Evidence-Based Geriatric Medicine: A Practical Clinical Guide PDF
Preview Evidence-Based Geriatric Medicine: A Practical Clinical Guide
P1:SFK/UKS P2:SFK Color:1C BLBK410-fm BLBK410-Holroyd-Leduc February7,2012 17:17 Trim:246mmX189mm PrinterName:YettoCome Evidence-Based Geriatric Medicine P1:SFK/UKS P2:SFK Color:1C BLBK410-fm BLBK410-Holroyd-Leduc February7,2012 17:17 Trim:246mmX189mm PrinterName:YettoCome Website: Evidence-Based Medicine Series The Evidence-Based Medicine Series has a website at: www.evidencebasedseries.com Where you can find: • Links to companion websites with additional resources and updates for books in the series • Details of all new and forthcoming titles • Links to more Evidence-Based products: including the Cochrane Library, Essential Evidence Plus, and EBM Guidelines. How to access the companion sites with additional resources and updates: • Go to the Evidence-Based Series site: www.evidencebasedseries.com • Select your book from the list of titles shown on the site • If your book has a website with supplementary material, it will show an icon next to the title • Click on the icon to access the website P1:SFK/UKS P2:SFK Color:1C BLBK410-fm BLBK410-Holroyd-Leduc February7,2012 17:17 Trim:246mmX189mm PrinterName:YettoCome Evidence-Based Geriatric Medicine A Practical Clinical Guide Edited by Jayna M. Holroyd-Leduc, MD FRCPC AssociateProfessor DepartmentsofMedicineandCommunityHealthSciences DivisionofGeriatrics UniversityofCalgary Calgary,AB Canada Madhuri Reddy, MD MSc HebrewSeniorLife Boston,MA USA A John Wiley & Sons, Ltd., Publication P1:SFK/UKS P2:SFK Color:1C BLBK410-fm BLBK410-Holroyd-Leduc February7,2012 17:17 Trim:246mmX189mm PrinterName:YettoCome Thiseditionfirstpublished2012,(cid:2)C 2012byBlackwellPublishingLtd. 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Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,or transmitted,inanyformorbyanymeans,electronic,mechanical,photocopying,recordingor otherwise,exceptaspermittedbytheUKCopyright,DesignsandPatentsAct1988,withoutthe priorpermissionofthepublisher. Designationsusedbycompaniestodistinguishtheirproductsareoftenclaimedastrademarks.All brandnamesandproductnamesusedinthisbookaretradenames,servicemarks,trademarksor registeredtrademarksoftheirrespectiveowners.Thepublisherisnotassociatedwithanyproduct orvendormentionedinthisbook.Thispublicationisdesignedtoprovideaccurateand authoritativeinformationinregardtothesubjectmattercovered.Itissoldontheunderstanding thatthepublisherisnotengagedinrenderingprofessionalservices.Ifprofessionaladviceorother expertassistanceisrequired,theservicesofacompetentprofessionalshouldbesought. Thecontentsofthisworkareintendedtofurthergeneralscientificresearch,understanding,and discussiononlyandarenotintendedandshouldnotberelieduponasrecommendingor promotingaspecificmethod,diagnosis,ortreatmentbyphysiciansforanyparticularpatient.The publisherandtheauthormakenorepresentationsorwarrantieswithrespecttotheaccuracyor completenessofthecontentsofthisworkandspecificallydisclaimallwarranties,includingwithout limitationanyimpliedwarrantiesoffitnessforaparticularpurpose.Inviewofongoingresearch, equipmentmodifications,changesingovernmentalregulations,andtheconstantflowof informationrelatingtotheuseofmedicines,equipment,anddevices,thereaderisurgedtoreview andevaluatetheinformationprovidedinthepackageinsertorinstructionsforeachmedicine, equipment,ordevicefor,amongotherthings,anychangesintheinstructionsorindicationof usageandforaddedwarningsandprecautions.Readersshouldconsultwithaspecialistwhere appropriate.ThefactthatanorganizationorWebsiteisreferredtointhisworkasacitationand/or apotentialsourceoffurtherinformationdoesnotmeanthattheauthororthepublisherendorses theinformationtheorganizationorWebsitemayprovideorrecommendationsitmaymake. Further,readersshouldbeawarethatInternetWebsiteslistedinthisworkmayhavechangedor disappearedbetweenwhenthisworkwaswrittenandwhenitisread.Nowarrantymaybecreated orextendedbyanypromotionalstatementsforthiswork.Neitherthepublishernortheauthor shallbeliableforanydamagesarisingherefrom. LibraryofCongressCataloging-in-PublicationData Evidence-basedgeriatricmedicine:apracticalclinicalguide/editedby JaynaM.Holroyd-LeducandMadhuriReddy. p.;cm. Includesbibliographicalreferencesandindex. ISBN978-1-4443-3718-1(pbk.:alk.paper) I.Holroyd-Leduc,JaynaM.,1970– II.Reddy,Madhuri,1972– DNLM:1.Geriatrics–methods. 2.Aged. 3.Aging–physiology. 4.Evidence-BasedMedicine. 5.GeriatricAssessment. WT100] 618.97–dc23 2011049726 AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsinprint maynotbeavailableinelectronicbooks. (cid:2) Setin9.5/12ptMinionbyAptaraR Inc.,NewDelhi,India 1 2012 P1:SFK/UKS P2:SFK Color:1C BLBK410-fm BLBK410-Holroyd-Leduc February7,2012 17:17 Trim:246mmX189mm PrinterName:YettoCome Contents Listofcontributors,vi 8 Enjoyingthegoldenyears:diagnosingand treatingdepression,94 Foreword,ix JanePearce&StuartCarney SharonStraus 9 Abalancingact:preventingandtreatingfalls,105 1 Functionandfrailty:thecornerstonesofgeriatric EmilyKwan&SharonStraus assessment,1 PaigeK.Moorhouse&KennethRockwood 10 Keepingdry:managingurinaryincontinence,124 CaraTannenbaum 2 Computer-basedclinicaldecisionsupportsystems inthecareofolderpatients,13 11 Keepingthingsmoving:preventingandmanaging MarinaMartin&MaryK.Goldstein constipation,140 DovGandell&ShabbirM.H.Alibhai 3 Simplifyingthepillbox:drugsandaging,25 SudeepS.Gill&DallasP.Seitz 12 Preventingandtreatingpressureulcers,155 MadhuriReddy,SudeepS.Gill,SunilaR.Kalkar, 4 Breathingeasier:respiratorydiseaseintheolder WeiWu,&PaulaA.Rochon adult,43 SalahaddinMahmudi-Azer 13 ElderAbuse,166 ErikJ.Lindbloom,LandonD.Hough,& 5 Breathingeasier:anapproachtoheartfailureina KarliR.E.Urban patientwithanagingheart,58 JaynaM.Holroyd-Leduc,MadhuriReddy,& 14 Agooddeath:appropriateend-of-lifecare,175 AnitaAsgar CariLevy&JeanS.Kutner 6 Clarifyingconfusion:preventionandmanaging Index,187 delirium,65 RanjaniAiyar&JaynaM.Holroyd-Leduc 7 Preservingthememories:managing dementia,73 DallasP.Seitz,PhilipE.Lee,SudeepS.Gill,& PaulaA.Rochon Evidence-Based Medicine Series TheEvidence-BasedMedicineSerieshasawebsiteat: www.evidencebasedseries.com v P1:SFK/UKS P2:SFK Color:1C BLBK410-bcontrib BLBK410-Holroyd-Leduc February9,2012 14:21 Trim:246mmX189mm PrinterName:YettoCome List of Contributors RanjaniAiyar DovGandell Fellow Resident,GeriatricMedicine GeneralInternalMedicine DepartmentofMedicine DivisionofGeneralInternalMedicine DivisionofGeriatrics DepartmentofMedicine UniversityofToronto UniversityofCalgary Toronto,ON,Canada Calgary,AB,Canada SudeepS.Gill ShabbirM.H.Alibhai AssociateProfessor AssociateProfessor DepartmentofMedicine DepartmentsofMedicineandHealthPolicy, DivisionofGeriatricMedicine Management,andEvaluation Queen’sUniversity UniversityofToronto Kingston,ON,Canada Toronto,ON,Canada; ConsultantGeriatrician MaryK.Goldstein TorontoRehabilitationInstitute Director Toronto,ON,Canada; GeriatricsResearchEducationandClinicalCenter(GRECC) StaffPhysician VAPaloAltoHealthCareSystem InternalMedicineandGeriatrics PaloAlto,CA,USA; UniversityHealthNetwork ProfessorofMedicine(CenterforPrimaryCare& Toronto,ON,Canada OutcomesResearch) StanfordUniversitySchoolofMedicine AnitaAsgar Stanford,CA,USA Director TranscatheterValveTherapyClinic JaynaM.Holroyd-Leduc InstitutdeCardiologiedeMontre´al QILead Montre´al,Quebec,Canada; DepartmentofMedicine AssistantProfessor UniversityofCalgaryandAlbertaHealthServices Universite´deMontre´al Calgary,AB,Canada; Montre´al,Quebec,Canada MedicalCoordinatorofClinicalInformatics DepartmentofMedicine StuartCarney AlbertaHealthServices DeputyNationalDirector Calgary,AB,Canada; UKFoundationProgrammeOffice CardiffBay,UK vi P1:SFK/UKS P2:SFK Color:1C BLBK410-bcontrib BLBK410-Holroyd-Leduc February9,2012 14:21 Trim:246mmX189mm PrinterName:YettoCome ListofContributors AssociateProfessor SalahaddinMahmudi-Azer DepartmentsofMedicineandCommunityHealthSciences ClinicalFellow Director,GeriatricMedicineTrainingProgram DepartmentofCriticalCareMedicine DivisionofGeriatrics FoothillsHospital UniversityofCalgary UniversityofCalgary Calgary,AB,Canada Calgary,AB,Canada LandonD.Hough MarinaMartin ResidentPhysician ClinicalInstructorofMedicine(GeneralInternalMedicine) DepartmentofFamilyandCommunityMedicine StanfordUniversity UniversityofMissouri Stanford,CA,USA Columbia,MO,USA PaigeK.Moorhouse SunilaR.Kalkar AssistantProfessor ResearchCoordinator GeriatricMedicine Women’sCollegeResearchInstitute DalhousieUniversity Women’sCollegeHospital Halifax,NS,Canada Toronto,ON,Canada JanePearce JeanS.Kutner ConsultantOldAgePsychiatristandHonorarySenior ProfessorofMedicine ClinicalLecturerinPsychiatry UniversityofColorado UniversityofOxford DenverSchoolofMedicine Oxford,UK; Aurora,CO,USA FulbrookCentre ChurchillHospital EmilyKwan Oxford,UK Resident,GeriatricMedicine DepartmentofMedicine MadhuriReddy DivisionofGeriatrics HebrewSeniorLife UniversityofToronto Boston,MA,USA Toronto,ON,Canada PaulaA.Rochon PhilipE.Lee VicePresident,Research AssistantProfessor Women’sCollegeResearchInstitute DivisionofGeriatricMedicine Women’sCollegeHospital UniversityofBritishColumbia Toronto,ON,Canada; Vancouver,BC,Canada SeniorScientist InstituteforClinicalEvaluativeSciences CariLevy Toronto,ON,Canada; AssociateProfessorofMedicine Professor UniversityofColoradoDenverSchoolofMedicine DepartmentofMedicine Denver,CO,USA; UniversityofToronto DenverVAMedicalCenter Toronto,ON,Canada Denver,CO,USA KennethRockwood ErikJ.Lindbloom Professor AssociateProfessor GeriatricMedicine DepartmentofFamilyandCommunityMedicine DalhousieUniversity UniversityofMissouri Halifax,NS,Canada; Columbia,MO,USA vii P1:SFK/UKS P2:SFK Color:1C BLBK410-bcontrib BLBK410-Holroyd-Leduc February9,2012 14:21 Trim:246mmX189mm PrinterName:YettoCome ListofContributors KathrynAllenWeldonProfessorofAlzheimerResearch CaraTannenbaum DalhousieUniversity AssociateProfessor Halifax,NS,Canada; FacultiesofMedicineandPharmacy ConsultantPhysician Universite´deMontre´al QueenElizabethIIHealthSciencesCentre Montre´al,QC,Canada; Halifax,NS,Canada Director GeriatricIncontinenceClinic DallasP.Seitz InstitutUniversitairedeGe´riatrie AssistantProfessor Universite´deMontre´al DepartmentofPsychiatry Montre´al,QC,Canada DivisionofGeriatricPsychiatry Queen’sUniversity KarliR.E.Urban Kingston,ON,Canada; ResidentPhysician Fellow DepartmentofFamilyandCommunityMedicine Women’sCollegeResearchInstitute UniversityofMissouri Toronto,ON,Canada Columbia,MO,USA SharonStraus WeiWu Professor StatisticalAnalyst DepartmentofMedicine Women’sCollegeResearchInstitute Director,DivisionofGeriatrics Women’sCollegeHospital UniversityofToronto Toronto,ON,Canada Toronto,ON,Canada; Director,KnowledgeTranslationProgram LiKaShingKnowledgeInstituteofSt.Michael’s Toronto,ON,Canada viii P1:SFK/UKS P2:SFK Color:1C BLBK410-bcontrib BLBK410-Holroyd-Leduc February9,2012 14:21 Trim:246mmX189mm PrinterName:YettoCome Foreword Worldwide a major change in the population demo- disciplines,patientsandpolicymakersamongstoth- graphicisposingchallengestohealthcaresystems.In ers[1].Thisgrowinginterestarosefromanumberof manycountriesthebabyboom,thatfollowedWorld realisationsincluding:ourinabilitytoaffordmorethan WarIIandextendedtothe1960s,willsoonresultin afewsecondsperpatientforfindingandassimilating a substantial increase in the number of people over evidence[2]ortosetasidemorethanhalfanhourper 65 years of age. Moreover, most countries includ- weekforgeneralreadingandstudy[3];andthefinding ing Canada, the United States and the United King- thatthegapsbetweenevidenceandpractice(including dom have experienced a continuing increase in life underuseandoveruseofevidence)leadtovariations expectancy,withanincreaseofapproximately1year inpracticeandqualityofcare[4,5]. occurringevery5years.Thesefactorstranslateintoa Tomeetthesechallenges,thisbookfocusesonpro- growingproportionofpeopleaged65andolderand viding an approach to care for older patients that is these people will have many more years of life after basedonthebestavailableevidence.Anidealevidence- attainingage65.Thissituationisnotuniquetowest- based resource should use rigorous and transparent ern countries; many developing countries will grow methodsforseekingandappraisingtheevidence,and oldbeforetheygetrich.Forexample,in2000,7%of providetheevidenceinaclinicallyusefulformat.The China’s population was ≥ 65 years old; by 2030 this formatofeachchapterinthisbookincludesquestions willincreaseto16%.Astheproportionofolderpeo- thathavebeengeneratedbyclinicianswhilethecon- ple increases, there is an increasing need for services tent focuses on a systematic review of the evidence targetedtocareforolderpeople,inparticulartoop- andprovidesthereaderwiththebottomlinefortheir timize the independence and vitality of those living clinicalpractice.Finally,thebookhighlightsthegaps inthecommunity.Thereisanurgentneedforhealth intheevidence,whicharetargetsforfutureresearch careprofessionalsfromalldisciplines(asidefrompae- (wehope!). diatrics!)tobecomecomfortablewithcaringforthis Topicsaddressedinthebookincludeassessingand population. This book will address this demand and managingthegeriatricgiantssuchasdelirium,demen- providearesourceforhealthcareprofessionalstopro- tia, urinary incontinence and falls. The authors also videevidence-basedcareforolderpatients. tackle issues, such as elder abuse, that are often un- Evidence-BasedGeriatricMedicine,aPracticalGuide derappreciatedinclinicalcare.And,thebookincludes focusesonbringingtogether2criticallyimportantis- discussion of the management of chronic diseases in suesinhealthcare–evidence-basedpractice(EBP)and thecomplexolderpatientwhichisusefulinformation careoftheolderpatient.InterestinEBPhasgrownex- foranygeneralistclinician. ponentiallysincethecoiningofthetermin1992,from Thisbookwillbearesourcefortraineesandclini- 1MEDLINEcitationinthatyeartomorethan75000 ciansfromvariousdisciplines,worldwide.Itaddresses hits in January 2012. Training in EBP has become a issuesofglobalimportance–promotinghealthyaging component of educational curricula for health care andbuildingcapacitytocareforolderpersons. ix
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