department
			Atypical Presentations and Multicomplexity
			Approaches to ED Care
				Person-Centered Care
				Caregivers
				Nursing Interventions
				Pain Assessment and Treatment
				Polypharmacy
				Iatrogenic Harm
				Critical Care
				Palliative Care and End of Life
				Social Complexity
			Common Geriatric Presentations in the ED
				Infections
				Chest Pain
				Abdominal Pain
				Frailty and Functional Decline
				Cognitive Dysfunction and Delirium
				Trauma
		Disposition of the Older Emergency Department Patient
			Admission
				Why Admission Is Not Always the Best Answer
				Disposition Decision-Making
			ED Teamwork
				Case Managers (CMs)
				Social Workers (SWs)
				Geriatric Nurse Specialists
			Alternatives to Admission
				Skilled Nursing Facilities (SNFs)
				Long-Term Acute Care Hospital (LTACH)
				Inpatient Rehabilitation Facility (IRF)
				Assisted Living Facilities (ALFs)
				Home Health (HH) Services
			ED Observation
			Palliative Care/Hospice
			Safe Discharge Home
				Discharge Stability
				Discharge Planning (CWs, SWs, and GNs Can Often Help with the Following)
				ED Discharge Instructions
		Future Steps
		References
	64 Approach to Acute Hospital Care
		Introduction
		Admission to Hospital
			Why, When, and Where of Hospitalization
				Why Is the Patient in the Hospital?
				When Is the Patient Ready for Transition?
				Where Will the Patient Go from Hospital?
		Vulnerability of Older Adults to Adverse Outcomes of Hospitalization
		The 4Ms Framework in the Care of Older Adults
			General Considerations to Promote Person-Centered Care Consistent with the 4Ms Framework (``What Matters´´)
			Consider Social Supports and Living Arrangements (``What Matters´´)
		Bedside Patient Evaluation: Interdisciplinary Team-Based Care
			Person-Centered Evaluation
			Medical Decision-Making (``What Matters´´)
			Polypharmacy and Adverse Events (``Medications´´)
				Medications and Mentation
			Assessing Risk of Functional Decline (``Mobility´´)
				The Functional Trajectory
				Tools to Predict Risk of Functional Decline
			Identify and Prevent Geriatric Syndromes
			Management of Geriatric Syndromes
				Delirium
				Immobility and Falls (``Mobility, Mentation, Medications´´)
				Urinary Incontinence
				Pressure Injury
		Transitions of Care
		Hospital Models of Care: Paradigms of the 4Ms
			Inpatient Models
			Care Transitions Models
		Case Study: The 3Ws in Action
		Take Home Message: Acute Care for Elders is Age-Friendly
		Conclusion
		References
	65 Surgical Care
		Introduction
		Surgical Care: A Person-Centered Approach
		Preoperative Assessment and Perioperative Care
			Procedure Risk
			Preoperative Assessment Framed by the 4Ms
				Mentation
				Mobility
				Medication Management
				What Matters
				Preoperative Testing
					Assessment of Cardiac Risk
					Assessment of Pulmonary Risk
					Preoperative Testing
			Perioperative Care
				Intraoperative Management (See section ``Anesthesia´´)
					Postoperative Care
				Mentation
					Delirium
					Postoperative Cognitive Dysfunction (POCD)
					Depression
				Mobility and Function
					Mobility
				Medication Management
					Pain Management
				What Matters Most
				Other Common Postoperative Complications
				Discharge Planning and Transitional Care
		Anesthesia and Intraoperative Care
			Anesthesia
			Preoperative Fasting
			Multimodal Analgesia
			Postoperative Nausea and Vomiting (PONV)
			Patient Safety
				Positioning
				Minimizing Pulmonary Complications
				Hypothermia
			Fluid Management
		Hip and Knee Replacement
		Medical Aspects of Hip Fracture Management
			Orthogeriatric Comanagement Programs
		Case Study (Evidence-Based Practice Case Studies or Vignette Which Highlights the Concept of Person-Centered Care in Order to ...
			Perioperative Geriatric Comanagement Case Study
		Conclusion/Summary
		References
	66 Care in the Community
		Learning Objectives
		Today´s Healthcare for the Elderly
		Other Developments Targeting the High-Needs Population
		Urgent Care at Home
		Acute Hospital-Level Care at Home
		Targeted Geriatric Evaluation Tools
		A Closer Look at Our Community
			Federal Level
			State Level
			Local Charitable Organizations
			Disease-Focused Organizations
		References
	67 Nursing Home Care in the USA
		Introduction
		Demographics
		Regulations
		Long-Term Care Versus Short Stay and Subacute Rehab
		Staffing
			Nurses
			Medical Providers
		Medical Care Issues
		The Interface of Acute and Long-Term Care
		Medical Direction
		Quality Improvement
		References
	68 Palliative Care
		Introduction
			Palliative Care and Geriatrics
			Team Approach
			Clinical Approach
			Palliative Care Settings
				Inpatient
				Outpatient Clinic
				Home-Based Programs
				Long-Term Care
			Prognostication
				Communication of Prognosis
			End of Life Care
			Palliative Care for Specific Conditions
				Dementia
				Congestive Heart Failure
				Chronic Obstructive Pulmonary Disease (COPD)
			Case Study
		Conclusion/Summary
		Cross-References
		References
	69 Geriatric Rehabilitation
		Introduction
		Geriatric Syndromes: Influence on Functioning
			Post-acute Care Needs (and Predictive Factors for Outcomes in Geriatric Rehabilitation)
			Goal Setting
				Approach to Goal Setting
			Interdisciplinary Team and Therapy
				Outcome Measures
				Integrated Care Pathways
				Informal Caregivers
		Conclusion/Summary
		Cross-References
		References
	70 Antibiotic Stewardship
		Learning Objectives
		Introduction: The Need to Optimize Antibiotic Prescribing
		Principles of Antibiotic Stewardship
		Antibiotic Stewardship in Ambulatory Care Settings
		Antibiotic Stewardship in the Hospital
		Antibiotic Stewardship in Post-Acute and Long-Term Care
		Case Study
		Conclusion/Summary
		References
	71 Population Health for Older Adults
		Demand and Supply
		Population Health Core Focus: Who CARES ME
			Wellness
			Caregiver Support and Coordinated Care
		Preventable Admissions and Readmissions
		Case Example
			Acute Care Management
			Medication Management
			End of Life Care
			Social Determinants of Health
			Behavioral Health Needs
		Population Health Delivery Models
			The Program of All-Inclusive Care for the Elderly
			Special Needs Plans
			Managed Care Plans
			CMMI Pilots
		Health Systems
			Grounded on the Fee for Service Dock
			In a Shaky Value-Based Boat
			Straddling the Two Worlds of FFS and Value-Based Care
			Falling in the Water
		References
	72 Mechanisms of Paying for Health Care
		Introduction
		Medicare Part A
		Medicare Part B
		Medigap
		Medicare Part C/Medicare Advantage
			Special Needs Plans
			Dual-Eligible SNP (D-SNP)
			Chronic Condition SNP (C-SNP)
			Institutional SNP (I-SNP)
			PACE/Program for All-Inclusive Care for the Elderly
			Social/Health Maintenance Organization
		Mechanism for Care Delivery Through Application of Managed Care Principles
		Medicaid and the Dually Eligible (Medicare and Medicaid)
		Medicare Part D
		Shift to Value-Based Care
		Complex Mechanism for Paying and Delivering Care Made Simple
		Conclusion
		References
	73 Interdisciplinary Care and Care Coordination
		Learning Objectives
		Introduction
		Background
			The Shift Toward Interprofessional Practice
			Health Education Reform
			Team-Based Care and Health System Reform
		Competencies
			IPEC Core Competencies
		Team-Based Care
			Why Is Team-Based Care Important?
			What Makes a Good Team?
		Integrating Team-Based Care into Practice
			Roles and Responsibilities
				Role of the Geriatrician
					Team Lead
					Geriatrics Medical Expert (Consult)
					Care Coordination
				Coordinating with Physicians from Other Disciplines
					Geriatrician as Primary Care Provider
					Geriatrician as Consultant
					Non-geriatrician Teams
				The Role of Advanced Practice Providers
				Licensed Nurses
				Social Workers
				Medical Assistants, Nursing Assistants, and Home Health Aides
				Team Differences in Settings
					Nursing Homes
					Assisted Living or Residential Care
					Hospice and Palliative Care
					Home Health
				Care Coordination
				Communication
			Values and Ethics
			Teams and Teamwork
				Patient and Family as Team Members
		Summary
		References
	74 Improving Quality and Safety in the Care of Older Adults
		Learning Objectives
		Introduction
			Background and Significance
				Patient Safety and Quality Improvement Definitions
				Two Landmark Reports
			The Triple Aim to the Quintuple Aim
			Quality and Safety Competencies
			Quality and Safety Agencies
			Implications for Geriatricians and Other Geriatrics-Trained Health Professionals
		Approach to Patient Safety and Quality Improvement
			Avedis Donabedian MD, the Father of Healthcare Quality
		Understanding Errors and Adverse Events
		Patient Safety Essentials
			Reducing Harm
			Root Cause Analysis
			The Human Component of Patient Safety
			The Swiss Cheese Model
			Patient Safety Metrics
			Safety Culture: Just Culture
		Integrating Patient Safety in Practice
			Key Aspects of Patient Safety in Primary Care
			Patient Safety Case
		Essentials in Quality Improvement
			QI Models
				The IHI Model for Improvement
				The Lean and Six Sigma Approaches
		The QI Process
			Identifying an Area(s) for Improvement
			Putting Together a Team
			Goal Setting
			Understanding the Current Process and Root Cause Analysis
			Developing an Intervention
			Determine Measures
			Developing an Implementation Strategy
				Implementing the Plan: The PDSA Cycle
			Quality Improvement Metrics
			Pilot Testing
		Conclusion
		References
Part VIII: The Science of Aging
	75 The Demography and Biodemography of Aging
		Introduction
		Causes and Consequences of Population Aging
		Individual Aging
		Conclusion
		References
	76 Molecular and Biological Factors in Aging
		Introduction
		Aging: Perspectives and Potential Mechanisms
			Normal Aging Versus Disease
			Evolutionary Perspective
			Disposable Soma Hypothesis
			Weak Link Mechanisms
				Immune System
				Neuroendocrine
			Loose Cannon Mechanisms
				Oxidative Stress
				Glycation
		Dietary Restriction (DR) Increases Life Span and Delays Age-Related Diseases
			Discovery in the 1930s
			Extension to Many Different Species
			Different Modalities of Restriction
			Extension to Diseases
				Cancer
				Neurodegenerative Diseases
				Immune Cell Function
		Mechanisms Implicated in Protective Effects of DR
			Macronutrients
			Metabolic Rate
			Temperature
			Hormesis
			Glucose Metabolism
		Role of the Insulin-Like Pathway in Regulating Life Span and Age-Related Diseases
		Dietary Restriction, Insulin-Like Signaling, and mTOR: Final Common Pathways
		Other Interventions
			Hormone Replacement Therapy
			DR-Mimetics
				Rapamycin
				Metformin, Resveratrol
				Senolytics
			Drugs That Increase Life Span in C. elegans
			Drugs That Delay Impairments in a C. elegans Model of Alzheimer´s Disease
		The Brain and Aging
			Normal Versus Disease
			Cognition
			Sensory
			Motor
			Neuroendocrine
		Endocrine Systems and Aging
			Menopause
			Andropause or Functional Hypogonadism (Also Referred to as Late-Onset, Age Related, or Adult-Onset Hypogonadism or Functional ...
			Pathophysiology of Testosterone Decline in Aging
			DHEA
			GH
			HPA
			Thyroid
		References
	77 Physiology of Aging
		Introduction
		Conclusion
		References
			Bibliography
	78 Immunology of Ageing
		Introduction
		Basic Principles and Constraints on Studies of Age-Associated Changes to Immunity in Humans
		What Is Immunosenescence?
		Hematopoiesis in Older Adults
		Age-Associated Changes to Innate Immunity
			Phagocytic Cells
			Natural Killer Cells
			Dendritic Cells
		Age-Associated Changes to Adaptive Immunity
			B and T Lymphocyte Development and Antigen Recognition Repertoire
				B-cells
				T-cells
			T-cell Immune Function
		Conclusions: Immune Correlates of Successful Vaccination and With Mortality
		References
Index