Hazzard's Geriatric Medicine and Gerontology

Description

Cleaned version with added pagination and bookmarks. Cover Copyright Contents Contributors Foreword Preface Part I: Principles of Gerontology Chapter 1: Biology of Aging and Longevity What Is Aging? Aging as a Coordinated, Malleable Process Key Themes from Studies of Invertebrate Models Molecular Leads for Further Study Delayed Aging in Mice and Rats Caloric Restriction Methionine-Restricted Diets Single-Gene Mutations That Extend Mouse Lifespan Stress Resistance and Aging Genetic Approaches to Analysis of Aging in Humans Models of Accelerated Aging Aging, Cellular Senescence, Telomeres, and Cancer Aging Research and Preventive Medicine Antiaging Research: Social Obstacles and Ethical Concerns Acknowledgments Further Reading Chapter 2: Genetics of Age-Dependent Human Disease The Biological Nature of Intrinsic Aging Why Aging Occurs Mechanisms of Aging Oxidative Damage DNA Damage and Repair Telomeres Mitochondria Proteins The Relationship Between Normal Aging and Disease Genetic and Nongenetic Effects on Aging Genetics of Human Longevity and the Implications for Age-Dependent Disease Malleability of the Human Aging Process Further Reading Chapter 3: Immunology and Aging General Aspects of Immunosenescence Effect of Aging on Different Cell Types Hematopoietic Stem Cells and Lymphoid Progenitor Cells Hematopoiesis Age-Related Changes of Hematopoiesis Involution of the Thymus Innate Immune System Components and Functions of the Innate Immune System Age-Related Changes of the Innate Immune System Adaptive Immune System Components and Principal Functions of the Adaptive Immune System T Lymphocytes Age-Related Changes in the T Cell Compartment Age-Related Changes of T Cells on the Single Cell Level Factors That Accelerate Age-Related Changes in the T Cell Pool B Lymphocytes Age-Related Changes of the B Cell Compartment Age-Related Defects in Interactions Between T and B Cells Cutaneous Immune System Mucosal Immune System Clinical Implications of Immunosenescence Infectious Diseases Immunosenescence and Cancer Immunological Interventions Vaccines Recommendations for Vaccination Improving Vaccination Efficacy Caloric Restriction Additional Measures to Improve Immune Function Conclusion Further Reading Chapter 4: Inflammation and Aging Inflammation in the Context of Aging and Adverse Health Outcomes Molecular Biology of Inflammation Inflammatory Signal Inflammatory Message Why Are Older Adults More Likely to Have Higher Levels of Inflammatory Cytokines? Chronic Inflammation Contributes Directly to Pathophysiological Changes in Older Adults Chronic Inflammation Contributes to Chronic Disease in Older Adults Potential Clinical Utility of Inflammatory Markers and Anti-Inflammatory Interventions Summary: Does Chronic Inflammation Contribute to an Altered Biological Platform for Late-Life Vulnerability? Further Reading Chapter 5: Demography and Epidemiology Introduction Demographics Aging of the Population in the United States Aging of the Population and Life Expectancy Around the World Life Expectancy at Different Ages Extreme Longevity Demographic Characteristics of the Aging Population Employment Mortality Leading Causes of Death Mortality Rates Disease Status Prevalence of Common Diseases Co-occurrence of Multiple Chronic Conditions Health Care Utilization Physician and Ambulatory Visits Causes of Hospitalization Cancer Dementia Disability Measures of Function and Disability Disability as an Indicator of Health Status and Prognosis Prevalence of Disability Risk Factors for Disability Recovery from Disability Types of Disability Progression Physical Performance Measures Trends in Disability Aging of Individuals with Life-Long Disabilities Behavioral Risk Factors Acknowledgment References Chapter 6: International Gerontology Implications of Global Population Aging for Health and Health Care Overview Demography of the Aging Global Population Effect of Population Aging on Health and Health Care International Comparisons America: United States Type of Health Care System Overall Organization and Services Available for Older Adults Peculiarities Difficulties and Solutions for a Typical Geriatric Patient America: Canada Type of Health Care System Overall Organization and Services Available for Older Adults Pecularities Difficulties/Solutions for a Typical Geriatric Patient Europe: Iceland Type of Health Care System Overall Organization and Services Available for the Elderly Peculiarities Difficulties/Solutions for a Typical Geriatric Patient Europe: Norway Type of Health Care System Overall Organization and Services Available for Older Persons Hospital Services Community Services Peculiarities Difficulties/Solutions for a Typical Geriatric Patient Europe: United Kingdom Type of Health Care System Overall Organization and Services for Elderly Persons General Medical Practices Hospitals Newer Models of NHS Provision Private Providers Local Government Authorities Peculiarities Difficulties/Solutions for a Typical Geriatric Patient Europe: France Type of Health Care System Overall Organization and Services Available for Elderly Persons Paying For Long-Term Care Integrating Health and Social Care Increasing Quantity and Quality of Services Increasing Empowerment of Older Persons Peculiarities Difficulties/Solutions for a Typical Geriatric Patient Europe: Italy Type of Health Care System Overall Organization and Services Available for Elderly Persons Peculiarities The Difficulties/Solutions for a Typical Geriatric Patient Asia: Japan Type of Health Care System Overall Organization and Services Available for Elderly Persons Peculiarities Difficulties/Solutions for a Typical Geriatric Patient Oceania: Australia Type of Health Care System Overall Organization and Services Available for Elderly Persons Difficulties/Solutions for a Typical Geriatric Patient Developing Countries: China Type of Health Care System Overall Organization and Services Available for Elderly Persons Peculiarities Difficulties/Solutions for a Typical Geriatric Patient Need for Standard Assessment of Health Needs and Services Across Countries InterRAI Experiences with InterRAI Ontario’s Experience European Union Experience Conclusion Further Reading Chapter 7: Psychosocial Aspects of Aging Psychosocial Factors, Health, and Quality of Life Social Relationships Stress and Distress Stressful Life Events Biological Consequences of Stress Personality, Affect, and Health Psychosocial Aspects of Quality of Life and Valuation of Life Conclusion Further Reading Chapter 8: General Principles of Pharmacology Introduction Pharmacokinetics Bioavailability Distribution Clearance Hepatic Drug Clearance Renal Clearance Glomerular Filtration Tubular Secretion Tubular Reabsorption Nonhepatic, Nonrenal Clearance Half-Life Summary of Pharmacokinetic Changes with Aging Pharmacodynamics Mechanisms of Aging Pharmacodynamic Changes Main Pharmacodynamic Changes with Aging Cardiovascular System Central Nervous System Pharmacogenetics and Pharmacogenomics Adverse Drug Reactions Frailty and Pharmacology Pharmacokinetics and Frailty Pharmacodynamics and Frailty Adverse Drug Events and Frailty Drug Development and Regulation Phase I Studies Phase II Studies Phase III Studies Phase IV Studies Pharmacoepidemiology Advantages of Pharmacoepidemiologic Studies Limitations of Pharmacoepidemiologic Studies Pharmacoeconomics Conclusion Further Reading Chapter 9: Preventive Gerontology: Strategies for Optimizing Health Across the Life Span Introduction Behaviors with Adverse Health Consequences Tobacco Use Substance Abuse Alcohol Illicit Drugs Prescription Drug Misuse Behaviors Increasing Risk of Injury Head Trauma and Risk for Alzheimer’s Disease Ultraviolet Light and Risk for Skin Cancers and Cataracts Prevention of Age-Related Macular Degeneration Excessive Noise and Risk for Hearing Loss Sleep Deprivation and Motor Vehicle Crash Fatalities Cell Phone Use While Driving and Motor Vehicle Crashes Obesity Taking a Proactive Approach to Personal Health and Well-Being Nutrition Physical Activity Social Connections Cognitive Activity Napping Health Care Blood Pressure Evaluations Lipid Evaluations Glucose Monitoring Cancer Screening Depression Screening Immunizations for Pneumococcal Pneumonia and Influenza Aspirin for Primary Prevention of Myocardial Infarction Low to Moderate Dose Aspirin for Reduction of All-Cause Mortality in Women Conclusion Further Reading Part II: Principles of Geriatrics Chapter 10: Evaluation, Management, and Decision Making with the Older Patient Presentation Evaluation Reason for Performing a Test or Evaluation Issues in Assessing and Interpreting Evaluation Results Definition of Normal in Older Persons Assessing Diagnostic Test Accuracy Ability of Tests to Distinguish Patients Who Do and Do Not Have the Disease or Condition Deciding Whether a Diagnostic Test Should Be Performed in a Specific Patient History/Interview Setting and Source of Information Ascertainment of Goals and Preferences Components of the History and Interview Review of Symptoms and Syndromes Assessment of Mood, Affect, and Cognition Physical Examination Functional Examination Interpreting Examination Findings Selecting Components of the Physical Examination to Perform Laboratory and Ancillary Tests Management Further Reading Section A: Assessment Chapter 11: Principles of Geriatric Assessment Geriatric Assessment by the Individual Clinician Components of the Geriatric Assessment Visual Impairment Hearing Impairment Malnutrition/Weight Loss Urinary Incontinence Balance and Gait Impairments and Falling Polypharmacy Cognitive Assessment Affective Assessment Assessment of Function Assessment of Social Support Economic Assessment Environmental Assessment Spirituality Advance Directives A Strategic Approach to Geriatric Assessment Comprehensive Geriatric Assessment Components of Comprehensive Geriatric Assessment Data Gathering Discussion among Team Development of the Treatment Plan Implementation of the Treatment Plan Monitoring Revising the Treatment Plan Effectiveness of Comprehensive Geriatric Assessment Geriatric Evaluation and Management Units Inpatient Consultation Posthospital Discharge Assessment and Management Outpatient Consultation In-Home Assessment Lessons Learned from Geriatric Assessment Further Reading Chapter 12: Mental Status and Neurological Examination in Older Adults The Neurology of Aging What Is Normal Neurological Aging? Age-Related Changes in the Neurological Examination Cognitive Changes Changes in Cranial Nerve Function Changes in Motor Function Changes in Sensory Function Changes in Gait and Station Changes in Deep Tendon Reflexes The Neurological History Neurological History from the Patient Neurological History from an Informant Mental Status Examination Observational Assessment Level of Consciousness Appearance Emotional State and Affect Behavior Movement Speech and Communication Cognitive Assessment Attention Memory Language Orientation Abstraction Judgment and Problem Solving Abilities Visuospatial Skills Calculation Executive Function Word List Generation Informant Assessment Neuropsychiatric Assessment Thought Form Thought Content Insight Behavior and Personality Neurological Examination Cranial Nerve Examination Cranial Nerve I: Olfactory Cranial Nerve II: Optic Cranial Nerves III, IV, and VI: Oculomotor, Trochlear, and Abducens Cranial Nerve V: Trigeminal Cranial Nerve VII: Facial Cranial Nerve VIII: Cochlear and Vestibular Cranial Nerves IX and X: Glossopharyngeal and Vagus Cranial Nerve XI: Accessory Nerve Cranial Nerve XII: Hypoglossal Motor System Examination Muscle Bulk Muscle Tone Strength Abnormal Movements Sensory Examination Light Touch Pain and Temperature Vibration Position Cerebellar Examination Gait and Station Muscle Stretch Reflexes Pathologic and Primitive Reflexes Higher Cortical Function Neurovascular Assessment Conclusion Acknowledgments References Chapter 13: Assessment of Decisional Capacity and Competencies Introduction Definition of Decisional Capacity Legal and Practical Aspects in Determining Decisional Capacity Process of Determining Capacity Traditional Mental Status Tools Tests of Decisional Capacity Capacity to Make Specific Decisions Medical Decisions Problems of Self-Care Problems of Finances Temporary Loss of Decisional Capacity Consent Versus Assent Informed Consent in Research Further Reading Chapter 14: Principles of Screening in Older Adults General Framework for Making Informed Cancer Screening Decisions Estimate Life Expectancy Estimate Benefits of Cancer Screening Estimate Harms of Cancer Screening Integrate Patient Values and Preferences Application of Screening Principles to Specific Cancers Breast Cancer Risk of Dying of Breast Cancer Benefits of Breast Cancer Screening Harms of Breast Cancer Screening Recommendations Colorectal Cancer Risk of Dying of Colorectal Cancer Benefits of Colorectal Cancer Screening Harms of Colorectal Cancer Screening Recommendations Cervical Cancer Risk of Dying of Cervical Cancer Benefits of Cervical Cancer Screening Harms of Cervical Cancer Screening Recommendations Other Cancers Screening for Noncancerous Diseases Further Reading Section B: Organization of Care Chapter 15: Health Care System Introduction The Elements of the System Providers Patients and Caregivers Insurers Public Health Insurance Private Health Insurance Medicare Advantage Supplemental Health Insurance Long-Term Health Insurance Medicare Part D Regulators Care Management Performance of the System Role of Primary Care Clinicians Improving the Health Care System Chronic Care Model Top–Down Organizational Change Bottom–Up Change Role of Academic Health Centers Recent Quality Improvement Initiatives Policy-Driven Initiatives Provider-Driven Initiatives Conclusion Further Reading Chapter 16: Transitions Introduction Transitions Traffic and Transitions Quality Predictors of Problematic Transitions Innovations in Transitional Care Roles and Responsibilities Strategies for Excelling at Transitional Care Special Cases of Care Transitions Educating Professionals in Care Transitions Summary Further Reading Chapter 17: Acute Hospital Care Hospital Admission Reasons for Admission for Geriatric Patients Admission Screening Communication with Family and Primary Care Providers Medication Reconciliation Identify Frailty Functional Screen Dementia Screen Hospital Stay Common Problems in Hospitalized Elderly Patients Delirium Immobility and Falls Nutrition Preventing Nosocomial Infections Hospital-Acquired Urinary Tract Infections Hospital-Acquired Pneumonia Clostridium difficile Infection Control Venous Thromboembolism Prophylaxis Patient Safety Palliative Care Hospital Discharge and Care Transitions Models of Hospital Care and the Elderly Patient Hospitalist Acute Care of the Elderly Units Stroke Units Further Reading Chapter 18: Emergency Department Care Epidemiology Pathophysiology and Presentations Evaluation Management Medication Processes and Environment Prevention Accessing Vulnerable Populations Prevention of Post-ED Decline Special Issues Emergency Medical Services Geriatricians and the ED The Emergency Department’s Relationship with Long-Term Care Alternatives to Hospitalization Disaster Planning Conclusions Further Reading Chapter 19: Critical Care Age-Related Changes in Physiology Common Admitting Diagnoses Associated Conditions That May Complicate ICU Care Dementia and Delirium Outcomes of Intensive Care Caregiver Outcomes Toward Improving Outcomes of Intensive Care in the Elderly Further Reading Chapter 20: Subacute Care Definition of Subacute Care Subacute Care Patients Subacute Care Physicians Role of Advanced Practice Clinicians Subacute Care Regulations Defining Quality in Subacute Care Admitting a Subacute Patient: the Hospital Perspective Admitting a Subacute Patient: the Facility Perspective Case 1: Transition of Care Issues in the First 24 Hours Patient/Family/Staff Interactions Physician’s Role in Rehabilitation Case 2: Importance of Communication in Subacute Care Physician’s Role in Family Meetings Medical Management in the Subacute Setting Pain Management Urinary Incontinence and Catheters Swallowing Issues Falls Pressure Ulcers Medication Issues Case 3: Issues in How Medications Are Ordered Dealing with Complications of the Acute Hospital Acute Medical Problems in Subacute Care Advance Directives and End-of-Life Issues Discharge Planning in Subacute Care Risk Management in Subacute Care Subacute Facility Reimbursement Reimbursement for Physicians Subacute Care as a Safety Net Further Reading Chapter 21: Nursing Facility Care Regulatory Issues Resident Assessment Instrument Nursing Facility Attending Physician Nursing Facility Personnel Practice Organization Quality of Medical Care Addressing Geriatric Syndromes Health Maintenance Behavioral Symptoms Urinary Incontinence Polypharmacy and Medication Errors Falls Altered Nutritional Status Pressure Ulcers Palliative Care Managing the Acute Change of Condition Acute Care/Nursing Facility Interface Infections Role of the Medical Director Summary Further Reading Chapter 22: Community-Based Long-Term Care and Home Care Semantic Challenges of CBLTC Who Receives CBLTC? Who Provides and Pays for CBLTC? Is CBLTC Effective? Innovations Trends Conclusion Further Reading Chapter 23: Rural Aging Demography of Rural Aging Health Status of Rural Elders Ethnic and Minority Rural Aging Rural Health Clinics Rural Hospitals and Long-Term Care Technology and Rural Aging Summary Further Reading Section C: Special Management Issues Chapter 24: Appropriate Approach to Prescribing Epidemiology of Drug Therapy Measuring the Quality of Drug Prescribing in Older Persons Prescribing Cascades Drug-Induced Parkinsonism Acetylcholinesterase Inhibitors and Anticholinergic Therapy Underuse of Beneficial Therapy Example of Underuse of Beneficial Therapy: Hypertension Example of Underuse of Beneficial Therapy: Beta-Blocker Therapy Postmyocardial Infarction Example of Underuse of Beneficial Therapy: Osteoporosis Example of Underuse of Beneficial Therapy: Opioid Analgesia and Cancer Pain Example of Underuse of Beneficial Therapy: Warfarin in Atrial Fibrillation Special Considerations Regarding Drug Therapy in the Long-Term Care Setting Antipsychotic Therapy in the Long-Term Care Setting Risk of Adverse Drug Events in the Long-term Care Setting Deficiencies in Information About Drug Therapy in Older Adults Inclusion of Older Persons in Clinical Trials Using Alternative Study Designs to Study Drug-Related Risks and Benefits Systematic Reviews to Guide Therapeutic Decision Making Policy Issues Related to Drug Therapy in Older Adults Cost-Related Adherence Limited Manufacturing of Low-Dose Formulations of Recommended Drug Therapy Medication Reconciliation Practical Approach to Prescribing Medications to Older Persons Review Current Drug Therapies Discontinue Potentially Unnecessary Therapy Consider Nonpharmacologic Approaches Reduce the Dose Summary Further Reading Chapter 25: Complementary and Alternative Medicine Introduction Current Use and Concerns with Cam Modalities Use of Cam Modalities for Disorders of the Elderly Patient Depression, Anxiety Disorders, and Insomnia Osteoarthritis, Degenerative Disk Disease, and Chronic Pain Dementia Benign Prostatic Hyperplasia Conclusion Further Reading Chapter 26: Team Care Collaboration and the Importance of “Interdisciplinarity” Principles of Successful Teamwork Teams and Team Member Rules The Well-Planned Meeting Suggested Structure for Regular Health Care Team Meetings Skills of Different Professionals on Teams Effective Team Communication Valuing Diversity Team Conflict Emphasizing Care Goals and Interdisciplinary Care Planning Interdisciplinary Care Planning Summary Further Reading Chapter 27: Social Work Key Roles for Geriatric Social Workers Direct Service Provision Linkage Roles Practice Issues with Populations Served Cultural Diversity The Poor Immigrants and Refugees Abused and Neglected Mentally Ill Cognitively Impaired Older GLBT Substance and Alcohol Abusers HIV/AIDS Victims Where Social Workers Practice Nursing Homes Community Mental Health Facilities Hospitals and Health Care Facilities Hospice Home Care Summary Further Reading Chapter 28: Self-Management of Health Behavior in Geriatric Medicine Introduction Defining Self-Management Health Behaviors Embodied in Self-Management Conceptual Framework for Self-Management Commonsense Model of Self-Regulation Conceptual Framework for Understanding the Complexities of Self-Management Facilitating Factors in Self-Management Inhibitory Factors in Self-Management Operating on Automatic Pilot Slips, Relapses, and Intergoal Conflict Toxic Environments Costs and the Problems of Distant Benefits Knowledge, Skills, and Strategies Lessons From the Literature on Self-Management Partnerships in Self-Management: A Description and Conceptual Rationale Traditional Versus Collaborative Patient Care The Conceptual Importance of Partnerships in Health Care Chronic Disease Self-Management Program Other Programs from Stanford University Individual Versus Group-Based Interventions Challenges to Active Self-Management Heterogeneity in Health Status and Health Goals Need to Change Health Goals as Health Declines Evidence of Effectiveness of Interventions that Facilitate Self-Management Principles and Suggestions for Integrating Self-Management Into Geriatric Medicine The Self-Management Partnership Fostering Collaboration Implementing a Framework for Effective Self-Management Targets for Self-Management: General Practices Targets for Self-Management: Assessing and Acting on Physical Disability Further Reading Chapter 29: Rehabilitation Defining Rehabilitation History of the Disability Framework Evaluation Goals of Evaluation Disability-Oriented History and Physical Examination Determining Rehabilitation Potential Components of Rehabilitation The Organization of Rehabilitation Settings for Care Rehabilitation Providers Process of Care: Rehabilitation Interventions Exercise/Physical Activity General Principles of Exercise Exercise to Increase Muscle Strength Exercise to Increase Endurance Exercise to Improve Balance Flexibility Exercises Task-Oriented Exercises to Improve Motor Control Designing Exercise Prescriptions Physical Modalities Thermal Agents (Including Aquatic Therapy) Electrotherapy Phototherapy (MIRE) Adaptive Aids Mobility Aids Bathroom and Self-care Aids Electronic Devices (Environmental Control Units/Augmentative Communication Aids) Orthotics and Prosthetics Specific Conditions Treated with Rehabilitation Pulmonary Rehabilitation Cardiac Rehabilitation Peripheral Arterial Disease Amputation Stroke Rehabilitation Parkinsonism Osteoarthritis and Total Joint Replacement Falls Hip Fracture Sarcopenia and Deconditioning Pain Conclusion Further Reading Chapter 30: Pain Management The Older Patient in Pain How Aging Affects Pain Perception Classification of Pain Acute Versus Persistent Pain Nociceptive Versus Neuropathic Pain Clinical Evaluation of Pain Pain History and Physical Examination Pain Assessment Scales Pain Assessment in Those with Cognitive Impairment Management of Acute and Perioperative Pain Management of Persistent Pain Analgesic Medications Acetaminophen Nonsteroidal Anti-inflammatory Drugs Opioid Analgesic Medications Other Nonopioid Medications for Pain Nondrug Strategies for Pain Management Further Reading Chapter 31: Palliative Care The Experience of Serious Illness for Patients and Their Families Palliative Care Symptom Assessment and Treatment Pain Dyspnea Gastrointestinal Symptoms Depression, Delirium, and Anxiety Fatigue Last Hours of Life Communication Systems of Care for the Seriously Ill Care Transitions Special Issues Dementia Artificial Hydration and Nutrition Grief and Bereavement Conclusion Further Reading Chapter 32: Legal Issues Overview of Health Care Regulation Regulation of Health Professionals Regulation of Health Care Facilities and Agencies Standards of Care and Professional Liability in Geriatrics Overview of Malpractice Liability Developing and Disseminating Standards of Care Informed Consent Basics of Informed Consent Decisional Capacity Issues Advance Health Care Planning as Prospective Decision Making Confidentiality State Law Federal Law Particular Health Care Settings Health Insurance Portability and Accountability Act Summary Further Reading Chapter 33: Spirituality Ways of Understanding Religion and Spirituality A Categorical Approach to Spirituality Historical/Contextual Anthropological/Social Scientific Theological/Normative The Organization of Health-Related Spiritual Care Future Directions: A Spirituality of Practice Within a Spirituality of Place Further Reading Chapter 34: Ethical Issues Introduction Deciding with Patients Disclosing a Diagnosis of Alzheimer’s Disease Advance Care Planning Quality of Life Refusing, Withdrawing, and Withholding Treatment Euthanasia, Physician-Assisted Suicide, and Terminal Sedation Deciding with Others: Surrogate Decision Making Deciding Together: Living and Working in Health Care Systems Conclusion Further Reading Section D: Surgical Management Chapter 35: Perioperative Evaluation and Management The Older Surgical Patient How Age Increases Surgical Risk Specific Considerations Cardiac Complications Pulmonary Complications Renal Complications Infectious Complications Functional Capacity Emergency Surgeries Other Concerns Period of Risk Preoperative Management History and Physical Medications Preoperative Assessment for Noncardiac Surgery Other Cardiovascular Concerns Hypertension Valvular Disease Perioperative Beta-Blockers Other Preventive Measures Do Not Resuscitate Orders Postoperative Management Pain Control Early Mobilization Catheters Postoperative Delirium Other Complications Summary Further Reading Chapter 36: Anesthesia Anesthesia and the Anesthesiologist Preoperative Care of the Older Surgical Patient Anesthetic Methods and the Older Adult General Anesthesia Intraoperative Anesthesia Care Anesthetic Agents Hemodynamic Stability During Anesthesia Anesthesia and the Pulmonary System Regional Anesthesia Regional Versus General Anesthesia Postoperative Analgesia Patient-Controlled Analgesia Peripheral Nerve Blocks Perioperative Complications Course of Recovery and Common Perioperative Complications in Older Patients Models of Collaborative Care for the Surgical Patient Conclusion Further Reading Chapter 37: Surgical Outcomes Predictors of Operative Morbidity and Mortality Age Comorbidity Functional Status and Cognitive Function Frailty Functional Outcomes Functional Status Outcomes Cognitive Outcomes Discharge Disposition and Independent Living Late Survival After Cancer Surgery Summary Further Reading Section E: Nutrition Chapter 38: Nutrition and Aging Introduction The Interrelationship Between Nutrition, Activity, and Disease Nutrition–Activity Interrelationship Nutrition–Disease Interrelationship Age-Related Changes That Affect Nutrition Changes in Body Composition Changes in Appetite and Energy Intake Regulation Loss of Taste, Smell, and Appetite with Advancing Age Gastrointestinal Tract and Postabsorptive Effects on Appetite Psychological, Socioeconomic, and Cultural Influences on Appetite Nutrient Requirements to Maintain Health Energy Protein Factors That Influence Protein Requirements Fat and Cholesterol Carbohydrates Water Fiber Vitamins and Minerals Recommended Intakes Vitamin and Mineral Supplementation Vitamin B-12 (Cobalamin) Folate (Folic Acid) Calcium, Vitamin D, and Bone Health Specific Dietary Considerations for Optimal Health Nutrients and Immunity Vitamins and Cognition Nutrition and Cardiovascular Disease Micronutrients and Cancer Nutrition and Age-Related Eye Diseases Assessment of Nutritional Status Initial Screening Assessment Comprehensive Nutritional Assessment Anthropometrics Laboratory Assessment Albumin Transferrin Prealbumin Cholesterol Assessment of Nutrient Intake Community-Based Nutrition Programs for Older Adults Further Reading Chapter 39: Weight and Age: Paradoxes and Conundrums Should the Health Practitioner Be Concerned About Weight in an Older Patient? Predicting Weight in Older People: Nothing Special Lifetime Weight History: Current Weight and Recent Weight Change Are Not Enough Adiposity Standards for Overweight and Obesity: Right for Older Patients? Risks Associated with Underweight Risks Associated with Overweight Morbidity and Disability Mortality Risks Interventions and Recommendations Body Composition Overweight and Weight Reduction Conclusions References Chapter 40: Malnutrition and Enteral/Parenteral Alimentation Malnutrition Definition Epidemiology Pathophysiology Presentation and Evaluation Assessment for Causes of Weight Loss Management General Considerations Patient Preference Enhancing Oral Intake Nonpharmacological Drugs Maintaining Lean Body Mass and Functional Status Anabolic Agents Physical Activity Nutritional Support Enteral Nutrition Efficacy Tube Placement Formula Selection Administration Guidelines Risks and Complications Parenteral Nutrition Efficacy Administration Guidelines Intravenous Access Patient Monitoring and Complications Special Issues Comorbidity Hip Fracture Chronic Obstructive Pulmonary Disease Nursing Home Care Setting Dementia Future Directions Further Reading Chapter 41: Disorders of Swallowing Impact of Dysphagia Swallowing Process Normal Swallowing Horizontal Subsystem Vertical Subsystem Neurophysiology of Oropharyngeal Swallowing Senescent Swallowing Age-Associated Changes in Swallowing Neurophysiological Correlates of Senescent Swallowing Differential Considerations for Dysphagia and Aspiration Etiologies Age-Related Conditions Age-Related Disease Symptoms Screening Across a Continuum of Care Settings Team Approach to Dysphagia Focused Assessment of Swallowing Noninstrumental Swallowing Assessment Instrumental Examination Oropharyngeal Videofluoroscopic Swallowing Evaluation Fiberoptic Endoscopic Evaluation of Swallowing Dysphagia Intervention Compensatory Dysphagia Interventions Postural Adjustments Food and Liquid Rate and Amounts Adaptive Equipment Diet Modification Knowing the Heimlich Maneuver Rehabilitative Dysphagia Interventions Optimizing Swallowing and Related Health Through Prevention Medications Oral Hygiene TuBe or Not TuBe—Oral Versus Nonoral Intake Further Reading Chapter 42: Oral Cavity Dentition Periodontium Salivary Glands Sensory Function Oral Mucosa Motor Function Summary Further Reading Section F: Sensory Function Chapter 43: Assessment and Rehabilitation of Older Adults with Low Vision Demographics Aging and Loss of Vision Normal Age-Related Changes in Vision Prevalent Age-Related Causes of Visual Impairment Age-Related Macular Degeneration Diabetic Retinopathy Cataract Glaucoma Traumatic Brain Injury Role of the Geriatrician in Vision Rehabilitation Adaptations of Clinical and Functional Evaluations for Older Adults Case History Interview Clinical Low-Vision Evaluation Nursing Homes Hospital Settings Community Service Agency Settings Private Home Settings Functional Visual Assessment Management of Low Vision Developing a Vision Rehabilitation Plan Instruction and Guided Practice Using Remaining Vision and Low-Vision Devices Low-Vision Devices Instruction in the Use of Low-Vision Devices Reading and Writing with Low-Vision Devices Environments for Older Persons Improving the Lighting Increasing Contrast Using Color Using Organizational Strategies Alternative Strategies Psychosocial Considerations Adaptation to Vision Loss Family and Social Support Funding for Low-Vision Rehabilitation Further Reading Chapter 44: Age-Related Changes in the Auditory System Introduction Epidemiology of Age-Related Hearing Impairment Risk Factors Modulating Age-Related Hearing Impairment Genetics Environmental Factors Gender Differences and Hormonal Factors Diabetes Mellitus Cardiovascular Disease Lifestyle Psychology Hearing Loss Basics: Frequencies and Sound Intensity Anatomy of the Auditory Periphery Functional Assessment of Hearing Peripheral Pathology of Age-Related Hearing Impairment in Humans Central Auditory Aspect of Age-Related Hearing Impairment Animal Models of Peripheral Age-Related Hearing Impairment Molecular Mechanisms of Age-Related Hearing Impairment in Animal Models Genetic Contributions to Age-Related Hearing Impairment in Animal Models Prevention of Age-Related Hearing Impairment Management of Age-Related Hearing Impairment Outlook Acknowledgment Further Reading Section G: Gender and Sexuality Chapter 45: Sex and Gender Across the Human Life Span Definitions History of the Sex Differential in Longevity When Does the Sex Differential in Mortality Begin? Mechanisms of the Biological Basis of the Sex Differential in Longevity Basic Molecular Genetics of Sex Differences Sex Differentials During Fetal, Childhood, and Adolescent Development Sex May Affect Regulation of Redox State and Oxidative Stress Sex Affects Neural Anatomy and Function Sex Affects Immune Function Sex Affects Sex Hormone Physiology Across the Adult Life Span Sex Differential in Longevity the Sex Differential in Atherosclerosis Sex Differential in Cardiovascular Disease Risk Factors Role of Sex Hormones in Mediating the Sex Differential in Coronary Heart Disease Risk Sex Differential in Atherosclerotic Cardiovascular Disease Female Hormone Replacement Therapy Predicting the Future: The Sex Differential in Longevity Is Declining Future of the Sex Differential in Longevity and Its Implications for Geriatric Medicine and Gerontology Further Reading Chapter 46: Menopause and Midlife Health Changes Physiological Basis of Reproductive Aging Disaggregating Menopause Symptoms and Chronological Aging Menopause Symptoms and Clinical Features Vasomotor Symptoms Sleep Disturbances Sexuality Dysfunction Depressed Mood Cognition and Memory Cardiovascular Disease Risk Diabetes Risk Obesity and Body Composition Bone Loss Physical Function Osteoarthritis Skin and Collagen Conclusions Further Reading Chapter 47: Sexuality, Sexual Function, and the Aging Woman Introduction Interactive Biopsychosocial Model Sociodemographic Context of Older Women’s Sexuality Sexuality in Long-Term Care Institutions Sexual Activity, Behavior, and Problems Sexual Partnership Sexual Activity Sexual Problems Sexually Transmitted Infection Sexual Trauma, Violence, and Abuse Female Sexual Response Cycle Female Sexual Physiology in Later Life Endocrine System Neurovascular System Musculoskeletal System Genitourinary System Gastrointestinal System Female Sexual Dysfunction Diagnostic Classification of Female Sexual Dysfunction Causes of Female Sexual Dysfunction Sexual History—Talking and Communication about Sexual Problems Clinical Management of Female Sexual Dysfunction Dyspareunia Vaginismus Orgasmic Disorder Persistent Sexual Arousal Disorder Medical Therapy for Sexual Desire/Arousal Disorders and Dyspareunia Conclusion Further Reading Chapter 48: Gynecological Disorders Gynecological History Physical Examination Issues and Conditions by Anatomical Approach Benign Breast Disease Breast Lump Breast Pain Nipple Discharge Breast Inflammation Vulva Examination of the Vulva Benign Conditions of the Vulva Inflammatory Dermatoses of the Vulva Ulcerations and Infections of the Vulva Cancer of the Vulva Urethra Vagina Vaginal Atrophy Vaginitis, Vaginosis, Vaginal Discharge Cancer of the Vagina Cervix Examination of the Cervix Cervical Cancer Screening Cancer of the Cervix Uterus Benign Conditions of the Uterus Cancer of the Uterus Endometrial Neoplasia Myometrial Neoplasia Adnexa Evaluation of the Adnexa Adnexal Cysts Cancer of the Ovary Cancer of the Fallopian Tube Common Clinical Issues Gynecological Malignancies Vaginal Bleeding Initial Approach to Vaginal Bleeding Endometrial Evaluation for Vaginal Bleeding Genital Prolapse and Incontinence Evaluation of Genital Prolapse Management of Genital Prolapse Pessaries for Genital Prolapse Pessaries for Urinary Incontinence Pelvic Pain and Dyspareunia Abdominal and Myofascial Pain Vulvar Pain, Vaginal Pain, and Dyspareunia Pain Associated with Reproductive Organs Interstitial Cystitis Hormone Replacement Therapy Summary Further Reading Chapter 49: Sexuality, Sexual Function, Androgen Therapy, and the Aging Male Sexuality and Sexual Function in Older Men Sexual Behaviors Changes in Male Sexual Physiology with Age The Aging Male Homosexual Sex in Long-Term Care Sex and Dementia Sexual Dysfunction in the Aging Male Categories of Male Sexual Dysfunction Erectile Dysfunction Physiology Etiologies Evaluation of Sexual Dysfunction Treatments for Erectile Dysfunction Testosterone and Male Sexual Dysfunction Androgen Replacement Therapy in Older Men Androgen Physiology and Changes with Aging Defining Hypogonadism in Older Men Testosterone Therapy Effects on Specific Target Organs Bone Body Composition and Strength Mood Cognition Cardiovascular System Adverse Effects of Testosterone Testosterone Preparations for Replacement Therapy Further Reading Chapter 50: Benign Prostate Disorders Definitions Epidemiology and Natural History Pathophysiology Hyperplasia Risk Factors Nocturia Evaluation History American Urological Association Symptom Index Other Measures of LUTS and Quality of Life Physical Examination Laboratory Tests Postvoiding Residual and Urine Flow Rate Bladder Diaries (Frequency–Volume Charts) Specialized Testing Urodynamic Studies Other Tests Management Making Treatment Decisions Nonpharmacological Management Watchful Waiting Medications Alpha-Adrenergic Blockers 5-α Reductase Inhibitors Combination Therapy Phytotherapy Emerging Therapies Surgery Transurethral Resection of Prostate Laser Prostatectomy Open Prostatectomy Minimally Invasive Procedures Prostate Incision Thermotherapy Stents Prevention Further Reading Part III: Geriatric Syndromes Chapter 51: Aging and Homeostatic Regulation Background Homeostasis in a Historical Context Homeostatic Regulation in Old Age General Considerations Systemic Patterns of Change Alterations in Specific Homeostatic Mechanisms Reconciling Different Views of Homeostatic Dysregulation Specific Homeostatic Challenges General Considerations ”Fight or Flight Response” Lowered Ambient Temperature Epidemiology Pathophysiology Clinical Presentation Treatment Emergency Care General Support Rewarming Raised Ambient Temperature Epidemiology Pathophysiology Clinical Presentation Treatment Orthostasis, Meals, and Hypovolemia Hyperglycemia and Hypoglycemia Fluid Challenge and Dehydration Bladder Outlet Obstruction Major Burns and Trauma Altered Physical Activity Anticholinergic Medications Antidopaminergic Medications Neuronal Degeneration Acknowledgment Further Reading Chapter 52: Frailty Frailty Is at the Core of Geriatric Medicine What Is Frailty? How Can Frailty Be Identifiedin Clinical Practice? Standardized Approaches Developed to Ascertain Frailty Potential Uses of an Operational Definition of Frailty Evidence and Theory Regarding the Pathogenesis of Frailty and Implications for Treatment Biomarkers of Frailty and Homeostatic Dysregulation Treatment and Prevention of Frailty Conclusion Further Reading Chapter 53: Delirium Definition Epidemiology Etiology Predisposing Factors Precipitating Factors Drug Use and Delirium Relationship between Delirium and Dementia Pathophysiology Presentation Cardinal Features Tools for Evaluation of Delirium Forms of Delirium Prognosis Evaluation History and Physical Examination Laboratory Tests and Imaging Differential Diagnosis Algorithm for the Evaluation of Altered Mental Status Prevention Management Pharmacological Management Neuroleptics Other Pharmacological Approaches Nonpharmacological Management Nonpharmacological Sleep Protocol Special Issues Nursing Home Setting Palliative Care Setting Ethical Issues Further Reading Chapter 54: Falls Definition Incidence and Consequences of Falls Incidence and Prevalence of Falling Fall Injuries Incidence of Fall Injuries Hip Fractures Death Other Consequences of Falling Etiology of Falls and Fall Injuries Risk Factors for Falling Age-Associated Changes and Chronic Diseases Postural Control Sensory Input Central Processing Musculoskeletal Impairments Postural Hypotension Medications Acute Illness and Hospital Discharge Challenges to Postural Control Opportunity to Fall Risk Factors for Fall Injury Osteoporosis Characteristics of the Fall Fall Prevention in Community-Dwelling Older Persons Trials of Interventions to Prevent Falls Single Interventions Multifactorial Interventions Strategy for Decreasing Falls and Fall Injuries Screen for Fall Risk Multifactorial Assessment Multidisciplinary Treatment Falls in Skilled Nursing Facilities Evaluation Treatment Multifactorial Approach Alternatives to Restraints Hip Protectors Hospital Falls Risk Factor Assessment Preventive Measures Evaluation of Falls and Revision of Care Plan Areas for Future Research Conclusion Further Reading Chapter 55: Sleep Disorders Introduction Changes in Sleep with Aging Sleep-Disordered Breathing Definition Epidemiology Pathophysiology Presentation Management Positive Airway Pressure Surgical Interventions Oral Appliances Diet and Lifestyle Periodic Limb Movements in Sleep/Restless Legs Syndrome Definition Epidemiology Pathophysiology Presentation Evaluation Management Circadian Rhythms Sleep Disorders Definition Epidemiology Pathophysiology Presentation Evaluation Management Bright-Light Therapy Rapid Eye Movement Sleep Behavior Disorder Definition Epidemiology Pathophysiology Presentation Evaluation Management Pharmacological Interventions Lifestyle Insomnia Definition Epidemiology Pathophysiology Presentation Evaluation Management Nonpharmacological Interventions Sleep Hygiene Stimulus-Control Therapy Sleep-Restriction Therapy Cognitive-Behavioral Therapy Pharmacological Interventions Special Issues Sleep in Institutionalized Elderly Patients and Neurodegenerative Disorders Summary Acknowledgment Further Reading Chapter 56: Dizziness Definition Epidemiology Pathophysiology Presentation Vertigo Dysequilibrium Presyncope Other and Multifactorial Etiology Discrete Diseases Causing Dizziness Vestibular Disorders Ménière’s Disease Benign Paroxysmal Positional Vertigo Recurrent Vestibulopathy Acoustic Neuroma Central Nervous System Disorders Psychiatric Disorders Cervical Disorders Systemic Causes Orthostatic Hypotension Postprandial Hypotension Medications Contributing to Dizziness Evaluation History Physical Examination Provocative Tests Laboratory Tests Management Pharmacological Therapy Vestibular Rehabilitation Surgery Patient Education Further Reading Chapter 57: Syncope Definition Epidemiology Pathophysiology Multifactorial Etiology Individual Causes of Syncope Presentation Evaluation Orthostatic Hypotension Pathophysiology Aging Hypertension Medications Other Conditions Primary Autonomic Failure Syndromes Secondary Autonomic Dysfunction Presentation Evaluation Management Carotid Sinus Syndrome and Carotid Sinus Hypersensitivity Pathophysiology Epidemiology Presentation Evaluation Carotid Sinus Massage Management Vasovagal Syncope Pathophysiology Presentation Evaluation Management Postprandial Hypotension Summary Further Reading Chapter 58: Pressure Ulcers Definition Epidemiology Morbidity Associated with Pressure Ulcers Pathophysiology Presentation Assessment Risk Assessment Assessment of Pressure Ulcer Stage Assessment of Pressure Ulcer Healing Management Local Treatment Surgery Drugs Nutrition Prevention Special Issues Summary Further Reading Chapter 59: Incontinence Definition and Epidemiology Pathophysiology and Classification Basic Causes Acute and Reversible Causes Persistent Incontinence Evaluation Management Behavioral Interventions Drug Treatment Surgical Approaches Mechanical Devices, Undergarments, Catheters, and Other Supports Fecal Incontinence Further Reading Chapter 60: Elder Mistreatment Definitions Epidemiology Pathophysiology Presentation Management Special Situations Summary Further Reading Part IV: Organ Systems and Diseases Section A: Human Brain Chapter 61: Cellular and Neurochemical Aspects of the Aging Human Brain Structural Changes in the Aging Brain Cytoskeletal and Synaptic Changes Vascular Changes Amyloid Accumulation Free Radicals and the Aging Brain Lipid Peroxidation Protein Oxidation DNA Damage Mechanisms that Promote Oxidative Stress in Aging and Neurodegenerative Disorders Alterations in Energy Metabolism and Mitochondrial Function in the Aging Brain Cerebral Metabolism Mitochondrial Function Neuronal Ion Homeostasis in the Aging Brain Neurotransmitter Signaling in the Aging Brain Cholinergic Systems Dopaminergic Systems Monoaminergic Systems Amino Acid Transmitter Systems Neuroendocrine Changes in the Aging Brain Immunologic Factors in Brain Aging Neurotrophic Factors in the Aging Brain Neurotrophic Factors Counteract Age- and Disease-Related Neurodegeneration ”Use It or Lose It” Genetic Factors in Brain Aging and Neurodegenerative Disorders Longevity Genes Disorder-Specific Genes Dietary Factors in Brain Aging and Neurodegenerative Disorders Calorie Intake Folic Acid (Homocysteine) Antioxidants Stimulatory Phytochemicals Conclusion Further Reading Chapter 62: Cognitive Changes Associated with Normal and Pathological Aging The Effects of Normal Aging on Cognitive Function General Intellectual Functioning Attention Executive Functions Memory Language Language Comprehension Language Production Visuospatial Skills Psychomotor Functions Cognitive Effects of Common Age-Related Medical Conditions Cardiovascular Disease Hypertension Nutritional Deficiency Type 2 Diabetes Mellitus Oxygen Deprivation Chronic Obstructive Pulmonary Disease Obstructive Sleep Apnea Thyroid Dysfunction Depression Medications Delirium Neurodegenerative Disease Alzheimer’s Disease Patient History Medical Examination Neuropsychological Assessment Memory Attention and Executive Function Language Visuospatial Function Motor Function Behavioral Changes Awareness of Deficits Variant AD Presentations Mild Cognitive Impairment Vascular Dementia Frontotemporal Dementia Primary Progressive Aphasia Lewy Body Disease Parkinson Disease Dementia with Lewy Bodies Progressive Supranuclear Palsy Alcohol-Related Dementia Persistent Alcohol Dementia Wernicke–Korsakoff Syndrome Prion Diseases Normal Pressure Hydrocephalus Human Immunodeficiency Virus Neurosyphilis Conclusions Further Reading Chapter 63: Psychoactive Drug Therapy Introduction Antidepressants Selective Serotonin Reuptake Inhibitors Fluoxetine Sertraline Paroxetine Citalopram and Escitalopram Side Effects and Safety Other Antidepressants Bupropion Duloxetine Mirtazapine Venlafaxine Tricyclic Antidepressants and Monoamine Oxidase Inhibitors Psychostimulants Methylphenidate Antipsychotics Conventional Antipsychotics Atypical Antipsychotics Clozapine Risperidone Olanzapine Quetiapine Aripiprazole and Ziprasidone Side Effects and Safety Mood Stabalizers Lithium Anticonvulsants Valproate Carbamazepine Gabapentin and Pregabalin Lamotrigine Anxiolytics Benzodiazepines and Nonbenzodiazepine Hypnotics Buspirone Summary Further Reading Chapter 64: Cerebrovascular Disease Ischemic Stroke or TIA Subtype Pathophysiology and Clinical Presentation Large Vessel, Atherothrombotic Stroke/TIA Subtype Atherothrombotic Disease of the Anterior Cerebral Circulation (Origin of the Internal Carotid Artery, Its Major Branches, and the Common Carotid Artery) Atherothrombotic Disease of the Posterior Cerebral Circulation: Vertebrobasilar and Posterior Cerebral Arteries and Their Branches Lacunar Stroke/TIA Subtype (Small Vessel Disease) Embolic Stroke/TIA Subtype Patent Foramen Ovale and Embolic Stroke Other Causes of Cerebral Infarction Evaluation Cardiac Evaluation Therapeutic Strategies for Ischemic Stroke Hyperacute/Acute Subacute Preventive Preventive Strategies for Controlling Primary Risk Factors Preventive Therapy Directed Toward the Specific Stroke/TIA Subtype Treatment and Prevention of Complications of Stroke Intracranial Hemorrhage Intracerebral Hemorrhage Deep Hemispheric Hemorrhage Lobar Hemorrhage Cerebral Amyloid Angiopathy Lobar Hemorrhages Caused by Metastatic Disease Vascular Malformations Subarachnoid Hemorrhage Further Reading Chapter 65: Dementia Including Alzheimer’s Disease Genetics of Alzheimer’s Disease Neuropathology of Alzheimer’s Disease Pathobiology of Alzheimer’s Disease Amyloid Precursor Protein Processing and Generation of Aβ Aβ: Pivotal Role in the Pathogenesis of Alzheimer’s Disease Epidemiology and Risk Factors for Alzheimer’s Disease Aging APOE Genotype Gender Hypercholesterolemia and Vascular Risk Factors Head Trauma Depression Education and Ethnicity Clinical Presentations of Alzheimer’s Disease Typical Clinical Presentation of AD Atypical Clinical Presentations of Alzheimer’s Disease Diagnosis of Alzheimer’s Disease Future Diagnostic Tools Managing Patients with Alzheimer’s Disease Presenting the Diagnosis Treatment of Cognitive Symptoms Disease-Modifying Therapies Preventive Strategies Behavioral Management Safety Management Caregiver Support End-of-Life Care Summary Further Reading Chapter 66: Parkinson’s Disease and Related Disorders Distinguishing Between Parkinson’s Disease and Parkinsonism Pathology of Parkinson’s Disease and Parkinson-Plus Syndromes Cause and Pathogenesis of Parkinson’s Disease and Parkinson-Plus Syndromes Epidemiology and Clinical Features of Parkinson’s Disease Principles of Therapy Neuroprotective Therapy Encourage Exercise to Keep the Patient Mobile Individualize Therapy Deep Brain Stimulation Medical Therapy of Parkinson’s Disease Motor Complications of Levodopa Therapy Treatment of the “Wearing-off” Phenomenon Treatment of Levodopa-Induced Dyskinesias Treatment of Nonmotor Features Surgical Therapy Further Reading Chapter 67: Other Neurodegenerative Disorders Approach to the Evaluation of Cognitive and Behavioral Disorders in Adults Disorders Associated with Alpha-Synuclein Deposition Dementia with Lewy Bodies Parkinson’s Disease Dementia Multiple System Atrophy Neurodegenerative Disorders Associated with Tau, Progranulin, or TDP-43 Pathology Frontotemporal Lobar Degeneration Syndromes Progressive Nonfluent Aphasia Semantic Dementia Frontal Variant Frontotemporal Dementia Pick’s Disease Other FTLD Neuropathologies Treatment of FTLD Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig’s Disease) Corticobasal Degeneration Progressive Supranuclear Palsy Spinocerebellar Ataxia Syndromes Concluding Remarks on Non-Alzheimer’s Disease Neurodegenerative Disorders Further Reading Chapter 68: Traumatic Brain Injury Epidemiology Etiology Falls Motor Vehicle Accident Mortality Types of Brain Injury Severity of Injury Outcomes Global TBI Outcome and Age Executive Dysfunction Speed of Processing Attention/Distractibility Memory Dysfunction Personality/Emotional Functioning Self-Awareness Neuropsychiatric Outcome TBI and Subsequent Brain Atrophy and Cognitive Aging Dementia and Trauma Does Trauma Increase the Risk of AD? Postacute Management of Geriatric Patients with TBI Neuropsychological Assessment Neuropsychiatric Disturbances Pain Further Reading Chapter 69: Epilepsy Definition of Epilepsy and Seizures Incidence and Prevalence of Epilpesy and Use of AEDs Incidence in Community-Dwelling Elderly Prevalence in Community-Dwelling Elderly Prevalence in Nursing Home Elderly Prevalence at Time of Admission to Nursing Homes Incidence After Admission to Nursing Homes Causes Diagnosis History CT and MRI Scans Electroencephalogram Treatment Deciding to Treat Clinical Pharmacology of AEDs in the Elderly Variability of AED Levels in Nursing Homes Clinical Trials of AEDs in the Elderly Choosing an AED for the Elderly Phenytoin Carbamazepine Valproate Phenobarbital Gabapentin Lamotrigine Levetiracetam Pregabalin Dosing of AEDs in the Elderly Alternative Routes of Administration Drug Interactions with Non-AEDs Conclusions Further Reading Chapter 70: Late-Life Mood Disorders Introduction The Subtypes of Late-Life Mood Disorders The Epidemiology of Late-Life Mood Disorders The Outcome of Mood Disorders in Late Life Origins of Late-Life Mood Disorders Biological Origins Psychological Origins Social Origins The Diagnostic Workup of Late-Life Mood Disorders Treatment of Late-Life Mood Disorders Biological Therapies Psychological Therapies Working with the Family of the Depressed Older Adult Evaluating and Managing Suicidal Risk in the Depressed Older Adult Further Reading Chapter 71: Schizophrenia Definition Inclusion Criteria Positive Symptoms Negative Symptoms Clinical Course Exclusion Criteria Associated Symptoms Age of Onset Early Onset Late Onset Differential Diagnoses Mood Disorders Schizoaffective Disorder Dementia Delirium Delusional Disorder Substance-Induced Psychotic Disorder Schizophreniform Disorder and Brief Psychotic Disorder Ictal Psychosis Etiology Genetic Developmental Treatment Antipsychotics Typical Antipsychotic Atypical Antipsychotics Psychosocial Treatments Nonpsychotic Disorders That Can Be Confused with Schizophrenia Charles Bonnet Syndrome Delusional Parasitosis (Ekbom Syndrome) Diogenes Syndrome Hallucinations in Grief Organic Delusional Disorder Further Reading Chapter 72: General Topics in Geriatric Psychiatry Suicide Factors Associated with Suicide Evaluation and Assessment Management and Treatment Anxiety Disorders in the Elderly Treatment Options for Anxiety Posttraumatic Stress Disorder Late-Life Psychotic Disorders Clinical Presentation Epidemiology and Terminology Risk and Comorbidity Psychosis in Dementia Treatment Considerations Alcohol and Substance Use in the Elderly Geriatric Substance Abuse Prevalence Diagnosis and Classification Therapeutic Interventions Clinical Approach and Management Other Addictive Substances and Treatment Personality Pathology in the Elderly Personality Disorder Classification Prevalence Age-Associated Personality Changes Treatment Strategies Further Reading Chapter 73: Management of Agitation in Dementia Introduction Pathophysiology Assessment of the Agitated Patient Clearly Define and Document the Problem Assess the Impact on the Caregiver Medical Workup: Rule Out Delirium Rule Out Primary Psychiatric Disorders Depression Anxiety Disorders Psychotic Symptoms Management of Agitation Identify Target Symptoms Set Realistic Goals Therapeutic Interventions Nonpharmacological Interventions Pharmacological Interventions Antipsychotics Efficacy Mortality Risk and Antipsychotics Cerebrovascular Adverse Events and Antipsychotics Antipsychotics and Mortality in Patients with Dementia with Possible Lewy Body Pathology Other Side Effects of Antipsychotics Antidepressants Anticonvulsants Carbamazepine Valproate Gabapentin Acetylcholinesterase Inhibitors Antiadrenergic Approaches Benzodiazepines Gonadal Hormones General Guidelines for the Selection of Pharmacological Interventions Conclusion Further Reading Section B: Cardiology Chapter 74: Effects of Aging on Cardiovascular Structure and Function Principles of Aging Biology Pertinent to the Cardiovascular System Aging of the Vasculature Age Changes in Arterial Structure Functional Changes of Aging Arteries Aging and Atherosclerosis Aging Changes in the Heart Changes in Myocardial Composition Myocite hypertrophy Myocyte Degeneration Connective Tissue Senile Cardiac Amyloid Adiposity Changes in Cardiac Structure Mass Ventricular Wall Thickness Chamber Size Aorta Valves Pericardium Atrial Septum Coronary Arteries Overall Appearance Changes in Cardiac Function with Age at Rest Heart Rate and Rhythm Diastolic Function Systolic Function Possible Implications of the Age-Related Changes in Resting Cardiovascular Function Effect of Age on the Cardiovascular Response During Exercise Summary Further Reading Chapter 75: Aging and Atherosclerosis Vascular Aging Exposure Accumulation Attrition Summary Risk Factors for Vascular Pathology in Older Adults Traditional Risk Factors Hypertension Dyslipidemia Altered Glucose Metabolism Smoking Nontraditional Risk Factors Chronic Renal Disease Biomarkers Associated with Atherosclerosis Depression and Social Isolation Frailty Obesity Autoimmune Disease Impact of Other Aging Organs Volume-Regulating Hormones Renal Aging Iatrogenic Contributors Medications Radiation Summary Clinical Implications of Vascular Aging and Atherosclerosis Isolated Systolic Hypertension Heart Failure with Preserved Systolic Function Coronary Artery Disease Cerebrovascular Disease Renovascular Disease Aneurysms Peripheral Arterial Disease Reduced Exercise Capacity Detection and Diagnosis Stress Testing Computed Tomography Magnetic Resonance Imaging Vascular Studies Strategies to Prevent, Retard, and Regress Vascular Aging and Atherosclerosis Novel Drug Targets Pleiotropic Effects of Available Therapies ACE-I/ARB Statins Exercise Summary and Take Home Points Further Reading Chapter 76: Coronary Heart Disease Prevalence Effects of Aging on the Cardiovascular System Presentation Diagnostic Evaluation Asymptomatic Elderly Patients Chronic Stable Angina in the Elderly Patient Acute Coronary Syndromes Prognosis Acute Coronary Syndrome Therapies Fibrinolysis and Primary Angioplasty in Elderly Patients Antiplatelet Therapy Antithrombin Therapy Beta-blockers Secondary Prevention Strategies Post-MI Testing Coronary Revascularization Special Considerations Underrepresentation in Clinical Trials Renal Function and Pharmacology Patient Preferences Social/Economic Issues Summary Further Reading Chapter 77: Valvular Heart Disease Aortic Stenosis Etiology Clinical Presentation and Diagnosis Management Asymptomatic Patients Medical Management Percutaneous Aortic Valvuloplasty Surgical Management Aortic Insufficiency Etiology Clinical Presentation and Diagnosis Management Medical Management Surgical Management Mitral Stenosis Etiology Clinical Presentation and Diagnosis Management Medical Management Percutaneous Mitral Valvuloplasty Surgical Management Mitral Regurgitation Etiology Clinical Presentation and Diagnosis Management Medical Management Surgical Management General Considerations Endocarditis Prophylaxis Anticoagulation Prosthetic Valve Choices Mechanical Valves Bioprosthetic Valves Aortic Homografts Pulmonary Valve Autotransplants (Ross Procedure) Valve Repair Chapter 78: Heart Failure Epidemiology and Economic Impact Pathophysiology Etiology and Precipitating Factors Precipitating Factors Clinical Features Symptoms Signs Systolic versus Diastolic Heart Failure Diagnostic Evaluation Systolic versus Diastolic Heart Failure Management Nonpharmacological Therapy Physical Activity and Exercise Exercise Prescription Cessation of Exercise Treatment of Systolic Heart Failure ACE Inhibitors Angiotensin II Receptor Blockers Other Vasodilators Beta-Blockers Diuretics Aldosterone Antagonists Digoxin Calcium Channel-Blockers Antithrombotic Therapy Statins Treatment of Diastolic Heart Failure Diuretics Beta-Blockers ACE Inhibitors Angiotensin II Receptor Blockers Aldosterone Antagonists Calcium Channel-Blockers Nitrates Digoxin Summary Refractory Heart Failure Prognosis Ethical Issues and End-of-Life Decisions Prevention Summary Further Studies Chapter 79: Cardiac Arrhythmias Overview of the Effect of Aging on Cardiac Electrophysiology and Evaluation of Arrhythmias Electrophysiology and Arrhythmias in the Elderly Clinical Testing Bradyarrhythmia and Cardiac Pacemaker Therapy in the Elderly Standard Indications Acquired Advanced AV Block AV Conduction Disease Sinus Node Dysfunction Pacemaker Therapy Prospective Trials of Ventricular (VVI) and Physiological (AAI or DDD) Pacing Syncope in the Elderly Hypersensitive Carotid Sinus Syndrome Neurocardiogenic (“Vasovagal”) Syncope Elderly Patients with Syncope of Uncertain Cause Tachyarrhythmias and Cardiac Implantable Defibrillator Therapy in the Elderly Atrial Fibrillation Stroke Prevention in Atrial Fibrillation Pharmacologic Therapy for Atrial Fibrillation Rate Control Rhythm Control Rate versus Rhythm Control Nonpharmacologic Therapy for Atrial Fibrillation Rate Control Rhythm Control Supraventricular Tachyarrhythmia Ventricular Tachyarrhythmia Secondary Prevention of Sudden Cardiac Death Primary Prevention of Sudden Cardiac Death Cardiac Resynchronization Therapy and Implantable Cardioverter Defibrillator Aging and Drug-Induced Proarrhythmia Changes in Pharmacokinetics Associated with Aging Drug-Induced Arrhythmias Novel, Emerging Therapies for Cardiac Arrhythmias Biological Pacemakers for Bradyarrhythmias Genetic and Cell Therapy for Tachyarrhythmias Summary Key Points Further Reading Chapter 80: Peripheral Vascular Disease Definition Epidemiology Pathophysiology Presentation Evaluation Pulse Palpation and San Diego Claudication Questionnaire Noninvasive Vascular Tests Treadmill Testing Physical Function Management Risk Factor Modification Smoking Cessation Hypercholesterolemia Hypertension Diabetes Antiplatelet and Anticoagulation Therapy Vasodilators Revascularization Therapy Effects of Exercise Rehabilitation Recommended Exercise Program for Treating Intermittent Claudication Prevention Summary Further Reading Chapter 81: Hypertension Introduction Epidemiology Classification Pathophysiological Characteristics Diagnostic Evaluation Measurement Considerations Evaluation Target Organ Damage and Risk Factor Assessment Approach to Treatment Treatment Effectiveness Therapeutic Goals and Monitoring Lifestyle Modifications Pharmacological Therapies Overview Thiazide-type Diuretics Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Antagonists Calcium Channel Antagonists Adrenergic Receptor Antagonists Barriers to Improving Blood Pressure Control Unanswered Questions and Future Research Directions Summary Further Reading Section C: Respiratory System Chapter 82: Aging of the Respiratory System Introduction Lung Volumes Maximal Expiratory Flow Spirometry Respiratory Muscle Strength Arterial Blood Gases Diffusing Capacity Differential Diagnosis of Asthma and COPD Tests to Assess Response to Therapy for Asthma and COPD Further Reading Chapter 83: Chronic Obstructive Pulmonary Disease Definitions Epidemiology Pathophysiology Risk Factors Pathogenesis and Pathology Changes in Respiratory Physiology in COPD Nonpulmonary Effects Clinical Manifestations Diagnosis Spirometry Other Tests Severity of COPD Natural History of COPD Management Goals of Management of Stable Disease Smoking Cessation Pharmacologic Management Short- and Long-Acting Beta Agonist Anticholinergic Agents Methylxanthines Corticosteroids Inhalation Techniques Mucolytic Agents Phosphodiesterase (PDE)-4 Inhibitors Adjunct Therapies Nonpharmacologic Interventions Oxygen Therapy Pulmonary Rehabilitation Weight Loss and Malnutrition Noninvasive Positive Pressure Ventilation Surgery for COPD Acute Exacerbation of COPD Diagnostic and Therapeutic Approaches Summary Further Reading Chapter 84: Diffuse Parenchymal Lung Disease Introduction Epidemiology Prognosis and Natural History Pathogenesis Diagnostic Approach History Physical Examination Laboratory Tests Chest Radiography High-Resolution Computed Tomography Pulmonary Function Tests Bronchoscopic Studies Lung Biopsy Therapeutic Approach Future Directions Further Reading Section D: Nephrology Chapter 85: Changes in Kidney Function Clinical Relevance The Aging Process Functional Changes Renal Blood Flow Glomerular Filtration Rate Classification of Kidney Disease Proteinuria Tubular Function Donor Organ Viability Underlying Structural Changes Gross Anatomy Glomerulus Age-Related Glomerulosclerosis Tubule Vasculature Mechanisms Underlying the Decline in Kidney Function Genetic Predisposition Animal Models Human Studies Environmental Predisposing Factors Diet Free Radicals and Lipid Peroxides Protein Restriction Lipids Hyperfiltration Consequences of Impaired Kidney Function Further Reading Chapter 86: Renal Disease Epidemiology Acute Renal Failure Definition Clinical Presentation Diagnosis Treatment Prognosis Glomerular Diseases Clinical Presentation Acute Glomerulonephritis and Rapidly Progressive Glomerulonephritis Nephrotic Syndrome Definition Pathophysiology Clinical Manifestations Histopathology Findings Diagnosis Treatment and Prognosis Renovascular Disease Definition Clinical Features Diagnostic Approach Treatment Tubulointerstitial Nephritis Functional Defects Acute Tubulointerstitial Nephritis Acute Bacterial Pyelonephritis Drug Hypersensitivity Chronic Tubulointerstitial Nephritis Analgesic Nephropathy Neoplastic Diseases Associated with Interstitial Nephritis Aging-Associated Interstitial Disease Chronic Kidney Disease Hemodialysis Peritoneal Dialysis Renal Transplantation Further Reading Chapter 87: End-Stage Renal Disease Definition Epidemiology Acute Kidney Injury in the Elderly Presentation Etiology of End Stage Renal Disease in the Elderly Population Referral of Patients to Nephrology Chronic Kidney Disease and Management of Chronic Health Conditions Indications for Initiation of Dialysis Contraindications to Renal Replacement Therapy Health-Related Quality of Life Management Choice of Renal Replacement Modality Hemodialysis Peritoneal Dialysis Kidney Transplantation Time-Limited Trial of Dialysis Conservative Management Management of End Stage Renal Disease on Dialysis Anemia Cardiovascular Disease Calcium, Phosphorous, Hyperparathyroidism, and Bone Disorders Metabolic Acidosis Malnutrition Pruritus Special Issues Prognosis and Survival Withdrawal from Dialysis Advance Directives Summary Further Reading Chapter 88: Disorders of Fluid Balance Effects of Normal Aging on Fluid Regulatory Systems Body Composition Thirst and Fluid Intake Renal Changes of Normal Aging Structural and Functional Changes Water Regulatory Capacity Renal Water Retention Renal Water Loss Sodium Regulatory Capacity Renal Sodium Retention Renal Sodium Loss Vasopressin System in Normal Aging Neurohypophyseal System Basal Plasma Vasopressin Levels Vasopressin Stimulation Age-Related Changes in Atrial Natriuretic Hormone Secretion, Regulation, and Action Renin–Angiotensin–Aldosterone Disorders of Fluid Regulation Hyponatremia Dilutional versus Depletional Hyponatremia Hyponatremia Risk Factors Syndrome of Inappropriate Antidiuretic Hormone Secretion Diseases Drugs Cerebral Salt Wasting Clinical Presentation Management Role of Aquaretics in the Treatment of Hyponatremia Hypernatremia and Dehydration Epidemiology Risk Factors Clinical Presentation Management Nocturnal Polyuria Evaluation Management Water Balance in Alzheimer’s Disease Summary Further Reading Section E: Gastroenterology Chapter 89: Effect of Aging on Gastrointestinal Function Oropharyngeal Function Esophageal Function Gastric Function Small Intestinal Function Colonic Function Colonic Neoplasia Hepatic and Biliary Function Pancreatic Structure and Function Gastrointestinal Immunity Gastrointestinal Drug Metabolism Summary Further Reading Chapter 90: Hepatic, Biliary, and Pancreatic Disease Hepatic Disease Introduction Liver Morphology Liver Function Liver Diseases Hepatitis A Virus Hepatitis B Virus Hepatitis C Virus Drug-Induced Liver Damage Primary Biliary Cirrhosis Autoimmune Hepatitis Hepatocellular Carcinoma Transplantation Biliary Disease Cholelithiasis Choledocholithiasis Acute Cholecystitis Chronic Cholecystitis Investigations Treatment Carcinoma Gallbladder Cancer Cancer of the Extra-Hepatic Bile Ducts Pancreatic Disease Anatomy Physiology Aging and the Pancreas Acute Pancreatitis Chronic Pancreatitis Pancreatic Cancer Further Reading Chapter 91: Upper Gastrointestinal Disorders Gastroesophageal Reflux Disease in the Elderly Definition Pathophysiology Symptomatology Diagnosis Treatment Lifestyle and Dietary Modifications Pharmacological Treatment: Short-Term Therapy Long-Term Maintenance Therapy Safety of Long-Term Antisecretory Treatment The Role of Surgery Peptic Ulcer Disease Definition Epidemiology Pathophysiology Helicobacter pylori-Associated Peptic Ulcer NSAID/Aspirin-Associated Peptic Ulcer Clinical Features Diagnostic Tests Testing for Helicobacter pylori Infection Posttreatment Helicobacter pylori Evaluation Other Noninvasive Tests Treatment Options for Peptic Ulcer Disease Eradication of Helicobacter pylori Infection Treatment and Prevention of NSAID-Related Peptic Ulcer Identify the High-Risk Patient Reduce Dosage and Use Less Damaging NSAIDs Use of Selective Inhibitors of Cyclo-Oxygenase-2 (Coxibs) Cotreatment with Gastroprotective Drugs Eradication of Helicobacter pylori Infection Educational Programs Non-NSAID, Non-Helicobacter pylori Ulcers Bleeding Peptic Ulcer Neoplasm of the Esophagus Esophageal Cancer Squamous Cell Carcinoma Adenocarcinoma Diagnosis Treatment Palliative Therapy Benign Tumors Gastric Cancer Epidemiology Etiology and Risk Factors Clinical Features Diagnosis Treatment of Gastric Cancer Surgery and Endoscopic Procedures Chemotherapy Palliative Therapy Further Reading Chapter 92: Common Large Intestinal Disorders Diagnostic Testing Endoscopic Procedures Colonoscopy Endoscopic Ultrasound Radiology Contrast Studies CT Colonography Diverticular Disease Pathophysiology Asymptomatic Diverticulosis Painful Diverticular Disease Diverticulitis Diverticular Hemorrhage Clostridium Difficile Colitis Pathogenesis Clinical Manifestations Diagnostic Tests Treatment Microscopic Colitis Pathology Treatment Inflammatory Bowel Disease Crohn’s Disease Symptoms and Signs Management Ulcerative Colitis Symptoms and Signs Management Colon Cancer in IBD Colon Ischemia Pathophysiology Clinical Features Management Colonic Obstruction Acute Colonic Pseudo-obstruction Pathophysiology Clinical Features Management Lower Gastrointestinal Bleeding Vascular Ectasias Summary Further Reading Chapter 93: Constipation Introduction Definitions Prevalence of Constipation and Constipation-Related Symptoms Self-Reported Constipation Infrequent Bowel Movements Difficult Evacuation Constipation Symptoms in the Long-Term Care Setting Pathophysiology Colonic Function Intrinsic Mechanisms for Colonic Dysfunction in Older People with Constipation Anorectal Function Age-Related Changes in Anorectal Function Anorectal Dysfunction in Older Persons Risk Factors for Constipation in Older People Reduced Mobility Polypharmacy/Drug Side Effects Dietary Factors Fiber Calories Enteral Nutrition Fluid Intake Amount Alcohol and Coffee Parkinson Disease Diabetes Mellitus Dementia Mood-Related Disorders Stroke Spinal Cord Injury/Disease Metabolic Disorders Colorectal Cancer Rectocele Presentation Clinical Evaluation Digital Rectal Examination Pelvic Floor/Rectal Prolapse General Assessment Plain Abdominal X-Ray Colonoscopy/Bowel Preparation Anorectal Function Tests Complications of Constipation in the Elderly Fecal Incontinence Fecal Impaction Urinary Retention/Lower Urinary Tract Symptoms Stercoral Perforation/Colon Ischemia Sigmoid Volvulus Colonic Pseudo-obstruction Rectal Prolapse Diverticular Disease Psychological Impact/Quality of Life Nonpharmacological Treatment Education Diet Fluids Physical Activity Abdominal Massage Pelvic Floor and Sphincter Strengthening Exercises Toileting Habits Toileting Access—Privacy and Dignity Medication Review Pharmacological Treatment Laxative and Enema Use and Abuse in Older People Evidence-Based Summary of Laxative, Suppository, and Enema Treatment in Older Persons Stimulant Laxatives Bulk Laxatives Magnesium Salts Hyperosmolar Laxatives Fecal Softeners Enemas Suppositories Enterokinetic Agents Treatment Guidance Further Research Conclusions Further Reading Section F: Oncology Chapter 94: Oncology and Aging: General Principles Relationship of Aging and Neoplasia Clinical Presentations and Disease Behavior Screening in Asymptomatic Individuals Breast Cancer Cervical Cancer Colon Cancer Lung Cancer Initial Presentation Biological Behavior of Tumors in the Elderly Host Management Major Therapeutic Modalities Surgery Radiation Therapy Chemotherapy and Hormonal Therapy Supportive Care Conclusion Further Reading Chapter 95: Breast Disease Risk Factors and Biology Diagnosis Primary Prevention, Screening, and Diagnosis Primary Prevention Screening Diagnosis Staging Treatment of Breast Cancer Carcinoma In Situ Management of Early Localized Lesions (Stage I and II) Local Management Management of the Breast Breast Reconstruction Radiation After Mastectomy Axillary Assessment Adjuvant Systemic Therapy Follow-up for Women with Early Breast Cancer Treatment of Metastatic Disease Special Considerations Endocrine Therapy as Initial Treatment Male Breast Cancer Conclusions Further Reading Chapter 96: Prostate Cancer Epidemiology and Risk Factors Prevention Finasteride Vitamin E and Selenium Presentation Evaluation Management Observation Active Surveillance Local Therapy: Surgery, Radiation, or Brachytherapy Radical Prostatectomy External Beam Radiation Therapy Brachytherapy Primary Androgen Deprivation Adjuvant Therapy Posttreatment Surveillance Biochemical Recurrence Salvage Local Therapy Advanced Disease Hormonal Therapy First-Line Hormonal Therapy Intermittent Androgen Deprivation Second-Line Hormonal Therapy Chemotherapy Supportive Care Bisphosphonates Pain Control Palliative Radiation and Systemic Radioisotopes Further Reading Chapter 97: Lung Cancer Epidemiology Etiology Risk Factors Tobacco Smoking Other Risk Factors Screening Pathology Clinical Presentation Paraneoplastic Syndromes Diagnosis Staging Metabolic Staging Prognostic Factors Treatment of Non–Small-Cell Lung Cancer Stage I (T1N0, T2N0) Stage II (T1N1, T2N1, T3N0) Stage IIIA (T3N1, T1–3N2) Stage IIIB (T4N0, any TN3) Stage IV (any T, any N, M1) Small-Cell Lung Cancer Special Problems Pancoast (Superior Sulcus) Tumors Chest Wall Tumors Superior Vena Cava Syndrome Solitary Brain Metastases Supportive Care Further Reading Chapter 98: Gastrointestinal Malignancies Introduction Colorectal Cancer Risk Factors of Colorectal Cancer Chemoprevention of Colorectal Cancer Screening of Colorectal Cancer Localized Colorectal Cancer Surgery—Localized Colon Cancer Surgery—Localized Rectal Cancer Adjuvant Therapy—Localized Colon Cancer Adjuvant Therapy—Localized Rectal Cancer Postoperative Surveillance—Localized Colorectal Cancer Advanced Colorectal Cancer Surgery—Advanced Colorectal Cancer Chemotherapy—Advanced Colorectal Cancer 5-Fluorouracil Capecitabine Irinotecan Oxaliplatin Bevacizumab Cetuximab/Panitumumab Pancreatic Cancer Treatment—Localized Pancreas Cancer Treatment—Advanced Pancreas Cancer Gastric Cancer Treatment—Localized Gastric Cancer Treatment—Advanced Gastric Cancer Primary Liver Cancer Treatment—Primary Liver Cancer Esophageal Cancer Treatment—Localized Esophageal Cancer Treatment—Advanced Esophageal Cancer Gallbladder Cancer Treatment—Gallbladder Cancer Anal Cancer Treatment—Anal Cancer Clinical Trials Further Reading Chapter 99: Intracranial Neoplasms Gliomas Low-Grade Gliomas Anaplastic Gliomas Glioblastoma Multiforme Background Radiation Therapy Chemotherapy Primary Nervous System Lymphomas Brain Metastases Radiation Therapy Surgery Prognosis Meningiomas Neuromas General Considerations Clinical Presentation Diagnostic Evaluation and Imaging Non-Chemotherapy Medication Considerations Conclusions Further Reading Chapter 100: Skin Cancer Introduction Etiology Nonmelanoma Skin Cancer Basal Cell Carcinoma Squamous Cell Carcinoma Treatment for BCC and SCC Electrodessication and Curettage Cryosurgery Topical Chemotherapy Radiotherapy Surgical Excision Mohs Micrographic Surgery Melanoma Staging and Prognosis Microstaging Treatment of Melanoma Biopsy Surgical Excision of the Primary Tumor Regional Node Management Sentinel Lymph Node Biopsy Lymphadenectomy Indications Treatment of Disseminated Melanoma (Stage IV) Other Cutaneous Tumors Further Reading Section G: Hematology Chapter 101: Aging of the Hematopoietic System Introduction Biology of Hematopoiesis Murine Hematopoiesis Effect of Age on CFU-S and LT-HSC Effect of Aging on Bone Marrow Function The Effect of Age on Hematopoiesis in Humans Normal Hematopoiesis Age-Related Changes in Lymphohematopoiesis Myeloid Lineage Hematopoietic Progenitors Polymorphonuclear Neutrophils Monocytes and Macrophages Red Cells Hematopoietic Growth Factors Lymphoid Lineage Hematopoietic Growth Factors in Elderly Persons Summary Further Reading Chapter 102: Anemia Definition of Anemia in Older Adults Prevalence and Types of Anemia Prevalence Types of Anemia Nutrient-deficiency Anemia Anemia with Iron Deficiency Anemia with Vitamin B-12 (Cobalamin) and/or Folate Deficiency Anemia of CKD Anemia of Chronic Inflammation ”Unclassified” or “Unexplained” Anemia Outcomes Associated with Anemia Mortality Decline in Physical Function Frailty Status Cognitive Function Other Selected Outcomes Nature of Associations: Anemia as a Causal or Noncausal (Marker) Risk Factor? Diagnostic Considerations Therapeutic Considerations Nutrient-deficiency Anemia Anemia of CKD Anemia of Chronic Inflammation ”Unclassified” or “Unexplained” Anemia Impact of Anemia Correction with Recombinant Erythropoietin on Clinical Outcomes Conclusion Further Reading Chapter 103: White Cell Disorders Decreased White Blood Cells Drug/Toxin Effects Nutritional Deficiency Infections Bone Marrow Failure Increased Destruction Splenic Sequestration Neoplastic Causes of Decreased WBC Increased WBC Benign Causes of Leukocytosis Infection Drug-Induced Leukocytosis Other Reactive Leukocytosis Malignant Disease of the Hematopoietic System Myelodysplastic (Preleukemia) Syndromes Acute Myelogenous Leukemia Acute Lymphoblastic Leukemia Chronic Lymphocytic Leukemia B-cell CLL B-Cell Prolymphocytic Leukemia T-Cell PLL/CLL Hairy Cell Leukemia T-cell Large Granular Lymphocytic Leukemia Chronic Myelogenous Leukemia Myeloproliferative Diseases Cancers Metastatic to Bone Marrow Further Reading Chapter 104: Non-Hodgkin’s and Hodgkin’s Lymphomas and Myeloma Non-Hodgkin’s Lymphoma Epidemiology Classification Etiology Evaluation and Staging Clinical Features and Therapy Diffuse Large B-Cell Lymphoma Follicular Lymphoma Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia Marginal Zone Lymphoma Mantle Cell Lymphoma Highly Aggressive Lymphomas Hodgkin’s Lymphoma Presentation Histologies Staging Therapy Response to Treatment and Survival Multiple Myeloma and Related Plasma Cell Dyscrasias Epidemiology Etiology Clinical Manifestations of Disease and Their Pathogenesis Bone Pain Infection Renal Failure Anemia and Bleeding Hyperviscosity Neurological Symptoms Diagnosis and Staging Monoclonal Gammopathy of Uncertain Significance Smoldering Myeloma Myeloma Staging Therapy Other Plasma Cell Dyscrasias Seen in Geriatric Populations Waldenström’s Macroglobulinemia Heavy-Chain Disease Amyloidosis Take Home Points for the Geriatrician Further Reading Chapter 105: Thrombosis Epidemiology Incidence of VTE Risk Factors Pathophysiology Natural History Acute Consequences of Venous Thromboembolism Chronic Complications of Venous Thromboembolism Diagnosis Deep Vein Thrombosis Clinical Features Diagnostic Testing Venography Venous Ultrasonography D-dimer Blood Testing Recurrent Deep Vein Thrombosis Pulmonary Embolism Clinical Features Diagnostic Tests Chest Radiography and Electrocardiography Pulmonary Angiography Ventilation–Perfusion Lung Scanning Computed Tomographic Pulmonary Angiography D-dimer Blood Testing Compression Ultrasonography Uncommon Thromboembolic Disorders Subclavian or Axillary Veins Mesenteric Vein Renal Vein Thrombosis Treatment of Venous Thromboembolism Management of Acute Venous Thromboembolism Overview Anticoagulant Therapy Duration of Anticoagulant Therapy Primary Prevention of Venous Thromboembolism Overview Therapies Indications for Venous Thromboembolism Prophylaxis General Surgery and Medicine Major Orthopedic Surgery Genitourinary Surgery, Neurosurgery, and Ocular Surgery Complications of Antithrombotic Agents Risks of Major Bleeding Consequences of Bleeding in Elderly Further Reading Chapter 106: Hemorrhagic Disorders Overview of Hemostasis Age-Related Effects on the Hemostatic System Clinical Approach to Bleeding in the Elderly Patient Age of Onset of Symptoms Bleeding Symptoms Bruising, Purpura, Petechiae, and Ecchymoses Oral Mucosal Bleeding Menorrhagia Gastrointestinal Bleeding, Hemoptysis, and Hematuria Family History of Bleeding Medications Diet Physical Examination General Examination Purpura Importance of Correlation of Clinical and Laboratory Findings Quantitative Disorders of Platelets Isolated Thrombocytopenia Pseudothrombocytopenia Immune Thrombocytopenia Posttransfusion Purpura Drug-Induced Thrombocytopenias Qualitative Disorders of Platelets Antiplatelet Agents Myeloproliferative Disorders Uremia/Chronic Renal Failure Coagulation Disorders Congenital Coagulation Disorders in Elderly Patients Acquired Coagulation Factor Inhibitors Acquired Hemophilia (Inhibitors to Factor VIII (fVIII) Acquired von Willebrand’s Syndrome Anticoagulants Combined Hemostatic Defects Disseminated Intravascular Coagulation Liver Disease Vascular Purpura Senile Purpura Scurvy Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Syndrome) Conclusions Further Reading Section H: Endocrinology and Metabolism Chapter 107: Aging of the Endocrine System and Selected Endocrine Disorders Principles of Geriatric Endocrinology Impaired Homeostatic Regulation Altered Presentation of Endocrine Diseases Changes in Diagnostic and Therapeutic Approach Neuroendocrine Regulation Neurotransmitters and Neuropeptides Dopamine Norepinephrine Opioid Peptides Melatonin Hormonal Changes in Alzheimer’s Disease Anterior Pituitary Prolactin Pituitary Adenomas Hypopituitarism and the Empty Sella Syndrome Posterior Pituitary Hypothalamic–Pituitary–Adrenal Axis Physiology Laboratory Testing of HPA Axis Function Hyperadrenocorticism Glucocorticoid Therapy Hypercortisolism Diagnostic Testing Treatment Adrenal Insufficiency Adrenal Androgens and Aging Dehydroepiandrosterone Supplementation for Older Adults Adrenal Neoplasms Sympathoadrenal System Physiology Clinical Hypertension Metabolic Syndrome Autonomic Insufficiency Pheochromocytoma Renin–Angiotensin–Aldosterone System Growth Hormone Axis Physiology Age Effects Growth Hormone Deficiency in Adults with Hypothalamic–Pituitary Disease Growth Hormone Supplementation for Older People Without Hypothalamic–Pituitary Disease The Hypothalamic–Pituitary–Testicular Axis Age Effects Laboratory Diagnosis of Hypogonadism Further Reading Chapter 108: Thyroid Diseases The Aging Human Thyroid Anatomy Physiology Screening for Thyroid Disease Nonthyroidal Illness Drugs and Thyroid Function Hypothyroidism Definition Prevalence Etiology and Pathogenesis Clinical Manifestations Diagnosis Treatment Subclinical Hypothyroidism Myxedema Coma Hyperthyroidism Definition Prevalence Etiology and Pathogenesis Clinical Manifestations Diagnosis Treatment Subclinical Hyperthyroidism Thyroid Nodules Prevalence Clinical Evaluation Diagnostic Tests Management Thyroid Cancer Papillary Thyroid Carcinoma Follicular Thyroid Carcinoma Medullary Thyroid Carcinoma Anaplastic Thyroid Carcinoma Thyroid Lymphoma Further Reading Chapter 109: Diabetes Mellitus Definition and Classification Type 1 Diabetes Type 2 Diabetes Other Specific Types of Diabetes Gestational Diabetes Mellitus Diagnostic Criteria Diagnostic Testing for Older Adults Epidemiology of Diabetes and Its Complications Diabetes Mellitus and Prediabetes Diabetes Complications Pathophysiology of Diabetes and Its Complications Effects of Aging Insulin Resistance Impaired Insulin Secretion Interaction Between Impaired Insulin Secretion And Insulin Resistance Genetics Mechanisms for Diabetes Complications Prevention Presentation Evaluation Medical Evaluation Other Evaluation Components Diabetes Knowledge Functional Status Cognitive and Psychosocial Status Overall Health Status Diabetes Management General Approach Management of Cardiovascular Risk Factors Prevention of Microvascular Complications Other Diabetes Complications Management of Hyperglycemia Basic Care Aggressive Care Specific Interventions for Hyperglycemia Diet Caloric Intake Diet Composition Dietary Issues in Older People Exercise Noninsulin Agents Sulfonylurea Drugs α-Glucosidase Inhibitors Biguanide Thiazolidinediones Meglitinide D-Phenylalanine Derivative Dipeptidyl Peptidase-4 (DPP-4) Inhibition Glucagon-like Peptide-1 (GLP-1) Analog Combination Therapy Insulin Therapy Advantages of Insulin Disadvantages of Insulin Insulin Regimens Amylin Analog: Adjunct to Mealtime Insulin Therapy Initiation of Insulin Therapy Combination of Insulin and Oral Agents Follow-up Care Special Issues Hypoglycemia Hypoglycemia Counterregulation Hypoglycemia in Elderly Patients Hyperosmolar Coma and Diabetic Ketoacidosis Diabetes in Long-Term Care Further Reading Chapter 110: Dyslipoproteinemia Definition Pathophysiology Overview of Lipoprotein Subclasses and Lipoprotein Metabolism Mechanisms Underlying the Age-Associated Changes in Lipids Changes in Diet Total and Visceral Adiposity Physical Fitness Lipoprotein Synthetic and Catabolic Rates Epidemiology Coronary Heart Disease Age-Associated Changes in Lipids Secular Changes in Lipoprotein Lipid Concentrations and Prescribing Patterns Secular Changes in Lipoprotein Lipid Concentrations Secular Changes in HMG-CoA Reductase Inhibitor (Statin) Prescription Patterns Lipoproteins as Risk Factors for Coronary Heart Disease Elevated Total and LDL-C Concentrations Reduced Concentrations of HDL-C Atherogenic LDL Pattern B Phenotype Apolipoprotein 4 Allele Elevated Lipoprotein (a) Summary Intervention Trials Presentation Evaluation Management Risk-Stratified Approach to Lipid Treatment Therapeutic Lifestyle Intervention Pharmacological Therapy HMG-CoA Reductase Inhibitors (Statins) Fibrates Bile Acid Sequestrants Nicotinic Acid (niacin) Ezetimibe Prevention Special Issues Secondary Dyslipidemias Caused By Medications Diabetic Dyslipoproteinemia and Metabolic Syndrome Hypocholesterolemia Management of Dyslipidemia in the Nursing Home Setting Further Reading Chapter 111: Hyperparathyroidism and Paget’s Disease of Bone Hyperparathyroidism Background and Epidemiology Etiology and Pathology Signs and Symptoms Diagnosis Differential Diagnosis Therapy Paget’s Disease of Bone Epidemiology Etiology Pathophysiology Clinical Manifestations Diagnosis Therapy Acknowledgments Further Reading Section I: Mobility and Musculoskeletal System Chapter 112: Aging of the Muscles and Joints Articular Cartilage Normal Structure and Function Regulation of Cartilage Matrix Turnover Age-Related Changes in Cartilage Changes in Cartilage Structure and Matrix Composition Aging and Chondrocyte Function Potential Role of Oxidative Stress in Cartilage Aging Aging and the Development of Osteoarthritis Aging as a Risk Factor for OA Contribution of Aging to the Anabolic and Catabolic Imbalance in OA Skeletal Muscle Skeletal Muscle Structure and Function Motor Unit Events in Muscle Contraction and Relaxation: Skeletal Muscle Excitation–Contraction Coupling Muscle Fiber Subtypes and Types of Contraction Neural Control of Muscle Contraction Mechanisms Underlying Skeletal Muscle Weakness in Old Age Neurogenic Mechanisms of Skeletal Muscle Impairment with Aging Myogenic Mechanisms of Skeletal Muscle Impairment with Aging Combined Neurogenic–Muscular Mechanism General Mechanisms of Aging that Involve Skeletal Muscle Clinical and Experimental Interventions Aimed at Delaying or Preventing Age-Associated Changes in Skeletal Muscle Composition and Function Tendons and Ligaments Intervertebral Disks Further Reading Chapter 113: Biomechanics of Mobility Prevalence of Mobility Problems Among Older Adults Age and Gender Differences in Falls and Fall-Related Injury Rates Fall-Related Injury Biomechanics The Biomechanics of Hip Fractures The Biomechanics of Wrist Fracture Age Changes in Components of Biomechanical Capability Myoelectric Latencies Reaction Times Age and Gender Group Differences in Latencies and Reaction Times Biomechanical Effects of Age Differences in Latencies and Reaction Times Are Minor Proprioception Joint ROM Muscle Strength and Power Rapid Development of Joint Torque Strengths Source of Age Differences in Rapid Strength Development Age Differences in Performance of Simple Mobility Tasks Assessment of Mobility Function Ascribing Functional Decline Fully to Insufficient Motivation, Activity, or Training is Questionable Gait Rising From Chairs, Beds, and Floors Turning in a Confined Space Walking on Irregular Surfaces Restoration of Standing Posture after Modest Disturbance Cognitive and Other Psychological Factors Age Differences in Performance of Time-Critical Mobility Tasks Times Needed for Quick Responses to Maintain or Recover Balance Studies of Time-Critical Obstacle Avoidance Tasks Avoiding Obstacles by Stepping over Them Avoiding Obstacles by Turning Away Before Reaching Them Avoiding Obstacles by Stopping Before Reaching Them Studies of Time-Critical Balance Recovery Tasks Recovery from a Slip Mechanisms Underlying Age and Gender Differencesin Performance of Time-Critical Tasks with High Strength Demands Conclusions Further Reading Chapter 114: Exercise: Physiological and Functional Effects Aging, Disuse, and Disease Aging and Exercise Endurance (Aerobic) Exercise Capacity Aging-Associated Changes in Endurance Exercise Capacity The Peripheral Components of Endurance Capacity The Central (Cardiovascular) Component of Endurance Capacity The Physiological Effects of Endurance Exercise Training Effects on VO2max Effects on Body Composition Effects on Cardiac Function Effects on Endothelial Function Skeletal Muscle Strength and Power Aging-Associated Changes in Muscle Strength and Power Muscle Mass Muscle Fibers Motor Units Muscle Quality Disuse versus Aging The Physiological Effects of Strength Training Effect on Muscular Strength and Power Physiological Mechanisms Explaining Gains in Strength with Exercise Exercise, Physical Activity, and Functional Limitations Evidence That Exercise Improves Functional Limitations Nonlinear Relationship Between Physiological Impairment and Functional Limitation Exercise and Common Geriatric Disorders Insulin Resistance and Glucose Intolerance Dyslipidemia Hypertension Atherosclerotic CVD and Overall Mortality Arthritis Osteoporosis Cancer Mood and Cognition Other Chronic Medical Disorders Risks Associated with Exercise Recommendations Further Reading Chapter 115: Mobility Introduction Definitions and Methods of Classification Defining Mobility Classification Methods for Mobility Epidemiology Prevalence Risk of Adverse Consequences Associated with Mobility Status Pathophysiology Epidemiological Perspective: Risk Factors Biomechanical Perspective: Direct Assessment of the Body in Motion Physiological Perspective: Using Organ System Impairment to Link Function and Disease Gait Speed as an Integrator of Multiple Approaches Evaluation Strategy for the Clinical Encounter Clinical Assessment of Mobility Performance Differential Diagnosis Based on a Physiological Perspective Psychosocial and Environmental Assessment Management Intervening Directly on Mobility Treating Impairments Attention to Factors that Modify Behavior and Environment Care for the Immobile Person Summary Further Reading Chapter 116: Osteoarthritis Introduction Epidemiology, Causes, and Predisposing Factors Age and Gender Joint Trauma and Nontraumatic Biomechanical Factors Obesity Muscle Strength Classification and Pathophysiology Classification Pathophysiology Presentation Symptoms Physical Abnormalities Evaluation Diagnostic Imaging Magnetic Resonance Imaging Laboratory Studies Management Patient Education Nonmedicinal Interventions Exercise Electrical Stimulation Ultrasound Cryotherapy and Thermotherapy Acupuncture Massage Orthoses Braces and Splints Assistive Devices Symptom-Directed Medicinal Therapy Topical Agents Simple Analgesics Non-steroidal anti-inflammatory Drugs Cyclooxygenase-2 Inhibitors Nutriceuticals Narcotic Analgesics Structure-Modifying Medicinal Agents Intra-articular Therapies Intra-articular Glucocorticoid Agents Hyaluronic Acid Derivatives Surgical Interventions Arthroscopy with Debridement Osteotomy Arthroplasty Unicompartment Arthroplasty Patellofemoral Arthroplasty Total Joint Arthroplasty Bilateral Knee Arthroplasty Hand Surgery Restorative Tissue Interventions Prevention Special Issues Pain and Incidental OA Conditions Superimposed with OA Functional Limitations Falls Comorbidities Conclusions Further Reading Chapter 117: Osteoporosis Definition of Osteoporosis Epidemiology Pathophysiology Bone Cells Genetics Mechanical Factors Local Factors Systemic Hormones Age-Related Bone Loss Osteoporosis in Men Presentation Secondary Causes of Osteoporosis Evaluation Bone Density Measurement Clinical Risk Factors Biochemical Markers of Bone Turnover Management Nonpharmacological Exercise Nutrition Pharmacological Estrogen Replacement Therapy Bisphosphonates Calcitonin Selective Estrogen Receptor Agonists Parathyroid Hormone Other Agents Strontium Ranelate Denosumab Osteoporosis in Nursing Homes Further Reading Chapter 118: Hip Fractures Introduction What to Expect When Seeing Patients in Hospital Medical Presentation and Fracture Characteristics Cognitive Status The Geriatrician’s Role in Caring for Patients with Hip Fracture on Entry into Acute Care and Recommendations Regarding Surgical Intervention Postoperative Care in Hospital The Geriatrician’s Role in Postoperative Care Postfracture Changes in Physical and Psychosocial Function and Implications for Care Physical Function Psychological Status Physiologic Changes Post Hip Fracture Functional Recovery Post Hip Fracture Postfracture Rehabilitation Discharge Planning Rehabilitation Services The Role of the Geriatrician in the Rehabilitation Setting What to Tell the Patient and Family to Expect in Terms of Function The Geriatrician’s Role in Caring for Patients with Hip Fracture Following Rehabilitation Conclusions Acknowledgments Further Reading Chapter 119: Myopathy, Polymyalgia Rheumatica, and Temporal Arteritis Skeletal Muscle, Aging, and Disease Myopathies Idiopathic Inflammatory Myopathies (IIM) Polymyositis Dermatomyositis Inclusion Body Myositis Treatment of Idiopathic Inflammatory Myopathies Other Myopathies Steroid-Induced Myopathy Hypothyroidism-Related Myopathy Hyperthyroidism-Related Myopathy Statin-Induced Myopathy Other Myopathies Polymyalgia Rheumatica Temporal Arteritis (Classic Cranial GCA) Further Reading Chapter 120: Rheumatoid Arthritis and Other Autoimmune Diseases Rheumatoid Arthritis Definition Epidemiology Pathophysiology Aging Effects Presentation Evaluation Management Nonpharmacological Therapies Pharmacological Therapies Biological Response Modifiers Safety and Other Issues with Biologics Surgical Interventions Prevention Special Issues Patient Preference and Comorbidity Care Settings Systemic Lupus Erythematosus Diagnosis Pathogenesis Presentation Management Sjögren’s Syndrome Definition Epidemiology Pathogenesis Presentation and Clinical Features Management Drug-Induced Rheumatic Syndromes Drug-Induced Lupus Drug-Induced Myopathy/Myositis Drug-Induced Vasculitis Rheumatic Syndromes and Cancer Musculoskeletal Symptoms Associated with Cancer Rheumatic Diseases and Cancer Risk of Cancer with Immunosuppression Further Reading Chapter 121: Back Pain and Spinal Stenosis Epidemiology Etiology of Back Pain Tumor Infection Vertebral Compression Fractures Osteoporotic Sacral Fractures Sciatica Lumbar Spinal Stenosis Mechanical Low Back Pain Diffuse Idiopathic Skeletal Hyperostosis Evaluation History Physical Examination Laboratory Tests and Imaging Management Vertebral Compression Fractures Lumbar Spinal Stenosis Mechanical Low Back Pain Further Reading Chapter 122: Primary Considerations in Managing the Older Patient with Foot Problems Introduction Etiological and Epidemiological Factors Anatomy of the Foot and Changes Related to Age Foot Changes with Age and Disease Clinical Assessment and Medicare Considerations Primary Management—Guidelines and Principles Skin Toenails Pathomechanics and Biomechanics Foot Orthopedics Footwear and Orthoses Therapeutic Shoes for Diabetics Ulcerations Diabetic and Peripheral Arterial Considerations Conclusion Further Reading Chapter 123: Fibromyalgia and Myofascial Pain Syndromes Fibromyalgia Syndrome Definition and Epidemiology Pathogenesis Peripheral Tissue Abnormalities Central and Peripheral Sensitization and Pain Amplification Neuroendocrine Abnormalities Biochemical Abnormalities Functional Imaging of Pain Genetics Clinical Presentation Patient History Physical Examination Treatment Medications Antidepressants Antiepileptics Analgesics Hormonal Supplements and Other Agents Nonpharmacological Therapies Assessing Response to Treatment Myofascial Pain Syndromes Background and Epidemiology Pathogenesis Clinical Presentation and Evaluation Cervicogenic Headaches Piriformis Syndrome Trapezius MP Upper and Lower Back Pain Pseudotrochanteric Bursitis Postherpetic Pain Other MP and Dysfunction Syndromes Management Treatment of Perpetuating Factors Trigger Point Treatment Conclusion Further Reading Section J: Infectious Diseases and Immunology Chapter 124: Infection in the Elderly Predisposition of the Elderly to Infection Comorbidities Waning Immunity Nutrition Social and Environmental Factors Diagnosis and Management of Infections in the Elderly Patient Presentation of Illness Antibiotic Management Clinical Syndromes in the Elderly Infective Endocarditis Bacteremia and Sepsis Prosthetic Device Infections Tuberculosis Fever of Unknown Origin Immunization of the Elderly Pneumococcal Vaccine Influenza Zoster Other Vaccines Travel Recommendations for the Elderly Person Further Reading Chapter 125: General Principles of Antimicrobial Selection Introduction Identifying the Causative Pathogen Clinical Features Epidemiological Context Determining Breadth of Coverage Severity of Infection Antimicrobial Resistance Pharmacological Considerations Pharmacokinetics Toxicity and Polypharmacy Final Considerations: Narrowing and Withholding Therapy Specific Infectious Syndromes Pneumonia and Other Respiratory Infections Skin and Soft Tissue Infections Gastrointestinal Infections Infectious Diarrhea C. difficile-Associated Diarrhea Bone and Joint Infections Osteomyelitis Septic Arthritis Prosthetic Joint Infection Central Nervous System Infection Meningitis Encephalitis Healthcare-Associated Infections Healthcare-Associated Pneumonia Skin and Soft Tissue Infections Urinary Tract Infection Bacteremia Further Reading Chapter 126: Pneumonia Definitions Epidemiology Etiology S. pneumoniae Staphylococcus aureus Chlamydophila pneumoniae Mycoplasma pneumoniae Legionnaires’ Disease Enterobacteriaceae M. tuberculosis Viruses Respiratory Syncytial Virus Human Metapneumovirus Severe Acute Respiratory Syndrome Other Coronaviruses Hantavirus Influenza A Aspiration Pneumonia Pathophysiology Presentation Evaluation Site of Care Transfer from a Nursing Home to Hospital ICU Admission Diagnostic and Therapeutic Evaluations Diagnostic Evaluations Therapeutic Evaluations Discharge Decision Management Drugs Antibiotics When to Switch from Intravenous to Oral Antibiotics in the Treatment of CAP Nonpharmacological Management Ancillary Measures Prevention Pneumococcal Vaccine Influenza Vaccine Cessation of Tobacco Smoking Prevention of Aspiration Pneumonia Special Issues Patient Preference Patient Education Quality of Care Measures Conclusions Further Reading Chapter 127: Urinary Tract Infections Presentations of Urinary Infection Epidemiology Asymptomatic Infection Elderly in the Community Institutionalized Older Adults Symptomatic Urinary Infection Elderly in the Community Institutionalized Older Adults Morbidity and Mortality Asymptomatic Bacteriuria Symptomatic Urinary Infection Pathogenesis Route and Site of Infection Microbiology Infecting Organisms Antimicrobial Resistance Host Factors Elderly in the Community Institutionalized Older Adults Immune and Inflammatory Response Clinical Presentation Symptomatic Urinary Infection Hematuria Clinical Deterioration Without Localizing Genitourinary Symptoms Laboratory Evaluation Microbiological Diagnosis Urine Specimen Collection Interpretation of Urine Culture Pyuria and Other Diagnostic Tests Management Asymptomatic Infection Symptomatic Urinary Infection Choice of Antimicrobial Oral Therapy Parenteral Therapy Resistant Organisms Duration of Therapy Outcome Following Therapy Controversies in UTI Management in Long-Term Care Facilities Prevention Asymptomatic Infection Symptomatic Infection Long-Term Indwelling Catheters Epidemiology Biofilm Formation Clinical Presentations Management of Symptomatic Infection Prevention Summary Further Reading Chapter 128: Human Immunodeficiency Virus Infection Clinical Presentation Diagnosis Prognosis Overlapping Complications, Comorbidities, and Toxicity HIV and Related Conditions Benefits and Harms of Antiretroviral Treatment Substance Use and Abuse Aging and Comorbid Medical and Psychiatric Disease Management Further Reading Chapter 129: Herpes Zoster Definition Epidemiology Varicella-Zoster Virus Transmission Herpes Zoster Incidence and Risk Factors Postherpetic Neuralgia Incidence, Prevalence, and Risk Factors Clinical Features Prodrome Rash Acute Herpetic Neuralgia Complications Diagnosis Differential Diagnosis Laboratory Tests Management Acute Herpes Zoster Nonpharmacological Management Antiviral Therapy Analgesics Corticosteroids Adjuvant Agents Postherpetic Neuralgia Oral and Topical Pharmacotherapy Topical Treatments Gabapentin and Pregabalin Tricyclic Antidepressants Opioid and Opioid-Like Analgesics Combination Pharmacotherapy Other Treatments Noninvasive Treatments Invasive Treatments Prevention Varicella Vaccine Zoster Vaccine Further Reading Chapter 130: Influenza and Respiratory Syncytial Virus Influenza Clinically Relevant Biological Characteristics of Influenza Virus General Epidemiology of Influenza Important Host Considerations in the Elderly Clinical Presentation Specific Diagnostic Tests Infection Control Aspects Immunization Influenza and Long-term Care Use of Antivirals to Prevent and Treat Influenza in Older Adults in the Community Indirect Benefit of Immunization in Children to Protect Older Adults Respiratory Syncytial Virus Characteristics of Respiratory Syncytial Virus General Epidemiology Community-Dwelling Elderly and Respiratory Syncytial Virus Epidemiology of Respiratory Syncytial Virus in Long-term Care Facilities Clinical Features of Respiratory Syncytial Virus in the Elderly Diagnosis Therapy Prevention Further Reading Index A B C D E 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