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Problem Solving in Older Cancer Patients providesan evidence-based guidebook forming an overview of the current thinking and clinical practice in this field. By referring to individual case studies written and/or overseen by experienced physicians, the reader can learn how to approach the management of older cancer patients and implement the appropriate treatment strategy that best suits the patient, taking account of comorbidities, frailty, and patient choice.The core readership envisaged is the physician in oncology or geriatrics (and other medical disciplines) involved with older cancer patients, working in primary care, district hospitals or main general hospitals, cancer units and cancer centres. Specialist nurses, trainee specialists and senior students are an important potential readership.The first part of the book consists of general perspective chapters, discussing generic issues such as radiotherapy in older patients and anaesthetic issues. These are then followed in the second part by clinical case scenarios. Each clinical case includes a concise discussion on patient presentation and of scenarios underpinning issues experienced by older patients followed by a clear appraisal of how the latest clinical research impacts on patient management. The aim is to help the busy clinician modify daily medical practice in response to individual cases.In the twenty-first century, this large cohort of patients requires both innovative care and individual attention. This carefully crafted book shares the experience of an expert multidisciplinary team in the interest of patient centred care..
This textbook presents hands-on training material for medical students. The style reflects the need for practice-based teaching with a modern edge in daily clinical routine; accordingly, it also employs online material and pocket cards. Each chapter begins with specific learning objectives, which are cross-referenced with the European curriculum for undergraduate medical education released by the European Union of Medical Specialists (UEMS) together with the European Union Geriatric Medicine Society (EUGMS), as well as the minimum geriatric competences for medical students established by the American Geriatrics Society (AGS). World-renowned European experts in practicing and teaching the interdisciplinary field of Geriatrics contributed to this work, with the aim of offering the new generation of health professionals a global perspective on one of the greatest public health challenges of our time: the management of the steadily increasing number of older, multimorbid, and vulnerable persons. The major strength of this book - published under the auspices of the EUGMS - is its pragmatic, goal-oriented approach, which makes it suitable for bedside learning and patient-centered medicine; further, all of the chapters are firmly based on the pillars of the ageing process in all of its biological aspects, helping readers understand the pathophysiology of and rationale behind interventions for the main geriatric syndromes and disorders.
Part of the Masterpass series, this highly authoritative guide covers all the required topics, with emphasis on important areas ensuring candidates are thoroughly tested. MCQs in Geriatric Medicine for Postgraduate Examinations is ideal for postgraduate doctors wanting to succeed in elderly medicine biased MCQs such as candidates for the Diploma in Geriatric Medicine and registrars in geriatric medicine reading for their specialty certificates. It is also highly recommended for Part I MRCP candidates requiring a grasp of this rapidly increasing branch of medicine in terms of information, number of patients and cost to the state. The overall proportions of topics are.suggested by the Royal College of Physicians, London but I have added more questions proportional to the importance of some topics.When you have cracked all 350, you will have the MCQ examiners on toast. Roger Gabriel, in the Preface
This new edition provides an accessible guide to the commonest neurodegenerative diseases, outlining the main clinical features, treatment options and outcomes of the conditions most frequently encountered in clinical practice. Beginning with an overview of the general principles that underlie degeneration, and the contribution of established and new diagnostics techniques, the book goes on to describe the most common neurodegenerative conditions and, new for the second edition, also HIV dementia and multiple sclerosis. Final chapters cover important management issues including the use of palliative care strategies, biomarkers and neuropsychology. Written by experts in the field internationally Neurodegenerative Disorders, Second Edition is a practical guide for clinicians that will be indispensable for the management of these conditions.
Mental Health Practice in Geriatric Health Care Settings emphasizes the major research and clinical findings realized in five years of research on mental health issues in older urban medical patients, many of whom represent minority groups. Chapters cover the high comorbidity of health and mental health problems in geriatric patients, neuropsychological (or cognitive) assessment, depression, alcohol abuse in health care settings, emerging behavioral medicine issues, and family relations and their tie to medical settings. As a practitioner, you'll find this book helps your practice by representing the first assessment and treatment techniques normed and validated on minority elderly. If you're a professional working in the mental health system, you'll see how to expand your services to health care markets.Mental Health Practice in Geriatric Health Care Settings devotes three chapters to neuropsychological assessment--first, a review of major principles; second, a new test battery for minorities; and third, extensive review on how to use test results in clinical decision making. Other chapters provide valuable information on: the analysis of outcomes for one thousand 60--103-year-olds a new validated behavioral treatment method for depression methods of detection and treatment of alcohol abuse emerging issues in behavioral medicine, including competency assessments; anxiety and pain disorders; and shaping the referral process family relations and health care, including caregiving and nursing home placement nursing home consultation and survival strategies in health care systemsAs Author Peter A. Lichtenberg describes in the Introduction, each chapter in Mental Health Practice in Geriatric Health Care Settings is multidisciplinary, empirically and statistically investigated, and focused upon urban elderly. "In addition, the major objectives are to provide clinicians with new understandings and new assessment and treatment knowledge to utilize in their practices. Finally, this book is hoped to provide clinicians [with] information about emerging trends in the field, and effective strategies for practice in healthcare settings."
This book provides up-to-date guidance on optimal care of the patient with an underactive bladder. It covers all aspects of management, including clinical evaluation, urodynamic diagnosis, standard care, drug therapy, and emerging treatment options. Nursing issues are extensively discussed, and advice offered on the use of catheters and avoidance of catheter-related complications. Further chapters address epidemiology, pathophysiology, animal modeling, and health care costs. While most practitioners are familiar with overactive bladder, the converse condition of underactive bladder has generally remained far below the radar. As a consequence, there is still a lack of empirically validated treatments and effective treatment strategies. This is a matter of concern, especially as the burden of the condition is expected to rise in line with the aging of global populations. The Underactive Bladder is a major step forward in raising awareness, exploring best practices in patient care, and searching for future therapies. It will be invaluable for urologists, geriatricians, other specialists, researchers, and nurses.
This book provides an in depth review of the current practice in treating elderly patients with coronary artery disease (CAD) as well as an update of the existing literature. It is intended to reflect the current science of elderly patients with stable angina, acute coronary syndromes and those patients who are forwarded for CAGB procedures. Evidence in the elderly patient group is often limited and/or non-existent therefore the main challenge, even for further research, will be to define the role of geriatric preconditions and its impact on outcome. A second topic will be to clarify how, if ever, existing cardiological outcome values like mortality can be applied to elderly patients or if other values like improvement of functional status or quality of life are more suitable parameters to measure interventional success in elderly patients. The role of pharmacotherapy in advanced age has to be discussed. These topics will be embedded in epidemiological, pathophysiological and ethical aspects of interventional treatment of CAD in older age.
Older patients carry some of the highest risks of suffering an adverse event or death following anesthesia and surgery. They are inherently vulnerable, presenting with numerous comorbidities and reduced physiological reserve, requiring 'gero-centric' perioperative care for everything from routine eye surgery to major cardiac surgeries. Dementia, frailty, and the need for palliative care and pain management for the orthopedic patient are important areas requiring special consideration in this group. This book provides a general overview of these topics for those healthcare providers who may not have extensive knowledge of this patient population, while at the same time offering practical tips for the more experienced clinician. Chapters cover the spectrum of perioperative care including preoperative management of comorbid conditions, intraoperative anesthetic management, postoperative pain control, and a primer on advanced directive discussions. This book is appropriate not only for anesthesiologists but for any perioperative physician caring for the older patient.
A MacArthur Genius Grant recipient pioneers a radical change in how we interact with older loved ones, especially those experiencing dementia, as she introduces a proven method that uses the creative arts to bring light and joy to the lives of elders. In Creative Care, Anne Basting lays the groundwork for a widespread transformation in our approach to elder care and uses compelling, touching stories to inspire and guide us all-family, friends, and health professionals-in how to connect and interact with those living with dementia. A MacArthur Genius Grant recipient, Basting tells the story of how she pioneered a radical change in how we interact with our older loved ones. Now used around the world, this proven method has brought light and joy to the lives of elders-and those who care for them. Here, for the first time, everyone can learn these methods. Early in her career, Basting noticed a problem: today's elderly-especially those experiencing dementia and Alzheimer's- are often isolated in nursing homes or segregated in elder-care settings, making the final years of life feel lonely and devoid of meaning. To alleviate their sense of aloneness, Basting developed a radical approach that combines methods from the world of theater and improvisation with evidence-based therapies that connect people using their own creativity and imagination. Rooted in twenty-five years of research, these new techniques draw on core creative exercises-such as "Yes, and . . ." and "Beautiful Questions." This approach fosters storytelling and active listening, allowing elders to freely share ideas and stories without worrying about getting the details "correct." Basting's research has shown that these practices stimulate the brain and awaken the imagination to add wonder and awe to patients' daily lives-and provide them a means of connection, both with the world and with those caring for them. Creative Care promises to bring light and hope to a community that needs it most.
Designed to provide a highly visual reference for surgeons and other members of the patient management team, Atlas of Intestinal Stomas is based on the 1967 gold standard text, Turnbull and Weakly's Atlas of Intestinal Stomas. Additions include chapters on anatomy and physiology, biliary stomas, pediatric ostomies, the continent ileostomy, urostomy, laparoscopic stoma construction, stomas in trauma surgery, stomas for antegrade continence enema, percutaneous ostomies, and quality of life. There are also sections on ileostomy, colostomy, enterostomal therapy and on the management of complications of stomas such as management of the high output ostomy, enterocutaneous fistula, parastomal hernia, prolapse, and skin conditions. The Cleveland Clinic pioneered the entire practice of ostomies, beginning in 1858 and continuing to this day as the world's leading academic and clinical center. The editors and contributors are all current or former Cleveland Clinic physicians and instructors. The fundamental focus of the book is not only how to install ostomies, but how to avoid complications and how to treat complications when they arise. Atlas of Intestinal Stomas will be of great value to colorectal and general surgeons, both in practice and in training.
Death is the destiny we all share. This will not change. But the way we die, which had been the same for many generations, has changed drastically in a relatively short time for those in developed countries with access to healthcare. For generations, if people were lucky enough to reach old age, not having died in infancy or childhood, in childbirth, in war, or by accident, they would take to bed, surrounded by loved ones who cared for them, and fade into death. Most likely, they would have seen their parents and grandparents die the same way, so this manner of dying would be familiar. It was part of the natural cycle of life. Now less than 25 per cent of Americans die at home, at much older ages than people would have dreamed of in past generations, often after surviving many illnesses and even diseases that would have been terminal for their grandparents. We are fortunate to live (and die) today, supported by myriad scientific, medical, and technological advancements. But we also face new problems as a result of the new way that we die. We cannot look forward to a peaceful waning when we know our lives will likely end in hospitals, having endured very expensive care, rather than at home with family. We have to decide what decisions we want our loved ones, or care-givers, to make when we cannot choose for ourselves. We have to think about whether in any circumstances we would seek physician-assisted death. We know we face other questions as well, but we may not even know where to start. In the face of these decisions, we can feel daunted and afraid. The best remedy is information and planning. In this book, Gregory Eastwood - a physician who has cared for dying patients, served as an ethics consultant, and taught end of life issues to medical and other health profession students - draws from his substantial experience with patients and families to provide the information that will help us think clearly about the choices and issues we will face at the end of our lives, and the end of our loved ones'. With sensitivity and profound insight, Eastwood guides us through all the important questions about death and dying in straightforward, clear language and through real-life stories. Throughout, he shows us how we can take ownership of the way we want to die, when we must die, and feel more in control as death approaches.
This brief, accessible book covers all aspects of transient global amnesia (TGA). First, it deals with the history of TGA before moving on to clinical and diagnostic features, and differential diagnosis. The investigation and management of TGA is then discussed, followed by treatment and prognosis. Each of the chapters is devoted to a practical and structured overview of the particular topic, with use of case studies to illustrate the material. Based in part on the author's experience of TGA cases over 15 years and in part on a review of the published literature, this book will hopefully enlighten clinicians from a broad range of medical backgrounds on the clinical features, investigation, and pathogenesis of TGA. Transient Global Amnesia is aimed at any clinician with an interest in, or who encounters patients with, acute amnesia: neurologists, general physicians, old age psychiatrists, geriatricians, clinical neuropsychologists, and primary care physicians, as well as other professions allied to medicine with similar interests, such as members of memory assessment teams.
This book has two main purposes: formative case analysis and self-assessment of medicine in old age. It presents clinicians with a series of cases on which to base discussion of the investigation and management of patients. It also provides the trainee, or established doctor, with a medium to help prepare for post-graduate examinations and clinical practice. The authors have chosen 109 cases, a total of 250 questions/answers, illustrated by color photographs, diagrams, and tables. The cases cover the main modes of presentation of acute illness in old age, such as fall, confusion, incontinence, weight loss and immobility, with examples from all the major systems. These illustrate the complexity of diagnosis and treatment of medical illness in frail older people and the need to think widely and laterally when caring for such patients. The questions are mostly in best-of-five format to reflect the current style of multiple choice questions used in examination, though some are open questions as the basis for tutorials. Many of the clinical stems have been expanded to improve the educational function of the book and to test more rigorously the reader's deductive thinking.
This book covers all aspects of the specialized field of gerontorheumatology, providing a complete overview of rheumatic and musculoskeletal diseases and related conditions in the elderly. The emphasis is particularly on pathogenesis, diagnosis, prevention, and treatment, including the latest advances in biological and pharmacological therapy and potential treatment side effects. The book will provide the reader with a keen awareness of the characteristic features, distinctive etiologies, and different courses of the various disorders of the musculoskeletal system in the geriatric population. Diagnostic and treatment considerations of special relevance in daily practice are highlighted, and the importance of comorbidities and their rheumatic consequences is also emphasized. The book will be of value for gerontologists, rheumatologists, internists, and rehabilitation physicians and will offer excellent guidance for general practitioners, who are typically the first to deal with disorders of the musculoskeletal system in elderly patients.
Caring for someone with dementia means devotedly and patiently doing a hundred little things each day. But few care providers are trained to meet the challenges of dementia-despite the fact that millions of people will struggle with it as they grow older. In A Loving Approach to Dementia Care, Laura Wayman, who is known professionally as the Dementia Whisperer, offers practical, compassionate advice on overcoming caregiving obstacles and maintaining meaningful relationships with loved ones who have dementia and memory loss. In this thoroughly revised third edition, Wayman includes * answers to common caregiver questions, such as "What is dementia?" * a detailed explanation of how to cope with and care for a spouse with dementia symptoms, including advice about communication * a new chapter on caring for someone who has dementia along with other health problems * recommendations about how to handle challenging situations and behaviors * dementia-aware activities that work for both family caregivers and professional care staff * fresh caregiving insights that emphasize the importance of taking time to care for oneself Each chapter contains two sections-"Lessons Learned" and "Perceptions and Approaches"-which provide details about how readers can apply lessons from the stories Wayman tells to their own caregiving practice. Providing support for the numerous difficulties and disruptions that all caregivers face along the way, A Loving Approach to Dementia Care is an empathetic guide filled with respect, calm, and creativity. It will leave readers feeling empowered and inspired.
Age-related macular degeneration is the most common cause for the loss of central seeing with humans beyond the age of 50 in the industrial nations. A triplication of the patients is expected in the next 25 years. Especially in the last couple of years the standard of knowledge regarding etiology, risk factors, diagnostics and therapy of this retina illness has substantially grown which is presented in this up-to-date multi-authored work. Apart from epidemiologically identified risk factors both the various pathophysiological aspects and clinical manifestations and angiographic characteristics are clearly represented and in line with standard usage. Furthermore, the different therapeutic approaches are treated, which include proven procedures as laser therapy and seeing-aids systems, in addition to latest methods in the area of the pharmacology, the photo-dynamic therapy, transpupil thermal therapy (TTT) and the macular surgery. The volume is well-illustrated and tables and summaries round up the representation.
Explore pastoral strategies for dealing with mental health problems! Mental health is increasingly being recognized as an important issue in later life. This valuable book will help you examine this dimension of aging in the context of pastoral, spiritual, and cultural issues. It explores the relationship between mental health, spirituality, and religion in later life, including the search for meaning, cultural issues, spiritual issues, depression, dementia, and issues of suicide in older people. The first part of Mental Health and Spirituality in Later Life focuses on theology, ethics, and cultural issues in mental health and aging. The second part addresses issues of multidisciplinary practice, including a challenging chapter written by a woman with early onset dementia (Alzheimer's) and other chapters that present perspectives on the uses and meanings of ritual and symbolism in mental health and pastoral approaches to care. Part one of Mental Health and Spirituality in Later Life deals with issues of theology, culture, and mental health in later life, focusing on: the importance of a richly textured understanding of personhood as a prerequisite for constructing a picture of late-life mental health in the context of theology the relationship between culture, spirituality, and meaning for older immigrants and their effects on mental health the adverse effects of a mental health system that reflects only the dominant culture of a society, leaving minority cultures vulnerable to misdiagnosis and inappropriate treatments that can do more harm than good a wholistic picture of aging that moves beyond the biomedical paradigm and demonstrates the power and potential of the human spirit in adjusting to and moving beyond suffering Part two of this valuable book addresses issues of concern to practitioners in mental health and spirituality for the aging, including: disruptive behavior among nursing home residents and common practices that fail to identify its causes or address the problem how some staff/resident interactions can produce suffering for all concerned with case study outlines that illustrate the point memory loss and its effect on spirituality, self-worth, and the faith community pastoral care for people suffering with dementia with practical information on helping them to make use of the power of prayer and to deal with loneliness, fear, and disempowerment an insightful look at a recent major study of residents in aged care facilities in Australia that explores the link between depression and spirituality risk and protective factors associated with suicide in later life and the treatment of depression pastoral interventions for depression and dementia
I was looking at Mrs T - all 45 kilos of her - with somewhat puzzled thoughts. I had prescribed her capecitabine at very prudent doses, in view of her 91-year-old kidneys and physiology. She had reduced my treatment even further, "because it was making her tired." As a result, she was taking a grand total of 500 mg of capecitabine a day. Yet, her metastatic, ER/PR-negative, Her2-positive breast cancer was undoubtedly responding. Her pain was improving and her chest mass was shrinking, as were her lung metastases... What was the secret of that response? Were Mrs T's kidneys eli- nating even less drug than predicted by her creatinine clearance? Was her sarcopenia altering drug distribution? Was she absorbing more drug than average? Or was her tumor exquisitely sensitive to fluoropyrimidines? "Physicians," said Voltaire, "pour drugs they know little for diseases they know even less into patients they know no- ing about." Medicine has made tremendous progress since the eighteenth century. Yet, there are fields where quite a lot remains to be learned. In developed countries, 25% of breast cancers occur in patients aged 75 years and older. Yet, these patients represent only 4% of the population of traditional clinical trials. That ought to let us wonder how relevant data acquired in patients in their 60s are to a nonagenarian. Fortunately, geriatric oncologists have been stepping up to the task and have gen- ated data to help us to treat such patients.
Caring for an elderly family member can be overwhelming. But fulfilling life experiences are still possible for both caregivers and their loved ones, despite the stress and fatigue of caregiving. Even an elderly spouse, parent, or other family member who is significantly impaired or increasingly dependent can enjoy simple pleasures and share their joy and wisdom. In this book, Ann Kaiser Stearns explores the practical and personal challenges of both caregiving and successful aging. In her engaging, conversational tone, Stearns shares stories and lessons from many resilient caregivers. She couples findings from the latest research with powerful insights and problem-solving tips to help caregivers achieve the best life possible for those they care for-and for themselves as they age. Topics include* improving the quality of life for the one giving and the one receiving care* distinguishing normal aging from early warning signs * understanding caregiver sadness, resentment, guilt, and grief* using strategies and skills to minimize an impaired elder's distress and emotional outbursts and the caregiver's own anxieties about growing old* finding resources to aid in the care of the loved one and protect the caregiver from stress overload * moving forward after the death of a loved one to have a meaningful life of one's own * overcoming ageist stereotypes and deciding what kind of "old person" one will be* making life easier for those who someday will care for us Redefining Aging will help readers think differently about caregiving and their own aging. It will also help them empathize with and interact positively with their elderly loved ones while imagining a positive future for themselves.
Understanding socially disruptive behavior in dementia is never easy. Most explanations offer neither solace nor solutions for families and carers, and treatment is often characterized by policies of control and containment. The result of Graham Stokes' 15 years of clinical work with people who are challenging, this book: disputes the traditional medical model of dementia and asserts that if we reach behind the barrier of cognitive devastation and decipher the cryptic messages, it can be shown that much behavior is not meaningless but meaningful. It contrasts the medical interpretation that sees anti-social behavior as mere symptoms of disease with a person-centered interpretation that resonates change and resolution. It offers a radical and innovative interpretation of challenging behavior consistent with the new culture of dementia care, focusing on needs to be met rather than problems to be managed.
Gerontological research is currently of great interest due to
ever-increasing longevity of human life spans. Created to provide
researchers and scientists with the technical methods essential to
their work, Methods in Aging Research is a practical bench-top
guide for everyone who plans, designs, or conducts research in
aging. It highlights experimental procedures that are key to the
investigation of the biological aging phenomena.
This authoritative handbook covers all aspects of immunosenescence, with contributions from experts in the research and clinical areas. It examines methods and models for studying immunosenescence; genetics; mechanisms including receptors and signal transduction; clinical relevance in disease states including infections, autoimmunity, cancer, metabolic syndrome, neurodegenerative diseases, frailty and osteoporosis; and much more.
This book discusses the pathology of the retina, and reviews current research on the use of cell replacement therapy and short peptides to restore functional activity in retinal neurons. As the book describes, pathologies of the retina, including age-related macular degeneration, diabetic retinopathy, and retinitis pigmentosa, present a long-standing challenge in the practice of clinical ophthalmology. Modern treatment for these conditions, which lead to irreversible blindness, includes laser exposure, surgical intervention, and drugs. These treatments aim to reduce the risk of new complications in the eye; pathogenetic therapy of degenerative diseases of the retina is practically absent in current ophthalmic practice. The first section of the book reviews the molecular mechanisms of age-related macular degeneration, diabetic retinopathy, and retinitis pigmentosa, and reports on methods of treatment. The second section presents the results of recent experimental studies of the effects of short peptides on pluripotent embryonic cells; on proliferative activity in retinal cells and pigment epithelium; on expression of markers of differentiation or retinal neurons and pigment epithelium; and on the course of hereditary retinal pigmentation in Campbell rats. The third section offers results of clinical studies on the effectiveness of short peptides in patients with macular degeneration, and in patients with retinitis pigmentosa. The author concludes that the regular use of peptides in the treatment of degenerative diseases of the retina can slow the progression of the pathological process and preserve the patient's vision for some 10-15 years. In addition, in 80 percent of patients, it is possible to increase visual function by increasing visual acuity, improving the boundaries of the visual field and the fundus.
Part of a series of pocket-sized books that set out to provide easily assimilable information on diagnosis and treatment of common medical conditions. This volume looks at depression in the elderly, covering such topics as aetiology and risk factors, clinical presentation and prognosis.
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