Pathy's Principles and Practice of Geriatric Medicine

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2 Volume I Volume I Dedication Page To my wife, Caroline, and children and grandchildren, present and future, for their invaluable contributions to my work, my life, and my happiness! Alan J. Sinclair To all my older friends and patients who have taught me geriatrics; to my wife, Pat, and my children, Robert, Susan, and Jacqueline; and to my grandchildren, Amanda, Conor, Katelyn, Nicole, Paige, and John, who are my eternal joy and my hope for the future of eldercare. John E. Morley Geriatric medicine is moving to healthy ageing and prevention. Of course, we will still have to take care of frail and sick older people, but this move will change geriatric medicine in everyday clinical practice more each year. I dedicate this textbook to my family and all those scientists that have inspired us to bring about positive change in the way we manage older people, such as Professor Alan Sinclair and those who continue to excel, as otherwise this textbook would not have been possible. Bruno Vellas To my family. Matteo Cesari To my patients, who taught me the most important lessons on how to age gracefully. Medha Munshi Title Page Copyright Page About the Editors About the Associate Editors List of Contributors Preface to the Fifth Edition Preface to the Sixth Edition Foreword Introduction: Historical perspectives Introduction The earlier writers on old age The birth of modern geriatric medicine British developments An overview of early geriatric medicine in the United Kingdom The early pioneers in geriatric medicine The second wave of geriatricians Third wave of geriatricians Geriatrics in the United States Geriatrics in the rest of the world Teaching geriatric medicine Achievements of geriatric medicine References PART 1: Ageing: Biological, Social, and Community Perspectives CHAPTER 1: A biological perspective of ageing Introduction A populational perspective on ageing The evolutionary roots of the phenomenon of ageing The components of biological ageing Genomic instability Challenges for the biology of ageing and geriatric medicine References CHAPTER 2: Physiology of ageing The nervous system The endocrine system The gastrointestinal system The genitourinary tract The immune system The musculoskeletal system The respiratory system The skin References CHAPTER 3: Psychological aspects of ageing Introduction Psychological development over the lifespan Personality changes in older adulthood Mental health and cognition in the elderly and associated medical issues Psychological interventions in the elderly Non‐pharmacologic interventions for cognitive decline Implications for practice References CHAPTER 4: Social and community aspects of ageing Introduction Demography of ageing Relationships, viewpoints, and ageing Community and societal structures Challenges of ageing References CHAPTER 5: Sexuality and ageing Introduction Sexual health in older adults Sexuality and the older woman Sexuality and the older man Sexuality and disease Dementia Sexually transmitted infections Special considerations for LGBTQ older adults Sexuality in the nursing home Conclusion References CHAPTER 6: Ageing of the brain Introduction Structural age‐related brain changes Neurobiological hallmarks of brain ageing Changes in the neurological examination with ageing Cognitive changes with ageing References CHAPTER 7: Physical fitness and exercise Introduction What is physical activity or exercise? Physical inactivity versus exercise Inter‐individual variability in response to exercise (non‐responder phenomenon) Does exercise increase life expectancy? Physical function as a biomarker of healthy ageing and objective of exercise programmes Preserving exercise capacity with age via an active lifestyle Optimisation of body composition with ageing Role of exercise and physical activity in bone health and fracture risk Role of exercise and physical activity in adipose tissue accretion and distribution Role of exercise in preserving muscle mass with age Promotion of psychological well‐being Exercise and cognitive function Disease prevention through exercise Summary of exercise recommendations References CHAPTER 8: Health literacy and cultural sensitivity Introduction The importance of health literacy in health care Factors that influence health literacy The role of education in health literacy Educational strategies to improve health literacy Cultural sensitivity in geriatrics Common areas of conflict or misunderstanding in the clinical encounter Increasing cultural sensitivity in the clinical encounter Resources References PART 2: Medicine and Prescribing in Old Age CHAPTER 9: Preventive geriatrics Introduction Background The Health Maintenance Clinical Glidepath References CHAPTER 10: Polypharmacy and deprescribing in older adults Introduction Ageing physiology affects medication efficacy and tolerance Tools for medication management Principles of appropriate prescribing Conclusion References CHAPTER 11: Patient safety Introduction What happens after an adverse event? Patient safety and older people Priorities for improving the safety and quality of care for older people Conclusion Acknowledgement References SECTION 1: Eating Disorders and Nutritional Health CHAPTER 12: Nutrition and healthy ageing: Emphasis on brain, bone, and muscle Introduction Body weight and composition Body mass index, weight loss, and ageing Central adiposity and healthy ageing Fluid status, dehydration, and healthy ageing Bone loss, nutrition, and healthy ageing Energy intake, macronutrients, and satiety in ageing Determinants of dietary preference and intake among older adults Dietary patterns and nutritional status associated with healthy ageing Dietary patterns associated with healthy cognitive ageing Nutritional status and healthy ageing Dietary guidelines and clinical applications References CHAPTER 13: The anorexia of aging Introduction Causes of undernutrition in older people Hormones and neurotransmitters: a selective review Chronic disease and anorexia in older adults Environment and social determinants of health Iatrogenic impact Conclusion References CHAPTER 14: Weight loss Introduction Weight loss and frailty Weight loss and sarcopenia The relationship of weight loss to mortality Effect of weight loss on comorbid conditions Weight loss, a hallmark of malnutrition Starvation Cachexia Anorexia The use of the Mini‐Nutritional Assessment (MNA) to explore weight loss Interventions Decreased food intake The effect of exercise to improve body mass and function Palliative treatment of anorexia Conclusion References CHAPTER 15: Water and electrolyte balances in ageing Introduction Normal physiology Water homeostasis in the elderly Workup and treatment of hyponatremia Workup and treatment of hypernatremia Conclusions References CHAPTER 16: Vitamins and minerals Introduction Recommended intakes of vitamins and minerals Medication influences on vitamin and mineral status Vitamins and minerals – functions and characteristics Micronutrients of special concern for older adults Role of vitamin and mineral supplements in chronic disease: some reviews of the evidence Summary References SECTION 2: Gastro Disorders CHAPTER 17: Changes in gastrointestinal motor and sensory function associated with ageing Introduction Control of gastrointestinal motility and sensation Pathophysiology of the ageing gut Oesophagus Small intestine Systemic disorders associated with disturbance of gastrointestinal motility Functional disorders Acknowledgements References CHAPTER 18: The liver and gallbladder in the geriatric population Introduction Acute viral hepatitis Chronic hepatitis B and C Fatty liver disease Drug‐induced liver injury Alcoholic liver disease Primary biliary cholangitis Hemochromatosis Autoimmune hepatitis Primary sclerosing cholangitis Hepatocellular carcinoma Biliary disease Liver transplantation Conclusion References CHAPTER 19: Faecal incontinence Introduction The physiology of defecation Changes relating to ageing Epidemiology of faecal incontinence Correlates and risk factors Assessment of faecal incontinence Management of faecal incontinence Surgical therapy Sacral neuromodulation Faecal diversion Containment Conclusions References CHAPTER 20: Constipation Defining constipation Epidemiology,