Geriatric Medicine: Problems and Practice

ISBN 10: 1447116488 / ISBN 13: 9781447116486

Editore: Springer, 2014

In. Codice articolo ria9781447116486_new

Riassunto:

Medical care of the elderly today challenges the practitioner to break away from narrow diagnostic labelling and view the whole picture of disease in old age. In an excellent problem-oriented approach, Geriatric Medicine offers a complete overview for practitioners. The main portion of the text deals with the common diseases of old age; important aspects such as physiology, demography, and health care delivery are discussed in separate chapters. Social and legal aspects in the major English-speaking countries receive adequate attention. All of the contributors have at some time been connected with the University Department of Geriatric Medicine in Cardiff and attest to a positive and dynamic approach in geriatric medicine, an approach that has international validity and relevance.

Contenuti: Section I. Ageing: An Overview.- 1 The Physiology of Ageing.- Cardiovascular Function.- Cardiac output; Blood pressure.- Respiratory Function.- Routine tests of lung function; Closing volumes; Defence mechanisms and the lung; Central control of respiration.- Renal Function.- Gastrointestinal Function.- Motility; Absorption; Liver; Exocrine pancreatic function; Glucose tolerance.- The Nervous System and Ageing.- The special senses; Cerebral function; Sleep; Peripheral nervous system.- Bone Mass.- Body Temperature Control.- Combating Physiological Decline.- 2 Demography and Epidemiology of Old Age.- Demography.- The Current Population Structure and Its Determinants.- Future trends.- The Distribution of Old People.- Future trends.- The Elderly Within the Community.- Epidemiology.- Population data; Mortality data; Morbidity data; Mortality; Future trends.- Section II. Clinical Problems in the Elderly.- 3 Headache and Facial Pain.- Headache.- Tension headache; “Vascular headaches”; Meningeal irritation; Raised intracranial pressure; Metabolic vasodilation; Drugs and toxins; Other causes.- Facial Pain.- Herpes zoster;Post-herpetic neuralgia; Trigeminal neuralgia; Glossopharyngeal neuralgia; Atypical facial neuralgia; Cluster headache; Tumours; Referred pain.- Clinical Evaluation.- Investigation.- 4 Chest Pain.- Central Chest Pain.- Myocardial ischaemia; Myocardial infarction; Pericarditis; Mitral valve prolapse; Acute aortic dissection; Aneurysm of the thoracic aorta; Pulmonary embolus; Oesophageal disorders; Mediastinal tumours; Acute mediastinitus Musculoskeletal disorders; Manubriosternal and xiphoid process syndromes; Psychogenic causes; Abdominal disorders.- Lateral Chest Pain.- Herpes zoster; Cervical spondylosis; Costochondritis; Trauma; Disorders of lungs and pleura; Spontaneous pneumothora.- Clinical Evaluation.- Management.- 5 Abdominal Pain.- Perception of Abdominal Pain.- Visceral pain; Parietal pain.- Acute Abdominal Pain.- Distension of a viscus; Intra-abdominal sepsis; Vascular disease; Miscellaneous causes.- Chronic Abdominal Pain.- Upper gastrointestinal tract disorders; Mesenteric ischaemia; Lower gastrointestinal disorders; Neuromuscular disorders; Miscellaneous causes.- Clinical Evaluation.- Further Investigation.- Blood count and blood viscosity; Blood biochemistry; Radiology; Ultrasonography and endoscopy.- Management.- 6 Musculoskeletal Pain.- Joint Disorders.- Osteoarthritis; Rheumatoid disease; Gout; Pseudogout; Seronegative spondyloarthritides; Infective arthritis; Haemarthrosis; Hypertrophic pulmonary osteoarthropathy.- Soft Tissue Pain.- Polymyalgia rheumatica; Frozen shoulder.- Bone Pain.- Paget’s disease; Osteopenia; Osteomalacia; Bone tumours.- Clinical Evaluation.- Management.- Pain relief; Surgery; Rest and exercise; Aids; Counselling.- 7 Dyspnoea.- Lung Disease.- Pneumonia; Lung collapse; Pulmonary fibrosis; Pulmonary oedema; Pulmonary embolism.- Airways Disease.- Chronic obstructive airways disease; Bronchial asthma.- Disease of the Pleura.- Pleural effusions; Spontaneous pneumothora.- Chest Wall Disease.- Bone and joint disorders; Neuromuscular disorders.- Psychogenic Factors.- Anxiety.- Metabolic Acidosis.- Clinical Evaluation.- Further Investigation.- Chest radiology; Arterial blood gases; Respiratory function tests.- Management.- Oxygen therapy.- 8 Hypertension.- Complication of Hypertension.- Stroke; Myocardial infarction; Heart failure; Aortic aneurysm; Malignant phase hypertension; Renal disease.- Clinical Evaluation.- Further Investigation.- Management.- Non-drug treatment; Drug treatment.- 9 Lower Limb Oedema.- Anatomy and Physiology.- Local Disorders.- Dependent oedema; Vascular disorders; Popliteal (Baker’s) cyst; Gastrocnemius rupture; Lymphoedema; Lipoedema; Infection.- Systemic Disorders.- Congestive cardiac failure; Hypoproteinaemic states; Thyroid dysfunction; Drugs; Exposure to extremes of temperature.- Clinical Evaluation.- Management.- 10 Weight Loss.- Decreased Ingestion of Food.- Decreased appetite; Mouth disease; Neuromuscular disorders of the pharynx and oesophagus; Structural lesions of thepharnyx and oesophagus; Nausea and vomiting; General debility; Poverty, ignorance and isolation.- Decreased Digestion and Absorption of Ingested Food.- Pancreatic disease; Coeliac disease; Bacterial overgrowth; Inflammatory bowel disease; Chronic mesenteric ischaemia; Short bowel syndrome; Cardiac failure; Drugs.- Increased Energy Requirements.- Malignant disease; Infective illnesses; Hyperthyroidism; Diabetes mellitus.- Clinical Evaluation.- Management of Weight Loss.- Oral supplementation; Enteral nutrition; Parenteral nutrition; Other measures.- 11 Constipation and Diarrhoea.- Constipation.- Motility disorders; Intestinal obstruction; Colorectal carcinoma; Endocrine disorders; Neurological disorders; Depression; Drugs.- Diarrhoea.- Infective diarrhoea; Irritable bowel syndrome; Malabsorption; Diverticular disease; Inflammatory bowel disease; Faecal impaction with overflow; Villous adenoma; Drugs; Endocrine disorders.- Clinical Evaluation.- Management.- Constipation; Diarrhoea.- 12 Incontinence.- Urinary Incontinence.- Bladder function.- Non-neurological Disorders.- Faecal impaction; Drug therapy; Impaired mobility; Urinary tract infection; Atrophic urethritis; Urethral obstruction; Pelvic floor incompetence; Psychological disorders; Endocrine disorders.- Neurological Disorders.- Uninhibited neurogenic bladder; Reflex neurogenic bladder; Atonic bladder; Autonomous neurogenic bladder.- Clinical Assessment.- Further Evaluation.- Charting; Cystometry.- Management.- Drugs; Incontinence aids.- Faecal Incontinence.- Faecal impaction; Neurogenic incontinence; Evaluation and management.- 13 Visual Impairment.- Clinical Evaluation.- Sudden Loss of Vision in the White Eye.- Retinal detachment; Retinal vein occlusion; Retinal artery occlusion; Ischaemic optic neuropathy; Vitreous haemorrhage.- Gradual Loss of Vision in the White Eye.- Cataract; Maculopathy; Chronic simple glaucoma.- Visual Impairment in the Red Eye.- Angle closure glaucoma; Acute iritis.- Diabetic Eye Disease.- Management of Visual Impairment.- Legal Aspects of Blindness in the Elderly.- Social Aspects of Blindness in the Elderly.- 14 Hearing Problems.- Conductive Hearing Loss.- Chronic otitis media; Otosclerosis; Bone disorders.- Sensorineural Hearing Loss.- Genetic disorders; Traumatic hearing loss; Ototoxic damage; Vascular disorders; Metabolic disorders; Neoplasia; Ménière’s disorder.- Clinical Evaluation.- Further Investigation.- Management.- Evaluation; Remediation.- 15 Impaired Mobility.- Locomotor Disorders.- Foot problems; Bone disorders; Joint disorders; Muscular disorders.- Neurological Disorders.- Cerebrovascular disease; Parkinson’s disease; Cervical myelopathy; Motor neurone disease; Peripheral neuropathy; Multiple sclerosis; Other neurological disorders.- Non-locomotor and Non-neurological Disorders.- Cardio-respiratory diseases; Impaired vision and hearing; Psychiatric disorders; Falls; Iatrogenic disease; Generalised weakness; Pain; Bedrest; Over protection.- Complications of Immobility.- Clinical Evaluation.- Management.- Rehabilitation; Community services; Financial support.- 16 Foot Problems.- Major Acquired Disorders.- Arthritis; Diabetes mellitus; Vascular disease; Callus and corns; Ulcers; Nails; Bursitis; Scarring; Fissures.- Clinical Evaluation.- Management.- Foot care; Footwear; Supports and appliances.- 17 Falls and Syncope.- Neurological Disorders.- Physiological age-related changes; Cerebrovascular disease; Space-occupying lesions; Parkinson’s disease; Dementia; Epilepsy; Transient ischaemic attacks; Drop attacks; Visual problems; Vestibular problems; Peripheral neuropathy; Cervical spondylosis.- Cardiovascular Problems.- Cardiac syncope; Carotid sinus hypersensitivity; Postural hypotension; Drugs.- Musculo-skeletal Problems.- Clinical Evaluation.- Further Investigation.- Complications of Falls.- Loss of confidence; Fractures; Subdural haematomas; Other complications.- Management.- Accidental Falls and their Prevention.- In the home; In hospital.- 18 Confusion.- Acute Confusion.- Causes; Clinical features; Diagnosis; Management.- Chronic Confusion.- Diagnosis; Alzheimer’s disease; Vascular dementia; Other causes; Management.- 19 Depression.- Suicide.- Aetiology.- Genetic factors; Life events; Chronic illness and disability; Drugs; Pre-morbid personality; Chronic stress; The ageing brain.- Clinical Evaluation.- Depressive pseudo-dementia; Hospitalised depressives.- Management.- Antidepressants; Electroconvulsive therapy; General supportive measures.- Prognosis.- 20 Anaemia.- Anaemia; Relative anaemia; Pre-anaemia; Incidence.- Common Forms of Anaemia.- Iron deficiency; Folic acid and B12 deficiency; Secondary anaemias; Refractory anaemias; Haemolytic anaemias.- Clinical Evaluation.- Further Investigation.- Management.- Transfusion; Iron supplementation; Vitamin B12 and folic acid supplementation.- 21 Vomiting and Haematemesis.- Gastrointestinal Causes of Vomiting.- Oesophagitis; Benign oesophageal stricture and oesophageal tumour; Peptic ulceration; Gastric outlet obstruction; Surgical emergencies.- Non-gastrointestinal Causes of Vomiting.- Clinical Evaluation.- Further Investigation.- Management.- Haematemesis.- Clinical evaluation; Further investigation; Management.- 22 Accidental Hypothermia.- Factors Predisposing to Hypothermia.- Physiological changes; Environmental factors; Pathological conditions.- Clinical Evaluation.- Cardiovascular system; Respiratory system; Renal system; Central nervous system; Gastrointestinal tract.- Laboratory Abnormalities.- Management.- Temperature stabilisation; Circulatory support; Transportation; Rewarming; Supportive measures; Laboratory investigation.- Prevention.- Diet; Conservation of body heat; Insulation; Money matters.- 23 Pruritus.- Dermatological Disorders.- Xerosis; Lichen simplex chronicus; Anogenitalpruritus; Dermatitis; Dermatitis herpetiformis; Urticaria; Infestation; Cutaneous neoplasms.- Systemic Disorders.- Hepatobiliary disease; Renal disease; Haematological disorders; Endocrine disorders; Malignant disease; Drugs; Psychogenic illness.- Clinical Evaluation.- Management.- Reduction of exacerbating factors and patient education; Physical methods; Symptomatic topical treatment; Systemic drug treatment.- Section III. Aspects of Medical Care in the Elderly.- 24 Drug Therapy.- Indications for Prescribing.- Practicalities of Drug Administration.- Determination of Dose and Dose Regime.- Absorption and bio-availability; Distribution; Metabolic biotransformation; Renal excretion; Drug sensitivity.- Assessing the Outcome.- Postural stability; Baroreceptor function; Thermoregulation; Maintenance of orientation; Pupillary autonomic responses; Neurological control of bladder and bowelfunction.- Conclusions.- 25 Rehabilitation.- The Rehabilitation Team.- The team leader; The doctor; Remedial therapists; Nursing staff; The patient.- The Rehabilitation Centre.- The Rehabilitation Process.- Assessment; Remediation; Discharge; After-care; Rehabilitation at home.- 26 Terminal Care.- Clinical Assessment.- Symptom Control.- Pain; Nausea and vomiting; Oral problems; Dysphagia; Squashed stomach syndrome; Gastrointestinal obstruction; Anorexia; Insomnia, anxiety and depression; Constipation; Dyspnoea.- Counselling.- Section IV. Delivery of Health Care to the Elderly.- 27 Geriatric Medicine and the Law.- The Law in the United Kingdom.- Compulsory Admission.- The National Assistance Act (1948) and National Assistance (Amendment) Act 1951; The Mental Health Act (1983); Guardianship.- Consent to Treatment.- Management of Property and Affairs.- Testamentary capacity; Agency and appointee; Power of attorney; Enduring power of attorney; The Court of Protection.- Medical Fitness to Drive.- The Law in Other Countries.- The Future.- 28 Supporting Old People in the Community.- Informal Carers.- Voluntary Bodies.- The Private Sector.- Statutory Bodies.- Health services; Social services.- Accommodation.- Financial Provision for the Elderly.- 29 Care of the Elderly in Other English-Speaking Countries.- Australia.- Canada.- New Zealand.- Republic of Ireland.- The United States.

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Titolo: Geriatric Medicine: Problems and Practice
Casa editrice: Springer
Data di pubblicazione: 2014
Legatura: Brossura
Condizione: New