Geriatric Diseases

795 Pages·2018·18.857 MB·English

by  Nages Nagaratnam, Kujan Nagaratnam, Gary Cheuk

Nages Nagaratnam
Kujan Nagaratnam
Gary Cheuk
Geriatric
Diseases
Evaluation and Management
Geriatric Diseases
(cid:129)
Nages Nagaratnam Kujan Nagaratnam
Gary Cheuk
Geriatric Diseases
Evaluation and Management
With90Figuresand79Tables
NagesNagaratnam KujanNagaratnam
TheUniversityofSydney TheUniversityofSydney
WestmeadClinicalSchool WestmeadClinicalSchool
Westmead,NSW,Australia Westmead,NSW,Australia
GaryCheuk
RehabilitationandAgedCareService
Blacktown-MtDruittHospital
MountDruitt,NSW,Australia
ISBN978-3-319-33433-2 ISBN978-3-319-33434-9(eBook)
ISBN978-3-319-33435-6(printandelectronicbundle)
https://doi.org/10.1007/978-3-319-33434-9
LibraryofCongressControlNumber:2017964114
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Preface
Many developed countries have experienced ageing demographics since the
early 1900s, especially in the oldest old, the ones over 85. This trend of
increased longevity showed little signs of abatement thus far, but with the
increasedprevalenceoflifestylediseasessuchasobesity,typeIIdiabetesand
hypertension,somehadpredictedthatitwillslowormayevenreverse.
Ageing is associated with a multitude of physiological changes and a
prevalence of multiple co-morbidities. This often leads to atypical presenta-
tionsofcommondiseases.Forexample,itiscommonforaninfectiveillnessto
presentwithfalls,cognitiveorfunctionaldecline.Itisalsoknownthattheage
ofonsetcanleadtodifferentdiseasepresentationasinthecaseoflate-onset
Parkinson’s disease, where the typical resting tremor is often absent. It is
therefore important for clinicians managing older persons to have an acute
awarenessofthe way that age-related physiological changes and co-existing
co-morbiditiescaninfluencethewayanolderpersonpresents.
Geriatric Medicine: Evaluation and Management provides a comprehen-
siveoverviewoftheimportanceofageofonsetonthepresentationofcommon
diseasesin the elderly. Apart from providing intense information on a given
subject, it also provides means for self-assessment with a combination of
multiple choice, short answer and extended matching questions which are
basedonthetext.Interestingshortcasesarealsoincluded.Theextensiveuse
oftablesandfiguresthroughoutthebookandaboxforkeypointsattheendof
eachpartshouldbeagreatassistancetotime-poorreaders.
Thebookcontains21partsarrangedbyorgansystemandisstructuredto
coverthespecificclinicalsub-specialitieswithemphasisontheageatonset.
Theyaredividedintointroduction,clinicalexpressionfollowedbydiagnosis
and treatment. Many parts follow a common pattern with headings and sub-
headings.Thetextofferstheprimarycarephysicians,juniordoctors,medical
undergraduates, specialist nurses and others working in aged-care settings a
systematic approach to geriatric medicine. The book we believe will be a
companion to theone publishedearlier, by thesame authors Diseases inthe
Elderly:Age-RelatedChangesandPathophysiology.
NagesNagaratnam
KujanNagaratnam
GaryCheuk
vii
Acknowledgements
WethankMr.LukeElias(PhysicalMedicine),Dr.DuncanGuy(Cardiology),
Dr. Logan Kanagaratnam (Cardiology), Prof. Arumugam Manoharan
(Haematology), Prof. Mahendra Somasunderam (Neurology), Dr. J. Sarks
(Ophthalmology), Dr. A. PunniaMoorthy (Oral and Maxillofacial) for their
helpinmanyways.AspecialthankstoAssoc.Prof.WMAmoaku(University
of Nottingham), Dr. Derek Davies (Dermatology), Prof. Nicholas Manolios
(The University of Sydney), Dr. Thiaga Nadaraja (ENT) and
Dr.P.Nithianandan(Ophthalmology)forkindlyprovidingnumerousfigures,
and Mr. Yogan Nagaratnam, Mr. Panjan Nagaratnam (for photographs), Sai
AditiyaNagaratnam,NathanNagaratnamandManishaNagaratnamfortheir
assistance.
ix
Disclaimer
Continuous development and research in the fields of medicine, science
technologyandhealthcareresultinongoingchangesinthedomainsofclinical
practice as evidence continues to evolve rapidly. We have taken reasonable
careandefforttoprovidematerialswhicharecurrent,accurateandbalancedat
thetimeofpublication.
Weandthepublishersdonotacceptresponsibilityorliabilityforanyerrors
inthetextoranyconsequencesarisingfromtheinformation,forinstance,to
takethedrugdosagesascorrect.Theinformationprovidedisneutralandfor
general education and does not replace interaction with the practicing clini-
cian.Cliniciansshoulddependontheirownexperiencewhenprovidingadvice
ortreatment.
We have acknowledged the sources and works of the cited sites at the
appropriate locations in the text and references. We have used the source
materials in the sense of fair use and extend our apology for any oversight.
Readersareadvisedtocross-referenceandconfirmpointsrelevanttothem.
xi
Contents
PartI CardiovascularDiseasesintheElderly ................ 1
1 HeartFailure ...................................... 3
2 CardiacArrhythmias ............................... 17
3 InfectiveEndocarditis ............................... 29
4 CoronaryArteryDisease ............................. 37
5 ValvularHeartDiseaseintheElderly .................. 47
6 HypertensionintheElderly .......................... 57
7 PeripheralArterialDisease ........................... 67
PartII RespiratoryDiseasesintheElderly ................... 75
8 PneumoniainGeriatricPatients ....................... 77
9 ChronicObstructivePulmonaryDisease(COPD) ......... 89
10 AsthmaintheElderly ............................... 99
11 LungCancerintheElderly ........................... 105
12 PulmonaryEmbolism ............................... 113
13 SleepDisorders .................................... 121
PartIII DisordersoftheDigestiveTractintheElderly ....... 125
14 TheOesophagusandOesophagealDisorders ............ 127
15 PepticUlcerDiseaseintheElderly ..................... 143
16 ColorectalCancer .................................. 147
17 InflammatoryBowelDiseaseintheElderly .............. 153
18 GastrointestinalBleedingintheElderly ................ 161
xiii
xiv Contents
19 AcuteAbdominalPainintheElderly ................... 169
20 InfectiousDiarrhoeasintheElderly .................... 179
PartIV LiverDiseasesintheElderly ........................ 187
21 ViralHepatitisintheElderly ......................... 189
22 ChronicLiverDisease ............................... 203
23 HepatocellularCarcinoma ........................... 217
24 AscitesintheElderly ................................ 221
PartV BloodDisordersintheElderly ....................... 227
25 TheAnaemias ..................................... 229
26 MyelodysplasticSyndromes .......................... 239
27 MyeloproliferativeNeoplasms ........................ 243
28 ImmunoproliferativeDisorders ....................... 253
29 LymphoproliferativeDisorders ........................ 259
PartVI RenalandLowerUrinaryTractDisordersin
theElderly .................................................. 267
30 GlomerularDiseaseintheElderly ..................... 269
31 RenovascularDiseaseintheElderly .................... 273
32 AcuteKidneyInjury ................................ 277
33 ChronicKidneyDiseaseintheElderly .................. 287
34 ProstateGlandandRelatedDisorders .................. 297
35 MaleSexualDysfunction:ErectileDysfunction(ED) ...... 309
PartVII NeurologicalDisordersintheElderly ............... 315
36 Parkinson’sDisease ................................. 317
37 MultisystemAtrophy(MSA) .......................... 329
38 MotorNeuroneDisease .............................. 333
39 MultipleSclerosis ................................... 337
40 PeripheralNeuropathy .............................. 343
41 DisordersofNeuromuscularTransmission .............. 351
42 Epilepsy .......................................... 361