Geriatrics

246 Pages·2012·10.231 MB·English

by  C. Atwood

GERIATRICS

Edited by Craig S. Atwood
Geriatrics
Edited by Craig S. Atwood

Published by InTech
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Copyright © 2012 InTech
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First published February, 2012
Printed in Croatia

A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from [email protected]

Geriatrics, Edited by Craig S. Atwood
p. cm.
ISBN 978-953-51-0080-5

Contents

Preface IX
Part 1 Functional Loss Associated with Aging 1
Chapter 1 Physical Function in Older People 3
Noran N. Hairi, Tee Guat Hiong,
Awang Bulgiba and Izzuna Mudla
Chapter 2 Sarcopenia in Older People 29
Noran N. Hairi, Awang Bulgiba, Tee Guat Hiong and Izzuna Mudla
Chapter 3 The Epidemiology of Vascular Dementia 41
Demet Ozbabalık, Didem Arslantaş
and Nese Tuncer Elmacı
Chapter 4 Swallowing Difficulties in Elderly People:
Impact of Maxillomandibular Wedging 51
Marie-Hélène Lacoste-Ferré,
Sophie Hermabessière and Yves Rolland
Chapter 5 Association of Disease-Specific
Mortality with Fitness Measurements and
Nonparticipation in an 80-Year-Old Population 59
Yutaka Takata, Toshihiro Ansai, Inho Soh, Shuji Awano,
Yutaka Yoshitake,Yasuo Kimura, Ikuo Nakamichi,
Sumio Akifusa, Kenichi Goto, Akihiro Yoshida,
Ritsuko Fujisawa, Kazuo Sonoki, and Tatsuji Nishihara
Part 2 Preventative Strategies for Maintenance
of Health and Extending Longevity 83
Chapter 6 Behavioral Treatment for Geriatric Syndrome 85
Hunkyung Kim
Chapter 7 Aging and Exercise Training on the
Neuromuscular Functions of Human Movements 105
Junichiro Yamauchi
VI Contents

Chapter 8 Tailor-Made Programs for Preventive Falls
that Match the Level of Physical Well-Being
in Community-Dwelling Older Adults 117
Minoru Yamada, Tomoki Aoyama and Hidenori Arai
Chapter 9 Vaccine-Preventable Infectious
Respiratory Diseases in the Elderly 133
Noriko Kojimahara
Chapter 10 Beneficial Effect of Viscous
Fermented Milk on Blood Glucose
and Insulin Responses to Carbohydrates
in Mice and Healthy Volunteers:
Preventive Geriatrics Approach by "Slow Calorie" 141
Mari Mori, Atsumi Hamada, Satoshi Ohashi,
Hideki Mori, Toshiya Toda and Yukio Yamori
Chapter 11 Health Education for the Elderly 153
Ayla Kececi and Serap Bulduk
Part 3 End of Life Care 177
Chapter 12 Expanding the Time Frame for Advance
Care Planning: Policy Considerations
and Implications for Research 179
Jeffrey S. Kahana, Loren D. Lovegreen
and Eva Kahana
Chapter 13 End of Life Care: Attitudes Toward
Autonomy and legal Instruments 195
Arthur Oscar Schelp
Chapter 14 Health Economics and Geriatrics:
Challenges and Opportunities 209
Julie Ratcliffe, Kate Laver, Leah Couzner and Maria Crotty

Preface

The decline in physical and mental functionality with aging has been attributed to the
endocrine dyscrasia, associated with the loss of the reproductive function with aging
(Bowen and Atwood, 2004; 2011). These biomolecular changes result in the
dysfunction and/or death of cells, and ultimately the loss of tissue function, that
presents clinically as conditions of aging (e.g. osteoporosis, arthritis) or as disease (e.g.
coronary heart disease, dementia). This book addresses a broad range of issues related
to geriatrics, including: 1) characterizing functional loss in the geriatric patient 2)
preventive strategies for the maintenance of health in the geriatric population, and 3)
end of life issues for geriatric patients that range from legal issues to patient education.
The first section of this book – ‘Functional Loss Associated with Aging’ addresses the
physical and mental decline in function associated with aging. The first chapter by
Hairi et al addresses the age-related changes in physical functioning from the
perspective of demographics, interventions and the further research required to guide
public health practitioners and clinicians as to the most appropriate interventions to
improve and maximize a person’s function. Hairi et al follow up this first chapter with
an examination of sarcopenia as a major cause of the decline in physical function with
age. As noted by the author, current research has shown promising results in the
assessment of sarcopenia, although further work is required in the management of
sarcopenic patients, in terms of prevention as well as treatment. The next two chapters
focus on specific changes in functional decline in the elderly, namely the cognitive
decline associated with vascular dementia (Ozbabalik et al.) and swallowing
difficulties (Lacoste-Ferre). Ozbabalik examine the epidemiology of vascular dementia
including the risk factors for the development of this form of dementia. Lacoste-Ferre
present new data, suggesting that disrupted mastication appears to be a factor
favoring dysphagia in the elderly, and that the preservation of dental status is a
good objective to prevent dysphagia in the institutionalized frail and dependent
elderly. Finally, Takata et al report on how lower fitness levels, for various muscle
strength tests is associated with increases in all-cause mortality as well as disease-
specific mortality in an 80-year-old community-dwelling population. This data fits
well with previous literature indicating a lower level of physical activity, physical
fitness, or muscle strength is associated with a higher total mortality in an elderly
population.
X Preface

In the next section of the book - ‘Preventative Strategies for Maintenance of Health and
Extending Longevity’ we move from an appreciation of functional decline in the
elderly to strategies of preventing frailty and extend longevity. In the first chapter of
this section, Hunkyung reviews risk factors for geriatric syndrome prior to elaborating
on treatments for frailty and falls prevention involving nutrition and exercise
strategies. Yamauchi follows by also reviewing the importance of exercise (resistance
training) as a countermeasure against sarcopenia and loss of muscle function. Indeed,
resistance training at home or in a community center (without the need for strength
training equipment) allows for important improvements in muscle function for the
elderly. In a similar vein, in the next chapter Yamada et al highlight the importance of
tailoring fall prevention programs to the elderly adult’s level of physical well-being.
Kojimahara advocate the benefits of annual immunization with influenza vaccine and
23-valent pneumococcal polysaccharide vaccine (PPV23) in the elderly with and
without chronic obstructive pulmonary disease. Decreasing the risk of heart disease,
the major killer in western society, by attenuating post-prandial hyperglycemia is the
topic of the next chapter by Mori et al. In this paper, intestinal glucose absorption after
fermented milk ingestion was shown to be attenuated experimentally in mice as well
as clinically in humans. Thus, the use of ‘Caspian Sea Yogurt’ such as used by long-
living populations in Georgia is suggested to reduce cardiovascular risk and to
contribute to the longevity. The final chapter in this section by Kececi and Bulduk
examines healthcare personnel attitudes towards the ability of the elderly to
understand and learn new information. The authors discuss the need for healthcare
professionals to be more in tune with the elderly, and to understand the physical,
psychological and socio-cultural changes that might impact learning in the elderly in
order to develop more efficient strategies to improve health promotion and
wellness.
The final section of the book examines end of life care. The first chapter by Kahana et
al advocate for educational interventions to help older patients marshal responsive
care during the extended period of service needs during the final years. As indicated
by the authors, effective advocacy by patients and families is an important
determinant upon making the final period of life more comfortable and livable. Schelp
addresses the attitudes toward autonomy and legal instruments at the end of life, and
discusses the multidimensional nature of the medical, social, cultural, religious, and
economic aspects involved in end of life decision making and care. The final chapter
by Ratcliffe et al discusses the challenges and opportunities of health economics with
respect of geriatric care. These authors discuss the methods for assessing the cost
effectiveness of new health care technologies and models of aged care service delivery,
as well as the methods adopted by health economists for measuring and valuing
patient or consumer preferences in health care.
It is hoped that the papers and reviews described here will help to update the
geriatrics research and clinical community on recent advances in identifying and
quantitating functional loss experienced by the elderly, strategies to maintain function