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Index
Cover
Title page
Copyright
Contents
Preface
Contributors
Chapter 1. From gut feeling to evidence base: drivers and barriers to the development of health care for older people
1 The emergence of geriatric medicine
2 Older people’s medicine into the mainstream
3 Demographics
4 Integrated services
5 Frailty and geriatric syndromes
6 Legislative frameworks
7 Access to facilities and treatment
8 The utilization of the CGA approach to non-elders
9 Future directions
10 Conclusion
Websites relevant to this chapter
Key guidelines, policy documents, and reviews
Chapter 2. Re-thinking care in later life: the social and the clinical
1 Introduction
2 Geriatrics as ‘social medicine’
3 Geriatrics and social gerontology: divergent paths
4 Gerontology and geriatrics: consensus and cooperation
5 Linking geriatrics and gerontology: areas for development
6 Conclusion
Websites relevant to this chapter
Key guidelines, policy documents, and reviews
Chapter 3. Health and social care services for older people: achievements, challenges, and future directions
1 Introduction
2 An expansion of health and social care services for older people closer to home
2.1 Rationale for service changes
2.2 Research evidence about the impacts of care closer-to-home services
3 Integrating health and social care services for older people
3.1 Rationale for service changes
3.2 Research evidence about the impacts of service integration strategies
4 Building the evidence base for integrated health and social care services
4.1 Identify the patient group to be targeted
4.2 Clarify why this patient group needs a more integrated approach to the delivery of care
4.3 Use baseline analysis to inform the design of new interventions
4.4 Adopt a theory of change design to evaluate the impacts of new interventions
4.5 Use evaluation findings to guide needed service modifications and to reinforce the need for service integration
5 Conclusion
Key guidelines, policy documents, reviews, and websites relevant to this chapter
Chapter 4. Service models
1 Introduction
2 Towards a strategic approach to older people
3 The changing nature of health in old age
3.1 The implications for evidence-based medicine
3.2 Health policies and levers
4 Current and emerging models of care
4.1 Acute and episodic illness
4.1.1 Interface geriatrics
4.1.2 Optimizing early care of acutely ill older patients
4.1.3 Support for frail older people undergoing surgery
4.1.4 Orthogeriatric services
4.2 Optimizing post-acute recovery
4.2.1 Intermediate care
4.3 Management of long-term conditions and frailty
4.3.1 Interspecialty collaboration
4.3.2 Systematic collaboration with primary care
4.4 Support for older people in care homes
4.5 End-of-life care
5 New horizons
5.1 Geriatric oncology
5.2 Frailty as a long-term condition
6 Conclusion
Websites relevant to this chapter
Key guidelines, policy documents, and reviews
Chapter 5. Therapeutics in older people
1 Introduction
2 Age-related changes in physiology and pharmacokinetics
2.1 Absorption
2.2 Distribution
2.3 Protein binding
2.4 Clearance—hepatic
2.5 Clearance—renal
2.6 Elimination half-life
3 Polypharmacy and multiple pathology
4 Inappropriate prescribing
5 Atypical presentation and response to medication (pharmacodynamics)
6 How can inappropriate prescribing in older people be reduced?
6.1 Good prescribing practice
6.2 Medication review
6.3 Using as few prescribers as possible
6.4 Education
6.5 Electronic prescribing
6.6 Audit
7 Future directions
8 Conclusion
Websites relevant to this chapter
Chapter 6. Dementia and memory clinics
1 Introduction
2 Development of memory clinics
3 What are the characteristics of a memory clinic?
3.1 What do they do?
3.2 What do they achieve?
4 The future of memory clinics
5 Conclusion
Acknowledgement
Websites and key guidelines relevant to this chapter
Chapter 7. Frailty: challenges and progress
1 Introduction
2 Definitions
2.1 Phenotypes and deficits
3 Frailty and the immune system
4 Prevalence
5 Frailty and sarcopenia
6 Treatment of frailty
7 Recent developments and future trends
7.1 Developments in primary care
7.2 Future trends
8 Conclusion
Websites relevant to this chapter
Chapter 8. Incontinence, the sleeping geriatric giant: challenges and solutions
1 Introduction
2 Prevalence and relation to age-associated changes in the brain
3 Types of incontinence
3.1 Urgency and urgency incontinence
3.2 Stress urinary incontinence
3.3 Mixed urinary incontinence
3.4 Nocturnal enuresis
3.5 Functional incontinence
4 Voiding inefficiency
5 Quality of life and impact
6 Evidence base for treatment
7 Treatment strategies for treating incontinence in the elderly
7.1 Lifestyle interventions
7.2 Behavioural interventions
7.3 Functional incidental training
7.4 Pharmacological therapy
7.5 Pharmacological therapy for nocturia
7.6 Surgery in older people
7.7 Interventions for nocturnal enuresis
8 Service delivery
9 Conclusion
Websites and key guidelines relevant to this chapter
Chapter 9. Depressions in later life: heterogeneity and co-morbidities
1 Introduction
2 Incidence and impact
3 Depression in the older person
4 Epidemiology and causes
4.1 Treatment and outcome
5 Co-morbidities and curiosities
6 Future developments
7 Conclusion
Websites relevant to this chapter
Chapter 10. Substance misuse and older people: a question of values
1 Introduction
2 Diagnosis of addiction in older people
2.1 Competence in the comprehensive assessment as prelude to treatment
3 Risk and consequences—the geriatric giants in the room
4 Treatment effectiveness and critical issues
5 The future—valuing ageing addicts
6 Conclusion
Websites relevant to this chapter
Key guidelines, policy documents, and reviews
Chapter 11. Sleep in older people
1 Introduction
2 Normal sleep in older people
3 Common medical and psychiatric disorders and sleep
4 Insomnia and circadian rhythm disorders
5 Sleep-disordered breathing
6 Parasomnias
7 Future directions
8 Conclusion
Websites relevant to this chapter
Key guidelines, policy documents, and reviews
Chapter 12. Assessment and management of pain in older adults
1 Introduction
2 Chronic and acute pain
3 Pain management
4 Physiological function and ageing
4.1 Pain threshold
5 Dementia and pain
6 The assessment of pain
7 Management of pain in the older population
8 Conclusion and future directions
Websites and guidelines relevant to this chapter
Chapter 13. Stroke units: research in practice
1 Introduction
2 The rationale for stroke unit care
3 The evidence for stroke unit care
4 Processes that contribute to a good outcome
5 Issues in providing stroke unit care
5.1 Organization of stroke units
5.2 Multidisciplinary practice on stroke units
5.3 The effect of stroke severity on benefits from organized care
5.4 Involving patients and caregivers
6 Future challenges for stroke units
7 Conclusion
Websites relevant to this chapter
Key guidelines, policy documents, and reviews
Chapter 14. Stroke care: what is in the black box?
1 Introduction
2 Structural elements of specialist stroke services
3 Key aspects of stroke-unit practice and treatment associated with good outcome
3.1 Hyperacute stroke treatments
3.2 Better management of intracerebral haemorrhage
3.3 Immediate access to advanced imaging and diagnostics
3.4 Seven-day specialist stroke ward rounds
3.5 Good nursing care
3.6 Pneumonia prevention and management
3.7 Prevention of venous thromboembolism
3.8 Avoidance of urinary catheters
4 Future developments
5 Conclusion
Websites relevant to this chapter
Key guidelines, policy documents, and reviews
Chapter 15. Involving older people in the design and conduct of clinical trials:
1 Introduction
2 Defining and promoting patient and public involvement
3 Role of older people in patient and public involvement in research
4 What are the benefits of PPI?
4.1 Benefits to older people who get involved
4.2 Benefits to researchers
4.3 Benefits to research quality
5 Drawbacks, cautions, and future work
6 Conclusion
Websites relevant to this chapter
Key guidelines, policy documents, and reviews
Chapter 16. Under-representation of older people in clinical trials
1 Introduction
2 The evidence for under-representation
3 Older people and clinical trials—barriers and promoters
3.1 Barriers
3.1.1 Physician endorsement
3.1.2 Transport and logistical barriers
3.1.3 Treatment risks
3.1.4 Lack of knowledge of the disease process
3.1.5 Lack of compulsion in study design
3.2 Promoters
3.2.1 Practical and logistical promoters
3.2.2 Involvement of medical and related staff
3.2.3 Communication within the health system
4 The EU Charter
5 Future directions
6 Conclusion
Websites and guidelines relevant to this chapter
Index
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