The master tool of logic is the syllogism. If A> Band B> C, then it must follow as the night the day that A > C. If the major and minor premises are true or scientifically correct by current knowledge, the conclusion is true or at least scientifically correct by current knowledge. The demographer of today beams a clear message, which if not true is at least scientifically correct by current knowledge. In the first 80 years of the Twentieth Century, the 'over-65' population of Americans increased eight fold. By century's end it will have increased 12-fold and shortly thereafter will include one in five Americans. While initially a fact of the developed world, the pace of similar graying is accelerating even more rapidly in the Second and Third Worlds. This gray delta constitutes about 35 million living Americans, who may use one-half or more of the health care resources. A would have to be a lot more foolish than B if they failed to recognize that in the coming decade the causation, case-mix, and area of the gray delta demands a change from early, mid-or even later-century medicine. If Homer Smith was right in saying, "We are what we are because we have the kind of kidneys we have" and "The kidneys make the stuff of philosophy", then the who, what, where, when, and why the gray delta will be cared for must focus on the stuff of geriatric nephrology.

nly two things are certain in life, one is that all of us will inevita Obly grow older, the other is that at some point during or at the end of this process we shall die. Inherent to the passage of time is a deterio ration in the structural and functional integrity of our bodies, this pro gressing to such an extent that one or more organ systems will eventu ally begin to fail with the continued health and well-being of the individual coming under threat. Age-associated deficiencies in the musculo-skeletal, cardiovascular, or endocrine systems producing arthri tis, hypertension, stroke or diabetes are all too apparent in our elderly population yet internally caused failures in the function of the nervous system provide the common, and mostly intractable, problems of memory and intellect or locomotion that face and frustrate clinicians. Perhaps the most important factor which can decide the outcome of research studies professing to examine the effects of the passage of time (i. e. the 'process of aging') on the function of the nervous system, or indeed any other organ system, is the selection of appropriate or repre sentative subjects for investigation. The heart of this problem lies in defining what might be considered as 'normal' aging as distinct from age-associated disease; setting the 'goal posts of normality' continues to 1 be a matter of considerable debate.

Elderly Care Medicine Lecture Notes provides all the necessary information, within one short volume, for a sound introduction to the particular characteristics and needs of elderly patients. Presented in a user-friendly format, combining readability with high-quality illustrations, this eighth edition has been thoroughly revised to reflect advances in knowledge on how disease presents in elderly people, and changes in management practice, particularly regarding stroke, dementia, delirium, and cancer. New for this edition, Elderly Care Medicine Lecture Notes also features: * More treatment tables and boxes throughout for rapid access and revision * Expansion of material on polypharmacy and prescribing * Discussion of emotional support, counselling and spirituality * Advice for doctors on breaking bad news and end-of-life care * Consideration of ethical and legal issues A companion website at www.lecturenoteseries.com/elderlycaremed features appendices which can be used as guidelines in a clinical setting, key revision points for each chapter, further reading suggestions, and extended content for specialty training in geriatrics. Not only is this book a great starting point to support initial teaching on the topic, but it is also easy to dip in and out of for reference or revision at the end of a module, rotation or final exams. Whether you need to develop or refresh your knowledge of geriatrics, Elderly Care Medicine Lecture Notes presents 'need to know' information for all those involved in treating elderly people.

The survival of the human species has improved significantly in modern times. During the last century, the mean survival of human populations in developed countries has increased more than during the preceding 5000 years. This improvement in survival was accompanied by an increase in the number of active years. In other words, the increase in mean life span was accompanied by an increase in health span. This is now accentuated by progress in medicine reducing the impact of physiologic events such as menopause and of patho logical processes such as atherosclerosis. Up to now, research on aging, whether theoretical or experimental, has not contributed to improvement in human survival. Actually, there is a striking contrast between these significant modifications in survival and the present knowledge of the mechanisms of human aging. Revealed by this state of affairs are the profound disagreements between gerontologists in regard to the way oflooking at the aging process. The definition of aging itself is difficult to begin with because of the variability of how it occurs in different organisms."

This concise practical guide is designed to facilitate the clinical decision-making process by reviewing a number of cases and defining the various diagnostic and management decisions open to clinicians. It is richly illustrated and diverse in scope, enabling the reader to obtain relevant information regarding both standard and unusual cases in a rapid, easy to digest format. The first in the series will be on Geriatric Dermatology and will be prepared within one month of acceptance and include photos. Each case will also include a narrative description and patient management tips

The preparation of Aging, Immunity, and Infection has been a "labor of labor. " When we began, there existed a huge literature-but manage able, we thought, given our years of experience in the area often referred to as immunogerontology. However, in the time that we have been at work, the new relevant literature has increased at a prodigious rate. The more we read and tried to assimilate, the farther we fell behind. In order to have any hope of completing a book on this rapidly evolving topic, we have been forced to become increasingly selective in covering new and re cent publications. We dare to hope that many read ers will find the book useful and only a few will dweIl on the inevitable inadequacies. We consider the book a work in progress, and welcome suggestions for future editions. Five chapters cover several aspects of infection and the decline of immunity with age. The first chapter "Human Aging: Present and Future," is devoted to demographics and theories of senescence. Chap ter 2 outlines the gradual breakdown of resistance to infection in the aged individual. Chapters 3 and 4 cover changes in innate and acquired immunity. The final chapter, "Nutrition, Longevity, and Integrity of the Immune System," discusses such provocative ideas as life-span exten sion and nutritional intervention for the delay of immunosenescence.

''Full of valuable definitions, descriptions, discussion and succinct summaries....the volume forms an interesting, up-to-date reservoir of information on 'preparation for aging'. As a source of specific insights and alternative perspectives it is a welcome addition to the literature.'' -Aging and Society

For more than 35 years the Swiss Society of Neuropathology has organiseditstraditionalInternationalWinterMeeting.Themainaimofthis venue is to bring together neuropathologists and clinicians as well as neuroscientistsinterestedindiseasemechanisms.TheXVIIIthInternational WinterMeeting washeld inMarch 2000 in St. Moritz, Switzerland. The topicofthe2000Meetingwas"NeuropathologyandGeneticsofDementia." Aprogrammeofinvitedplenarylecturesofhigheducationalvalueaswellas platform andposterpresentations given by manyparticipantscoveredthe broadspectrumofdementingdisorders.Encouragedbythehighstandardof the meeting, and probably also influenced by the advent of a new Millenniumwedecided, togetherwithKluwerAcademiclPlenumPublishers, topublishtheProceedingsofthe2000Meetinginthepresentbook. The increaseofthe agedpopulation challenges social and health care systemsinindustrializedsocieties.Maintenanceofhealthandautonomyinto oldage isakeyfactor, andtheautonomyandindependenceofoldpersons crucially depend on mental health. However, neurodegenerative disorders accompanied bydementiaaffect 5-10%ofindividualsoverthe ageof65, and for the age group between 65 and 95 the prevalence of cognitive dysfunction doubles every 5 years. With this challenge in mind, Rossor discusses the clinical syndrome of dementia which encompasses an enormousvarietyofunderlyingdisorders. Over the last few years it has become apparent that many neurodegenerative disorders are characterised by protein misfolding and aberrant polymerization and may therefore be viewed as "aggregation proteopathies." Among them a substantial subsetofdementing disorders, either with or without motor dysfunction, are characterised by abundant v VI Preface neuronaland/orglialaccumulationofhyperphosphorylatedtauprotein.The molecular parametersofthese "tauopathies" are reviewed by Delacourte. Therecentdiscoverythatmutationsofthetaugenearecausativeforfamilial formsoffrontotemporaldementiaandParkinsonism(FTDP-17)broughtthe "taupathway"and the"tauopathies"tothecentrestage.Thisextraordinary breakthroughwillbecoveredbySpillantiniandGoedert.Thereisincreasing evidence that argyrophilic grain disease is much more frequent in older patients than previously thought. Tolnay et al. are reviewing recent contributionstothepathologyofthislate-onsetdementingdisorderinwhich ofamyloidbetadeposits, isalmost taupathology, inthealmosttotalabsence exclusivelyrestricted to the limbic lobe and the amygdala. Schultzet al. report an intriguing age-related progression of neuronal and glial tau pathologyinbaboonsthusrenderingthe baboonapotentialprimatemodel forage-relatedhuman"tauopathies." Gotzetal. introducetransgenicmice expressingmutated human tau as valuable animal models for reproducing formationofneuro-andglialfibrillarylesions.

Coronary artery bypass surgery in the elderly: Too often or too seldom? It is a testimony to scientific advances that raising a simple inquiry today, such as whether coronary artery bypass surgery is done too often or too seldom in elderlypatients, requiresanexplorationofwhatviewsonemightholdonseveral medical as well as non-medical issues. Unlike earlier years when doctors were clinically free to decide what should be done with a patient, health has become an expensive human right, decisions about which also involve the patient, the epidemiologist, the health policy administrator, politicians, the exchequer, and the philosopher. In its broadest definition health has come to mean the core of well-being and, therefore, the goal ofany socio-economic system. Until only a decade ago, medical opinion regarding how often coronary artery bypass surgery (CABG) was indicated or useful was unclear. Becauseof multi-organ senescence, the elderly were expected to have a higher rate operative morbidity and mortality and, having crossed an advanced life span, might not live very long after the operation. Decision making on medical grounds first depends on knowing if a patient can survive an operation compared to how long they would survive without it, i. e.

"e of the reasons for all the F ASEB Societies to meet yearly is the possibility O to interrelate recent progress in diverse areas of research. The F ASEB Conferences have been organized to promote such interdisciplinary approaches. They center around a basic theme with the aim of discussing active research, in cluding widely divergent approaches, towards a better understanding of a general biological phenomenon. Because of the mounting interest in the subject of aging and development, this has been chosen as the theme for this year's symposia. We have necessarily been limited in the number of topics that could be covered. In our choice we have attempted to' select those facets of the main subject which at this time are gen erating active research interest among our membership. We have included invited speakers from abroad, such as Drs. Goldstein, Liew and Miller from Canada and Drs. Wolpert, Holliday and Williamson from England. I am sorry to say that the two speakers that we had invited from Russia, Dr. Frolkis, and from Czechoslovakia, Dr. Sterzl, were unable to attend.

Elderly people are the main drug consumers in Western societies, as multimorbidity seems to justify a high load of drugs to be supplied to them. People above 65 years of age take an average of five drugs, and this figure increases to almost ten drugs at the age of 75. Serious adverse events (SAE) related to drug use are considered to lead to 100,000 deaths per year in the United States. The primary motivation of doctors resulting in polypharmacy is the treatment of all diagnoses according to the guidelines which recommend three drugs per disease, on average. The mean number of diagnoses at age 80+ is 3.3, leading to ten drugs prescribed to each elderly patient.

As this multimorbidity/polypharmacy challenge apparently leads to therapies which are costly, ineffective and potentially harmful, there is a need to structure drug load reduction approaches. This must be coupled with the enormous and contradictory challenge of undertreated diseases. The DETECT study on the prevalence of hypertension in the Western world, for example, shows that 75% of 75-year-old patients required antihypertensive treatment, but only 20% were sufficiently treated.

The solution is rooted in the skills and experiences which lead medicine in the pre-EBM era. Though the strengths of EBM are indisputable, without evidence-based guidelines applicable to the elderly, careful reasoninig, patient assessment, treatment observation, and integration are the keys to success. "Drug Therapy for the Elderly" provides the practitioner with:

- Background information on the elderly population regarding their needs for particular drugs (with an eye to frailty, co-morbidity patterns, and special sensitivities regarding drug metabolism and excretion)

- Practical advice about drug treatment surveillance paramters in the elderly

- In-depth discussion of drugs in relation to the elderly with specific diagnoses

- Integration of multimorbidity/polypharmacy situations into prioritization schems

- A plan for how to deal with the complexity of polypharmacy situations in a five-minute consultation

An original classification of drugs is proposed by the editor which relates the power of effects, prognostic data, and tolerability to a prioritization scoring with labels ranging from A (indispensible, clear-cut benefit for efficacy/safety ration proven even in elderly patients for a given indiacation, unanimous morbidity and/or mortality data) to D (avoid in elderly, delete first). Whereas current lists intend to eliminate unsafe drugs for the elderly, this novel approach underlines both indispensable and dispensable elements of drug therapy. This approach is the first to not only provide a negative liesting, but also integrates positive data into an overall assessment for drugs fit for the aged.

The demographic revolution of an aging society will lead to increased pressure to come to a rationalistic and age-tailored process of diagnosing and treating increasingly complex situations in the elderly. "Drug Therapy for the Elderly" is focused on the most important treatment modality in medicine and serves as a timely reference for a wide array of physicians.

This volume presents the work of clinical health care teams and natural work groups, quality improvement teams, committees, and task forces made up of employees in health care settings. It discusses proven multidimensional instruments that measure team performance along with future needs for measuring team performance. It will be a resource for medical instructors and students, public health workers, and health administrators interested in team management.

In keeping with the traditions of deve1opmenta1 bio1ogy and geronto1ogy, there was a long incubation period before fu11 expres sion of the plans for an International Conference on the Werner Syndrome and the pub1ication of the present monograph based upon the proceedings of that conference. The initial concept emerged at the Xlth International Congress. of Geronto1ogy, which took p1ace in Tokyo in 1978. Drs. G.M. Martin, Y. Fujiwara and Y. Mitsui met on that occasion to discuss ways of acce1erating the pace of research on this important disorder, inc1uding banking and sharing of ce11 cu1tures, establishment of patient registries, and p1anning of joint conferences and pub1ications. In November 1979, under the auspices of the Geronto1ogica1 Society of America and a conference grant from the National Institute on Aging of the U.S. National Institutes of Hea1th, a group of Japanese investigators (Drs. Fujiwara, Mitsui, M. Goto, T. Ishii, K. Oota and .T. Matsumura) met with Drs. Martin, D. Sa1k and W. Ted Brown to deve10p plans to implement the goals discussed at the initial Tokyo meeting. A workshop focused on the needs of ce11 banking and 1ed to an accumu1ation of research materials both in Japan (main1y under the leadership of T. Matsumura) and in the U.S.A. (with the cooperation of Dr. Arthur Greene of the Institute of Medica1 Research)."

The Manual of Geriatric Anesthesia is a practical guide for physicians, residents, and students interested in the care of the elderly patient undergoing surgery. Although primarily written for anesthesiologists, other perioperative physicians and nurses will also find the information highly valuable. Highlights of the text include concise and clear discussions of preoperative assessment, anesthetic administration, the immediate postoperative care, as well as the more classic 'geriatric' topics such as the hip fracture patient, cataract surgery, postoperative delirium, dementia, ethics and end of life care. Clinical geriatric principles are woven into the text so that the reader can develop skills in geriatrics and develop a broader understanding of terminology and principles used in geriatric medicine.

The three of us, working in different institutions but in the same city, were very aware of the differences between our diverse approaches to the biology of aging and our perceptions of the sub ject matter. However, three years ago we began to hold informal meetings to discuss our research. These meetings eventually be came more frequent and, with this association, we became increas ingly cognizant of the commonality of our research problems de spite our separate perspectives. The idea for this symposium, therefore, grew from our aware ness that the underlying problem of the biological basis for aging was a common denominator in our research. The papers presented here represent three areas of active investigation: cell divi sion, biological membranes and hormonal regulation. They are sub mitted with the expectations that a greater understanding of the role of each of these separate approaches will help clarify, not only the interrelationships between our fields of research, but more importantly, the biology of aging itself. ACKNOWLEDGEMENTS We would like to extend our sincere thanks for the interest and contributions of the companies listed below: Abbott Laboratories Hoffman-LaRoche Arthur D. Little McNeil Laboratories Bristol Laboratories Mead Johnson & Company Burroughs H'ellcome Co. Merck Sharp & Dohme Research Labs. Charles River Breeding Labs. Rom-Amer Pharmaceuticals Dow Chemical Co. Sandoz Pharmaceuticals E.R. Squibb & Sons, Inc. Schering Corp. Eli Lilly Research Laboratories Smith Kline Corp."

Late life is characterized by great diversity in memory and other cognitive functions. Although a substantial proportion of older adults suffer from Alzheimer's disease or another form of dementia, a majority retain a high level of cognitive skills throughout the life span. Identifying factors that sustain and enhance cognitive well-being is a growing area of original and translational research. In 2009, there are as many as 5.2 million Americans living with Alzheimer's disease, and that figure is expected to grow to as many as 16 million by 2050. One in six women and one in 10 men who live to be at least age 55 will develop Alzheimer's disease in their remaining lifetime. Approximately 10 million of the 78 million baby boomers who were alive in 2008 can expect to develop Alzheimer's disease. Seventy percent of people with Alzheimer's disease live at home, cared for by family and friends. In 2008, 9.8 million family members, friends, and neighbors provided unpaid care for someone with Alzheimer's disease or another form of dementia. The direct costs to Medicare and Medicaid for care of people with Alzheimer's disease amount to more than $148 billion annually (from Alzheimer's Association, 2008 Alzheimer's Disease Facts and Figures). This book will highlight the research foundations behind brain fitness interventions as well as showcase innovative community-based programs to maintain and promote mental fitness and intervene with adults with cognitive impairment. The emphasis is on illustrating the nuts and bolts of setting up and utilizing cognitive health programs in the community, not just the laboratory.

The problem of senescence, as reflected in the history of reli gion and philosophy, has long been one of the greatest concerns of humankind. In contrast, gerontology as a branch of science is still comparatively young. During the past decade, concomitant with rapid progress in our understanding of the basic life sciences, vast stores of knowledge about biological aging have been accumulated. This knowledge, however, arising from many scientific disciplines and focused on varying levels of biologic organization, seems almost random and covers everything from molecules to human societies. Theories advanced to interpret the facts and to understand the mech anisms involved in senescence have remained in individual, rather than general, territories. It has long been felt by some gerontologists that it was time for the various specialists to step back and take a generalist view of gerontology, to reconsider and reevaluate the fruits of their analyt ical pursuits at different levels within a broader context. Some others may think it still premature. It seemed, however, that the majority of those who gathered in Tokyo on the occasion of the XIth International Congress of Gerontology were of the opinion that there was much to be gained in looking for interrelationships among the facts and theories originated in the different levels of investiga tion in an attempt to observe and appreciate the biological drama of senescence as an entity.

These Proceedings emanate from the Second Tarbox Parkinson's Disease Symposium held February 2-4, 1978, at the SouthPark Inn in Lubbock, Texas. The Symposium was sponsored by the Tarbox Parkin son's Disease Institute and the Department of Pharmacology and Therapeutics of the Texas Tech University School of Medicine at Lubbock. The First Symposium took place in October, 1976. The Second Tarbox Parkinson's Disease Symposium boldly brought together investigators at the cutting edge of aging and neuroendo crine research and attempted to relate them to Parkinson's disease. Credit for the concept must go to the Program Chairman, Dr. David E. Potter. Once the plan was conceived the organizers relied heavily on the advice of Dr. Caleb E. Finch, whose counsel in developing the program was invaluable. The final verdict on the success of this daring venture must await the outcome of the publication of this Volume. Nevertheless, those in attendance could not fail but note the enthusiasm and excitement of the participants as their findings from the diverse disciplines of the neurological, aging, and endo crine sciences converged. This in itself is testimony that the Sym posium accomplished some degree of success. The Tarbox Parkinson's Disease Institute was established in 1973 with funds appropriated by the State of Texas and is dedicated to research, patient care, and education in Parkinson's disease and related neurological disorders. The Institute is named after Mr.

Among the various theories proposed to account for the process of aging, the free radical theory is of practical interest since it includes the possibility of retarding this process by administrating natural or synthetic antioxidants and free radical scavengers. The book "Free Radicals and Aging" summarizes knowledge accumulated during recent years in 42 reviews written by experts in the field. Aspects of free radical involvement in the intrinsic aging process and in age-related diseases, as well as the importance of the pro-antioxidant balance throughout life are discussed. Epidemiological studies from several European countries are reported showing correlations between low plasma levels of essential antioxidants and the occurence of coronary heart disease, cancer and cataract formation. Appropriate nutrition as well as prophylactic and therapeutic use of antioxidants are considered. This book represents a milestone in the field of age-related free radical biology and medicine. With contributions by: A. Azzi, B. Chance, R.G. Cutler, H. Esterbauer, P.H. Evans, F. Gey, C. Guarneri, D. Harman, N.I. Krinsky, M. Meydani, J. Miquel, A. Mori, L. Packer, C. Rice-Evans, M. Simic, A. Taylor, T. Yoshikawa.

This volume is the third in the Contemporary Geriatric Medicine series. As in previous volumes, information is presented in the form of easy-to read essays to bring the reader up to date on state-of-the-art develop ments in the area of geriatric medicine. Once again, a system approach is utilized. In addition, several new topics-including alcoholism, throm boembolic disease, and decubitus ulcer management-have been intro duced to enhance this volume's usefulness to the busy clinician and student. Each chapter is not meant to be an exhaustive review of all topics in the field, but rather to focus on issues currently receiving a great deal of attention. Our goal continues to be to create an exciting approach to contemporary issues in geriatric medicine. The editors are once again appreciative for having been given the opportunity to develop this series. Appreciation is also expressed to our professional colleagues, families, and administrative assistants, who have enabled this volume to reach fruition. As in the past, we thank, most of all, our elderly patients for providing the inspiration and impetus to improve our knowledge and understanding of the health care needs of the elderly. Steven R. Gambert, M.D. V alhalla, New York ix Contents Chapter 1 Geriatric Cardiology and Blood Pressure 1 Edmund H. Duthie, Jr., and Michael H. Keelan, Jr."

The central nervous system controls vital functions by ef?ciently coordinating peripheral and central cascades of signals and networks in an orchestrated manner. Historically, the brain was considered to be insulin independent. These earlier views have been challenged by ?ndings demonstrating that insulin exerts multiple actions in the brain, regulating vital biological processes such as life span, neuronal survival, cognition, reproduction, feeding behavior, energy balance, and glucose and fat metabolism, and that inef?cient central action of insulin contributes to the development of severe pathologies (Banks et al. 2000; Gerozissis 2003, 2004, 2008; Lustman and Clouse 2005; Okamoto et al. 2001; Park 2002; Perrin et al. 2004; Pocai et al. 2005; Reger et al. 2008; Schwartz and Porte, 2005; Schubert et al. 2004; van der Heide et al. 2005; Woods et al. 1979; Wrighten et al. 2008). Insulin and speci?c insulin receptors are widely distributed in the networks of the central nervous system related mainly to feeding or cognition (Baskin et al. 1983; Bruning et al. 2000; Gerozissis 2003, 2008; Havrankova et al. 1978a, b; Schechter et al. 1996; Schulingkamp et al. 2000; Schwartz et al. 1992; Zhao et al. 2004). Insulin receptors located in the synapses of neurons and in astrocytes are present in high concentrations in the cerebral cortex, olfactory bulb, hippocampus, amygdala, cerebellum and hypothalamus (Abbott et al., 1999; Havrankova et al.

It has been estimated that there are at least 2,500,000 adults, 10% of the population above age 65, who are currently in need of some sort of mental health services (Kramer, Taube, and Redick, 1973). Other estimates are even higher (e. g., Pfeiffer, 1977). It is expected that this number will increase as the number of older adults increases over the next 40 years. Probably less than 400 clinical psychologists are now provid ing services to this age group. The number of elderly patients actually seen by these psychologists is very, very small. One national survey found that of 353 psychologists who reported that they had older clients, only 495 individuals were seen for psycho logical testing and 1423 for psychotherapy in the one month just prior to the response (Dye, in press). Assuming that the same in dividuals were not seen for both testing and therapy within the one month period--a questionable assumption--approximately . 08% of the at least two-and-one-half million older adults in need of psychological services are now being supplied with these services in some form or another. Thus, the need for increased involvement of clinical psychology with the aged is undeniable. However, few resources currently exist which will serve to increase the number of clinical psychologists trained to meet this need. Probably less than 100 clinical psychologists living today have received any kind of formal graduate training in the clinical psychology of the aging (Storandt, 1977)."

This volume marks the first of a new series, Contemporary Geriatric Medicine, joining the ever growing "Contemporary" family. As with the other "Contem porary" volumes, our goal is to assist the reader in maintaining currency in a rapidly changing field. Perhaps no field has shown such major advances in such a short time as geriatrics. Over the last several years, the "demographic impera tive" has become a source of concern for many, including clinicians, scientists, econ omists, and health planners. Our geriatric knowledge base continues to grow, often making it difficult to keep abreast of advances and current therapeutic modalities. Contemporary Ger iatric Medicine presents the state-of-the-art thinking regarding a variety of topics all of major concern to the health practitioner caring for the elderly person. The authors, for the most part serving as members of a stable editorial board, have chosen topics that should have immediate interest to the readership. By having a stable editorial board, continuity is ensured in successive volumes. Every two years, a subsequent issue will either address new thoughts on already presented topics or focus on new topics of current interest. As with the other "Contempo rary" series volumes, the every other year interval is intended to allow new find ings to develop and be tested. It also provides the authors with time to provide the highest quality of work."

In the last two years, a wealth of new information has accumulated regarding both clinical and research aspects of health care for the elderly. Although many controversial issues have been resolved, many still remain. Volume 2 of Contemporary Geriatric Medicine is once again dedicated to the clinician who cares for the elderly on a continuing basis. Although, for the most part, general topics first introduced in Volume 1 have been retained, all infor mation in this volume is new and represents the current state of the art. In addi tion, several new topics-including falls, interpretation of laboratory data, and oral health care-have been introduced to enhance this volume's usefulness to the busy clinician. Through these easy-to-read essays, we attempt once again to keep the non geriatrician abreast of the current state of the art regarding the special needs and problems of the elderly. Each chapter is not meant to be an exhaustive review of all topics in the field, but rather to focus on issues receiving a great deal of atten tion. Our goal is to create an exciting approach to contemporary issues in gerIatric medicine."

This volume brings together noted scientists who study presbycusis from the perspective of complementary disciplines, for a review of the current state of knowledge on the aging auditory system. Age-related hearing loss (ARHL) is one of the top three most common chronic health conditions affecting individuals aged 65 years and older. The high prevalence of age-related hearing loss compels audiologists, otolaryngologists, and auditory neuroscientists alike to understand the neural, genetic and molecular mechanisms underlying this disorder. A comprehensive understanding of these factors is needed so that effective prevention, intervention, and rehabilitative strategies can be developed to ameliorate the myriad of behavioral manifestations.