Since the first edition of this book was published there have been considerable changes in continuing care. NHS nursing homes have been created, enthusiasts have developed new initiatives, and attempts have been made to improve attitudes. The recent White Paper on Community Care is likely to accelerate the transfer of large numbers of elderly patients from long-stay hospital beds to private-sector accommodation: a move often accompanied by much anxiety about standards of care. Although Health Authorities visit private nursing homes and apply the National Association of Health Authorities' standards to them, anxieties continue. Unfortunately for the patients who remain in hospital, many Health Authorities seem reluctant to apply these same standards to their own long-stay departments, since many would fail abysmally. The 1987 annual report of the Health Advisory Service (see Chapter 3) presents a damning indictment of the care given to old people: A recent review of twelve consecutive HAS Reports on services for older people in hospitals shows that long-stay wards consistently offered environments which were unable to offer privacy, homely surroundings, personal space and possessions or adequate furniture. In the twelve districts there was not one comprehensive personalised clothing service. Half of the reports commented on the lack of effec- tive management of continence. Catering was often provided according to the needs of the institution rather than those of the resident patients.

This volume presents a clear, concise overview of the current state of knowledge about the biology of aging - serving as both an invaluable graduate-level text and a key reference for practicing professionals. Over a dozen distinguished contributors probe the latest developments in our knowledge of why people age and how the process works. These authoritative chapters are not just written for biologists - but for gerontologists in general. Marks the tenth anniversary of the Annual Review of Gerontology and Geriatrics.

A high-level text on the molecular and genetic aspects of human ageing with reference to cognitive functions and age-related diseases."

Neurotransmitter changes taking place in the brain of patients with dementia disorders, mainly Alzheimer type dementia, are reported. Their role in the pathogenesis of Alzheimer's disease is discussed; and the neurochemical changes are considered as a base for formulating treatment strategies. By studying markers in the cerebrospinal fluid, diagnostic methods may be achieved that will aid in diagnosing subgroups of dememtia.

Traditional methods in the clinical practice of neurology have dominated clinical teaching in this specialty for about 100 years. Essentially these methods involve meticulous attention to detail and the recording of clinical facts. Thus the clinical history must be recorded chronologically, preferably in the patient's own words, and of the nervous sys followed by a carefully structured examination tem set out in such a way as to allow the precise localisation of the lesion or system involved. Clinical neurology taught and practised in this way has bred generations of neurologists throughout the world and raised the standards in the specialty to a level where clinical skills are probably unexcelled in any other specialty. With increasing availability and reliance upon non-invasive imaging techniques, the need for these skills in large areas of neurological practice has diminished. But perhaps more importantly, the classical clinical methods in neurology were developed when the elderly population was much smaller and when the specialty of geriatrics did not exist. As a result, much of the methodology is irrelevant or unreliable in of geriatrics will frequently the elderly population and the student find himself searching in vain in the textbooks of neurology for help in assessing an elderly patient with an atypical presentation (for example disturbance of balance or recurrent confusional episodes) of some common neurological disorder."

The number of diabetics in the elderly population is increasing rapidly, not merely because of the increasing size of the elderly population itself. In elderly people diabetes is often poorly diagnosed and occurs as a consequence of, or in addition to, some other condition. Although diabetes may manifest itself less dramatically in the elderly there is evidence to suggest that diabetes-related complications do arise more rapidly in this group. It is therefore extremely important that doctors and health professionals can spot the symptoms of diabetes at an early stage. This book provides a concise description of diabetes in the elderly as well as discussing related complications and should be useful to all health workers dealing with elderly people.;This book should be of interest to all health professionals working with elderly people.

The study of "the end of life" has become a major focus on medicine, the social sciences, ethics, and religion. This volume brings together the latest research on issues around death and dying, life's attributes as it nears death, planning and preparation for death, and care and intervetion-related issues. This evidence-based finding of this volume will help shape how we approach the topic for years to come.

There is no doubt that the need for a multidisciplinary cadre of informed and skilled health professionals in geriatrics is growing as the population ages. This book was developed as a response to that need and is designed to assist health care professionals in locating some of the best materials in geriatrics available in the various disciplines. The annotations found in this volume are written clearly and concisely so that the reader can quickly grasp the essence of each reference. The book is organized into two sections, the first of which identifies resources for specific health care disciplines, and the second focuses on resources in health care issues that cut across all disciplines. Specifically, Section I (Geriatrics in the Health Care Disciplines) provides annotations for most major health care disciplines. Section II (Special Issues in Geriatric Health Care) includes ethnic and minority health issues in aging, geriatric care and older women, medical ethics in geriatrics, and new reimbursement systems for medical care for the elderly. Each chapter has been compiled by experienced geriatric professionals who are trained and actively practice in the discipline they cover. This book will be a useful tool for health practitioners, educators, and researchers involved in promoting geriatric education and quality clinical care of older adults.

Illness in old age is characterised by vague and atypical presenting features which are often missed and wrongly attributed to the ageing process. This is particularly true of endocrine disorders where hypothyroidism may mas querade as dementia, where electrolyte imbalance may cause lassitude, and where diabetes mellitus may produce a wide range of complications com monly associated with ageing. It is our intention that our book provide straightforward practical guidance in this difficult area by delineating the effects of ageing on endocrine function and the clinical consequences of these; and by describing in detail the wide range of presenting clinical fea tures of endocrine disease in the elderly. Physicians are also often baffled and misled by the effects of ageing and disease on laboratory tests used in the investigation of endocrine disease. Our book describes these changes in detail, and gives guidance on which tests are most appropriate. Ageing and disease also produce subtle changes in the response of patients to drugs and replacement, and this is also dis cussed in detail. Subjects included separately and in depth include thyroid disease, the clinical features and treatment of diabetes, postmenopausal changes, bone disease, fluid and electrolyte imbalance, energy imbalance, and drugs caus ing endocrine and metabolic disorders. These have been chosen because we consider that they present problems which are particularly relevant to the elderly. Many other issues are covered in general textbooks of endocrin ology and have been omitted."

The concept of dementia has itself been the subject of increasing refinement and precision in definition and diagnosis. Two important sub-types have been identified: Alzheimer's disease and multiple-infarct dementia. Alzheimer's disease or Senile Dementia of the Alzheimer Type (SDA T), arises out of changes in the brain which are as yet poorly understood and identifiable with certainty only at post mortem examination. This type of dementia has been named after Alois Alzheimer, who first identified these changes, in the earliest years of this century. Alzheimer's is the commonest type of identified dementia. The second commonest type is multi-infarct dementia (MID), which follows a stroke or strokes affecting the relevant part of the brain. Like SDA T, it can be diagnosed with certainty only after death, although Jorm (1987, Ch. 8) reviews progress in using various types of tests which can suggest, if not confirm, its presence during the sufferer's lifetime. As will be shown in Chapter 2, some populations appear to reverse the general picture and exhibit more MID than SDAT. Many dementia sufferers cannot, even after a post-mortem examination, be neatly categorized as one or the other of these sub-types. A considerable uncertain 'grey area' of dementia remains at present very poorly understood. Some elderly people develop dementia as a side-effect of known physical disease. Some of these conditions are curable. Care of the demented person has traditionally taken place in the community: hospitalization is a fairly recent innovation.

Elderly patients are major consumers of antidepressant drugs, yet this subject is under-researched. The elderly are particularly sensitive to the adverse affects of psychotrophic drugs, and they are often given a variety of drugs simultaneously. It is therefore vital that doctors should be well informed about this subject.;The aim of this book is to provide comprehensive guidance on the drug therapy for depression in old age to the clinicians involved in the health care of elderly people.;The book starts be discussing the epidemiology, presentations and assessments of depression in old age. The main part of the book deals with problems of antidepressant drug therapy, such as which antidepressant to prescribe, how to monitor side effects, what is the adequate dose, how long to treat a single episode of depression and who requires long-term medication.;This book should be useful reading for all doctors who care for elderly people.;This book should be of interest to general physicians, psychiatrists, psychopharmacologists and physicians in geriatric medicine.

Incontinence is still a subject which is rarely discussed. But, since this very common condition can severely impair a person's lifestyle, information about it needs to be made more widely available, both to health professionals and to lay people.;This text describes the nature of incontinence, how it can be managed, and gives information about the aids, equipment and services available to help those affected by this problem. It is a revised version of a book originally published in 1977 under the title - "Incontinence: A Guide to Understanding and Management of a Very Common Complaint". Since the earlier publication the services available to people with incontinence have increased significantly. More doctors and Incontinence Advisers (usually nurses) have expertise in the field, and manufacturers have improved their products. Incontinence can severly affect a person's self-esteem, family relationships and mobility. It is hoped that this book will help educate lay and professional readers about incontinence and how sufferers can be helped.;This book should be of interest to health professionals (doctors, nurses, physiotherapists), social workers, volunteers working with disabled people, lay people.

The study of "the end of life" has become a major focus on medicine, the social sciences, ethics, and religion. This volume brings together the latest research on issues around death and dying, life's attributes as it nears death, planning and preparation for death, and care and intervetion-related issues. This evidence-based finding of this volume will help shape how we approach the topic for years to come.

Cardiovascular drug therapy has markedly progressed in the recent decades. Not only have new drugs been introduced to clinical practice, but new classes of drugs have been developed. While in 1960 the practicing cardiolo gist had a selection of about only ten drugs, in 1987 about 150 drugs are routinely used in cardiovascular diseases. Elderly patients, however, usually do not enjoy the full benefit of this progress. This might be due to lack of knowledge, a conservative approach, or the worldwide tendency not to try new drugs in the elderly. It is now clear that the majority of patients that will be treated in car diovascular clinics will be, in the near future, elderly patients. Even now, elderly patients form about one-third of the patients with cardiovascular diseases. These patients are approached, however, according to criteria devel oped for younger populations. This is despite the fact that elderly patients differ from younger ones in most aspects, including pathology, epidemiol ogy, pathophysiology, diagnostic approach, management, pharmacology, pharmacokinetics, rehabilitation, and supportive treatment. It is the purpose of this book to present to the clinician all drugs with which there is clinical experience in the elderly or which might be potentially useful for the elderly with cardiovascular diseases. The data are presented without the authors taking a position. This should allow the clinicians to make their own selection and individualize treatment, vii viii Preface based on a wide data base. Comparative data are presented only when specific comparative studies were performed."

Dementia, now known as major neurocognitive disorder, is not one monolithic disease. Nor is behavior disturbance driven by one particular neurocognitive dysfunction. In fact if we are able to understand it, behavior is an excellent form of nonverbal communication. There are many different causes of dementia. A major challenge with both researching and implementing interventions is viewing dementia and related behaviors as single entities. This approach leaves room for critical errors in the treatment of dementia patients, beginning with misdiagnosis. This book approaches dementia by reviewing cognitive and functional assessments to provide a more accurate diagnosis, which then allows physicians to design specific interventions that are tailored to the person and their challenges. Because person centered care is vital to quality of life and longevity to an aging patient, this understanding of individual needs is vital. Written by experts in the field, this book incorporates the latest evidence-based behavioral interventions matched to specific deficits. Behavioral management focuses not on controlling behavior, but using it to teach staff and caregivers how to interpret common actions and maximize function for people with major neurocognitive disorders. Quality of life and individualized care planning will be the theme and the book will provide practical case examples. The book begins by introducing dementia and other neurocognitive illnesses, contextualizing them both historically and contemporarily. Next, the text focuses on the comprehensive assessment of a person with neurocognitive challenges in order to identify strengths and understand what the person is trying to communicate with their behavior. This process allows individualized care planning and behavioral (non-pharmacologic) management to meet the cognitive challenges and maximize individual strengths and thereby improve outcomes, making this a cutting edge resource.

As our population continues to age, health professionals are being called on to care for an ever-increasing number of elderly patients. A thorough understanding of what constitutes normal aging versus age-prevalent illness is essential. In addition, the atypical and nonspecific presentation of illness commonly encountered when caring for an older patient must be expected and watched for carefully. In recent years, the health professional has been exposed to an exponentially increasing number of publications attempting to teach geriatric principles. To date, few publications lend themselves to use by the busy practitioner, student, or nurse in search of immediate facts, flow sheets, and clinically applicable data. It was felt that the health professional would benefit greatly from a book based on the concept of a ready-reference "hand book," with chapters filled with tables, flow sheets, and listings similar in scope to those in a well-presented lecture series. Our goal was to create a geriatrics handbook that would have value at the bedside as well as in the classroom. It is to this end that the contributors dedicated their efforts."

The National Institute on Aging (NIA) has historically been concerned with the protection of human subjects. In July 1977, the NIA sponsored a meeting to update and supplement guide lines for protecting those participating in Federal research pro jects. Although the basic guidelines had been in effect since 1966, it had been neglected to include the elderly as a vulnerable population. In November 1981, the NIA organized a conference on the ethical and legal issues related to informed consent in senile dementia cases. The present volume offers the latest and best thinking on Alzheimer's Dementia to have emerged from the dialog that was first embarked upon at the NIA meeting. Indeed, the issues and concerns it treats now seem even more relevant than they appeared historically because of the vastly greater awareness in the community of the entire spectrum of problems Alzheimer's disease confronts us all with. Our interest and concern is both humanitarian and self serving. Clearly older people must be protected from in appropriate research and careful attention must be paid to the circumstances under which research is conducted on those older persons who have given anything less than full consent. It is equally necessary, however, for the research enterprise to be protected so that today's elderly and those of the future can benefit from the fruits of research."

Millions of people are living with dementia in the United States and globally. To live well with dementia, people need care, services, and supports that reflect their values and preferences, build on their strengths and abilities, promote well-being, and address needs that evolve as cognitive impairment deepens. Persons living with dementia co-manage their care with or rely on the support of a wide range of care partners and caregivers, including spouses, other family members and friends, and direct care workers in homes or residential care settings. While dementia care has improved since the 1970s, many individuals still lack access to high-quality care and are not living as well as they might. Disadvantaged groups, especially racial and ethnic minorities, still face challenges in access to care, services, and supports, due to deep and persistent inequities. Meeting the Challenge of Caring for Persons Living with Dementia and Their Care Partners and Caregivers: A Way Forward examines the complex body of evidence on dementia care and informs decision making about which interventions are ready to be broadly disseminated and implemented. It also offers a blueprint to guide future research using rigorous, cutting-edge methods that are inclusive, equitable, and yield critical information for real-world implementation, toward the ultimate goal of better supporting persons living with dementia and their care partners and caregivers in living as well as possible. Table of Contents Front Matter Summary 1 Introduction 2 Moving Toward Better Dementia Care, Services, and Supports 3 Complexity of Systems for Dementia Care, Services, and Supports 4 Making Decisions About Implementation 5 Assessing the Current State of Evidence 6 A Blueprint for Future Research Appendix A: Agency for Healthcare Research and Quality Systematic Review and Inclusion Criteria Appendix B: Public Meeting Agendas Appendix C: Biographical Sketches of Committee Members and Staff

Population aging is challenging countries around the globe to adapt their public policy responses to the new world. Long-term care is a relevant topic today both because of the rapid growth in long-term care needs in every country and the lack of responses from governments. The Future of Long-term Care explores some issues related to the implementation of long-term care responses in different countries. Looking at six different cases, the book highlights the need to foster an urgent debate in the area, as well as emphasizing the need for action in the coming years. The examples analysed show common problems faced by countries trying to respond to their people's needs, as well as the dissimilar stages, contexts, and paths followed by each one in the endeavour for providing long-term care services to the population. Whether the analysis is carried out in countries with well-established long-term care systems or in places where the debate is just starting, the book proves that this is an area in which many challenges remain. Learning lessons from others is important but providing a space for countries to frame their problems and propose their solutions is crucial. This book contributes to fill this gap and contribute to a debate that is just starting in many places around the world.

Alzheimer's disease (AD) and vascular dementia (VaD) are commonly viewed as the first and second most common types of dementia, respectively. The traditional paradigm has been to view and treat each illness as a separate entity with a separate pathophysiology. However, clinical and pathological studies suggest that the boundary separating AD and VaD, as well as their mild cognitive impairment (MCI) analogs, is not well defined. Thus, there is increased interest in viewing these diseases along a spectrum because of the significant overlap in the characterization and diagnosis of AD, VaD, and MCI. The focus of this edited volume is to examine how AD and VaD, as well as their MCI analogs, are best viewed as a heterogeneous, intersecting, if not a continuous disease state rather than separate, distinct entities. This book examines this approach by providing empirically based evidence, reviews of the literature, and chapters by key leaders in the field and will be of interest to clinical neuropsychologists and anyone studying or treating dementia in its many forms.

While the problems of aging are being studied with microscope, computer, and questionnaire as a medical, social, and economic challenge, these essays introduce the humanistic perspective. The assumption behind this work is that in history, literature, folklore, and art we have the record of centuries of human experience to enhance our present understanding of aging, old age, and death.Growing old is a process that occurs in every person every minute, every hour that passes. But if aging does not begin on the day of retirement at the age of sixty-five, what is the definition of old age? Is it chronologically; physiologically, mentally, or culturally determined? Old age may not be a phase of life as easily identified as adolescence.As our population continues to grow older we are ever more in need of greater sensitivity to the joys and tragedies of old age. In recent years, however, our view of old age has been clouded by our negative feelings about death. Old age has become inextricably associated with death. It was not always so: until a lower infant mortality rate, better nutrition, and a higher standard of living so greatly increased our chances of surviving into old age, death was recognized as a threat at every stage of life.This volume brings together twelve eminent scholars from various humanistic disciplines to trace the origins of our present attitudes and to identify the models and myths of old age in our culture. The historians in the group ask how old people were treated in past societies. Literary scholars and art critics discuss the effects of aging on the later works of authors and artists and art as a source of solace, inspiration, and revelation to the aged. A philosopher explores a theme shared by all: that the way one ages and dies is a function of the way one has lived.Contributors John Demos, Leon Edel, Erik H. Erikson, Leslie Fiedler, Tamara K. Hareven, Robert Kastenbaum, Robert Kohn, Juanita M. Kreps, Peter Laslett, Francis V. O'Connor, Robert F. Sayre.

This textbook presents hands-on training material for medical students. The style reflects the need for practice-based teaching with a modern edge in daily clinical routine; accordingly, it also employs online material and pocket cards. Each chapter begins with specific learning objectives, which are cross-referenced with the European curriculum for undergraduate medical education released by the European Union of Medical Specialists (UEMS) together with the European Union Geriatric Medicine Society (EUGMS), as well as the minimum geriatric competences for medical students established by the American Geriatrics Society (AGS). World-renowned European experts in practicing and teaching the interdisciplinary field of Geriatrics contributed to this work, with the aim of offering the new generation of health professionals a global perspective on one of the greatest public health challenges of our time: the management of the steadily increasing number of older, multimorbid, and vulnerable persons. The major strength of this book - published under the auspices of the EUGMS - is its pragmatic, goal-oriented approach, which makes it suitable for bedside learning and patient-centered medicine; further, all of the chapters are firmly based on the pillars of the ageing process in all of its biological aspects, helping readers understand the pathophysiology of and rationale behind interventions for the main geriatric syndromes and disorders.