Part of the What Do I Do Now? Psychiatry series, Geriatric Psychiatry offers comprehensive expertise for clinicians seeking answers for how to manage complex situations in geriatric psychiatry, with a focus on individuals with Alzheimer's disease and other neurocognitive disorders. This volume addresses conditions common to all psychiatric settings as well as features that must be factored into diagnosis and treatment in later life for anxiety, depression, psychosis, apathy, and agitation. Chapters feature brief clinical case vignettes and further resources for topics in neurocognitive disorders, anxiety disorders, mood disorders, psychotic disorders, and substance use in elderly patients. An authoritative guide for clinicians facing an aging population, Geriatric Psychiatry provides clear answers to some of the most complex situations in geriatric psychiatric care.

What are the fundamental mechanisms of decision making, processing speed, memory and cognitive control? How do these give rise to individual differences, and how do they change as people age? How are these mechanisms implemented in neural unctions, in particular the functions of the frontal lobe? How do they relate to the demands of everyday, 'real life' behaviour? Over almost five decades, Pat Rabbitt has been among the most distinguished of British cognitive psychologists. His work has been widely influential in theories of mental speed, cognitive control and aging, influencing research in experimental psychology, neuropsychology and individual differences. This volume, dedicated to Pat Rabbitt, brings together a distinguished group of 16 contributors actively pursuing research in the fields of speed, memory, and control, and the application of these fields to individual differences and aging. With the latest work from senior figures in the field, and a focus on fundamental topics in both teaching and research, the book will be valuable to students and scientists in experimental psychology and cognitive neuroscience.

These plays show a fascinating side of the American melodramatic imagination as it was nurtured in the social world of the nineteenth century, and later grew to be a dominant genre in the theatre, film, and television of today. Includes: "The Poor of New York" by Dion Boucicault, "Uncle Tom's Cabin" by George Aiken/Harriet Beecher Stowe, "Under the Gaslight" by Augustin Daly, "The Girl of the Golden West" by David Belasco.

Alzheimer's disease can be thought of as a multi-faceted neuropsychological disorder, with diverse impairments in cognitive abilities, such as attention, memory, language and executive functioning. Over the last decade cognitive neuropsychology has provided a far richer understanding of these impairments, and this book describes these advances, placing them in their clinical context. The first section deals with background theoretical and clinical issues, such as the extent to which Alzheimer's disease can be considered as a single entity or whether it is more fruitful to explore the neuropsychology of individual patients. It considers the diagnostic aspects of Alzheimer's disease, the natural history of the disease, how it progresses over time and the characteristics of the prodromal phase. A second section, the core of the book, covers major cognitive functions and delineates how impairments can be differentiated from each other. A third portion integrates what is known about cognitive decline with the underlying neurobiological basis, including pathological structural brain abnormality and neuropharmacological changes. A final section explores the clinical implications of the research with an overview of the neuropsychological assessment of this disease, cognitive approaches to management, and neurobiological treatment.
As an introduction to this field, The Cognitive Neuropsychology of Alzheimer's Disease brings together the opinion of leading researchers in a book that will provide a useful source of information for neurologists, neuropsychologists, psychiatrists and neuroscientists who wish to broaden their knowledge concerning this debilitating illness.

Stroke care has been revolutionised by better prevention, treatment, and more widely available rehabilitation. Nonetheless, stroke remains the second most common cause of death worldwide. This fully-updated new edition provides clear facts and practical advice as to why strokes occur and how they can be prevented in the future. Concise in style but comprehensive in approach, Stroke: The Facts describes the myriad of symptoms, varied presentations, and longer-term consequences of this disabling condition. The journey from treatment through to rehabilitation and preventing a further stroke is made easy by the author, a stroke doctor and researcher involved in many of the studies that have advanced care. Supplemented with case studies, this guide concentrates on developments in treatment, providing an important update on the first edition. It is essential reading for those who have had a stroke or Transient Ischaemic Attack and their families, and will also be of interest to medical professionals working within stroke care.

We live in an aging world. Illnesses that are prevalent and cause significant morbidity and mortality in older people will consume an increasing share of health care resources. One such illness is depression. This illness has a particularly devastating impact in the elderly because it is often undiagnosed or inadequately treated. Depression not only has a profound impact on quality of life but it is associated with an increased risk of mortality from suicide and vascular disease. In fact for every medical illness studied, e.g. heart disease, diabetes, cancer, individuals who are depressed have a worse prognosis. Research has illuminated the physiological and behavioral effects of depression that accounts for these poor outcomes. The deleterious relationship between depression and other illnesses has changed the concept of late-life depression from a "psychiatric disorder" that is diagnosed and treated by a psychiatrist to a common and serious disorder that is the responsibility of all physicians who care for patients over the age of 60.
This is the first volume devoted to the epidemiology, phenomenology, psychobiology, treatment and consequences of late-life depression. Although much has been written about depressive disorders, the focus has been primarily on the illness as experienced in younger adults. The effects of aging on the brain, the physiological and behavioral consequences of recurrent depression, and the impact of other diseases common in the elderly, make late-life depression a distinct entity. There is a compelling need for a separate research program, specialized treatments, and a book dedicated to this disorder. This book will be invaluable to psychiatrists, gerontologists, clinical psychologists, social workers, students, trainees, and others who care for individuals over the age of sixty.

There is no group of individuals more iconic of 1960s counterculture than the hippies - the long-haired, colorfully dressed youth who rebelled against mainstream societal values, preached and practiced love and peace, and generally sought more meaningful and authentic lives. These 'flower children' are now over sixty and comprise a significant part of the older population in the United States. While some hippies rejoined mainstream American society as they grew older, others still maintain the hippie ideology and lifestyle. This book is the first to explore the aging experience of older hippies by examining aspects related to identity, generativity, daily activities, spirituality, community, end-of-life care, and wellbeing. Based on 40 in-depth interviews with lifelong, returning, and past residents of The Farm, an intentional community in Tennessee that was founded in 1971 and still exists today, insights into the subculture of aging hippies and their keys to wellbeing are shared.

With an ever increasing population of aging people in the western world, it is more crucial than ever that we try to understand how and why cognitive competence breaks down with advancing age. Why do some people follow normal patterns of cognitive change, while others follow a path of progressive decline, becoming stricken with neurodegenerative diseases such as Alheimer's. What can be done to prevent cognitive decline-or to avoid neurodegenerative diseases? The answers, if they come, will not emerge from research within one discipline, but from work being done across a range of scientific and medical specialities.
This volume brings together leading experts from a range of fields studying cognitive aging, including neuroscience, pharmacology, health, genetics, sensory biology, and epidemiology. Unlike other books in this area, this book is more about "new frontiers" than past research and accomplishments. Recently cognitive aging research has taken several new directions, linking with, and benefiting from, rapid technological and theoretical advances in these neighboring disciplines. This book provides unique interdisciplinary coverage of the topic. With each chapter including commentaries from other specialists in related fields, the book provides integrative study of the topic. For those within the fields of psychology, cognitive neuroscience, and geriatrics, this volume will make an important contribution in furthering our understanding of a problem that affects all of us.

The average life expectancy has increased worldwide in the recent decades. This has presented new challenges as old age brings the onset of diseases such as cancer, neurodegenerative disorders, cardiovascular disease, type 2 diabetes, arthritis, osteoporosis, stroke, and Alzheimer's disease. Studies and research have shown the potential preventive and therapeutic roles of antioxidants in aging and age-related diseases by inhibiting the formation or disrupting the propagation of free radicals and thus increasing healthy longevity, enhancing immune function, and decreasing oxidative stress. This has made an antioxidant rich diet of increasing importance in battling the detrimental effects of the aging process. "The Role of Antioxidants in Longevity and Age-Related Diseases" is the book that compiles research on antioxidants and their biological mechanisms that mediate age-related diseases. This book covers the major issues linked to antioxidants, aging, and age-related diseases, including changes in organ systems over the lifespan, age-related oxidative stress-induced redox imbalance, inflammaging, implications of inflammation in aging and age-related diseases, and the important role of antioxidant-rich foods in their prevention and treatment of various age-related diseases. For researchers seeking a comprehensive single source on antioxidants and their roles in aging and age-related diseases, this novel text provides an up-to-date overview.

Vascular dementia, caused by multiple small strokes, is the second commonest cause of dementia behind Alzheimer's disease. In recent years there has been a radical reappraisal of the concept of vascular dementia and a move away from an Alzheimer-based diagnostic paradigm towards one more appropriately tailored for vascular disease. Vascular Cognitive Impairment presents a new definition for this class of cerebrovascular process with an emphasis on early detection, prompt treatment and the prevention of disease progression.

Vascular Cognitive Impairment: Preventable Dementia presents an overview of the current state of our knowledge in this field. It reviews the historical background, prevalence, risk factors and economic consequences of the condition. In addition, the book summarises our knowledge of the pathological process, describing insight derived from genetic and imaging studies, before examining opportunities for early diagnosis, prevention and the options for management, both now, and as a result of ongoing clinical trials.

With contributions from an expert team of international contributors, this book provides a comprehensive summary of the state-of-the-art in this field, providing a framework for a new understanding of a complex, disabling but Preventable condition.

Delirium is a cognitive disorder consisting of deficits of attention, arousal, consciousness, memory, orientation, perception, speech and language. It represents the most frequent complication of hospitalisation in the older population. Despite its importance in terms of clinical, economic and social considerations, and despite considerable advances in the past decade, it remains a relatively misunderstood and mis-diagnosed condition.

This book provides a state-of-the-art update of delirium research, covering its history, conceptualisation, measurement, epidemiology, pathophysiology, assessment, diagnosis, causes, prevention and management. The final chapter takes a look to the future, highlighting the importance of ongoing interdisciplinary research.

As well as being important as a clinical syndrome in its own right, the study of delirium provides a valuable opportunity to understand brain functioning at a fundamental level, and as it is a preventable condition, it is also now being used as a marker to measure the quality of hospital care provided for older people.

This volume will serve as a catalyst to revive interest and progress in delirium research and clinical care, and should be read by psychiatrists, neurologists, geriatricians and all those involved in working with the elderly in hospitals or in the community.

This book provides a comprehensive and practical guide to orthostatic hypotension (OH) for doctors and nurses involved in the care of older adults, together with a state-of-the-art update on OH, covering its epidemiology, pathophysiology, assessment, diagnosis, causes, prevention, management, and relevance for geriatric practice. In addition, it addresses mechanisms of orthostatic tolerance and other orthostasis related conditions, as well as drugs, comorbidities and geriatric syndromes related to OH. The homeostatic ability to maintain blood pressure while standing requires an adequate blood volume and the integrity of the nervous system, heart, blood vessels and muscle pump. However, in older adults, some age-related factors can contribute to the development of OH. For example, decreased baroreflex sensitivity, -1-adrenergic vasoconstrictor response to sympathetic stimuli, parasympathetic activity, renal salt and water conservation, increased vascular stiffness and decreased ventricular diastolic filling, as well as concentrated capacities of the kidney may be associated with changes in postural blood pressure. It has also been shown that OH is associated with falls, cardiac events, heart failure, stroke, reduced quality of life, and increased risk of overall mortality in these patients. "Orthostatic Hypotension in Older Adults" will be of considerable interest to all professionals working in the fields of geriatrics, geriatric psychiatry, neurology, internal medicine, cardiology, and emergency medicine, or working with older people in hospitals or in their community.

This new edition of the popular and market-leading Diabetes in Old Age features up-to-date and comprehensive information about the key aspects of managing older people with diabetes, predominantly type 2 diabetes. With a strong evidence-based focus throughout, the entire range of issues surrounding diabetes and its many complications are covered, each with a clear focus on how they relate directly to the older patient. Varying approaches to optimizing diabetes care in the community, primary care and secondary care health care arenas are presented, and the importance of comprehensive functional assessment is emphasized. Coverage of areas unique to an ageing population of older people with diabetes such as falls management, frailty and sarcopenia, and cognitive dysfunction form a key cornerstone of the book. In every chapter, best practice points and key learning outcomes are provided, as well as published evidence bases for each major conclusion. Diabetes in Old Age, 4th edition is essential reading for diabetologists and endocrinologists, diabetes specialist nurses, primary care physicians, general physicians and geriatricians, podiatrists and dieticians with an interest in diabetes, as well as all health professionals engaged in the delivery of diabetes care to older people.

Most physical illness effects people at the extremes of life, particularly in late life. A significant proportion of hospitalized older patients will experience some mental health problems, and medical units lacking specialist old age psychiatric services must rely on adult psychiatric and consultation liaison services for support. These generalists assume the role of old age psychiatrists by default. A key aim of the book is to provide guidelines for the appropriate treatment of psychiatric disorders in older people when medical illness complicates the picture. The book is divided into five sections. The first two sections cover the nature of the problem and initial assessment procedures. Section three focuses on specific disorders, including, amongst others, the most common reasons for referral - dementia, depression and delirium. Section four provides guidelines for treatment including pharmacological therapies, psychotherapeutic interventions and the use of ECT. The book concludes with short section considering the ethical and legal issues involved. This book covers the theoretical and practical knowledge required by psychiatrists in training, those seeking to specialize in consultation liaison or old age psychiatry, geriatricians and general practitioners. It will also be of interest to all other members of the healthcare team responsible for the medical management of older patients.

This book analyzes the development of medical big data projects in Japan.Japan is experiencing unprecedented population aging, and labor productivity has decreased accordingly. Big data analysis of the Japanese medical real-world database (RWD) has the potential to tackle this issue.To allow readers to gain an understanding of Japanese medical big data analysis, the book discusses the original Japanese system that generates medical RWDs in the hospital medical records system, the nationwide standardized health checkup system, and the public medical insurance system in Japan.After introducing four major big data projects in the healthcare-medical field in Japan, the book explains the importance of creating information standards to maintain data quality and to analyze medical big data. It enables readers to analyze which standards are installed in which RWDs, how the standards are maintained, and which issues are prevalent in Japan.This book also describes the ethical processes involved in big data projects involving medical RWDs in Japan.

This book offers a concise and updated guide for all readers (physicians and non-physicians) interested in gaining a comprehensive and precise understanding of sarcopenia. Over the last several years, sarcopenia has increasingly developed from being a concept known only in research settings to one that is commonly explored in journals and scientific meetings for various disciplines, such as geriatrics, rheumatology and rehabilitation medicine. Thus, all domains of sarcopenia, from molecular aspects to clinical management, represent highly active areas of research and clinical practice for health professionals in a variety of fields, including geriatric medicine, nutrition, and epidemiology. Despite being a relatively new concept in medicine, sarcopenia is increasingly being recognized as an important determinant of other health conditions, including mortality and disability. This book, written by experts from around the globe, covers several core aspects of sarcopenia management, from molecular mechanisms to genetics, epidemiology, diagnosis and finally treatment, including the clinical impact of sarcopenia as a risk factor, the known genetic and molecular aspects that can aid in predicting sarcopenia, and selected treatment and therapy concepts, including indications for nutrition and physical exercise. Sharing data from the latest studies, it will be of considerable interest not only for geriatricians, but also for a wide range of other readers.

This is the second edition of the Oxford Specialist Handbook in Parkinson's Disease and Other Movement Disorders aiming to provide its readership with the latest developments and innovation across the discipline. Alongside this update in content, the addition of new, insightful sections suggested by readers and other experts in the field, will allow the handbook to further develop as the premier quick reference guide for movement disorders. The varied and detailed composition of the handbook's chapters is extremely useful for the various readership of this title. The new edition advances the the knowledge and depth of the previous edition with the addition of a number of new sections. This new and improved edition will be a welcome and extremely useful addition to the neurological world.

This book discusses the contemporary medico-social, psychological, legal, and therapeutic concerns related to people affected by dementia as a patient or as a caregiver. It provides global emerging responses to dementia. It highlights different dimensions of dementia in terms of issues, concerns, policies, and strategies all around the globe. The contributing authors present issues from cross-cultural education visible in dementia studies and discuss the power of music, art therapy, artistic collaborations, and many innovative practices in dealing with dementia. Written by international specialists from various disciplines, the chapters include challenges and emerging issues related to the role of family caregivers, the concern with vulnerability to elder abuse and neglect, and the role of technology in dementia care. The book provides a diverse perspective to dementia care not covered in such a broad way by any other books on the topic. This book is intended for academics from a wide range of fields such as sociology, geriatrics, community medicine, public health, clinical psychology, social work all of which, collectively, bear on the problem and the solutions for better dementia care.

This book focuses on the nutrients and nutraceuticals that promote active and healthy ageing - recently defined by the WHO as the process of development and maintenance of functional capacity that allows well-being at an advanced stage of life. There has been a rapid rise in the use of nutritional interventions as well as specific nutraceuticals in the management of multifactorial aspects of clinical health outcomes. Written by leading experts this book comprehensively discusses the various ageing phenotypes and age-related diseases. It also assesses the nutritional status of the elderly and the various epidemiological factors that influence it. It reviews the role of dietary fiber in disease-free and fully functional ageing. Further, the book explores the benefits of polyphenols, which are secondary plant metabolites, in protecting against cancer, cardiovascular diseases, and various neurodegenerative diseases.

Almost a decade has passed since the first edition of this book was published and the explosion of new research in stroke is very apparent. Several important themes have coloured medicine during this time: the development of evidence based health care, new optimism for acute drug treatments for stroke, the growth of new information about the human genome, a dramatic increase in the number of stroke clinicians and researchers world-wide, and the establishment of the Cochrane Collaboration. All of these trends are relevant in revising a book of this nature. Clinical epidemiology remains an essential foundation for the practice of evidence-based healthcare. The enthusiasm of the pharmaceutical industry has resulted in a large number of new trials, often too small to detect clinically important differences, and have increased the number of clinicians actively engaged in stroke research. It is even more important that these clinicians should have a good understanding of the design of trials, the rationale for randomisation and blinding, and the importance of selecting the most appropriate outcomes. Surprisingly, little of practical importance has resulted from the decade of exploration of the human genome - the best indication of a person's risk remains their phenotype and not their genotype. The impetus to organise stroke medicine into a defined speciality, with emphasis on acute stroke, is even stronger - but it is essential to bear in mind the importance of interdisciplinary working, the value of primary care, geriatric medicine, psychiatry and rehabilitation in the prevention, treatment rehabilitation and long-term care of stroke patients. The Cochrane Collaboration is currently grappling with a task of enormous size - the compression of tens of thousands of randomised control trials -and other scientific evidence- into systematic reviews of the effects of interventions. Citations to this work are made in the section on management. In this edition, there is an extra opening section entitled Epidemiology which comprises the nuts and bolts of the subject and reviews the purposes of health care for stroke patients. The remaining sections follow the format of the first edition: Diagnosis, Management, and Prognosis. All chapters have been substantially updated. The book retains its focus on epidemiology that is relevant to the clinician and attempts to use examples from stroke to illustrate many aspects of epidemiological thinking. The book aims to stimulate readers to think about their own practice, the nature of scientific evidence and the vast areas of clinical uncertainty that remain the target for research over the coming decades.

This book addresses key questions about the need for palliative care, the current provision of services and the evidence for the effectiveness of a range of alternative models of organisation in palliative care. A broad approach is taken to include the needs of both cancer patients and patients with other terminal diseases and the relationship between palliative care and other aspects of health care services. The book is based on a comprehensive and detailed review of the international scientific literature on evaluation of palliative care, providing an essential evidence base for policy decisions.

Organised services for those with memory disorders are growing. This growth is stimulated by an increase in the number of people with memory problems and by an increased appreciation of the complexity of the needs of such patients. Further growth is likely, especially now that we appear to have crossed the threshold of effective treatment for many patients with dementia. With these advances has come the recognition of the necessity for an interdisciplinary approach to management. Diagnosis and Management of Dementia: A Manual for Memory Disorders Teams is an edited volume covering all aspects of the operation of a memory disorders team. It is aimed at all those working in the dementia or memory disorders team, whether in a clinic or a community setting. The book is divided into three sections. Section one takes the reader through the practical details of setting up and organising a clinic, from timetabling, through managing information, to the assessments needed and the opportunities such a service provides. Section two deals with the diagnostic process; and section three addresses management issues, from carer support, pharmacological and physiological interventions, through managing common problems, to the role of the primary care physician. An Appendix contains the results of a survey to the memory disorder services. This survey provides the reader with examples of other services and demonstrates the wide variation in how these services operate. The Manual is unique in that it combines up to date thinking on diagnosis and management with practical and helpful ideas on how to run a dementia or memory disorders service.

When the first edition of this book (Terminal Care Support Teams: the hospital-hospice interface, 1990) was written, there were only a few advisory palliative care teams working in hospitals. Since then the number of teams has grown rapidly. The concept of these teams in now widely accepted but there is an increased need for information about setting up a team, how they work and how effective they are. This book looks at the need for hospital- based palliative care teams and the challenges of bringing palliative care into the acute hospital setting. It reviews the needs of patients, their families and their professional carers, and also looks at the theoretical and practical problems which may be encountered. For example there is practical advice on setting up hospital-based palliative care teams, the selection of team members as well as coverage of team dynamics, and the role of the pain clinic and palliation oncology.

Dementia is increasingly being recognised as a public health priority and poses one of the largest challenges we face as a society. At the same time, there is a growing awareness that the quest for a cure for Alzheimer's disease and other causes of dementia needs to be complemented by efforts to improve the lives of people with dementia. To gain a better understanding of dementia and of how to organize dementia care, there is a need to bring together insights from many different disciplines. Filling this knowledge gap, this book provides an integrated view on dementia resulting from extensive discussions between world experts from different fields, including medicine, social psychology, nursing, economics and literary studies. Working towards a development of integrative policies focused on social inclusion and quality of life, Dementia and Society reminds the reader that a better future for persons with dementia is a collective responsibility.

Seven in ten Americans over the age of age of sixty who require medical decisions in the final days of their life lack the capacity to make them. For many of us, our biggest, life-and-death decisions—literally—will therefore be made by someone else. They will decide whether we live or die; between long life and quality of life; whether we receive heroic interventions in our final hours; and whether we die in a hospital or at home. They will determine whether our wishes are honored and choose between fidelity to our interests and what is best for themselves or others. Yet despite their critical role, we know remarkably little about how our loved ones decide for us. Speaking for the Dying tells their story, drawing on daily observations over more than two years in two intensive care units in a diverse urban hospital. From bedsides, hallways, and conference rooms, you will hear, in their own words, how physicians really talk to families and how they respond. You will see how decision makers are selected, the interventions they weigh in on, the information they seek and evaluate, the values and memories they draw on, the criteria they weigh, the outcomes they choose, the conflicts they become embroiled in, and the challenges they face. Observations also provide insight into why some decision makers authorize one aggressive intervention after the next while others do not—even on behalf of patients with similar problems and prospects. And they expose the limited role of advance directives in structuring the process decision makers follow or the outcomes that result. Research has consistently found that choosing life or death for another is one of the most difficult decisions anyone can face, sometimes haunting families for decades. This book shines a bright light on a role few of us will escape and offers steps that patients and loved ones, health care providers, lawyers, and policymakers could undertake before it is too late.