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71 results in Reichel's Care of the Elderly

Page 1 of 4

  • Chapter 56 - Caregiving

  • from Section IV - Principles of care for the elderly
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 749-755

  • Summary

    Family members have long provided physical, emotional, and financial assistance to relatives in need of support because of frailty, dementia, disability, and other conditions common in late life. As our country faces an enormous increase in the number of older Americans, the role of family caregivers will become increasingly important. Health care professionals, especially primary care physicians, should identify people in the caregiving role and screen for caregiving stress or burden. It is likewise important to screen for health effects including depression, anxiety, and substance abuse. Informal caregivers—friends and family members—often care for chronically ill older adults, including those who have a diagnosis of dementia. Caregiver stress can cause health issues for caregivers; clinicians are encouraged to use available tools to screen for stress and to link caregivers to local and online resources.

  • Chapter 27 - Urinary incontinence and fecal incontinence

  • from Section III - Care of the elderly by organ system
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 383-397

  • Summary

    Urinary and fecal incontinence are common problems among older adults, with many not discussing symptoms with providers. Incontinence has a significant negative impact on quality of life and can contribute to caregiver strain. The evaluation of urinary and fecal incontinence should focus on potentially reversible or treatable contributing factors. Treatment often depends on the type of incontinence, and initial treatment should begin with behavioral approaches. Common behavioral treatments include dietary management, timed voiding, pelvic floor muscle exercises, and strategies to control urgency symptoms. Biofeedback should be considered for the treatment of fecal incontinence, along with other behavioral treatments. Pharmacologic treatments differ for urinary and fecal incontinence. Anti-muscarinic and beta-agonist drugs are available for the treatment of urinary incontinence. Pharmacologic treatments for fecal incontinence focus on improving stool consistency. Non-invasive office-based procedures have an important role for treating both types of incontinence.

  • Chapter 33 - Common rheumatologic diseases in the elderly

  • from Section III - Care of the elderly by organ system
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 453-461

  • Summary

    Rheumatologic disease is often encountered in the geriatric population. Osteoarthritis, rheumatoid arthritis, and crystal-induced arthritis primarily affect the joints. Osteoarthritis, or degenerative arthritis, is the most common joint disease of the elderly. The most common sites include the hands, spine, hip, knees and feet. Rheumatoid arthritis also occurs in the geriatric population. This autoimmune disorder requires early and aggressive treatment to prevent increased morbidity and mortality. Crystal-induced arthritis, mostly gout and pseudogout, has an increased incidence and prevalence in the elderly. Other rheumatologic diseases seen more commonly in the elderly include polymyalgia rheumatica, giant cell arteritis, remitting seronegative symmetrical synovitis with pitting edema, Sjogren’s syndrome, and inclusion body myositis. Polymyalgia rheumatica, an inflammatory disease primarily involving the shoulders and pelvic girdle, is only found in the elderly. Giant cell arteritis, a vasculitis of large vessels, is also only present in the geriatric population. Remitting seronegative symmetrical synovitis with pitting edema is a disease of patients older than 50 years of age.

  • Chapter 21 - Pulmonary issues in the elderly

  • from Section III - Care of the elderly by organ system
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 298-310

  • Summary

    Physiologic changes of the respiratory system occur with aging; for example, the chest wall stiffens, airway size decreases, and the diaphragm becomes less efficient. However, these changes alone should not cause significant breathing difficulties unless there is an underlying disease process. The most commonly encountered pulmonary diseases in the geriatric patient population are obstructive lung diseases, pneumonia, pulmonary embolism, interstitial lung diseases, nontuberculous mycobacterium infections, and sleep disorders. Due to their increased likelihood of comorbidities, older patients have numerous special diagnosis and treatment considerations. Practitioners should focus on utilizing the most effective therapies to optimize lung function while minimizing potential harm to the patient.

  • Chapter 25 - Renal disorders in the elderly

  • from Section III - Care of the elderly by organ system
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 357-365

  • Summary

    Kidney function changes with aging. Elderly patients with kidney disease are at increased risk for a number of disorders, including alterations in electrolytes, changes in sodium absorption, and chronic changes in kidney function. Traditional estimations of glomerular filtration rate from serum creatinine, through the use of estimating equations, may not be appropriate for the geriatric population, particularly when results suggest only mild impairment in kidney function without proteinuria or hematuria. Still, as the population ages, kidney disease prevalence grows as well. Also, acute kidney injury (AKI) commonly occurs in this patient population. Anatomic and physiologic changes appear to be contributory. Complexities associated with kidney disease in the elderly include the risks as well as benefits of polypharmacy, the timing and indications of referral for specialist care, and the appropriateness of dialysis initiation, presenting challenges for the clinician.

  • Chapter 37 - Anemia and other hematological problems in the elderly

  • from Section III - Care of the elderly by organ system
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 523-536

  • Summary

    Hematologic abnormalities occur commonly in the elderly. The prevalence of anemia appears to increase with age and may be caused by various underlying etiologies, including iron deficiency, anemia of inflammation, or myelodysplastic syndrome. Thrombocytopenia due to underlying comorbidities, medications, or immune thrombocytopenia (ITP) may also occur. Underlying hematologic malignancies such as chronic lymphocytic leukemia (CLL) and multiple myeloma also become more prevalent with age. A systematic approach to the evaluation of these hematologic abnormalities is imperative to help guide diagnosis and management. For acute or progressive conditions, a multidisciplinary team of both geriatricians and hematologists is essential to ensure proper diagnosis, frailty assessment, and initiation of appropriate therapies. Novel therapies for the various hematological malignancies are well tolerated, turning life-threatening illnesses into chronic disease that can be managed while preserving quality of life.

  • Chapter 36 - Pressure ulcers

  • from Section III - Care of the elderly by organ system
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 509-522

  • Summary

    Despite extensive prevention and treatment efforts for pressure ulcers, they remain prevalent in various health care delivery settings. Pressure ulcers are increasingly viewed as public health and patient safety issues, and regulatory pressure exists to prevent ulcer development. Because of the significant morbidity and mortality associated with pressure ulcers and because they are considered, for the most part, preventable, effective pressure ulcer prevention has been included in hospital safety strategies. Treatments include palliative wound care, pressure redistribution and repositioning interventions, nutritional intervention, surgery to close pressure ulcers, and pain management. An interdisciplinary team approach that includes not only interprofessional clinical staff and hospital administration, but also patients and their families, is important for achieving care that supports function, independence, and quality of life.

  • Chapter 46 - Aging in adults with intellectual disabilities and severe and persistent mental illness

  • from Section IV - Principles of care for the elderly
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 640-650

  • Summary

    Although they are distinct populations, older persons with intellectual disabilities (ID) and older persons with severe and persistent mental illness (SPMI) share a variety of characteristics that affect their clinical needs and, hence, their interactions with community-based health care practitioners. Physical comorbidity is the rule for older persons with intellectual disabilities and serious and persistent mental illnesses. Several promising evidence-based programs such as health education, health screenings, and healthy lifestyle changes through exercise and nutrition have been demonstrated to improve the quality of life of older adults with disabilities and reduce the long-term medical burden of care. Health promotion should be a cornerstone of care for older patients with disabilities. The family provides a safety net of support for older adults with disabilities, as significant numbers of older adults with ID and SPMI live with their families. Even when they live apart, family members provide high levels of support. These families face significant challenge as the caregivers themselves age, and long-term caregiving takes a toll on their health and well-being.

  • Chapter 7 - Frailty

  • from Section II - Geriatric syndromes
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 97-106

  • Summary

    Frailty is an important geriatric syndrome characterized by diminished physiologic reserves and function, and a decreased capacity to withstand stressors. More than a third of people over age 85 are estimated to be frail, and are at higher risk of adverse health outcomes, including dependency, institutionalization, and death. Although advanced age, multi-morbidity and disability are associated with frailty, there is strong evidence that frailty is a distinct entity. It is characterized by diminished strength and endurance, and impaired physiologic function in many organ systems (including musculoskeletal, neuroendocrine, and immune systems) and includes nutritional, cognitive, and psychosocial dimensions. The two main frailty constructs are a biological syndrome model and an accumulation of deficits model. Frailty is an important syndrome to guide clinical care, and several screening tools include combinations of nutritional status, physical activity, mobility, energy, strength, cognition, mood, and social relations and support.

  • Chapter 9 - Evaluation and management of dizziness

  • from Section II - Geriatric syndromes
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 116-124

  • Summary

    Dizziness is a common symptom in the elderly characterized by a distorted sense of spatial orientation. Vertigo, a related symptom, includes the illusion of self-motion. Dizziness (spatial disorientation without an illusion of self-motion) occurs when distorted input to the vestibular system is relatively symmetrical, while vertigo often occurs when the input is relatively asymmetrical. Patients may use terms such as lightheaded, woozy, off-balance, or spinning to describe dizziness or vertigo. Characterizing the experience (e.g., “What do you mean by dizziness?”) is not specific enough to identify the cause. More important is determining the timing, triggers, and associated findings of the experience. ‘Timing’ refers to the continuity and duration of symptoms, with three categories: episodic vestibular syndrome (EVS)—brief, intermittent episodes lasting seconds to hours; acute vestibular syndrome (AVS)—continuous symptoms for days to weeks; and chronic vestibular syndrome (CVS) persisting for months to years. ‘Triggers’ are actions that initiate dizziness (e.g., specific head movements, standing posture, or exercise).

  • Chapter 11 - Recognition, management, and prevention of delirium

  • from Section II - Geriatric syndromes
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 148-156

  • Summary

    Delirium is a serious neuropsychiatric condition characterized by an acute change in cognition and attention that affects a significant proportion of hospitalized older adults and is associated with significant morbidity and mortality. Prevention of delirium is an important part of the care of hospitalized older adults. The Hospital Elder Life Program is a multicomponent intervention that has been shown to reduce the incidence of delirium. As many cases of delirium are overlooked, its diagnosis is important and can be achieved using the Confusion Assessment Method, which relies on four cardinal features of delirium: acute onset, inattention, altered level of consciousness, and disorganized thinking. The etiology of delirium is often multifactorial with contributions from predisposing factors (such as sensory impairment, chronic illness, and cognitive impairment) and precipitating factors (such as infection, polypharmacy, or illness). Once diagnosed, delirium should be evaluated with a thorough history, complete physical, medication review, and targeted tests in an effort to identify these factors.

  • Chapter 41 - Dental care for the elderly patient

  • from Section III - Care of the elderly by organ system
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 587-596

  • Summary

    The establishment and long-term maintenance of comfort, function, health, and aesthetics in the oral cavity is important for nutrition, hydration, self-esteem, and survival. Recent research has shown a correlation between oral health and systemic health. The general physician has an opportunity to interview and examine patients to determine whether there is a need for an oral health professional’s services. The timeless value of an emphasis on prevention and patient and caregiver education is particularly germane to oral health. Salivary integrity, diet (processed carbohydrate discipline), oral hygiene, fluoride exposure, and periodic examination by an oral health professional are important to maintain the health of the mouth.

  • Chapter 50 - The mistreatment of older adults

  • from Section IV - Principles of care for the elderly
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book:
    Reichel's Care of the Elderly
    Published online:
    05 June 2016
    Print publication:
    23 June 2016, pp 685-690

  • Summary

    Elder mistreatment is a surprisingly common and often misunderstood phenomenon. It causes significant pain and suffering and is especially prevalent among those who have a dementing illness. Financial abuse is one of the most common types of mistreatment and often co-exists with other types (such as emotional and/or physical abuse). Sometimes the clinician is called upon to assess capacity for financial transactions. The implications and consequences of such an assessment are significant, and it is often helpful to engage a geropsychologist or neuropsychologist to assist with an accurate determination. It is critically important for the clinician to ask about abuse and to identify high-risk situations. Once abuse is suspected, the clinician must know what the reporting requirements and options are, as these vary among states. In general, suspected abuse in licensed facilities is reported to the Long-Term Care Ombudsman, and suspected abuse in community settings is reported to Adult Protective Services. Health practitioners have an opportunity to prevent and detect abuse at early stages, thus improving the quality of life for their patients and those who love them.

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