EXPLORING A BROAD ARRAY OF ISSUES FOR ELDER CARE

The Care of the Older Person is broken up into chapters written by an esteemed group of doctors and other professionals, each covering a different aspect of elder care:

Part I: Helping

Introduction (by Jose Morais, MD) presents an in-depth overview of the current state of geriatric medicine, including the unique challenges and opportunities characterizing this growing field today.

Caring for the Older Person (by Abraham Fuks, MD) focuses “attention to chronic illnesses and the needs of the older person whose ailments need a more deliberate, longer-term horizon with different goals and aspirations.”

Frailty (by Sathya Karunananthan, PhD and Howard Bergman, MD) explores the increasing vulnerability of our bodies and organs as we age and what care providers can do to diagnose and treat individuals.

Physical Activity as a Countermeasure to Frailty (by Guy Hajj Boutros, MSc and Antony D. Karelis, Phd) makes a compelling case for avoiding the sedentary state when possible, and demonstrates interventions that can potentially reverse frailty.

Doctor, My Spouse is Getting Forgetful (by Serge Gauthier, MD) explores the natural decline in memory, and how to diagnose and address dementia in your patients, clients, or family.

Update on Alzheimer’s Disease Diagnosis and Management (by Serge Gauthier, MD) is a synopsis of the diagnosis and management of AD, as well as its natural history and progression, by one of the acknowledged leaders in the field.

Navigating the Journey of Dementia as a Caregiver (by Claire Webster, CPCA) identifies who caregivers are, their demanding roles, and the toll the caregiving may take on them.

How to Diagnose and Manage Delirium (by Haibin Yin, MD). Among elderly patients who come into the ER, 15% suffer from delirium or “acute brain failure.” This chapter explores the signs and treatments.

Why Does My Patient Have Gait & Balance Disorders? (by Olivier Beauchet, MD, PhD) explores the main causes and best treatments for the broad category of walking and balance problems.

Could My Patient Be Malnourished? (by Jose Morais, MD) explores the prevalence of malnutrition in older populations, how to diagnose it, and how to treat it.

Dental Care in Older Persons (by Michael Wiseman, DDS) makes the point that periodontal disease is a prominent chronic infection of older persons that can be associated with systemic health. The importance of dental hygiene is stressed.

Eating, Drinking and Swallowing Problems of Vulnerable Older Adults (by Heather Lambert, PhD) shares that up to 38% of older adults living in the community and an even higher percentage of those in long term care have a loss of skills related to swallowing. This loss of ingestive skills is explored in detail. 

Part II: Vulnerability

Architecture and the Aging (by Julia Gersovitz, O.C, OAQ, QAA, AANB FIRAC/FRAIC, FAPT, CAHP and Boris Morin-Defoy, M.Arch) starts with a stark assessment of the state of nursing homes and the disproportionate death rate of residents within them during the COVID19 pandemic. Innovative solutions and architectural approaches are detailed.

Are the Immunizations of My Patient Up to Date? (by Dominique Tessier, MD) stresses the importance of immunizations in our vulnerable older population, with details of the various immunizations that may be necessary.

Management of Older Patients in the Emergency Department (By Cyrille Launay, MD, PhD) provides an overview of the unique challenges facing ER staff in diagnosing and working with older patients.

Critical Care of the Older Person (by Astrid F. Pilgrim, MD, and Michael R. Pinsky, MD) is a comprehensive look at the important differences seen in the critically ill older person, and how to efficiently respond to these issues and counteract them.

COVID19 in Long-Term Care (by Julia Chabot, MD, Philippe Desmarais, MD, and Michael Stiffel, MD) addresses the particularly onerous effects of the global pandemic on older persons, particularly those in long-term care facilities.

Part III: Caring

Arthritis in the Older Person (by Joseph Markenson, MD, Linda Yue, MD and Kevin Yip, MD) offers a comprehensive chapter on arthritis, and how it specifically impacts the older person. The various forms of arthritis that afflict older persons, and the management of those conditions, are discussed. This highly researched chapter has concluding take home points.

Stroke Prevention in the Elderly (by Liam Durcan, MD) emphasizes the need to identify predisposing causes of this major cause of death and disability, and to modify those risks before serious harm occurs.

Advances in Cardiac Care for Older Persons (by P. David Myerowitz, MD) is a detailed chronicle of medical problems encountered with the aging heart, and state of the art measures to deal with each of those problems.

Could My Patient be at Risk of Orthostatic Hypotension? (by Eric Hedge, MSc and Carmelo Mastandrea, MD, PhD) discusses orthostatic hypotension, which is the inability of the body to maintain adequate blood pressure during movement to an upright position because of gravity. The condition may be as prevalent as one in five for community living individuals 60 years of age or older. 

The Care of Chronic Obstructive Pulmonary Disease in Older Adults (by Jean Bourbeau, MD and Bryan Ross, MD) COPD, a very common and often preventable condition affecting many older adults, encompasses both emphysema and chronic bronchitis. Dr Jean Bourbeau and Dr Bryan Ross elaborate on the nature of the condition, the risk factors and treatments.

How Do I Manage My Patient with Peripheral Arterial Disease? (by Oren Steinmetz, MD and Anna Kinio, MD) defines peripheral arterial disease as chronic occlusive disease of the lower extremities secondary to atherosclerosis. The epidemiology of PAD is discussed, noting that the aging of the population has contributed to PAD becoming a global health concern. Management and treatment options are considered.

How to Manage Type 2 Diabetes in Frail Elderly Patients (by Young-Sang Kim, MD, PhD, and Jose A. Morais, MD) explores this important disease condition that is highly prevalent in older adults, and stresses the differences in treatment and approach that are necessary in the older population.

Hepatobiliary Considerations, Including Cancer (by Erica Roth, MD, Sunil Karhadkar, MD and Antonio di Carlo, MD) With the evolution of perioperative care, minimally invasive techniques, and improved health of older patients, considering an octogenarian for a major hepatobiliary operation is not that unusual. Gallbladder, liver, and pancreatic conditions are discussed.

Abdominal Organ Transplantation in the Older Person (by Antonio di Carlo, MD and Sunil Karhadkar, MD) covers the important issues in the transplantation of kidneys, livers and other organs into older persons. 

Part IV: Cancer

Cancer in Older Adults (by Doreen Wan-Chow-Wah, MD) brings the relatively young subspecialty of Geriatric Oncology to the forefront. Particularities of older persons with cancer are noted, including fitness for treatment. Life expectancy is factored in.

Cancer Screening in the Older Adult (by Catalina Hernandez-Torres, MD, and Tina Hsu, MD) discusses the sometimes controversial role of cancer screening in older adults. Screening recommendations are covered in the light of treatment options and patient preference.

Diagnosis and Management of Bowel Cancer (by Jessica Holland, MD and Barry Stein, MD) points out that colorectal cancer has the third highest cancer incidence worldwide, along with the second highest mortality. Screening techniques including colonoscopy are discussed. Diagnosis and staging investigations are elucidated, as well as surveillance and treatment options including chemotherapy, radiation and surgery. Improving the functional capacity of the older person prior to surgery is stressed.

Precision Medicine and Care of the Older Patient (by Donald White, PhD and Anne Croudass, RN, MSc) begins with an illustrative vignette that describes the symptoms of non-small cell lung cancer, leading to diagnosis and ultimately chemotherapy with its side effects, and the emotional, psychological, social, and financial toll. This is contrasted with transformative treatment that targets specific molecular changes within cancer cells.

Psycho oncology: Living with the Fear of Death (by Norman Straker, MD) is a discussion of the emotional and psychiatric care of cancer patients and their families by one of the originators of the subspecialty. The relationship between various psychiatric disorders and cancer is examined.

Part V: Considerations

Incontinence in Older Adults (by Samer Shamout  MD and Lysanne Campeau, MD) explores the risks, diagnosis, and treatment of urinary incontinence.

Sleep Disorders in Older Persons (by Shachi Tyagi, MD) addresses one of the most prevalent health concerns encountered in older adults. Changes in sleep with aging and common sleep complaints in older adults are discussed. Insomnia, with difficulty in falling asleep or maintaining sleep, is delved into, as well as contributing or associated medical and psychiatric conditions.

Polypharmacy and Deprescribing in the Elderly (by Louise Mallet, Pharm.D). Polypharmacy is taking multiple medicines for chronic issues at the same time and is common among the elderly. This chapter explores the risks of polypharmacy and how to “deprescribe” unnecessary medications.

After Menopause (by Ronald M. Caplan, MD) brings to the fore the fact that, with dramatically increasing lifespan, the postmenopausal years represent a very significant proportion of a woman’s productive life. Physiologic changes, screening for possible problems, prevention and possible treatments are discussed.

The Senior Adult Eye (by Peter Odell, MD) notes that the frequency of eye problems increases as people age, increasing the need for regular follow up. Cataracts, glaucoma, and macular degeneration are all elucidated and management discussed. Other common ocular disorders are covered as well.

Hearing Loss and Aging (by Joseph Montano, Ed.D) makes the point that hearing loss is an invisible condition with no obvious outward indications. The early signs of hearing loss are discussed, as is the relationship between hearing loss and cognition. Amelioration strategies are elucidated.

Skin Care of the Older Person: The Skin and its Associated Changes (by Hao Feng, MD, and Aziz Khan, MD) comprehensively details disorders of the skin in older persons and the management of those conditions.

Caring for the Older Person Undergoing Plastic Surgery (by Subhas Gupta, MD and Erin O’Rorke, MD) focuses on patient selection and state of the art methods of optimally readying patients for surgery.  People 65 years of age and older account for a large percentage of plastic surgical cases. The range of procedures undergone is elucidated.

Part VI: Understanding, Protecting

Elder Abuse (by Mark J. Yaffe, MD). Unfortunately, elder abuse is far too common in our society, and takes on many forms. This chapter helps care providers to identify elder abuse and learn how to address it.

Late-Life Anxiety (by Jess Friedland, MD, Paulina Bajsarowicz, MD, and Philippe Desmarais, MD) describes the risk and predisposing factors for the development of anxiety disorders in older persons and the treatments of those disorders.

An Overview of Late-Life Depression (By Artin Mahdanian, MD, and Silvia Monti De Flores, MD) explores the importance of understanding late-life depression for care professionals, including tools for diagnosis and treatment.

Assessment of Decision-Making Capacity (By Catherine Ferrier, MD) provides an important analysis of how to determine a patient’s ability to make key decisions about their medical treatment, living situation, finances, and more.

How Can Older People be Protected? (By Randy S. Perskin, Esq., JD) explores the important legal issues facing elderly patients and how care providers can best support them.

Financial Guidance for Seniors (by Karen C. Altfest, PhD, CFP) recognizes that, among the paramount concerns of older persons is financial stability. Financial concerns can affect mental and physical health, wellbeing, and even lifespan. Advice is offered to caregivers, including family, and to the older individual on how to anticipate and overcome these problems.

The Role of Religious Belief in the End-of-Life Care of Older Persons (by A. Mark Clarfield, MD,) compassionately shows that we cannot treat older persons near the end of life, and their families, without an understanding of their religious beliefs, and appropriately responding to their needs and concerns in ways that respect those beliefs.

Part VII: Medical Terms

Medical Terms and their Meaning: Glossary (by Ronald M. Caplan, MD). A highly researched glossary of medical definitions that will help you to understand what you’re reading and navigate the often-confusing world of scientific terminology. Includes forward-looking research that gives you a sense of where the advances in medicine are going in the future.

EDITORS & CONTRIBUTORS

Contributors (cont.)

Louise Mallet, Pharm.D

Joseph A. Markenson, MD

Carmelo Mastrandrea, MD

Joseph J. Montano, Ed.D

Silvia Monti De Flores, MD

Boris Morin-Defoy, M.Arch

P. David Myerowitz, MD

Peter M. Odell, MD

Erin O’Rorke, MD

Randy S. Perskin, Esq., JD

Astrid F. Pilgrim

Michael R. Pinsky

Bryan Ross, MD

Erica C. Roth, MD

Samer Shamout, MD

Barry L. Stein, MD

Oren K. Steinmetz, MDCM

Michael Stiffel, MD

Norman Straker, MD

Dominique Tessier, MD

Shachi Tyagi, MD

Doreen Wan-Chow-Wah, MD

Claire Webster, PAC, CPCA

Don White, PhD

Michael Wiseman, D.D.S.

Mark Yaffe, MD

Haibin Yin, MD

Kevin Yip, MD

Linda Yue, MD