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2128 results in Geriatrics

Page 31 of 107

  • Chapter 30 - Diabetes mellitus in the older adult

  • 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 421-435

  • Summary

    Diabetes mellitus (DM) is a dominant chronic disease in the older adult population in the United States as well as in many other countries of the world. The prevalence of DM in the future is only expected to grow with the increase in the population of older adults, the prevalence of obesity, and physical inactivity. Clinicians are faced with many unique challenges when caring for this older diabetic population. The clinician’s major challenges are 1) to avoid symptoms and complications of hyper- and hypoglycemia, 2) to minimize or delay micro- and macrovascular complications, if possible, and 3) to maximize daily functioning. Underlying these challenges is the realization that the geriatric population is a heterogeneous one. Goals of care and treatment decisions may vary, depending more on the patient’s functional abilities and on other comorbidities or co-existing geriatric syndromes, and less on the chronological age of the patient. After a diagnosis of diabetes in the older adult, diabetes care requires lifestyle modifications and glycemic control strategies, in addition to prevention and management of cardiovascular, eye, and foot disease.

  • Chapter 45 - Geriatric sexuality

  • 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 630-639

  • Summary

    Sexuality is an important part of health and quality of life at all ages. Misinformation and misperceptions about sexuality and older adults are held by both patients and clinicians. Failure to adequately address sexuality and diagnose and treat sexual problems can have significant consequences, including depression, social withdrawal, and increased risk for sexually transmitted infections. The physiological changes with age alone are insufficient cause to cease sexual activity, and for some these changes are felt to enhance their sexual activity. Medical conditions and their treatments may negatively alter one’s perception of body image, create preoccupation with concern about exacerbation of symptoms, reduce exercise tolerance, and limit flexibility and positions of comfort. Patients desire informed health care providers who openly discuss sexuality and offer a variety of management approaches.

  • Chapter 4 - Prevention and screening

  • from Section I - General approach to the care of 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 46-57

  • Summary

    The need for key screening and prevention activities for older adults is evidence-based. Prevention of infectious disease and illness is often overlooked or considered irrelevant in the geriatric population and is equally as important as management of the multiple acute and chronic conditions that are encountered. Approaches to screening for chronic illness, cancer, and preventable illnesses have evolved and undergone modification over many decades of research and evaluation of outcomes. Screening of common geriatric syndromes such as depression and dementia has been recently updated.

  • Chapter 16 - Prevention, diagnosis, and management of stroke and TIA 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 233-244

  • Summary

    Stroke is the leading cause of physical and cognitive disability in the United States, with a larger burden in patients over 65. Prevention of stroke includes the understanding and identification of risk factors, symptoms, and mechanisms of stroke and TIA. Atrial fibrillation is a major contributor to stroke in the elderly. Anticoagulation can prevent stroke, but is associated with significant risks. Newer anticoagulants offer novel strategies for prevention. Antiplatelet, antihypertensive, and lipid-lowering drugs are all used for stroke prevention and risk factor modification. Following stroke, recovery can be enhanced by addressing complications such as gastrointestinal complications, venous thromboembolism, fever, depression, and urinary incontinence. Addressing the challenges associated with caregiving of the older patient with stroke, and end-of- life care and decision making, are important considerations in stroke management.

  • Chapter 52 - Integrative medicine in the care of the elderly

  • 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 702-718

  • Summary

    A large and growing percentage of older Americans use complementary and alternative medicine (CAM)—therapeutic modalities, practices, and products that either supplement or substitute for conventional approaches and that are not conventionally used or taught in mainstream Western medicine. Increasingly, conventionally trained health care providers and institutions are recognizing the value of becoming familiar with CAM philosophies, techniques, and practitioners to enhance patient communication and improve clinical practice. CAM modalities used for common conditions impact health and function in the geriatric population. These modalities are broadly grouped under the categories of mind-body therapies, manipulative/body-based therapies, biologically based therapies, and alternative healing systems, and include such practices as meditation, chiropractic, herbal medicine, acupuncture, homeopathy, and energetic healing. The selective incorporation of CAM diagnostic and healing approaches into mainstream health care—can play a role in enhancing elders’ care. Challenges face a shift to integrative health care as clinicians take steps towards integrating CAM into clinical practice.

  • Chapter 8 - Gait impairment and falls

  • 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 107-115

  • Summary

    Falls are common in the older adult population, and balance and mobility problems are important fall risk factors. Clinical conditions give rise to gait, balance, and mobility impairments. However, normal aging may also impact sensorimotor function, increasing the risk of falls as well as leading to poor recovery from slips and trips. Gait impairments, including observational and objectively measured changes, are associated with poor health outcomes. Exercise interventions can enhance gait in certain clinical groups. Furthermore, interventions including exercise can prevent falls in the general older community. The effectiveness of exercise-based fall prevention interventions in people with particular health conditions known to increase the risk of falls requires further investigation.

  • Chapter 14 - Peripheral artery disease 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 192-202

  • Summary

    Peripheral artery disease (PAD) is an atherosclerotic disease of the lower extremity arteries causing obstruction of blood flow to the legs. The prevalence of PAD increases with age, and while some patients with PAD remain asymptomatic, others develop the debilitating symptom of intermittent claudication (pain on walking), or critical limb ischemia, where the blood supply is so poor that limb viability is threatened. Other atherosclerotic diseases may coexist with PAD, particularly coronary artery disease. As these two diseases share risk factors, modifiable factors such as smoking, hypertension, dyslipidemia, and diabetes should be managed. Medical management of PAD based on the latest clinical evidence includes exercise and pharmaceutical therapy initially; however, in some cases lower extremity angioplasty (stenting or bypass surgery) may be warranted.

  • Chapter 59 - Advance care planning

  • 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 781-796

  • Summary

    Though oral decisions for end-of-life care are valid, clinicians should guide their patients towards written mechanisms, through a process of ongoing conversation that may change as preferences and goals change over the course of time. Living wills and durable powers of attorney for health care, as well as newer forms of advance directives like medical orders regarding life-sustaining treatment outside of the hospital, have ethical implications. Ethical conflicts can be associated with the use of written advance directives. Through the tools of the Values history and the family covenant, a preventive ethics approach to these challenges can be employed through using advance directives in clinical practice.

  • Chapter 19 - Clinical geropsychiatry

  • 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 274-284

  • Summary

    Psychiatric disorders in older patients can be lifelong or begin in later life. Those beginning in later life are sometimes associated with dementia, delirium, and stroke/brain vascular disease but are often idiopathic. In general, the same psychological and pharmacologic treatments that are effective in younger individuals have similarly efficacy in the elderly, but the presence of structural brain disease and comorbid physical illness are risk factors for poorer response. Antidepressants are effective therapies for major depression and often require the same doses as in the young. Antipsychotics should be used sparingly and at as low a dose as possible. Benzodiazepines should be avoided if possible.

  • Chapter 43 - Surgical care of the elderly

  • 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 607-612

  • Summary

    The geriatric population in the United States is rapidly increasing; consequently, a significant rise in the number of operations and injuries amongst the elderly is occurring. Since age is an independent risk factor for mortality, it is of utmost importance to note that the elderly have different needs in their pre-operative, intra-operative, and post-operative care than the general population. Risk assessment using tools and calculators can predict outcomes and help guide discussions regarding goals of care and code status that ought to be addressed prior to operation. Post-operatively, medical management is geared towards avoiding cardiac, pulmonary, and neurologic complications that occur at much higher rates in this population. Finally, geriatric trauma leading to emergency surgical management poses a unique challenge in that an unpredicted acute change in health occurs and is associated with increased mortality as well. Continued communication regarding expectations and predicted outcomes with the patients and their families throughout the hospital course is essential.

  • Chapter 26 - Urological issues in older adults

  • 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 366-382

  • Summary

    Urological problems are extremely common in older adults. The prevalence of many urological disorders increases with advancing age in both men and women. Estimates indicate that approximately 20% of all primary care visits include some type of urological complaint. In fact, the specialty of urology ranks third, behind only ophthalmology and cardiology, in the total annual number of outpatient clinical visits by older Medicare recipients in the United States. These trends hold steady even when stratifying for ages older than either 75 or 85 years. There is a critical need for more clinicians across all specialties focused on care of older adults, including providers skilled in the evaluation and management of many of the common urological conditions seen in the geriatric population.

  • Chapter 22 - Gastrointestinal disease 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 311-330

  • Summary

    Gastrointestinal symptoms are common in patients aged 65 and older and can range from mild, self-limited episodes of constipation or acid reflux to life-threatening episodes of infectious colitis or bowel ischemia. Geriatric-aged patients may present with unusual or subtle symptoms of GI disease due to alterations in physiology with aging and the superimposed effect of other comorbidities and their treatments. Balancing risks and benefits of treatment in this population requires an understanding of the impact of chronic disease and patient preferences of older adults.

  • Chapter 10 - Evaluation and management of dementia

  • 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 125-147

  • Summary

    Diagnostic criteria for dementia are separated into major and minor neurocognitive disorders. In major neurocognitive disorder, cognitive symptoms show a significant decline from a previous level of functioning in at least one cognitive domain. The prevalence of dementia increases with age, rising from 15% of those 65-74 years to more than 38% of those 85 and older. Estimated annual economic cost of dementia is $214 billion. Alzheimer’s dementia is the most common form of dementia. Cerebrovascular disease contributes to various subtypes of dementia. Although a definitive diagnosis of a syndrome often requires a postmortem examination, a comprehensive approach with a thorough history-taking, physical examination, tailored laboratory work and imaging studies, and neuropsychiatric testing when appropriate permit a probable diagnosis in the majority of cases. Despite the availability of diagnostic guidelines, routine screening of older adults is not recommended. Advances in understanding the pathophysiology of dementia have led to more targeted pharmacological therapies

  • Chapter 6 - Healthy aging: exercise and nutrition as medicine for older adults

  • from Section I - General approach to the care of 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 69-96

  • Summary

    Effective exercise and nutrition prescriptions, along with counseling and support of healthy lifestyle choices, are as important as treatment of disease in promoting healthy aging. Exercise prescriptions should consider individual risks and benefits, appropriate modality and dose; possible drug interactions, and use of behavioral techniques to optimize adoption and adherence. The elderly, women, minorities, and those with low income, low educational level, disabilities, or chronic health conditions are at highest risk for low levels of physical activity. They also bear a large burden of diseases amenable to prevention and treatment with exercise but often have the least opportunity for physical activity. Physical activities for older adults have previously focused on improving cardiorespiratory fitness and prolonging life; however, exercise designed to maintain or improve functional independence can also be beneficial. Age-related changes in metabolism, loss of integrity of the oral cavity, social isolation, and chronic illness are among factors putting the elderly at risk of malnutrition syndromes, including anorexia, cachexia, and sarcopenia.

  • Chapter 2 - The biology of aging

  • from Section I - General approach to the care of 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 17-27

  • Summary

    The aging process has been studied at the molecular and physiologic level for decades, and many theories have been proposed for why this universal phenomenon evolved. Multiple tissue-level changes occur with aging, including chronic, “sterile” inflammation; cellular senescence; macromolecular damage, and progenitor cell function decline. These changes underlie age-related pathologies that lead to a decline in global function of the individual. In the study of aging biology, there is much to be learned from exceptionally long-lived humans, such as centenarians, as well as animal models of exceptional longevity, like the naked mole rat. In addition, attention should be paid to disparities that exist in life span even within the United States. Importantly, drugs have been developed that extend life span, enhance health span, or delay or alleviate age-related conditions in mice. The field of aging biology is more poised than ever to turn toward the translation of basic research findings into clinical applications that might extend human health and life span.

Page 31 of 107