Pathy's Principles and Practice of Geriatric Medicine

Name: Pathy's Principles and Practice of Geriatric Medicine
Brand: Wiley
Price: 475.99 EUR
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Alan J. Sinclair John E. Morley Bruno Vellas Matteo Cesari Medha Munshi(Herausgeber*in)

Wiley (Verlag)

6. Auflage

Erschienen am 18. Februar 2022

1856 Seiten

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Inhalt

Cover
Volume I
Title Page
Copyright Page
Contents of Volume 1
About the Editors
About the Associate Editors
List of Contributors
Preface to the Fifth Edition
Foreword
Introduction: Historical perspectives
Introduction
The earlier writers on old age
The birth of modern geriatric medicine
British developments
An overview of early geriatric medicine in the United Kingdom
The early pioneers in geriatric medicine
The second wave of geriatricians
Third wave of geriatricians
Geriatrics in the United States
Geriatrics in the rest of the world
Teaching geriatric medicine
Achievements of geriatric medicine
Gerontology: the science of the ageing process
Problem areas
References
Part 1 Ageing: Biological, Social, and Community Perspectives
Chapter 1 A biological perspective of ageing
Introduction
A populational perspective on ageing
The evolutionary roots of the phenomenon of ageing
The components of biological ageing
Genomic instability
Epigenetic changes
Mitochondrial dysfunction
Loss of proteostasis
Metabolic dysfunction
Cell senescence
Stem cell exhaustion
Immunosenescence
Challenges for the biology of ageing and geriatric medicine
References
Chapter 2 Physiology of ageing
The nervous system
Age-related changes in the nervous system
The cardiovascular system
Age-related changes in the cardiovascular system
The endocrine system
Thyroid
Growth hormone
Dehydroepiandrosterone (DHEA)
Oestrogen
Testosterone
Hypothalamic-pituitary-adrenal (HPA) axis
Arginine-vasopressin (AVP)
The gastrointestinal system
Age-related changes in the GI tract
Age-related changes in GI organs and glands
The genitourinary tract
Age-related changes in the kidneys
Age-related changes in the lower urinary tract
Age-related changes in genital organs
The immune system
Age-related changes in the immune system
The musculoskeletal system
Age-related changes in the skeleton
Age-related changes in the muscles
The respiratory system
Age-related changes in the respiratory system
The skin
Age-related changes in the skin
References
Chapter 3 Psychological aspects of ageing
Introduction
Psychological development over the lifespan
Personality changes in older adulthood
Normal cognitive change with age
Abnormal cognitive ageing
Mental health and cognition in the elderly and associated medical issues
Psychological interventions in the elderly
Non-pharmacologic interventions for cognitive decline
Implications for practice
References
Chapter 4 Social and community aspects of ageing
Introduction
Demography of ageing
Ageing population
The causes of population ageing
Old-age dependency ratio
Gender imbalance
Geographic considerations: migration and immigration
Relationships, viewpoints, and ageing
Shifting attitudes
Marriage, cohabitation, and divorce
The changing family
Caregiver relationships
Religiousness and spirituality
Community and societal structures
Housing
Environment
Making a move
Incarcerated older adults
Employment and retirement
The internet and social media
Challenges of ageing
Ageism
Sensory impairments
Disability
Poverty
Social isolation and loneliness
Elder abuse
Scams and fraud
Natural disasters
References
Chapter 5 Sexuality and ageing
Introduction
Sexual health in older adults
Sexuality and the older woman
Menopause
Sexuality and the older man
Andropause
Sexuality and disease
Dementia
Sexually transmitted infections
Special considerations for LGBTQ older adults
Sexuality in the nursing home
Conclusion
References
Chapter 6 Ageing of the brain
Introduction
Structural age-related brain changes
Atrophy
Small-vessel disease
Altered proteins
Neurobiological hallmarks of brain ageing
Mitochondrial dysfunction
Oxidative damage
Loss of proteostasis
Dysregulation of calcium homeostasis
Impaired adaptive cellular stress responses
Inflammation
Aberrant neuronal network activity and altered synaptic plasticity
Impaired DNA repair
Impaired neurogenesis
Dysregulated energy metabolism
Changes in the neurological examination with ageing
Vision
Hearing
Taste and smell
Sensation
Reflexes
Posture, gait, and balance
Extrapyramidal signs
Cognitive changes with ageing
References
Chapter 7 Physical fitness and exercise
Introduction
What is physical activity or exercise?
Physical inactivity versus exercise
Inter-individual variability in response to exercise (non-responder phenomenon)
Does exercise increase life expectancy?
Physical function as a biomarker of healthy ageing and objective of exercise programmes
Preserving exercise capacity with age via an active lifestyle
Optimisation of body composition with ageing
Role of exercise and physical activity in bone health and fracture risk
Age-related changes in bone
Physical activity and bone health
Exercise intervention trials in postmenopausal women and older men
Optimal exercise modality and intensity for bone health
Exercise in the treatment of osteoporotic fracture
Role of exercise and physical activity in adipose tissue accretion and distribution
Cross-sectional studies of physical activity and fat mass
Experimental studies of the influence of physical activity on abdominal fat
Relationship between exercise intensity and changes in body fat
Relationship between exercise modality and changes in body fat
Role of exercise in preserving muscle mass with age
Exercise to maintain or increase muscle mass
Predictors of muscle hypertrophy after exercise
Muscle power training
Promotion of psychological well-being
Exercise and cognitive function
Considerations regarding exercise for frail individuals with cognitive impairment
Effects of exercise interventions on mobility and frailty syndromes
Disease prevention through exercise
Evidence for the role of exercise in the treatment of disease
Exercise in the treatment of type 2 diabetes
Exercise to counteract iatrogenic disease
Exercise and the prevention and treatment of disability
Exercise for acute hospitalised older patients
Summary of exercise recommendations
Resistance training recommendations
Balance training recommendations
Aerobic and gait training
Multicomponent training
Conclusions:
References
Chapter 8 Health literacy and cultural sensitivity
Introduction
The importance of health literacy in health care
Factors that influence health literacy
The role of education in health literacy
Educational strategies to improve health literacy
Cultural sensitivity in geriatrics
The need for cultural sensitivity
When cultures clash
Barriers to cultural understanding
Common areas of conflict or misunderstanding in the clinical encounter
Prior experiences
Identifying the patient
Communication
Stereotyping
Age
Increasing cultural sensitivity in the clinical encounter
Increase self-awareness
Improve communication
Explanation
Treatment
Healers
Negotiate
Intervention
Collaborate
Spirituality/seniors
Understand non-verbal cues
Use professional translators when possible
Promote health
Resources
Cultural competence in health care
Health promotion programs
References
Part 2 Medicine and Prescribing in Old Age
Chapter 9 Preventive geriatrics
Introduction
Background
The Health Maintenance Clinical Glidepath
Office visits
Blood pressure (BP), including orthostatic measurements
Weight
Height
Pain
Medication review including over-the-counter (OTC) and herbal medicines
Lifestyle education
Maintain awareness of elder abuse
Assess ADLs and IADLs
Visual acuity and auditory testing
Ask about urinary incontinence
Males: screen for erectile dysfunction (ED) and hypogonadism
Rapid Geriatric Assessment
Cognitive screening
Depression screening
Screening for gait and balance
Advance directives
Influenza vaccine
Pneumococcal vaccine
Tetanus
Zostavax and Shingrix
Hepatitis C
Breast cancer screening
Cervical cancer screening
Colon cancer screening
Prostate cancer screening
Lung cancer screening
Osteoporosis
Cholesterol screening
Thyroid-stimulating hormone (TSH)
Diabetes mellitus
Sleep apnoea
Abdominal aortic aneurysm
References
Chapter 10 Polypharmacy and deprescribing in older adults
Introduction
Ageing physiology affects medication efficacy and tolerance
Tools for medication management
Principles of appropriate prescribing
Conclusion
References
Chapter 11 Patient safety
Introduction
History and evolution of the concept of patient safety
Definitions
Measurement - the scale of harm
Studies of errors
Why do adverse events occur?
Learning from other industries
Human error
System and organizational factors
What happens after an adverse event?
Reporting and learning
Understanding why things go wrong
Caring for patients after an adverse event
Supporting staff
Patient safety and older people
The incidence of adverse events in older people in the hospital
Types of adverse events experienced by older people in the hospital
Why are older people more susceptible to healthcare-associated harm than younger patients?
Improving patient safety for older people
Priorities for improving the safety and quality of care for older people
Patient safety for older people across the world
Improved definitions and measurement
Patient safety research in non-hospital settings
Conclusion
Acknowledgement
References
Section 1 Eating Disorders and Nutritional Health
Chapter 12 Nutrition and healthy ageing: Emphasis on brain, bone, and muscle
Introduction
Body weight and composition
Body mass index, weight loss, and ageing
Central adiposity and healthy ageing
Fluid status, dehydration, and healthy ageing
Bone loss, nutrition, and healthy ageing
Energy intake, macronutrients, and satiety in ageing
Determinants of dietary preference and intake among older adults
Dietary patterns and nutritional status associated with healthy ageing
Dietary patterns associated with healthy cognitive ageing
Nutritional status and healthy ageing
Micronutrients
Minerals
Macronutrients and omega-3 fatty acids
Dietary guidelines and clinical applications
References
Chapter 13 The anorexia of aging
Introduction
'Ideal' body weight in older people
Weight loss in older people
Cachexia in older people
Causes of undernutrition in older people
Reduced food intake
Physical factors
Physiological changes
Declining senses
Hormones and neurotransmitters: a selective review
Central neurotransmitters and hormones
'Peripheral' hormones, including gut peptides
Chronic disease and anorexia in older adults
Environment and social determinants of health
Iatrogenic impact
Conclusion
References
Chapter 14 Weight loss
Introduction
Weight loss and frailty
Weight loss and sarcopenia
The relationship of weight loss to mortality
Effect of weight loss on comorbid conditions
Weight loss, a hallmark of malnutrition
Starvation
Cachexia
Anorexia
The use of the Mini-Nutritional Assessment (MNA) to explore weight loss
Interventions
Decreased food intake
The effect of exercise to improve body mass and function
Palliative treatment of anorexia
Conclusion
References
Chapter 15 Water and electrolyte balances in ageing
Introduction
Normal physiology
Water homeostasis in the elderly
Workup and treatment of hyponatremia
Workup and treatment of hypernatremia
Conclusions
References
Chapter 16 Vitamins and minerals
Introduction
Recommended intakes of vitamins and minerals
Medication influences on vitamin and mineral status
Vitamins and minerals - functions and characteristics
Micronutrients of special concern for older adults
Role of vitamin and mineral supplements in chronic disease: some reviews of the evidence
Bone health, fractures, vitamin D, and calcium
Mild cognitive impairment and dementia
Eye disorders - age-related macular degeneration and age-related cataracts
Cancer and cardiovascular diseases - selenium
Cancer and cardiovascular diseases - multiple vitamins and minerals
Practical implications
Nutrient intake and healing of pressure injury: focus on zinc
Summary
References
Section 2 Gastro Disorders
Chapter 17 Changes in gastrointestinal motor and sensory function associated with ageing
Introduction
Control of gastrointestinal motility and sensation
Pathophysiology of the ageing gut
Oesophagus
Changes in oesophageal motor function related to ageing
Clinical presentation of disordered oesophageal motility
Achalasia
Distal oesophageal spasm and 'jackhammer' oesophagus
Minor disorders of peristalsis
'Pill esophagitis'
Non-cardiac chest pain
Gastro-oesophageal reflux disease
Stomach and duodenum
Changes in gastric motor function related to ageing
Small intestine
Changes in small-intestinal motor function related to ageing
Postprandial hypotension
Systemic disorders associated with disturbance of gastrointestinal motility
Parkinson's disease
Diabetes mellitus
Progressive systemic sclerosis
Functional disorders
Acknowledgements
References
Chapter 18 The liver and gallbladder in the geriatric population
Introduction
Acute viral hepatitis
Chronic hepatitis B and C
Fatty liver disease
Drug-induced liver injury
Alcoholic liver disease
Primary biliary cholangitis
Hemochromatosis
Autoimmune hepatitis
Primary sclerosing cholangitis
Hepatocellular carcinoma
Biliary disease
Liver transplantation
Conclusion
References
Chapter 19 Faecal incontinence
Introduction
The physiology of defecation
Anatomy of the lower alimentary canal
Defecation
Changes relating to ageing
Epidemiology of faecal incontinence
Prevalence
Correlates and risk factors
Gastrointestinal disorders
Non-GI risk factors
Assessment of faecal incontinence
Investigations
Management of faecal incontinence
Conservative Measures
Pelvic floor training and biofeedback
Surgical therapy
Sphincter repair
Neosphincter operations
Sacral neuromodulation
Faecal diversion
Containment
Conclusions
References
Chapter 20 Constipation
Defining constipation
Epidemiology, pathophysiology, and impact
Aetiology of constipation
Clinical approach
History
Physical examination
Diagnostic tests
Treatment
Pharmacological management
Special categories of constipation
Conclusion
References
Chapter 21 Diseases of the pancreas
The ageing pancreas
Inflammatory diseases of the pancreas
Acute pancreatitis
Chronic pancreatitis
Pancreatic cysts and tumours
Cystic lesions of the pancreas
Endocrine tumours of the pancreas
Pancreatic adenocarcinoma
References
Section 3 Haematological Disorders
Chapter 22 Anaemia in older people
Background
Epidemiology
Nutritional deficiencies
Iron deficiency anaemia
Vitamin B12 deficiency anaemia
Folate deficiency anaemia
Inflammatory anaemias
Anaemia of chronic disease
Anaemia of chronic kidney disease
Anaemia of clonal disorders
Conclusion
References
Chapter 23 Disseminated intravascular coagulation
Introduction
Pathophysiology
Diagnosis
Management
Chronic disseminated intravascular coagulation
References
Chapter 24 Disorders of haemostasis
Introduction
Disorders of platelet number
Decreased platelet production
Increased peripheral destruction
Increased pooling of platelets
Thrombocytopenia due to drugs
Functional platelet defects
Hereditary coagulation defects
Acquired coagulation defects
Vascular disorders
Thrombotic disorders
Thrombophilia
Lupus anticoagulant
References
Chapter 25 When to anticoagulate, and which anticoagulant?
Introduction
The elderly are more prone to thromboembolism
The elderly are more prone to haemorrhage
Anticoagulant response differs in the elderly
Anticoagulants are effective in the elderly
Optimizing the risk-benefit equation in the elderly
Intensity of anticoagulation
Age-related factors that predispose to bleeding
Tissue modifications
Falls
Concomitant use of antiplatelets
Duration of anticoagulant therapy
Start-stop-start anticoagulation
Starting anticoagulation in elderly patients
Situations that force interruption of anticoagulation
Intracranial bleeding (ICB)
Surgical interventions
Poor control of the INR
Definitive interruption of anticoagulation
References
Chapter 26 Myelodysplasia
Introduction
Epidemiology and clinical presentation
Elderly patients and risk assessment
Diagnosis
Blood and bone marrow examination
Cytogenetics
Other genetic events
Diagnostic criteria
Classification
Uncertain conditions
Prognosis
Treatment
Treatment of lower-risk MDS
Supportive measures for anaemia: erythroid-stimulating agents
Transfusion support and iron overload
Alternative strategies to treat anaemia in MDS
Lenalidomide
Erythropoiesis maturating agents
Platelet growth factors
Pyridoxine, androgens, and vitamins
Disease-modifying agents for high-risk disease
Hypomethylating agents
Haematopoietic stem cell transplantation
References
Chapter 27 Management of myelodysplastic syndromes and acute myeloid leukaemias in the elderly
Introduction
Myelodysplastic syndromes
Pathophysiology
Epidemiology
Diagnosis
Prognostic factors
Treatment of lower-risk MDS
Treatment of higher-risk MDS
Therapeutic decision
Acute myeloid leukaemias (AMLs)
Pathophysiology
Epidemiology
Diagnosis
Prognostic factors
AML features in the elderly
Treatments of AML
Conclusion
Bibliography
Section 4 Cardiovascular Diseases and Health
Chapter 28 Epidemiology of heart disease
Introduction
Coronary heart disease
Risk factors and prevention
Reverse epidemiology
Heart failure
Ethnic variations
Risk factors and prevention
Diastolic heart failure
Complexity and care for heart failure
Valvular heart disease
Degenerative valve disease
Infective valve disease
Rhythm disorders
Atrial fibrillation
Sudden cardiac death
Conclusion
References
Chapter 29 Arrhythmias
The normal cardiac conduction system
The ageing heart
Twelve-lead and ambulatory ECG surveys
Incidental findings that may be normal in older people
Pathological findings in older people
Symptomatic bradycardias
Presentation
Assessment
Sinus node dysfunction (sick sinus syndrome)
Atrioventricular blocks
Choice of pacemaker
Atrial tachyarrhythmias
Atrial ectopic beats
Atrial tachycardia
Multifocal atrial tachycardia (MAT)
Atrial flutter
Atrial fibrillation
Classification
Epidemiology
Aetiology
Consequences of AF
Atrial remodelling
Hemodynamic function
Thromboembolism
Clinical manifestations
History and examination
Management
Rate control
Non-pharmacological rate control
Rhythm control
Antiarrhythmic agents for preventing recurrence of AF
Recommendations for rhythm control
Non-pharmacological rhythm control
When to anticoagulate in AF
Anticoagulation issues in older patients
Non-pharmacological possibilities to prevent stroke
Other supraventricular arrhythmias
Ventricular premature beats (VPBs)
Ventricular arrhythmias
Prognosis
Pathogenesis
Management
Acute management
Drug therapy
Role of implantable cardioverter defibrillators
References
Chapter 30 Ischaemic heart disease
Introduction
Cardiac changes with ageing
Pathogenesis
Epidemiology
Clinical presentation
Diagnosis
Management
Risk assessment
Prevention
Treatment
Prognosis
Considerations in old age
Future perspectives
Conclusion
References
Chapter 31 Lipid management
Introduction
Lipoprotein metabolism and ageing
Dyslipidaemia and prevention of ASCVD in the elderly
Secondary ASCVD prevention
Primary ASCVD prevention
Clinical approach to dyslipidaemic older subjects
Conclusions
References
Chapter 32 Hypotension
Introduction
Orthostatic hypotension
Definition and measurement
Epidemiology
Pathophysiology
Symptoms
Prevention and treatment
Postprandial hypotension
Definition and measurement
Prevalence
Pathophysiology
Symptoms
Prevention and treatment
Hypotension with carotid sinus syndrome (carotid sinus hypersensitivity)
Definition and measurement
Prevalence
Pathophysiology
Symptoms
Prevention and non-pharmacological treatment
Pharmacological interventions
Conclusion
References
Chapter 33 Hypertension in older people
Introduction
Age-related vascular changes
Pathophysiology
Epidemiology
Definition and classification
Diagnosis
Types
Management
Recommended targets
Suggested targets
Lifestyle modification
Pharmacologic intervention
Considerations in old age
Future perspectives
Conclusion
References
Chapter 34 Heart failure
Introduction
Pathophysiology
Pathogenesis
Cardiovascular ageing and HF
Epidemiology
Clinical features
Diagnosis
Aetiology and precipitating factors
Impact of comorbidities on HF
Cardiac comorbidities
Noncardiac comorbidities
Frailty and HF
Management of HF
Management of aetiological and precipitating factors
Nonpharmacological treatment
Pharmacological management of HFrEF
Approach to treatment
Device therapy
Treatment of heart failure with a preserved ejection fraction
Palliative care in HF
Prognosis
Future perspectives
Summary
References
Chapter 35 Cardiac surgery and percutaneous interventions in the elderly
Introduction
Cardiac surgery and percutaneous intervention in the elderly
Mortality
Morbidity - neurological dysfunction
Assessment of the elderly patient for cardiac surgery or percutaneous intervention
Operative risk - estimated mortality for cardiac surgery or percutaneous intervention
Benefit of cardiac intervention - intended improved quality of life
Management of coronary artery disease
Coronary revascularisation - coronary artery bypass graft surgery or percutaneous coronary intervention/stent
Valve surgery - conventional or minimal-access cardiac surgery or percutaneous catheter-based valve intervention
Aortic valve disease in the elderly
Mitral valve replacement or repair
Anticoagulation management in the elderly
Anticoagulation for biological prosthetic valves or valve repairs
Anticoagulation for mechanical prosthetic valves
Anticoagulant management of patients with mechanical prosthetic valves undergoing noncardiac surgery
Anticoagulation for atrial fibrillation
Nonpharmacological curative therapy for atrial fibrillation
Heart failure
Cardiac resynchronisation therapy
Cardiac transplantation
Mechanical circulatory support
Thoracic aortic surgery
Ascending and aortic arch aneurysms
Descending and thoracoabdominal aneurysms
Conclusions
References
Chapter 36 Peripheral arterial disease
Introduction
Epidemiology
Risk factors for PAD
Consequences of PAD
Pathophysiology
Diagnosis
Anamnesis and physical assessment
Clinical presentation
Physical examination
Non-invasive tests
Invasive tests
Treatment
Risk factor modification
Exercise rehabilitation
Foot care
Pharmacological therapy
Revascularization
Conclusion
Acknowledgements
References
Chapter 37 Venous thromboembolism in the elderly
Introduction
Risk factors
Diagnosis
Clinical presentation
Clinical prediction rules
D-dimer testing
Imaging for VTE
Treatment - anticoagulation
Prognosis and risk stratification
Bleeding and recurrent VTE
Conclusion
References
Section 5 Respiratory Diseases
Chapter 38 Epidemiologic and pathophysiologic overview of respiratory infections
Introduction
Host factors
Alterations in immunity
Anatomic alterations in the host
Altered airway protective mechanisms
Environmental factors
Overview
Travel and geographic factors
Family and close associate exposures
Institutional factors
Environmental aerosol and dust exposure
References
Chapter 39 Pneumonia
Introduction
Causative agents
Clinical presentation of pneumonia in the elderly
Differential diagnosis of lower respiratory tract infection
Bronchitis
Exacerbation of chronic obstructive disease
Heart failure and pulmonary embolism
Cancer and other diseases of the lungs
Hospitalization and further investigations in elderly people with a suspected diagnosis of community-acquired pneumonia
Referral to the hospital of an elderly person with suspected pneumonia
Are additional tests required?
Chest imaging
Biological tests
Therapy of pneumonia in the elderly
General measures
Non-infectious treatments for pneumonia
First-line anti-infective agents
Follow-up of patients
Prevention of pneumonia in the elderly
Further reading
Chapter 41 The COVID-19 pandemic in older people
Introduction
Coronaviruses
Transmission
Clinical impact
COVID-19 in older people
Risk factors
Clinical presentation
Diagnosis
Management
Prevention
Ethical issues
Future perspectives
Conclusion
References
Chapter 42 Chronic obstructive pulmonary disease and asthma
Ageing mechanisms in the lungs
Generalities on lung function testing in the elderly
Inhalation techniques and adherence improvement issues
Polypathology and polypharmacy in elderly respiratory patients
Chronic obstructive pulmonary disease (COPD)
Epidemiology
Diagnosis and clinical features
Investigations
Assessing COPD severity
Management of COPD - stable state
Management of COPD exacerbations
Asthma
Epidemiology
Clinical features and diagnosis
Management
References
Chapter 43 Pulmonary rehabilitation
Introduction
Organization
Patient selection
Components of pulmonary rehabilitation
Exercise
Education
Psychosocial support
Outcomes
Maintenance following pulmonary rehabilitation
Summary
References
Section 6 CNS Disorders
Chapter 44 Neurological signs of ageing
Introduction: interpreting ageing changes
Neurological signs of ageing
Cranial nerves, including special senses
Sensorimotor function: motor systems
Reflexes
Phasic muscle stretch reflexes (deep tendon reflexes)
Superficial or cutaneous reflexes
Primitive or developmental reflexes (frontal-release signs)
Station and gait: postural responses
Sensorimotor function: sensory systems
Cognitive function
Conclusions
References
Chapter 45 Sleep apnoea and sleep disorders
Introduction
Basic sleep concepts
What is normal sleep?
How does sleep change in old age?
Main sleep alterations in seniors
Obstructive Sleep Apnoea
Restless legs syndrome (RLS) and periodic leg movement during sleep (PLMS)
REM sleep behaviour disorder
Circadian rhythm sleep disorders
Insomnia
Non-pharmacological treatment
Pharmacological treatment
References
Chapter 46 Normal pressure hydrocephalus
Introduction
Aetiology and pathophysiology
Clinical presentation
Differential diagnosis
Diagnostic modalities
CT/MRI
Brain morphology
CSF flow and CSF flow rate
Prognostic tests
Lumbar puncture
Lumbar drain trial or extended lumbar drainage protocol
Intracranial pressure measurement
ICP monitoring
Lumbar or CSF infusion test
Neuropsychological testing
Other tests
Diagnostic criteria of NPH
Treatment
Patient selection and decision-making
Ventriculoperitoneal shunting
Ventriculoatrial shunting
Lumboperitoneal shunting
Endoscopic third ventriculostomy
Type of shunt valves
Drug therapy
Risks and complications
Outcome and prognosis
Long-term care and follow-up
References
Chapter 47 Acute stroke care and management of carotid artery stenosis
Introduction
Stroke aetiology
Stroke mimics
Prognosis of stroke
Clinical evaluation and stroke syndromes
Total middle cerebral artery (MCA) syndromes
Partial MCA syndromes
Lacunar syndromes
Posterior circulation syndromes
Thalamic syndromes
Prehospital care
Initial investigations and imaging
In-hospital care
Airway
Breathing
Circulation
Blood sugar
Environment
Thrombolysis
Thrombectomy
Neuroprotective drugs
Neurosurgery for ischaemic stroke
Palliative care
Stroke units
Secondary prevention
Antiplatelet therapy
Blood pressure management
Cholesterol management
Diabetes management
Anticoagulation
Carotid artery stenosis
Atherosclerosis
Arterial dissection
Investigations
Carotid endarterectomy
Asymptomatic patients
Carotid artery stenting
Vertebral and intracranial arterial stenting
Intracranial and subarachnoid haemorrhage
Spontaneous intracerebral haemorrhage
Subarachnoid haemorrhage
Conclusion
References
Chapter 48 Stroke and stroke rehabilitation
Introduction
The neurological basis of recovery
Patterns of recovery
Objectives of rehabilitation
Process of rehabilitation
Assessment
Planning
Intervention
Early mobilization
Restoration of motor function
Neuromuscular stimulation
Motor imagery
Spatial neglect
Organised (stroke unit) care
Evaluation
Common problems in stroke rehabilitation
Dysphagia
Dysphasia
Perception
Tone and spasticity
The hemiplegic shoulder
Depression
Pain
Fatigue
Psychosocial aspects
Conclusion
References
Chapter 49 Communication disorders and dysphagia
Communication
Ageing and communication
Hearing
Vision
Cognition
Motor speech
Depression
Diagnosis and assessment of communication disorders
Dysphasia
Dyspraxia of speech
Dysarthria
Augmented and alternative communication
Swallowing
The normal swallow
Oral phase
Pharyngeal/oesophageal phases
Dysphagia
References
Chapter 50 Acute and chronic subdural hematoma
Introduction
Acute subdural hematoma
Epidemiology
Pathophysiology
Clinical presentation
Diagnosis
Prognosis
Management
Prevention
Chronic subdural hematoma
Epidemiology
Pathophysiology
Clinical presentation
Differential diagnosis
Investigations
Management
Prognosis and outcome
References
Chapter 51 Epilepsy
Introduction
Epidemiology
Definition of epilepsy
Aetiology
Epileptic seizures
Epilepsy
Clinical manifestation
Seizure type
Epilepsy type
Epilepsy syndrome
Diagnosis
Differential diagnosis
Transient ischaemic attacks (TIAs)
Transient global amnesia (TGA)
Syncope
Delirium and confusional states
Psychogenic non-epileptic seizures
Drop attacks
Parasomnias
Treatment
General recommendations
Polypharmacy
Indications
Comorbidities
Indications for adding a second AED
Side effects
Other new drugs and non-pharmacologic treatments
Driving regulations
Treatment of status epilepticus
Conclusion
References
Chapter 52 Syncope and non-epileptic attacks
Introduction
Syncope
Mechanisms underlying syncope
Clinical manifestations of syncope
Other clinical features
Diagnosis and investigation of syncope
Management of syncope
Other non-epileptic attack disorders
Panic attacks and hyperventilation attacks
Psychogenic non-epileptic attacks
Sleep phenomena, hypoglycaemia, migraine, transient global amnesia, cataplexy, paroxysmal movement disorders, and paroxysmal symptoms in multiple sclerosis
References
Chapter 53 Parkinson's disease
Introduction
Signs and symptoms of very late-onset Parkinson's disease
Differential diagnosis of Parkinson's disease
Tremor
Extrapyramidal syndromes other than Parkinson's disease
Advanced Parkinson's disease
Management of Parkinson's disease in the elderly
Pharmacological treatment
Non-pharmacological treatments
Further reading
Chapter 54 Non-Parkinsonian movement disorders in the elderly
Introduction
Myoclonus
Clinical characteristics
Pathophysiology and classification
Diagnosis and treatment
Tremor
Clinical characteristics
Pathophysiology
Diagnosis and treatment
Dystonia
Clinical characteristics
Pathophysiology
Diagnosis and treatment
Tardive dyskinesia
Clinical characteristics
Pathophysiology
Diagnosis and treatment
Chorea
Clinical characteristics
Pathophysiology
Diagnosis and treatment
Functional movement disorders
Clinical characteristics
Pathophysiology
Diagnosis and treatment
Restless legs and periodic limb movements during sleep and while awake
Clinical characteristics
Pathophysiology
Diagnosis and treatment
References
Chapter 55 Diabetic neuropathy
Introduction
Epidemiology and risk factors
Pathogenesis
Classifications
Clinical presentation
Diabetic somatic neuropathy
Diabetic autonomic neuropathy
Diagnosis
Management
Prevention
Treatment
Conclusion
References
Chapter 56 Disorders of the neuromuscular junction
Introduction
Myasthenia gravis
Clinical features
Symptoms and signs
Clinical classification of MG and associated diseases
Differential diagnosis
Diagnostic investigations
Is MG different in the elderly?
Management
Prognosis
Lambert-Eaton myasthenic syndrome
Peripheral nerve hyperexcitability
Acknowledgement
References
Chapter 57 Muscle disorders
Introduction
Clinical assessment
Laboratory investigations
Biochemical studies
Electrophysiology
Muscle biopsy
Molecular studies
Acquired myopathies
Idiopathic inflammatory myopathies
Toxic and drug-induced myopathies
Endocrine and metabolic myopathies
Inherited myopathies
Muscular dystrophies
Sarcopenia
Acknowledgements
References
Chapter 58 Motor neuron disease
Clinical presentation
Epidemiology
Genetic aspects
Diagnostic criteria
Heterogeneity and variants
Physiopathology
Treatments
Aetiologic treatments
Supportive treatments
Symptomatic treatments
References
Chapter 59 Chronic pain
Introduction
Pain and ageing
Prevalence of chronic pain
Age-related changes in the nociceptive system
Pathophysiology
Special considerations in the management of pain in older people
Assessment
Pain
Comorbidities
Function
Psychosocial
Cognitive impairment
Management
Pharmacological therapies
Nonpharmacological therapies
Procedural modalities
Conclusions
Acknowledgement
References
Chapter 60 Multiple sclerosis
Introduction
Pathophysiology, aetiology, and epidemiology
Diagnostic evaluation
Clinical spectrum
Visual, brainstem, and cerebellar dysfunction
Sensory manifestations
Pain
Muscle weakness and other motor manifestations
Gait and coordination disorders
Fatigue and sleep disorders
Neurogenic bowel
Neurogenic bladder
Sexual dysfunction
Other autonomic changes
Cognitive involvement
Mood and affective involvement
Seizures and other paroxysmal manifestations
Treatment: disease-modifying drugs
Prognosis
Comorbidities
Complementary and alternative medicine (CAM)
Access to healthcare
Fostering healthy living and resilience
References
Appendix Function assessment scales
Dental
Hallpike Manoeuvre
Osler Manoeuvre for pseudohypertension
The Mini-Nutritional Assessment (MNA) Scale
Index
Volume II
Ttle Page
Copyright Page
Contents of Volume 2
About the Editors
About the Associate Editors
List of Contributors
Preface to the Fifth Edition
Preface to the Sixth Edition
Foreword
Section 7 Dementia and Cognitive Disorders
Chapter 61 Delirium in older patients
Introduction
Rates of delirium
Consequences of delirium
Delirium phenotypes
Pathophysiology
Predisposing and precipitating factors
Delirium identification: screening versus diagnosing
Delirium screening
Delirium prevention
Pharmacologic prevention of delirium
Management of delirium
Non-pharmacologic management
Pharmacologic management
Conclusion
References
Chapter 62 Memory clinics
Introduction
Developments around the world
Why the need?
Are they effective?
The memory clinic team
What happens in a memory clinic?
History and medical examination
Cognitive assessment
Laboratory tests
Neuroimaging
What interventions can be offered?
Diagnostic disclosure and meeting information needs
Memory aids
Memory training
Pharmacotherapy
Summary
References
Chapter 63 Alzheimer's disease
Introduction
Epidemiology of Alzheimer's disease
Risk factors of Alzheimer's disease
Neuropathology of Alzheimer's disease
What is the chronological relationship between amyloid deposits and neurofibrillary degeneration?
Definition of the stages of cognitive severity
Process for the diagnosis of Alzheimer's disease
Biomarkers of AD
Treatment
Toward a new paradigm: the prevention of Alzheimer's disease
Conclusion
References
Chapter 64 Mild cognitive impairment: an update
Core clinical criteria for the diagnosis of MCI
MCI research criteria incorporating biomarkers
Conclusion: clinical acceptance of MCI
References
Chapter 65 Vascular dementia
Historical perspective and definitions
Vascular cognitive impairment - current definitions
General epidemiological issues
Pathophysiology
Large single or multiple cortical infarcts
Subcortical vascular dementia
Single-strategic infarct dementia
Genetically based vascular dementias
Clinical impact: cognitive and motor impairment
Preventive (risk-factor control) and curative therapies
Conclusions
References
Chapter 66 Mental stimulation and dementia
Introduction
Cognitive (mental) interventions
Supporting evidence
Animal studies
Observational studies
Clinical trials
Mechanisms
Cognitive reserve
Vascular
Stress
Targets of intervention
Implementing interventions
Conclusions
Acknowledgements
References
Chapter 67 Exercise and dementia
Introduction
Physical activity and the prevention of dementia in clinical research
Physical activity and executive function
Frailty, physical activity, and cognitive reserve
Biological mechanisms of physical activity in preventing cognitive decline
Clinical practical applications: physical activity and prevention of AD
Intensity and frequency
Type of activity
Duration
Physical activity in AD populations
Practical clinical applications: physical activity for demented patients
Conclusion
References
Chapter 68 Drug development and Alzheimer's disease
Introduction
Impact on cholinergic deficit
Anti-amyloid therapies
Drugs to promote A clearance
Drugs to reduce A production
Drugs to target tau protein
Neuroprotective agents
Antioxidants
Anti-inflammatory drugs
Glutamate-mediated neurotoxicity
Neurorestorative approaches
Hormonal therapy
Drugs to target mitochondrial dysfunction
Statins
Receptor for advanced glycation end-product inhibitors
Others
Non-pharmaceutical therapies
Prevention and AD
Conclusion
References
Chapter 69 Other dementias
Introduction
Vascular cognitive impairment/vascular dementia
Lewy body disease
Dementia with Lewy bodies
Parkinson's disease with dementia
Progressive supranuclear palsy
Corticobasal degeneration
Multiple system atrophy
Frontotemporal lobar degeneration
Behavioural-variant frontotemporal dementia
Semantic dementia
Progressive non-fluent aphasia
Treatment
Depression
Medications
Dementia with parkinsonism
General approach
Conclusion
References
Chapter 70 Management of neuropsychiatric symptoms in dementia
Introduction
Epidemiology
Outcomes of NPSs
Measurement of NFS
Aetiology of NPSs
Factors related to the person with dementia
Caregiver issues
Environmental issues
Management of NPSs
General principles
Non-pharmacological management
Pharmacological treatment
The DICE approach
Step 1: Describe
Step 2: Investigate
Step 3: Create
Step 4: Evaluate
Summary of treatments of NPSs in dementia
Perspectives and future directions
References
Chapter 71 Late-life depression
Introduction
Definitions and concepts of depression
Classifying diagnosis of depression in old age
Clinical presentation of depression in older people
Psychomotor symptoms
Somatic symptoms
Age at onset
The 'vascular depression' hypothesis
Depression and neurodegenerative disorders
Diagnosis and risk factors
Suicidality
Instruments
Risk factors
Impact
Treatment
General aspects of treatment
Psychotherapy
Medication
Other interventions
Conclusion
References
Chapter 72 Geriatric psychiatry
Introduction
Epidemiology
Challenges in geriatric psychiatry
The psychiatric interview of an older adult
Workup
Interdisciplinary approach and individualised care plan
Successful ageing
Depression
Bereavement
Severe mental illness
Bipolar affective disorder and late-onset mania
Schizophrenia
Late-life psychosis
Cognitive disorders
Dementias
Delirium
Mild cognitive impairment (MCI) and cognitive impairment no dementia (CIND)
Vascular dementia
Managing agitation and aggression in individuals with dementia
Substance use disorder (SUD)
Alcohol use disorder
Opioid use disorder (OUD)
Chronic benzodiazepine use
Chronic cannabis use
Anxiety disorders
Trauma-related disorders
Personality disorders
Apathy syndrome
Suicide
Abuse and older people
Sleep disorder
Medication-induced mental health problems
Special populations in geriatric psychiatry
LTC residents
Older adults visiting the emergency department (ED)
Older prisoners
Caregivers
Oldest old
Hospitalised older adults
End-of-life and palliative care
Rational deprescribing
Electroconvulsive therapy
Transcranial magnetic stimulation therapy (TMS)
Psychotherapy and other psychosocial interventions
ATMAN approach to managing chronic non-cancer pain
Requests for physician-assisted dying
Spirituality and mental health
Prevention in geriatric psychiatry
Best-practice models for geriatric psychiatry services
Geriatric psychiatry in primary care offices
Geriatric emergency department and psychiatric emergencies
References
Chapter 73 Organisation of services in geriatric psychiatry
Introduction
The ageism saga continues
Developments in the UK 2000-2019
Moving on from the National Service Framework for Older People
A brief overview of more recent developments in the UK
Wider societal changes
Race - black and minority ethnic groups
Sexual orientation and gender reassignment - LGBT+ elders
Disability - older adults with intellectual disabilities
People with enduring mental illness
Alcohol and substance misuse
People with young-onset dementia
Other marginalised groups
Services
Primary care
Secondary care
Bed-based care, hospital-based facilities, and acute in-patient beds
Interface services
Patient and carer involvement
References
Chapter 74 The older patient with Down syndrome
Introduction
Genes and Down syndrome
The physician, and the patient with Down syndrome
Disorders associated with Down syndrome
Endocrinological
Otolaryngological conditions
Joint problems
Coeliac disease
Dermatological conditions
Cardiovascular disorders
Dental problems
Cancer
Foot problems
Gynaecological problems
Eye disorders
Alzheimer's disease
Epilepsy
Behaviour disorders
Conclusion
References
Section 8 Special Senses, Bone, and Joint Health
Chapter 75 Disorders of the vestibular system
Introduction
Vestibular anatomy
Physiology and ageing of the vestibular apparatus
Clinical aspects and diagnostic strategy
History
Character of dizziness
Time course
Associated symptoms
Examination
Otological examination
Vestibulo-ocular examination
Vestibulospinal assessment
Peripheral vestibular disorders
Vestibular neuritis (acute peripheral vestibulopathy)
Ramsay-Hunt syndrome (see Chapter 102)
Bacterial infection
Neoplasia
Vascular disorders
Trauma
Unilateral auditory and vestibular failure
Benign paroxysmal positional vertigo (BPPV)
Menière's disease
Iatrogenic vestibular dysfunction
Central vestibular disorders
Cerebrovascular disease
Vertebrobasilar artery ischaemia
Completed strokes (see Chapter 47)
Cervical vertigo
Neoplasia
Infection
Neurological conditions
Management
References
Chapter 76 Smell and taste
Introduction
Olfaction
Terminology
Anatomy of the olfactory system
Age-related changes in olfactory function
Olfactory dysfunction and mortality
Evaluating olfactory function in the clinical setting
Odour threshold tests
Odour identification tests
Prevalence of smell impairments
Causes of smell dysfunction in the elderly, and clinical diagnosis
Nasal/paranasal sinus disease
Prior upper respiratory infections
COVID-19 infection
Head trauma
Neurodegenerative diseases
Other causes of olfactory loss
Taste
Terminology
Anatomy of the gustatory system
Age-related changes in gustatory function
Clinical testing of gustatory function
Prevalence of taste dysfunction
Causes of taste dysfunction in the elderly
Evaluating and managing elderly patients with taste disorders
Treatment of gustatory dysfunction
References
Chapter 77 Osteoporosis: burden, diagnosis, and management
Introduction
Global epidemiology of fragility fractures and regional disparities
Burden of osteoporosis
The osteoporosis treatment gap
Intervention and assessment thresholds29,30
Management
Conclusion
References
Chapter 78 Gait, balance, and falls
Introduction
Balance
Gait
Age-related changes
Falls
Epidemiology
Risk factors
Evaluation strategies
Prevention strategies
Appendix 78.1 Short Physical Performance Battery
Short Physical Performance Battery
Appendix 78.2 Tinetti Assessment Tool
Tinetti Assessment Tool
References
Chapter 79 Hip fracture and orthogeriatrics
Background
Diagnosis and classification
Preoperative care
Minimizing surgical delay
Analgesia
Preoperative traction
Electrolyte balance and blood transfusion
Thromboembolic prophylaxis
Prevention of pressure ulcers
Fracture repair and perioperative care
Surgical management
Conservative or operative treatment
Operative treatment
Type of anaesthesia
Postoperative care
Surgical complications
Secondary fracture prevention
Falls risk assessment and intervention
Hip protectors
Osteoporosis assessment and treatment
Fracture liaison service
Orthogeriatric collaboration and orthogeriatric models
References
Chapter 80 Foot problems
Introduction
Epidemiology of foot problems in older people
Prevalence
Risk factors
Impact of foot problems on individuals andthe healthcare system
Clinical assessment of foot problems
History taking
Physical examination
Management of foot problems in older people
Routine foot care and maintaining foot hygiene
Common foot disorders in older people and their management
The role of footwear
Conclusion
References
Section 9 Endocrine and Metabolic Disorders
Chapter 81 Endocrinology of ageing
Introduction
The modern field of endocrinology
Regulation of hormonal action
The principle of negative feedback
Hormonal rhythm and pulsatility
General changes in regulation and action of major hormones of metabolism, reproduction, and growth with age
General changes seen in the hypothalamus-pituitary-end organ axis with age
General changes in responsiveness to hormones with age
General changes in total circulating content hormones with age
Effects of ageing and related diseases on endocrine function
Effects of common endocrine diseases on ageing
Thyroid disease
Insulin resistance - obesity and metabolic syndrome
The hormonal fountain of youth
Oestrogen
Testosterone
Dehydroepiandrosterone (DHEA)
Pregnenolone
Growth hormone (GH) and insulin-like growth factor 1 (IGF-1)
Ghrelin
Thyroid
Vitamin D
Melatonin
References
Chapter 82 The pituitary gland
Introduction
Anatomy
Blood supply
Anterior pituitary disorders - clinical manifestations
Anterior pituitary disorders - treatment
Nonfunctioning pituitary tumours
Prolactinomas
Cushing's disease
Acromegaly
Thyrotropin (TSH)-secreting tumours
Gamma-knife radiosurgery
Empty sella turcica
Anterior pituitary hormone secretion - functional changes with age
Gonadotropins (LH and FSH)
Prolactin (PRL)
Growth hormone
Posterior pituitary gland
References
Chapter 83 Thyroid disorders
Introduction
Age-related modifications in thyroid function
Prevalence of thyroid disease in older populations
Hypothyroidism
Subclinical hypothyroidism
Hyperthyroidism
Subclinical hyperthyroidism
Nonthyroidal illness (NTI)
Thyroid nodules and nodular goitre
Conclusion
References
Chapter 84 Ovarian function and menopause
Introduction
The biological basis of menopause
Subclinical phase
Perimenopause/menopausal transition
Postmenopause
The Staging of Reproductive Aging Workshop (STRAW)
The impact of menopause
Menopausal symptoms
Impact on body systems and risk for disease
Osteoporosis
Sarcopenia and dynapenia
Metabolic syndrome and cardiovascular disease
Cognition
Management of menopause
Hormone therapy
Health benefits of HT
Oestrogen and progestogens: compounds and combinations
Dose and route of administration
Other forms of hormonal treatment
Complementary and alternative medicine
Lifestyle
References
Chapter 85 Testicular function
Introduction
Decline in serum T with ageing
Decline in spermatogenesis with ageing
Diagnosis of hypogonadism in elderly men
Laboratory diagnosis
Treatment of late-onset hypogonadism
Intramuscular injection
Subcutaneous injection
Transdermal systems
Oral and buccal agents
Subdermal implants
Intranasal T
Benefits of T replacement therapy
Effect of T therapy on symptoms
Risks of T therapy
Other side effects of T therapy
Cardiovascular events and T therapy
Conclusion and recommendations
References
Chapter 86 Diabetes mellitus
Introduction
Epidemiology, pathogenesis, and modes of presentation
Modes of presentation
Impact of diabetes mellitus
Diabetic foot disease
Sexual function
Metabolic comas
Diabetes-related disability, cognitive dysfunction, and depression
Cognitive dysfunction
Type 2 diabetes mellitus and depression
Importance of functional evaluation
Importance of detecting frailty
Treatment and care issues: learning from the literature
Glucose regulation
Blood pressure regulation and lipid lowering
Inpatient diabetes care
Hypoglycaemia
Special features A: frailty and management in hospital inpatients with diabetes
Special features B: type 1 diabetes
Special features C: cardiovascular safety of glucose-lowering agents
Special features D: deintensification of treatment
Special features E: care home diabetes
Prevalence of diabetes mellitus in care homes
Intervention studies in care homes
Rationale for early detection of diabetes mellitus in care homes
Diabetes care home provision - recommendation to improve safety and care
Prevention
Impact of Covid-19 on residents with diabetes in care homes
Conclusion
Appendix 86.1: A scheme for treating older adults with type 2 diabetes using a three-step approach
Note on insulin therapy in older adults
Appendix 86.2: Individualised metabolic targets according to major international guidelines
Appendix 86.3
Appendix 86.4: End-of-life diabetes care
References
Chapter 87 New therapies for diabetes mellitus
Introduction
Lifestyle intervention
Currently approved antiglycaemic therapies
Basal insulin
Bolus insulin
Developing antiglycaemic classes and their characteristics
Gut microbiota: a new potential target for the treatment of type 2 diabetes
Conclusion
References
Section 10 Urogenital Disorders
Chapter 88 Gynaecology and the older patient
Introduction
Effect of ageing on the genital tract
Vulva and vagina
Cervix and uterus
Ovaries and fallopian tubes
Pelvic floor
Urethra and bladder
Postmenopausal bleeding
Diagnosis
Investigation
Pelvic ultrasound scan
Treatment
Discharge per vagina
Uterovaginal prolapse
Symptoms
Classification
Assessment
Management
Conservative management
Surgical treatment
Urinary incontinence
Causes of urinary incontinence
Management
Surgical management of female urinary incontinence
Effect of chronic illness and surgery on sexuality
Management
Medical management
Psychological therapy
Vulval disorders
Lichen sclerosus (LS)
Squamous cell hyperplasia
Other dermatoses
Vulvodynia (vulval pain)
Hormonal changes with ageing and menopause
Menopause
HRT in the geriatric population
Menopausal symptoms
Nonhormonal treatment
Genitourinary syndrome of menopause (GSM)
Osteoporosis
Extended use of HRT after 65
Major risks of hormone therapy
Gynaecological cancer
Cervical cancer
Endometrial cancer
Ovarian cancer
Vulval cancer
HIV in old age
Conclusion
References
Chapter 89 Prostate diseases
Introduction
Benign prostatic hyperplasia
Epidemiology
Treatment30
Watchful waiting
Medical treatment
Minimally invasive treatment
Surgery
Prostate cancer
Epidemiology
Diagnosis and screening
Evaluation of health status of aged patients with prostate cancer
Management of localised prostate cancer
Low-risk patients
Intermediate-risk patients
High-risk patients
Treatment modalities for localised prostate cancer in the elderly
Management of advanced and metastatic prostate cancer
Castration-refractory prostate cancer
Side effects of androgen suppressive hormones59-61
Comprehensive care
Prostatitis
Definition
Acute prostatitis or male urinary tract infection
Chronic bacterial prostatitis
Chronic prostatitis/chronic pelvic pain syndrome
References
Chapter 90 The ageing bladder
Introduction
Anatomy of the ageing bladder
Bladder physiology and correlation to the anatomy of the ageing bladder
Special disease states
Parkinson's disease
Cerebrovascular accidents (CVAs)
Nocturia
Dementias
Pharmacology as it relates to the ageing bladder
Receptors
Adrenergic stimulation/blockade
Antimuscarinics
5-alpha reductase inhibitors
Surgical disease of the ageing bladder
Female stress urinary incontinence
Pelvic floor conditioning
Pharmacological management
Injection therapy
Operative therapy
Benign prostatic hyperplasia (BPH) in older males
Medical therapy
Minimally invasive therapy
Transurethral resection of the prostate gland (TURP)
Minimally invasive therapy for overactive bladder
Conclusion
References
Chapter 91 Geriatric nephrology
Introduction
Normal ageing: glomerular level
Decrease in glomerular filtration (senile glomerulosclerosis)
Estimating glomerular filtration
Consequences of senile hypofiltration
Diseases: at the glomerular level
Glomerulonephritis
Normal ageing: renovascular level
Senile renal vascular changes
Consequences of senile vascular changes
Diseases: reno-vascular level
Renal vasculitis in older adults
Normal ageing: tubular-interstitial level
Senile tubular-interstitial changes
Consequences of tubular-interstitial changes
Tubular dysfunction
Medulla hypotonicity: water handling
Tubular frailty
Diseases: tubular-interstitial level
Interstitial nephritis
Urinary tract infection (pyelonephritis)
Obstructive uropathy
Acute kidney injury (AKI)
Chronic kidney disease (CKD)
Dialysis
Transplantation
Renal pharmacology
References
Section 11 Cancer
Chapter 92 Cancer and ageing
Introduction
Epidemiology and disparities
Ageing and tumour development
Cancer prevention
Cancer screening
Cancer treatment
Decision-making
Surgery
Radiation
Systemic therapy
Conventional chemotherapy
Hormonal therapy
Biological agents
Targeted therapy
Supportive care
Multidisciplinary care models
Survivorship
Conclusion
References
Chapter 93 Oncological emergencies
Introduction
Haematological emergencies
Febrile neutropenia
Thrombocytopenia
Disseminated intravascular coagulation
Hyperviscosity syndrome
Metabolic emergencies
Hypercalcaemia
Hyponatraemia
Tumour lysis syndrome
Cardiovascular emergencies
Superior vena cava syndrome
Cardiac tamponade
Venous thromboembolic complications
Volume depletion
Neurological emergencies
Brain metastases and increased intracranial pressure
Spinal cord compression
Delirium
Structural emergencies
Airway obstruction
Bowel obstruction
Urinary obstruction
Pathological fractures
Acute pain emergencies
The role of geriatric evaluation in the prediction of oncological emergencies
Conclusion
References
Chapter 94 Breast cancer
The presentation
Stage of presentation
Variation in care and undertreatment in the elderly
Screening in the elderly
Risk factors in the elderly
Natural history of breast cancer in the elderly
Treatment of operable disease
Role of radiotherapy
Adjuvant endocrine therapy
Chemotherapy
Adjuvant bisphosphonates
Neoadjuvant therapy
Treatment of advanced disease
Prognostic factors in elderly breast cancer
Quality of life issues
Conclusion
Guidelines for therapy
References
Chapter 95 Maintaining functional status among older adult cancer patients and survivors
Introduction
A role for geriatricians in cancer care
Use structured methods to establish decisional capacity prior to treatment
Geriatric management during cancer treatment
Transitions of care and the older patient
Supportive management during cancer treatment is just good geriatric care
Follow AGS guidelines to treat pain in the elderly cancer patient
Treat fatigue in elderly cancer patients to limit functional decline
Anticipate anorexia, recognize cachexia, and support nutrition
Anticipate and prevent nausea and vomiting
Exercise
Exercise maintains function. How good is it for older cancer patients and survivors?
How cancer affects exercise tolerance
Choosing appropriate exercise along the trajectory of disease
Exercise and radiation toxicity
Exercise and chemotherapy toxicity
Breast and prostate cancer survivors experience accelerated ageing
Exercise and subjective quality of life
Conclusion
References
Section 12 Functional Disorders and Rehabilitation
Chapter 96 Multidimensional geriatric assessment
Introduction
Definition
Rationale
Brief history of geriatric assessment
Components of geriatric assessment
Settings of geriatric assessment
Assessment in the office practice setting
Preventive home visits
Inpatient geriatric assessment
Hospital-home assessment programmes
Geriatric assessment in the care of older cancer patients
Geriatric assessment in the care of nursing home patients
Effectiveness of geriatric assessment programmes
The pioneering studies of geriatric assessment
Evidence from controlled studies
Meta-analytic data
Conclusion
References
Chapter 97 Frailty
Introduction
Pathophysiology of frailty
Disease
Decreased food intake
Sarcopenia
Conclusion
References
Chapter 98 Rehabilitation
Introduction
Terminology and classifications
Determinants of activity and participation restrictions
Psychological aspects of rehabilitation
Principles of rehabilitation
The rehabilitation process
The rehabilitation setting
Emerging technologies and rehabilitation
Development of devices
Rehabilitation at home
Specific rehabilitation problems
Cardiac rehabilitation
Pulmonary rehabilitation
Musculoskeletal disorders
The elderly amputee patient
Neurological rehabilitation
Future challenges
References
Chapter 99 Cachexia
Introduction
Consequences of cachexia
Pathophysiology of cachexia
Anorexia
Energy metabolism
Molecular mechanisms of muscle wasting in cachexia
Treatment of cachexia
References
Chapter 100 WHO Integrated Care for Older People (ICOPE)
Introduction
ICOPE steps
ICOPE implementation
Expected outcome moving forward
References
Section 13 Iatrogenic Infections
Chapter 101 Valvular heart disease and infective endocarditis
Introduction
Epidemiology and prevalence of valvular heart disease in the ageing population
Aetiology of valvular heart disease
Aortic stenosis
Aortic regurgitation
Mitral stenosis
History and physical exam
Investigations
Electrocardiogram (ECG)
Chest X-ray
Echocardiography
Cardiac catheterisation
Cardiac magnetic resonance
Cardiac computed tomography
Aortic stenosis
Symptoms and signs
Investigations
Indications for surgical or interventional treatment
Treatment
Aortic regurgitation
Symptoms and signs
Investigations
Prognosis and treatment
Mitral stenosis
Symptoms and signs
Investigations
Prognosis and treatment
Mitral regurgitation
Aetiology
Symptoms and signs
Investigations
Prognosis and treatment
Interventions
Tricuspid regurgitation
Aetiology
Symptoms and signs
Investigations
Interventions
Tricuspid stenosis and pulmonic valve disease
Mixed valve disease
Aortic stenosis with mitral regurgitation
Aortic regurgitation with mitral regurgitation
Severe mitral or aortic disease with tricuspid regurgitation
Management of patients following valve interventions
Antithrombotic therapy
Prophylactic antibiotic use
Routine imaging of prosthetic valves
Prosthetic valve complications
Infective endocarditis
Epidemiology
Diagnosis
Treatment
Antibiotic prophylaxis for endocarditis
Conclusion
Chapter 102 Infections of the central nervous system
Introduction
Meningitis
Community-acquired meningitis
Viral meningitis
Bacterial meningitis
Healthcare-associated ventriculitis and meningitis
Diagnosis of HCAVM
Management of HCAVM
Prognosis and prevention of HCAVM
Tuberculous meningitis
Spirochetal meningitis
Fungal meningitis
Focal central nervous system infections
Brain abscess
Subdural empyema
Epidural abscess
Encephalitis
Herpes simplex virus
Varicella zoster virus
West Nile virus
Postpolio syndrome
Creutzfeldt-Jakob disease
References
Section 14 Special Issues
Section I Abuse and Older People
Chapter 103 Good quality care: abuse
Ageism
Psychological control
Abuse
Good treatment
Laws and regulation
Ethics
Deontology
Prevention
Inclusive society
Conclusion
Bibliography
Chapter 104 Alcohol consumption and cognition
Evidence from studies
Prospective evidence
Alcohol consumption and Alzheimer's disease
What is the cognitive and brain atrophy pattern in heavy drinkers?
Impact on cognitive performance
Impact on brain atrophy
Conclusion
References
Chapter 105 The use and abuse of prescribed medicines
Introduction
Use and harmful use
Pharmacology
Prevalence and correlates
Benzodiazepines
Prevalence of benzodiazepine use
Psychiatric morbidity
Gender and age
Illicit drug misuse
Aetiology
Polysubstance misuse
Detection
Detection of benzodiazepine use
Treatment
Initiating treatment
Psychological interventions
Prognosis
Conclusion
References
Chapter 106 Drug misuse and the older person: a contradiction in terms?:
Introduction
Medications and the older people: geriatric specificities, adverse drug reactions, and drug misuse
Medications and the older people: geriatric specificities
Medications and the elderly: iatrogenic consequences
Medications and older people: drug misuse or suboptimal prescribing
Prevention of iatrogenic incidents in practice: general rules for individual prescription
Prevention of iatrogenic incidents in practice: tools for collective evaluation
References
Section II Emerging Themes
Chapter 107 Transportation, driving, and older adults
Introduction
Illness and transportation
What do we need to know to assess our older patients?
Taking a driving/transportation history
What factors are important in driving assessment?
What driving risks are associated with common diseases of later life?
What interventions can we make?
What is the physician's responsibility with regard to driver licensing and insurance authorities?
Conclusion
References
Chapter 108 Smart Homes
Introduction
Definition of a Smart Home
Healthcare-enabled Smart Homes
Ubiquitous Homes
The elderly as technology users
Example: healthcare-enabled Smart Home for an aged resident
Challenges
Conclusions
References
Chapter 109 Modern use of biomarkers in geriatric medicine
Introduction
Comprehensive geriatric assessment
Dementia
Frailty
Biomarkers related to inflammatory response
Biomarkers related to metabolism
Biomarkers related to the endocrine system
Biomarkers related to the immune system
Other commonly measured biomarkers
Experimental biomarkers
Sarcopenia
Imaging markers for muscle mass
Circulating markers of muscle mass and strength
Growth factors
Markers of nutritional status
Genetic markers
Intrinsic capacity
Concluding remarks
References
Section III Dermatology
Chapter 110 Geriatric dermatology
Introduction
Inflammatory dermatoses
Asteatotic eczema
Seborrheic dermatitis
Stasis dermatitis
Bullous pemphigoid
Neurodermatitis
Infectious dermatoses
Bacterial
Fungal
Viral
Neoplastic dermatology
Benign
Malignant
Conclusion
References
Chapter 111 Pressure injuries: prevention and management
Clinical staging of pressure injuries
Measuring pressure injury healing
Risk factors
Risk assessment
Prevention of pressure injuries
Support surfaces
Nutrition
Moisturizing skin
Avoidability
Treatment of pressure injuries
Support surfaces
Nutrition
Local wound care
Adjunctive therapies
Diagnosing infection in chronic wounds
Accuracy of symptoms and signs for infection of chronic wounds
Non-healable pressure injuries and skin failure
References
Section IV Surgical Themes
Chapter 112 Perioperative medical assessment of older adults
Shifting demographics create more need
Physiology of ageing and frailty
Age-related changes in the cardiovascular system
Age-related changes in the pulmonary system
Age-related changes in the renal system
Age-related changes in the neurological system
Essentials of preoperative assessment
How to screen
Framework for organizing complexities
Mobility
Medications
Mind
Multicomplexity
What matters most
Postoperative management
Care after the hospital
Conclusion
References
Chapter 113 Anaesthesia
Introduction
Outcome of surgery and anaesthesia in the elderly
Cardiovascular morbidity associated with surgery and anaesthesia
Respiratory morbidity associated with surgery and anaesthesia
Central nervous system morbidity associated with surgery and anaesthesia
Postoperative confusion
Postoperative stroke
Renal morbidity associated with surgery and anaesthesia
Perioperative hypothermia
Preoperative assessment
Pain assessment and management in the elderly
Pain assessment
Pharmacological management of pain
The role of regional analgesia
The role of patient-controlled analgesia (PCA) in the elderly
Ethical considerations for perioperative care of the elderly
Strategy to reduce postoperative morbidity and mortality in the elderly
Preoperative nutritional supplementation
Prevention of perioperative decubitus ulcers
The role of day case admissions
Safe sedation of older patients
Choice of surgical approach
Early access to critical care
Perioperative audit
Conclusion
References
Section V Ageing Themes and Ethical Issues
Chapter 114 Health issues in the ageing woman
Cancer
Endometrial cancer
Ovarian cancer
Breast cancer
Cervical cancer
Vulvar cancer
Vaginal cancer
Menopause
Diagnosis
Genitourinary syndrome of menopause (GSM)
Postmenopausal vaginal bleeding
Sexual dysfunction in menopausal women
Acknowledgements
References
Chapter 115 Antiageing strategies
Introduction
The demographic revolution
What is antiageing medicine?
Can death be delayed?
Can the course of disability and functional dependence be reversed?
Can disability and functional dependence be delayed?
Mechanisms and evidence from biogerontological research
Caloric restriction (CR)
Epigenetics
Microbiota
Stem cells and ageing
Senolytics
Translation of results into humans
The hormonal fountain of youth
Preventive gerontology
Exercise
Diet
Antioxidants
Lifestyle
Ethical issues
Conclusion
References
Chapter 116 The ethics of geriatric care
Introduction
Ageism and geriatric care
Ethics and the geriatric patient
Longevity, healthspan, and health promotion
Conclusion
References
Chapter 117 Participation of older people in clinical trials
Introduction
The need for clinical trials involving older people
Why are older people excluded from clinical trials?
Consequences of the exclusion of older adults from clinical trials
Temporal trends in the inclusion of older people in clinical trials
Clinical trials reported in the literature
Clinical trials recorded in an online registry
Determinants of participation of older people in clinical trials
Patient factors
Physician factors
Environmental/logistical factors
Facilitating the access of older people to clinical trials
Strategies tested in randomised controlled trials
Other proposed strategies
Conclusion
References
Chapter 118 Restraints and immobility
Introduction
Immobility
Physical restraints
Siderails
Risk factors and justification
Complications
Outcomes of restrictive device reduction
Approaches to reduce restrictive device usage
Promote mobility
Facilitate observation
Offer activities
Maintain continence
Promote comfort
Investigate mental status changes
Address fall risk
Reduce injury risk
Address treatment interference
Advanced practice nursing interventions
Staff education programmes
Conclusion
References
Chapter 119 Centenarians
Demography of centenarians: past, present, and forecasts
Sex differences and the paradox of centenarians
An optimistic view
Compression of morbidity versus disability
Heredity (nature) versus environment (nurture)
Omics technologies in centenarian studies
Conclusion
References
Section VI End-of-life Care
Chapter 120 End-of-life and palliative care
Introduction to palliative care
Hospice care
Communication
Prognostication
Symptom assessment and treatment
Pain
Dyspnoea and respiratory symptoms
Nausea and vomiting
Constipation
Bowel obstruction
Agitation and delirium
Fatigue
Psychosocial and spiritual domains
Cross-cultural issues
Care transitions in end-of-life care
References
Chapter 121 End-of-life care: special issues
Introduction
The benefits of a palliative approach
When to involve SPCTs
Withholding and withdrawing treatment
Cardiopulmonary resuscitation (CPR)
Artificial nutrition and hydration
Care planning
Autonomy
Advance care planning
Planning for future care
End-of-life and terminal care
Terminal sedation
Assisted dying
Bereavement
Conclusion
References
Part 3 Global Healthcare Systems
Chapter 122 Improving quality of care
Introduction
The history of quality
The history of quality in business
The evolution of quality in healthcare
Organisations leading healthcare quality improvement
Quality improvement in geriatrics
Quality indicators
Geriatric medicine organisations focus on quality
Healthcare financing drives quality
Integrated care and population health
Healthcare accreditation
Quality in geriatrics hospital care
Quality in the community setting
Health outcomes research
Clinical practice guidelines
Healthcare audits as a QAPI process
Future initiatives in healthcare quality
Conclusion
Appendix 122.1: Healthcare quality organisations
References
Chapter 123 Clinical audit of healthcare
Introduction
History of clinical audits
Clinical audit versus quality improvement
Local versus national audit
Why do a clinical audit?
Designing and completing an audit
Planning
Determining audit criteria
Determining standards
Defining terms
Sampling
Consent and confidentiality
Piloting
Data analysis
Identifying the cause of problems
Disseminating results and creating change
Re-auditing and sustaining improvement
Audit as a driver for change
Big data
Patient and user input: codesign
Audits in relation to older people
Conclusion
References
Chapter 124 Caring for the caregiver
Impact of caregiving on the caregiver and the family
Distinctions between paid and unpaid caregivers
Aspects of caregiving
Mental health
Physical health
Financial well-being
Social support
Spiritual well-being
Assessments for caregivers
Strategies for coping and improved well-being
Psychoeducation
Mindfulness
Support groups
Cultural diversity in caregiving
Topics to address with caregivers
Roles of healthcare providers in assisting caregivers
Discussion
References
Chapter 125 Nursing home care
Introduction
Societal role and governance of nursing homes
Spending
Regulation
Facility demographics
Medical care provided, providers, and care models
Resident demographics
Quality
Intersection between nursing homes and the law
End-of-life care in nursing homes
Challenges of research and cross-country comparisons
Gaps, best practices, and innovations
Discussion - future directions
References
Chapter 126 Geriatric occupational therapy: achieving quality in daily living
Overview
Humans are occupational beings
Conceptual foundations of geriatric occupational therapy
Person-Environment-Occupation-Performance/Participation model
Person (intrinsic factors)
Environment (extrinsic factors)
Occupation (activity)
Participation
Scope of occupational therapy services
Occupational therapy process
Assessment and intervention
Occupational profile
Occupational performance assessment
Intervention
Development of the intervention plan
Intervention implementation via client-centred care
Use of occupation to enhance QOL health promotion
End of life
Community-level instruction and patient/client education
Remediation strategies for functional decline
Physical environment adaptations
Technological aids and devices
Intervention review
Outcomes (engagement in activity to support participation)
Case examples
Conclusion
References
Chapter 127 Geriatric medicine education in Europe and the United States
Introduction
Geriatric education in Europe
Undergraduate geriatric medicine education in Europe
Geriatric medicine teaching at the postgraduate level
Initiatives for improving undergraduate and postgraduate geriatric education in Europe
Geriatrics education in the United States of America
Undergraduate geriatrics education in the United States
Postgraduate geriatric education in US
Geriatrics education in other health professions education
Initiatives for geriatric education
Conclusion
References
Chapter 128 Systems of healthcare: the United States
Introduction
Overview of healthcare demographics
Development of geriatric medicine
Home healthcare
Post-acute and long-term care
Assisted living
Hospital care
Geriatric emergency departments (GEDs)
Acute care for the elderly (ACE) units
Stroke centres
Academic geriatrics
Conclusion
References
Chapter 129 Systems of healthcare: Australia
Overview of healthcare demographics
Healthcare services in Australia
Home healthcare
Nursing home care
Hospital care
Academic geriatric medicine
Conclusion
References
Chapter 130 Systems of healthcare: the UK
Introduction
Overview of healthcare demographics
Development of geriatric medicine
Home healthcare
Care homes
Hospital care
Academic geriatrics and geriatric training
References
Chapter 131 Geriatric medicine in China
Introduction
Service provision
Training
Research
Conclusion
References
Chapter 132 Ageing in developing countries
Introduction
Demography
Heterogeneity in the ageing population in LAMICS
Socioeconomic differences in adult mortality and health status
Ageing and health
Evolution of life expectancy
Evolution of healthy life expectancy
Dementia and cognitive impairment
Multimorbidity
Frailty
Healthcare and geriatric medicine
References
Chapter 133 Geriatric medicine in the European Union: towards unification of diversity
Introduction
Demography: an ageing society
Epidemiology: health and function
Organisation of the European Union
Healthcare systems in Europe
Geriatric medicine across Europe
Geriatric organisations in Europe
Recent developments in EU policy
References
Chapter 134 Research horizons for the twenty-first century
Introduction
Ageing research models
Cell cultures
Animal models
Research in humans
Basic research
Clinical and epidemiological research
Cohort studies
Clinical trials
Setting priorities for research on ageing
Conclusions
References
Appendix Function assessment scales
Dental
Hallpike Manoeuvre
Osler Manoeuvre for pseudohypertension
The Mini-Nutritional Assessment (MNA) Scale
The Confusion Assessment Method (CAM) diagnostic algorithm
Index
EULA

List of Contributors

Araceli Abad
Department of Pulmonary and Sleep Medicine, University Hospital of Getafe, Madrid, Spain

Jorge Abril-Pérez
Service of Obstetrics and Gynecology, Hospital Clínico Universitario-INCLIVA, Valencia, Spain

Carmen Acosta
Department of Pulmonary and Sleep Medicine, University Hospital of Getafe, Madrid, Spain

Charlotte Ågrup
University College of London Hospitals NHS Trust and University College London, London, UK

Awais Ahmed
Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA

Guillaume Albaret
Department of Geriatrics, Le Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France

Stewart G. Albert
Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Missouri, USA

Christian Johannes Amlang
Yale Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA

Richard Anderson
Cardiff and Vale University Health Board; Department of Cardiology, University Hospital of Wales, Cardiff, UK

Sandrine Andrieu
Center for Epidemiology and Research in Population health (CERPOP), University of Toulouse, INSERM UMR1295, UPS, Toulouse, France; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France

Javier Angulo
Servicio de Histología-Investigación, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain

Jean-Pierre Aquino
French Society of Geriatrics and Gerontology, Paris, France

Almudena Areosa Sastre
Department of Geriatrics, Hospital Universitario de Getafe, Madrid, Spain

Nandkishor V. Athavale
Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, UK

Laurent Balardy
Gerontopole, Toulouse University Hospital, Toulouse, France

Connie W. Bales
Geriatric Research, Education and Clinical Center, Durham VA Medical Center, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA

Mario Barbagallo
Geriatric Unit, University of Palermo, Palermo, Italy

Michelangela Barbieri
Department of Advances Medical and Surgical Sciences, University of Campania, L. Vanvitelli, Italy

Andrea Bellieni
Fondazione Policlinico Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

Joël Belmin
Groupe Hospitalier Pitié-Salpêtrière-Charles Foix and Sorbonne Université, Ivry-sur-Seine, France

Susan Mary Benbow
Centre for Ageing Studies, University of Chester, Riverside Campus, Chester, UK

Marla Berg-Weger
Saint Louis University School of Social Work, Gateway Geriatric Education Center, Saint Louis University School of Medicine, St Louis, Missouri, USA

Rachelle E. Bernacki
Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA

Chantal Bernard-Marty
Institut Claudius Regaud, Toulouse, France

Sarah D. Berry
Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA

Tyler M. Berzin
Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA

Sharmi Bhattacharyya
Centre for Ageing Studies, University of Chester, Riverside Campus, Chester, UK

Elizabeth L. Bisbee
Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA

Alessandro Blasimme
Department of Health Sciences & Technology, ETH, Zurich, Zurich, Switzerland

Ben Blomberg
Division of Geriatric Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC

Danielle L. Boisvert
Medical Family Therapy Program, Saint Louis University School of Medicine, St Louis, Missouri, USA

Isabelle Bourdel-Marchasson
CHU Bordeaux, Pôle de gérontologie, Université Bordeaux/CNRS, Bordeaux, France

Ray Bourey
Division of Endocrinology, Diabetes, and Metabolism, Saint Louis University, St Louis, Missouri, USA

Cristina Alonso Bouzón
Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, (Madrid), Spain

Gene L. Bowman
Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon, USA; NIA-Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA

Delphine Bréchemier
Gérontopôle, Toulouse University Hospital, Toulouse, France

Marguerite Briand
Gérontopôle, CHU Toulouse, Toulouse, France

Martin M. Brown
Queen Square UCL Institute of Neurology, University College London, London, UK

Olivier Bruyere
Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium; WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Ageing, Liège, Belgium

Lyndal Bugeja
Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia

Gwendolen T. Buhr
Duke University Medical Center, Department of Medicine, Division of Geriatric Medicine, Durham, North Carolina, USA

Alessandra Bura-Riviere
Vascular Medicine Department, Toulouse University Hospital, Toulouse, France; UMR 1031 INSERM, StromaLab, Université Paul Sabatier, Toulouse, France

Riccardo Calvani
Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden

A. John Camm
University of Oxford, Oxford, UK; St George's, University of London, London, UK

C. Fielder Camm
University of Oxford, Oxford, UK; St George's, University of London, London, UK

Marco Canevelli
Department of Human Neuroscience, Sapienza University, Rome, Italy; National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy

Antonio Cano
Service of Obstetrics and Gynecology, Hospital Clínico Universitario-INCLIVA, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain

Elizabeth A. Capezuti
Hunter College School of Nursing, New York, New York, USA

Gideon A. Caplan
Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, AustraliaPrince of Wales Clinical School, University of New South Wales, Sydney, Australia

David Carr
Medicine and Neurology, Washington University School of Medicine, St Louis, Missouri, USA

Vittoria Cataldo
Department of Advances Medical and Surgical Sciences, University of Campania, L. Vanvitelli, Italy

Hannah Chapman
The Christie NHS Foundation Trust, Manchester, UK

Ian M. Chapman
University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia

Edward Cheong
Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia

Antonio Cherubini
Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento. IRCCS INRCA, Ancona, Italy

Pascal Cintas
Department of Neurology, University Hospital, Toulouse, France

Elspeth A. Clark
Duke University Medical Center, Department of Medicine, Division of Geriatric Medicine, Durham, North Carolina, USA

Nicola Coley
Center for Epidemiology and Research in Population health (CERPOP), University of Toulouse, INSERM UMR1295, UPS, Toulouse, France; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France

Coilin Collins-Smyth
Department of Renal Medicine, St Vincent's University Hospital, Dublin, Ireland

Giuseppe Colloca
Fondazione Policlinico Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

Simon Conroy
Department of Health Sciences, University of Leicester, Leicester, UK

Joanne Conway
Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, UK

Matthew T. Corey
Harvard Medical School, Boston, Massachusetts, USA; Geriatric Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, USA

Suzanne Crowe
Department of Paediatrics, Our Lady's Children's Hospital, Dublin, Ireland

Alfonso J. Cruz-Jentoft
Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain

Vito Curiale
Centre Hospitalier Princesse Grace, Centre Rainier III, Principality of Monaco

Jean-François...

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