""I want to provide the best care possible. The suffering has gone on for a long time, and I want to be sure the end stage is as comfortable as possible.""

This common sentiment is ex-pressed by both health care professionals responsible for caring for frail elders experiencing the later stages of dementia and family members trying to ensure the most compassionate care for their loved ones. Health care providers and family members often struggle with painful decisions when confronting the inevitable while providing love, compassion, and care. Modern medicine may offer seemingly promising treatments, but eventually, the impact of Alzheimer's disease and other causes of dementia can cause profound deterioration in the patient's quality of life. The focus must eventually shift to compassionate end-of-life care. This guidebook reflects Dr. Gordon's extensive experience with health care professionals and families struggling with these poignant and difficult decisions.

..". families will learn much about helping patients with dementia, but so too will physicians and other caregivers. Michael Gordon's humanity shines through every page, and, when combined with his medical expertise, the result is a guide which is both truly thoughtful and practically useful."
-Professor Arthur Schafer, Director, Centre for Professional and Applied Ethics, University of Manitoba

"Dr. Gordon is truly a healer whose experience as a geriatrician provides a road map for all of us who want to provide care, respect, and love for people diagnosed with dementia."
-Steven R. Sabat, PhD, Professor, Department of Psychology, Georgetown University

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."

Public health and antiseptic measures, vaccination and antibiotics, have all contributed to the reduction in the incidence and impact of diseases due to infections in younger age groups. Unfortunately, however, infections remain a very important cause of both morbidity and mortality in the elderly. The reasons for the continued effect of infection on the older person are multifactorial. Firstly, the immune response alters with age and may result in opportunistic infections. Secondly, while the diagnosis and management of some infections in the elderly can present little problem, altered signs and symptoms in other older patients, especially the old elderly, can cause considerable diagnostic difficulties with resulting delays in definitive treat ment. Thirdly, a degree of complacency can develop because some infec tions are seldom seen and, consequently, may not be considered in the differential diagnosis. The presence of other, more common, diseases serve only to distract attention and confuse the diagnosis. Since the number of elderly people is increasing, the need for continued high standard of skill in diagnosis and management is emphasized. These factors are considered in this book by contributors who are experi enced in their fields. The altered immune response with age, the appropriate use of antibiotics in older people and the latest developments of therapy are reviewed. Infections in various body systems are considered, with emphasis on differing presentations and diagnostic difficulties, ways of improving diagnostic skills as well as management and treatment."

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."

In recent years ideas about the influence of psychological status on physical health have been elevated from intuition and clinical lore to a legitimate area of scientific study. Mechanisms of influence are, indubitably, diverse. Some of this influence is indirect, accounted for simply by the instrumental help that social engagement, associated with good mental health, affords people; for example, psychologically "healthy" people are probably more likely to comply with medication regimens and engage in other healthful behaviors to a greater extent than those who are socially withdrawn or psychologically unstable. But recent studies suggest that while the importance of these more obvious factors cannot be denied, the complete picture includes factors that are much more subtle and complex. A body of research is beginning to accumulate that suggests that all three major regulatory systems -- the central nervous system, the endocrine system, and the immune system -- are affected by cognitions, emotions and behavior. There is no doubt that a relationship between mental and physical health exists, but very little is known about the specific mechanisms by which such influence occurs. At least in part, empirical research in this area has been limited by the inherent need for an interdisciplinary approach and synthesis of collected data. Recently, a few researchers in a number of different disciplines have begun to study directly the linkage between psychological and emotional well being and health."

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.

In this third volume on longevity Fondation Ipsen has again collected the most recent results in research on genes and diet in the evolution of human longevity, educational level and longevity, cognitive impairment and survival at older age and other contributions. The preponderance of relatively short - compared to long-lived organisms suggests that morphogenesis is easier to accomplish than is maintenace of soma, whereas the broad range of longevities of organisms demonstrates that maintaining soma for extended periods of time is possible. The underlying assumption of "disposable soma" theory of aging is that the expense of maintaining somatic cells depends on their contribution to the welfare of the germ cells.

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.

After the age of 40, we may notice occasional lapses - a forgotten phone number, a friend's name, or a word that was right on the tip of our tongue. By 60, we may find ourselves wondering who called this morning, why we came into the kitchen, where we parked the car. In an aging nation, where one citizen in seven will be 65 when the next century arrives, these little difficulties raise a larger question: what precisely happens to our thinking as we grow older? What is normal, what is not, and how are we to know the signs? Douglas Powell offers a comprehensive account of cognitive aging of how our mental functions change as we mature. Defining patterns of normal decline, as well as severe forms of cognitive impairment, this book will help us understand and address the needs of an aging population. Powell integrates the latest literature on aging with the findings of his recent study of 1,000 physicians and 600 other subjects ranging in age from 25 to 92. His work reveals patterns of cognitive aging throughout the life cycle, particularly the way in which variability among individuals outpaces the decline of overall ability. Tackling an issue of growing interest in the field of gerontology, he notes the effect of certain factors such as gender, diet, health, and physical and mental exercise on changes in cognitive functioning over time. Along with the criteria for mild cognitive impairment and normal cognitive aging, this book addresses the question of optimal cognitive aging, identifying its characteristics and searching out their implications for the maintenance of intellectual abilities in the post-retirement years.

Whereas chronic stress has well known harmful effects, recent research shows that intermittent exposure of cells and organisms to mild stress can improve various biological parameters. This book brings together some of the world leaders in this area of research who present a critical analysis of the ongoing research with respect to the effects and mechanisms of action of various types of mild stress. Novel approaches to improving health and longevity are introduced.

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. "

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."

This book gathers current research from across the globe in the study of cancer in the elderly. Topics discussed include cancer-related fatigue in elderly patients; rectal cancer staging; hormone therapy treatment in elderly patients with hormone-sensitive breast cancer; age and gender-related risk for oral cancer; cancer treatment for patients with Alzheimer's disease and oesophageal cancer in the elderly.

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.

With this book, Siegel, an internationally known demographer and gerontologist, has made a unique contribution to the fledgling fields of health demography, and the demography and epidemiology of aging. The book represents a felicitous union of epidemiology, gerontology, and demography, and appears to be the first and only comprehensive text on this subject now available. Drawing on a wide range of sciences in addition to demography, gerontology, and epidemiology, including medical sociology, biostatistics, public policy, bioethics, and molecular biology, the author treats theoretical and applied issues, links methods and findings, covers the material internationally, nationally, and locally, and while focusing on the elderly, treats the entire life course. The methods, materials, and pespectives of demography and epidemiology are brought to bear on such topics as the prospects for future increases in human longevity, the relative contribution of life style, environment, genetics, and chance in human longevity, the measurement of the share of healthy years in total life expectancy, the role of population growth in the rising costs of health care, and the applications of health demography in serving the health needs of local communities. The separate chapters systematically develop the topics of the sources and quality of health data; mortality, life tables, and the measurement of health status; the interrelationships of health, on the one hand, and mortality, fertility, migration, and age structure, on the other; health conditions in the less developed countries; the concepts and theories of aging and projections of the aged population; and local health applications, public health policy, and bioethical issues in health demography. Given its comprehensiveness, clarity, interdisciplinary scope, and authencity, this book appeals to a wide range of users, from students and teachers of medical sociology, the demography of aging, and public health studies to practitioners in these areas, both as a text in health demography and the demography/epidemiology of aging, and as a reference work in these fields.

For centuries people have puzzled over the inevitability of human aging. At the end of the 20th century a remarkable scientific discovery emerged, based on a series of important interconnected insights over quite a long period of time. The aim of this book is to dispel ignorance by explaining in non-technical language what are the reasons for aging and the myth of excessive prolongation of life.

The Pool Activity Level (PAL) Instrument is widely used as the framework for providing activity-based care for people with cognitive impairments, including dementia. The Instrument is recommended for daily living skills training and activity planning in the National Institute for Clinical Excellence Clinical Guidelines for Dementia (NICE 2006), and has been proven valid and reliable by a recent research study. It is an essential resource for any practitioner or carer wanting to provide fulfilling occupation for clients with cognitive impairments. This fourth edition of The Pool Activity Level (PAL) Instrument for Occupational Profiling includes a new section on using the PAL Checklist to carry out sensory interventions, together with the photocopiable Instrument itself in a new easy-to-use format, and plans that help to match users' abilities to activities. It includes the latest research on the use of the PAL Instrument in a range of settings, and new case studies, as well as information about how a new online PAL tool complements and supports the book. The book also contains suggestions for activities, together with information on obtaining the necessary resources and guidance for carrying out the activities with individuals of different ability levels, as revealed by the PAL Checklist.

Throughout my clinical training and practice, I have been surprised by the number of times that sexual issues have emerged as an unexpectedly central feature in my work with older adults. I can vividly remember my own internal reaction on hearing one of my elderly female patients tell me that she was date raped a few years after the death of her elderly husband-when she was 68 years old. I can see in my mind's eye the blood splattered on the floor of an inpatient unit from an elderly man who smashed his arm through a window, furious that his antidepressant medication made it impossible to climax through masturbation. On a much less dramatic but equally important note, I think about the elderly amputee who told me softly about his fears of resuming sexual activity with his wife of 25 years. I also think about the elderly woman whose inability to take herself shopping to find fashionable, comfortable clothes to fit over her hunched shoulders and large breasts helped precipitate a serious depression. In sum, I learned early on that elderly sexuality is not just about how many times a week someone makes love. It is my hope that sharing these experiences and introducing the related theories, research, and interventions will assist other clinicians in dealing with these often challenging and clinically demanding situations. Without my patients, this text would not have been possible.

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.

The Oxford Specialist Handbooks series provides readers with clear, concise information on all that is needed to successfully train in the medical sub-specialties. Each book gives an overview of clearly defined procedures, skills, guidelines, and technologies and provides practical tips and case studies to supplement hands-on experience. Where appropriate, each book complements the revised curriculum as developed by the Specialist Advisory Committees.
Dementia is a growing issue, exacerbated by improvements in health care which have led to an ageing population; currently three quarters of a million people suffer from dementia in the UK, and this is expected to rise to 1.8 million by 2050. This book concentrates on advanced disease and addresses issues such as pain management, decision-making, spiritual needs, communication, the Mental Health Capacity Act, dementia in the younger patient, and the carer's perspective.
Written by specialists, this book will be invaluable for doctors and nurses involved in palliative medicine, geriatrics, and old-age psychiatry, and the generalist who treats the patient with dementia.

In comparison to Husserl and Heidegger, Max Scheler's philosophy of time as first presented here, is considerably wider in scope. Using posthumous manuscripts, Frings shows that Scheler conceived the origin of time in the self-activating center of individual and universal life as threefold "absolute" time of a four-dimensional expanse. This serves as a basis for establishing the phenomenon of objective time in multiple steps of constitutionality, including the physical field theory and theory of relativity.
For Scheler, objective time, even though anchored in absolute time, deserves "maximum attention" in a technological society. Frings focuses here with Scheler on time experience of values and among social groups, time experiences in the mind-set of capitalism, in politics and morals, in population dynamics, and time experiences in the process of aging, all of which were signposts in Scheler's thought before his early demise.

This book arises from a conference held in November 1996 designed to examine how competence can be improved in the different stages ofthe lifespan. To this end, we brought together eminent researchers in different areas of human development-infancy, childhood, and adulthood, including the late adult years. The conference was based on the premise that discussion arising from the interfaces of research and practice would increase our knowledge of and stimulate the further application of effective interventions designed to improve competence. The editors wish to acknowledge the contributions of Concordia University and the Fonds pour la Formation de Chercheurs et l'Aide a la Recherche (FCAR) in providing funding and other assistance toward the conference "Improving Competence Across the Lifespan" and toward the publication of this book. Finally, we wish to express our gratitude to the numerous students associated with our Centre for their help and to Gail Pitts and Lesley Husband of the Centre for Research in Human Development for their assistance. We are especially grateful to Donna Craven, Centre for Research in Human Development, for her heroic work on both the conference and the present volume. We could not have met our goals without you.

This volume brings together leading researchers on quality of life in old age to focus on one of the most important issues in both gerontology and quality of life studies. Quality of life is a holistic construct and assessed from many different perspectives and by many disciplines. Moreover, the concept of quality of life can be applied to practically all important domains of life. Thus, quality of life research has to include social, environmental, structural, and health related aspects and be approached from an interdisciplinary perspective. Recently research in gerontology has begun to systematically study quality of life - following the WHO dictum 'years have been added to life and now the challenge is to add life to years' - however there are very few texts available on this topic and none of an international and multi-disciplinary nature. Quality of life studies have neglected older people and, given the size and growth of this population, it is time to publish a volume on this topic that systematically pursues a comprehensive perspective and includes theoretical approaches and empirical findings with respect to the most important components of quality of life in old age. For these reasons and the high quality of the authors we have assembled, this will be a seminal text for both gerontology and quality of life researchers.