Current Diagnosis and Treatment: Geriatrics, 3/e

Louise Walter, MD, Professor and Chief, Division of Geriatrics, University of California San Francisco Anna Chang, MD, Professor, Division of Geriatrics, University of California San Francisco Rebecca Conant, MD, Professor, Division of Geriatrics, University of California San Francisco Pei Chen, MD, Assistant Professor, Division of Geriatrics, University of California San Francisco Daphne Lo, MD, MAEd, Assistant Professor, Division of Geriatrics, University of California San Francisco G. Mike Harper, MD, Professor, Division of Geriatrics, University of California San Francisco Josette Rivera, MD, Associate Professor, Division of Geriatrics, University of California San Francisco Michi Yukawa, MD, Professor, Division of Geriatrics, University of California San Francisco

Table of Contents

Section1. Principles of Geriatric Assessment and Care



Introduction to the Care of Older Persons: Knowledge, Skills & System Change


Guiding Principles


Overview of Geriatric Assessment (6)


Geriatric Assessment in Primary Care
Teams
Patient Goals
Prognosis
Functional Assessment
Falls & Gait Impairment
Vision Impairment
Hearing Impairment
Dementia
Incontinence
Depression
Nutrition
Medication Use
Caregiver Support
Financial, Environmental and Social Resources
Abuse
Preventive Services


The Interprofessional Team (5)


Key Definitions & Context
Innovations in Geriatric Interprofessional Teams
Evidence for Interprofessional Teams
Barriers to Teamwork
Resources and Tools for Teamwork


Goals of Care and Consideration of Prognosis (3)


Guide to Goals of Care Discussions
Importance of Surrogate Decision Makers
Prognostication
Prognosis Related to Specific Diseases
Communicating Prognosis to Patient or Surrogate


Functional Assessment & Functional Decline (2)


Epidemiology of Functional Limitations
Assessment of Functional Status
Risk Factors for Functional Decline
Prevention of Functional Decline
Treatment of Functional Decline


Falls & Mobility Impairment (25)


Epidemiology of Falls
Assessment of Fall Risk and Mobility
Risk Factors for Falls
Prevention of Falls
Treatment of Mobility Impairment


Managing Vision Impairment (61)


Normal Changes in the Aging Eye
Cataracts
Age-Related Macular Degeneration
Diabetic Retinopathy
Glaucoma
Systemic Effects of Eye Medications
Visual Symptoms Indicating Need for Urgent Referral to an Eye-Care Specialist


Managing Hearing Impairment (62)


Age-related Hearing Changes
How and when to test for Hearing Impairment
Sensory Hearing Impairment
Neural Hearing Impairment
Conductive Hearing Impairment
Treatment for Hearing Impairment


Cognitive Impairment & Dementia (22)


Age-related Cognitive Changes
Screening for Cognitive Impairment
Mild Cognitive Impairment
Common types of Dementia
Dementia-related Behaviors
When to refer to subspecialty care


Urinary Incontinence (39)


Age-related Urogenital Changes
Screening for Urinary Incontinence
Common Causes, Diagnosis, and Treatment of Male-Sex Urinary Incontinence
Common Causes, Diagnosis, and Treatment of Female-Sex Urinary Incontinence


Sexual Health & Dysfunction (46)


Age-related physiologic changes affecting sexual function
Taking a Sexual History
Sexually-transmitted Infections
Common Causes, Diagnosis, and Treatment of Male-Sex Sexual Dysfunction
Common Causes, Diagnosis, and Treatment of Female-Sex Sexual Dysfunction


Depression & Other Mental Health Issues (45)


Depression
Suicide
Bipolar Disorder
Anxiety & Stress Disorders
Schizophrenia & Psychotic Disorders


Defining Adequate Nutrition (68)


Assessment of Nutritional status in Older Adults
Recommendation on Essential Nutrients, Vitamins and Minerals intake
Definition and potential causes of involuntary weight loss
Obesity in older adults
Interaction of food and medications
Types of nutrition deficiencies
Nutrition in special populations


Principles of Prescribing & Adherence (9)


General Principles & Polypharmacy
Drug Metabolism & Physiologic Effects
Geriatric Therapeutics
Prescribing for Older Adults
Adherence
Intervening to Reduce Polypharmacy
Prescribing Across the Care Continuum


Addressing Multimorbidity (10)


Background and Definitions
Multimorbidity & Health Outcomes
Challenges to Managing Multimorbidity
General Considerations in the Care of Multimorbid Older Adults


Atypical Presentations of Illness (7)


Defining Atypical Presentations
Identifying Patients at Risk


Caregiving and Caregiving Support (new)


Defining Caregiving
Caregiving in Context
Interventions to support caregivers
Caregiver resources
Potential Outcomes from Caregiving
Assessing for Caregiver Burden
Responding to Caregiver Burden


The Social Context (4—delete Medicare and include legal issues—conservatorship, etc. )


Financial Issues Facing Older Persons
Food Insecurity
Legal Issues & Conservatorship (new)
General Recommendations for Clinicians


Detecting, Assessing & Responding to Elder Mistreatment (72)


Detecting and Assessing Elder Mistreatment
Responding to Elder Mistreatment


Prevention & Health Promotion (8)


General Principles of Screening & Prevention in Older Persons
Screening for Geriatric Syndromes
Assessment of Health-Related Behaviors
Immunizations
Screening for Endocrine Disorders
Screening for Cardiovascular Disease
Cancer Screening


Ethics & Informed Decision Making (12)


Ethical Issues in the Care of Older Persons
Decision-Making Capacity & Informed Decision-Making
Advance Care Planning & Advance Directives
Surrogate Decision-Making
Balancing Promotion of Independence & Patient Safety


Geriatric Palliative Care (11)


General Principles
Psychological, Spiritual and Social Issues
Aid in Dying (new)
Challenges to Providing Palliative Care in Long-Term Care Settings
Caring for Family Members: Grief & Bereavement


Assessing Therapies for Longevity & the Biology of Aging (56—rename for John N)


Add domains here


Applying Evidence-Based Care to Older Persons (74)


Challenges with Current Evidence
Applying the Evidence to Older Persons



 

Section 2: Care Settings



Ambulatory Care & Care Coordination (14—look at content)


General Principles
Models of Ambulatory Care
Care Coordination and Integration Across Health Systems and Services


Transitions of Care (13)


General Principles
Background & Definitions
Adverse Events During Transitions
Barriers to Successful Care Transitions
Evidence-Based Interventions & Best Practices
Innovations
Future of Care Transitions


Emergency Department Care (15)


General Principles
Mod
els of Emergency Care
Structural Enhancements
Financing
Clinical Care
Future of Emergency Care


Hospital Care (16)


General Principles
Hazards of Hospitalization
Successful Models of Care
Approach to the Hospitalized Older Person
Therapy
Prevention
Transitioning from Hospital to Home


Perioperative Care for Older Surgical Patients (17)


General Principles
Surgical Risk in Older Persons
Clinical Care
Models of Surgical Care


Home-Based Care (19)


General Principles
Models of Medical House Calls (Home-Based Primary Care, Transitional Care, Hospital at Home, Home-Based Palliative Care)
Models of Home Nursing & Rehabilitation
Eligibility Requirements & Payment Denials
Approach to Home Care & Assessments
Innovations


 Residential Care and Assisted Living Care (new)


General Principles
Models of Residential Care and Assisted Living Care


Nursing Home Care & Rehabilitation (18)


General Principles
Institutional Long-Term Care
Short-stay Rehabilitation (new)
Consider Dementia locked unit care? Other domains?


Technology to Enhance Geriatric Care (new)


New technology for older adults in the community
New technology for older adults in institution
How to evaluate the efficacy and benefits of these new technology
Potential list of reliable sites to rate these devices or services
The Geriatric Care Industry
Safety Enhancing technology
Transportation Enhancing technology



 

Section 3: Common Conditions & Diseases inGeriatrics



Osteoarthritis (26)
Osteoporosis & Hip Fractures (27)
Delirium (21)
Parkinson’s Disease & Essential Tremor (24)
Cerebrovascular Disease (23)
Coronary Artery Disease (28)


Acute Coronary Syndrome
Chronic Coronary Artery Disease


Heart Failure & Heart Rhythm Disorders (29)


Heart Failure
Bradyarrhythmias
Tachyarrhythmias—Atrial Fibrillation & Atrial Flutter
Ventricular Arrhythmias
Decision-Making about Implantable Devices (new)


Hypertension (30)
Valvular Disease (31)


Aortic Stenosis
Aortic Insufficiency
Mitral Stenosis
Mitral Regurgitation


Peripheral Arterial Disease & Venous Thromboembolism (32)
Anticoagulation (55)


Classes of Anticoagulant Therapy
Management of Bleeding in Older Persons on Anticoagulants


Chronic Venous Insufficiency, Stasis Ulcers & Lymphedema (33)
Chronic Lung Disease (replaces COPD chap 34)
Gastrointestinal Disease (35)


Gastroesophageal Reflux Disease
Dysphagia
Motility Disorders
Peptic Ulcer Disease
Dyspepsia
Diarrhea
Diverticular Disease
Inflammatory Bowel Disease
Fecal Incontinence
Colonic Ischemia
Abdominal Pain


Fluid & Electrolyte Abnormalities (37)


Hyponatremia
Hypernatremia
Hypokalemia
Hyperkalemia
Nocturnal Polyuria


Chr
onic Kidney Disease (38)
Thyroid, Parathyroid & Adrenal Gland Disorders (41)


Subclinical Hypothyroidism
Subclinical Hyperthyroidism
Hypothyroidism & Myxedema Coma
Hyperthyroidism
Nodular Thyroid Disease & Neoplasia
Acute Adrenal Insufficiency
Cushing Syndrome
Hyperparathyroidism


Diabetes (42)
Anemia (43)
Common Cancers (44)


Breast Cancer
Lung Cancer
Colorectal Cancer
Prostate Cancer (new)
Pancreatic Cancer
Ovarian Cancer