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."

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)."

The second edition of the Handbook of Pain Relief in Older Adults: An Evidence-Based Approach expands on the first edition by providing a number of timely new features. Most important of these are the revised recommendations from the American Geriatrics Society on prescribing that reflect the many new agents available since the last guidelines were released in 2001. Additionally, concepts such as synergy in prescribing for older adults have been better delineated in this edition. The most salient features of the original edition have been retained and updated, including the full range of approaches for pain assessment and prevention, interventional strategies, guidance on pharmacotherapy and nonpharmacologic pain relief strategies for seniors, preventive analgesia, the role of rehabilitation in sound pain treatment, legal and public policy issues in pain care for seniors, pain management in long-term care, and even the issue of spirituality as an adjunct to pain management. The second edition also includes a new chapter on resources, which includes organizations, internet websites, and guidance on acquiring additional consultation for pain intervention. Of particular interest is an updated discussion of the effect that electronic medical records and internet-based personal health records will have on pain relief in older adults and a new chapter that serves as a resource guide for patients and caregivers trying to navigate the waters of pain relief assistance. This issue has not been addressed substantively in the pain management literature and the ramifications for older adults are particularly poignant. Comprehensive and practical, the Handbook of Pain Relief in Older Adults: An Evidence-Based Approach (Second Edition) is a comprehensive resource with targeted, practical information that will be of vital importance for all clinicians who provide care for seniors.

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."

Although thousands of articles and hundreds of books on aging have been published, only a small percentage of this material has dealt with anatomy, particularly at the fine structural level. It was with this in mind that Aging and Cell Structure was conceived. Volume 1 of Aging and Cell Structure was published in 1981 and represented a current compilation of information, concentrating at the electron microscopic level, on morphological changes which occur in cells and tissues as they age. The present volume completes the two-volume set. While Volume 1 highlighted structural changes occurring in the aging nervous system, Volume 2 centers its efforts on studies of in vitro aging. Chapters on other subjects are included as well. These include age-related changes seen in neuromuscular junctions, oral tissues, and the pancreas. Although these two volumes represent a very small part of the published infor mation on experimental gerontology, their approach is rather unique because they focus on anatomy, perhaps the most basic of all the biomedical sciences. Because many dif ferent tissue types are examined, we begin to see recurrent, definitive patterns in the aging cell which may not be fully apparent from studies taking one cell type at a time. This becomes even more evident in the present volume where changes seen in popula tions of cells grown in culture-isolated from hormones or nervous impulses from other body areas-are found to be similar to those changes found in vivo."

Handbook of Non-Motor Symptoms in Parkinson's Disease is designed to provide practical tips and emphasize key priorities for treatment of non-motor aspects of the disorder. The quick-reference handbook format, with key points highlighted by the use of figures and tables, will provide the reader with high-value practical information.

America is quickly going grey. There are more Americans alive today over the age of 80 than ever before in our history; by 2030, that number is expected to almost triple. But when we discuss how long people live, we must also consider how well they live. Aging Our Way follows the everyday lives of 30 elders (ages 85-102) living at home and mostly alone to understand how they create and maintain meaningful lives for themselves. Through extensive interviews, Meika Loe explores how elders navigate the practical challenges of living as independently as possible while staying healthy, connected, and comfortable. Aging Our Way celebrates these men and women as they really are: lively, complicated, engaging people finding creative ways to make their aging as meaningful and manageable as possible. Written with remarkable warmth and depth of understanding, Aging Our Way offers a vivid look at a group of people who too often remain invisible-those who have lived the longest - and all they have to teach us.

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.

Guide to Fitness After Fifty presents basic and applied research data, authoritative advice and tested techniques for professional workers who want to learn more about physical exercise, fitness and health for aging people and for all who seek to become more physically and mentally fit. The editors and contributors believe that physical activity and exercise following the pri ciples and practices utlined in this inter disciplinary volume can improve the health and quality of life by increasing en durance and cardiovascular fitness, strengthening the musculoskeletal system, im proving mobility, posture and appearance, and relaxing emotional tensions. Evidence at hand and discussed in this book demonstrates that properly prescribed physical activity or exercise can raise the level of physical fitness and health, both physical and mental, at any age, delay the ravages of aging, and prevent or reduce disability from musculoskeletal and circulatory disorders. Section I, Perspectives on Exercise and Aging, surveys the fundamental problems and relationships of exercise to aging and health and provides historical insights and philosophic perspectives on the significance and importance of physical fitness and exercise through the centuries and in contemporary society. Section II, Evaluation and Physiology of Exercise, presents objective scientific and medical evidence that reasonable improvement in fitness and other bodily func tions may be achieved by people of all ages who follow well designed exercise and relaxation routines for at least 30 minutes three or more times weekly."

The aim of these short notes is to provide the newcomer to the speciality of geriatrics with a wide though not exhaustive differential diagnosis of most of the commonly encountered symptoms in the elderly, and to draw particular attention tothe common and important disorders. The common causes of symptoms and the common dis eases as well as certain features which have special importance to the medicine of the elderly are emphasized. A final section on investigations (with short notes) which one may employ in the practice of geriatric medicine is included along with an appendix of normal values for the elderly. In our view this book does not show how geriatric medicine is practised but it does provide an outline of clinical aspects of medicine (geriatrics), knowledge of which is essential to the practice of ger iatrics. G.S.R. V.P. Foreword I take the view that if vitality is reduced to the extent that it interferes with life as the old person would wish to live it, then a proper medical assessment should be made as part of the overall appraisal of that person's problems. The provision of a home help or the meals on wheels service cannot be expected to revitalize the person suffering from hypothroidism or pernicious anaemia In the event both medical treatment and social support may be needed and to provide one without the other would be half measures."

Experimental gerontopsychology attempts to test causal hypotheses about old age-related behavioral changes by the manipulation of age-differences. An experimental treatment is introduced with the purpose of equating different age-groups with respect to a potentially relevant function. If the treatment results in an assimilation of the behavior of the different age-groups (age by-treatment interaction), differences in this function are con sidered as causal for the normally observed behavioral differ ence. If it does not result in an assimilation of the behavior of the different age-groups (main effect of treatment), differ ences in this function are considered as irrelevant for the nor mally observed behavioral difference. The different interpretations of age-by-treatment interactions and main effects of treatment in this kind of research are reasonable only if the experimental treatment actually results in an equalization of the age-groups with respect to the func tion of interest. As is shown, such a functional equalization can neither be demonstrated nor assumed in many cases. In such cases, studies with either age-group can be used to investigate hypotheses about potential causes for old age-related behavioral changes, studies with young subjects having important advantages over studies with old subjects. A test of causal relationships by age-by-treatment interactions is possible in cases where the experimental treatment evidently results in an equalization of the age groups with respect to the function in question. Unfortunately, the field of application for this kind of approach is rather limited."

Events in anyone day of the aged consist of the functions of daily living modified or enhanced for each individual according to his or her capability. It is the constant aim of the medical professions to enhance the individual's quality of life and to try to avoid what is preventable. Among some of the hazards of the geriatric day are fits, faints and falls. It is the fall which often highlights the first two and the consequences may be serious for an old person. Perhaps one day an easy way to circumvent the 'forces of gravity' or drugs to counteract impaired sensory input will be found. The importance of the study of gait has been increasingly recognized by physicians working in this field of medicine for the elderly; writings by geriatricians on the subject are numerous. Bernard Isaacs in his gait research laboratory in Birmingham is studying the subject. In this book the experience of the contributors is brought together, inevitably with some overlap, which has in the main been avoided by restructuring, modification and crosschecking of articles.

The mammalian central nervous system is a remarkable structure which has attracted many new investigators, as evidenced by the dramatic increase in scientific publications dealing with neurobiology. Every day basic scientists conduct new and exciting experiments, resulting in remarkable discoveries des tined to help mankind. Unfortunately many of these new findings are slow to be accepted by the clinical world. This is especially true in the area of brain trauma, where the present prognosis is usually very poor. We have known for quite some time that the mammalian central nervous system is capable of compensating for severe damage in many different ways, and under some circumstances behav ioral compensation can be observed. However, much is still to be learned about the various factors and events that lead to functional recovery and those condi tions that do not. It is this challenge that originally excited a number of the contributors to this volume to explore the subject of recovery from brain damage. One factor in particular that is known to change the prognosis of recovery is the age of the organism at the time of the damage. This book is an attempt to explore this important variable. Most of the literature concerning aging deals with widespread degenerative changes and paints a grim picture for the aging central nervous system in terms of recovery of function following trauma."

The year was 1943. As a third-year medical student at Stanford, I was about to witness the beginning of a medical miracle. Dr. Arthur Bloomfield, Professor of Medicine, had selected my patient, a middle aged man, who was dying of acute pneumococcal pneumonia, as one of the first patients to receive miniscule doses (by today's standards) of his meagre supply of a new drug - penicillin. The patient's response amazed everyone especially this impressionable medical student. The rest of the story is history. With one stroke, the introduction of penicillin removed from the medical scene the 'friend of the aged' - lobar pneumonia. The consequences, which no one could have imagined at the time, are still becoming manifest as other 'miracles' such as respirators, artificial kidneys and many potent new antibiotics have come upon the scene. All of us are aware that these miracles have created a variety of new challenges around the states of dying and near dying. We have no easy answers for these problems. Nevertheless as dialysis techniques, especially CAPD, are applied more widely to the treatment of the elderly, the task of helping the patient meet death with dignity becomes increasingly important and vexing because once begun, dialysis is difficult to terminate.

Distinguished physicians critically review the clinical consequences of the endocrinological changes that occur with aging-in both men and women-and examine the use of hormonal therapy to reduce them. Topics range from bone disease and water balance in all older people, to androgen deficiency in aging males, gynecomastia, and menopause. The authors also discuss Type II diabetes in persons over 65, emphasizing the cognitive benefits of good glycemia control, and the interaction of nutrition and metabolism, focusing on hypocholesterolemia, obesity, the anorexia of aging, trace elements, and vitamins. The aging of the sympathetic nervous system and its impact on hypertension in the elderly is also covered. Timely and authoritative, Endocrinology of Aging offers endocrinologists, geriatricians, and primary care physicians critical insight into the endocrine problems of our rapidly growing elderly population.

As people live longer and health care costs continue to rise and fewer doctors choose to specialize in geriatrics, how prepared is the United States to care for its sick and elderly? According to veteran psychologist Seymour Sarason's eloquent and compelling new book, the answer is: inadequately at best. And rarely discussed among the grim statistics is the psychosocial price paid by nursing home patients, from loneliness and isolation to depression and dependency.

In "Centers for Ending," Dr. Sarason uses his firsthand experience as both practitioner and patient in senior facilities to reveal wide-ranging professional and moral issues affecting this seemingly familiar terrain. Insensitive medical personnel, poorly trained nurses and aides, indifferent administrators, and a prevailing culture content with treating "bodies" instead of human beings are identified as contributing factors. Drawing on America's rich history of large-scale solutions to social problems, Dr. Sarason offers penetrating insights and bold suggestions in such areas as:

The widening care gap between haves and have-nots.Why professional caregivers fail to understand patients.The nursing home resident as immigrant.Why previous reform efforts have not worked.The need for a Presidential commission for the elderly.The scenario if conditions are allowed to remain as they are or worsen.

This concise volume is essential reading for researchers, graduate students, professionals, practitioners, and policy makers across such fields as geriatric medicine, health psychology, social work, public health, and public policy. "Centers for Ending "is a clarion call to be ignored at great cost to our elders and ourselves. "

1h The 5 International Conference on the Progress in Alzheimer's Disease and Parkinson's 51 1 Disease took place from March 31 to April 5 \ 2001 in Kroto, Japan. This international 1 conference was organized as a joint Congress with the 9 International Catecholamine Symposium. A total of 1258 clinicians and researchers participated in this joint congress 1h from 38 countries in the world. This book represents the proceedings of the 5 Conference on Alzheimer's and Parkinson's disease. The International Conference on the Progress in Alzheimer's and Parkinson's disease was first launched by Professor Abraham Fisher of Israel and Professor Israel Hanin of USA. The first conference was held in Eilat, Israel in 1985. The second conference was organized in Kyoto, Japan in 1989; the third one in Chicago, USA, in 1993, and the fourth one in Eilat, Israel in 1997. The International Catecholamine Symposium (ICS) is an international meeting devoted to the development of basic as well as clinical research on catecholamines. The first Catecholamine Symposium was held in Bethesda, USA in 1958. Since then this symposium has occurred every 5 years. Professor Toshiharu Nagatsu was appointed as 1h the president of the 9 International Catecholamine Symposium, which was to be held in 200 I also in Japan. Therefore, we decided to organize a joint congress of the two meetings, because there is much overlap in research between Alzheimer's disease, Parkinson's disease, and catecholamines. We thank Professor Nagatsu very much for agreeing to organizing this joint congress.

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

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.

"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.

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.

Memory is essential for the retention of learning. In the presence of memory deficits, new learning is impaired and performance of previously learned habits deteriorates. What is the nature of memory? Where does it reside in the brain? What biological events are associated with the formation and retrieval of memory? These questions are explored in the first chapter of this volume. The answers are not final, but we have learned a great deal about memory processes during the past few decades. Memory is influenced by most of the pathological processes that influ ence the brain such as infection, trauma, cerebrovascular disorders, and met abolic and degenerative diseases. The nature and course of memory impairment are unique for each of the disorders and are fairly distinguishable. More than fifty conditions are known to cause dementia, which now affects several million Americans. In Alzheimer's disease, memory disorder predominates for two to three years before other intellectual functions are affected. Many neurological diseases, such as Huntington's disease, Friedreich's ataxia, and multiple sclerosis, are associated with progressive memory deficits. Forgetting is a problem that becomes progressively worse with age. Most individuals in their forties begin to experience some difficulty in quick recall of past events. By age sixty definite changes are evident in the process of registration, storage, and recall of memory. At this age the material that is to be remembered is processed more slowly, stored less firmly, and poorly recalled."

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."

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.