Geriatrics for Specialists

399 Pages·2021·10.568 MB·English

by  Andrew G. Lee (editor), Jane F. Potter (editor), G. Michael Harper (editor)

Andrew G. Lee
Jane F. Potter
G. Michael Harper
Editors
Geriatrics
for Specialists
Second Edition
123
Geriatrics for Specialists
Andrew G. Lee • Jane F. Potter
G. Michael Harper
Editors
Geriatrics for Specialists
Second Edition
Editors
Andrew G. Lee Jane F. Potter
Blanton Eye Institute Home Instead Center for Successful Aging
Houston Methodist Hospital University of Nebraska Medical Center
Houston, TX Omaha, NE
USA USA
G. Michael Harper
San Francisco VA Health Care System
University of California, San Francisco
San Francisco, CA
USA
ISBN 978-3-030-76270-4 ISBN 978-3-030-76271-1 (eBook)
https://doi.org/10.1007/978-3-030-76271-1
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Foreword to the Second Edition
In the later decades, America witnessed the increasing population of seniors and many with
complex healthcare problems. This demographic reality energized organizations to help clini-
cians create knowledge to more effectively provide healthcare to the increasing populations of
medically complex and vulnerable seniors.
This book reflects the pioneering work of the American Geriatrics Society and one of its
programs, the Geriatric for Specialists Initiative. This initiative from 1994 to 2019 in partner-
ship with the John A. Hartford Foundation provided a series of grants to develop and expand
research, teaching, and advocacy to help specialty physicians provide the highest quality care
for seniors. Also, collaborative grant support from the Atlantic Philanthropies helped expand
the initiative from 2002 through 2014.
The initiative’s central premise was geriatric concepts and principles must be a part of the
expertise of all clinicians caring for adults. Specialty leaders focused on geriatrics were needed.
The Initiative supported potential leaders with scholarships to help develop the science needed
to improve the healthcare of seniors. Now this scholarship program continues under the aus-
pices of the NIA/NIH: Grants for Emerging Medical/Surgical Specialists Transitioning to
Aging Research (GEMSSTAR). The Geriatrics for Specialists Initiative also fostered geriatrics
innovations in postgraduate education and encouraged geriatric principles inclusion in spe-
cialty curricula and board examinations.
Many of these scholars, educators, their mentors and geriatrician partners created this text-
book, Geriatrics for Specialists, published originally in 2017. With the expanding scientific
basis for providing healthcare for seniors, this second addition is timely.
Now national organizations are moving broadly to infuse geriatric principles among spe-
cialty clinicians. For example, the American College of Surgeons, in 2019, launched the
Geriatric Surgical Verification Program (similar to their programs in trauma and bariatric sur-
gery). In addition, emergency medicine, anesthesiology, ophthalmology, and cardiology exem-
plify the many organizations focusing on programs to generalize geriatric concepts within their
disciplines.
The second edition of Geriatrics for Specialists is edited by leaders of the Geriatrics for
Specialists Initiative and written by geriatric focused specialists and geriatricians. I was greatly
honored to participate in the creation of the first edition. Now from retirement, I am proud of
and confident in the committed and talented editors and the many authors they have selected
for this new edition. They have enriched greatly this textbook.
Professor Emeritus, The Johns Hopkins University School of Medicine John R. Burton,
Baltimore, MD, USA
v
Preface to the Second Edition
Reasons for This Book
Over the last two decades, medical and surgical specialists have collaborated to bring together
individual advances for geriatric populations within their specialties. This has resulted in a
robust body of knowledge that now guides the standards of care for older people, the research
agenda for the future, and the innovations in geriatric education among specialty trainees. This
book is intended to fill the void of a single source of knowledge concerning these advances in
specialty care. This second edition expands the number of specialist chapters reflecting growth
in research in aging and clinical care for older people in dermatology, plastic surgery, and
behavioral neurology.
Intended Audience
This book is designed to be a resource to the following major audiences:
(a) Specialty clinicians caring for seniors.
(b) Researchers with interest in the geriatric aspects of specialty fields. Chapters include
description of the limits on knowledge and propose next research questions.
(c) Academicians who create and deliver content on aging within the clinical graduate and
postgraduate specialty training programs.
(d) Geriatricians seeking in-depth knowledge of specialty care for older patients.
(e) Members of the interprofessional teams that are so critical to clinical care and research
within geriatrics, including nursing, social work, pharmacy, physical and occupational
therapies, and others.
(f) Policy makers seeking to understand the strength of evidence concerning quality care for
older patients provided by specialists and their associates.
The Approach Used in Developing the Book
This book is divided into three parts: crosscutting issues, medical specialties, and surgical and
related specialties.
Part I: The first part deals with the crosscutting issues and addresses concepts of critical
importance to all specialist providers who conduct research for and about and who also care
for older patients. These chapters are cross-referenced heavily throughout Parts II and III. This
has reduced repetition within individual chapters on critical concepts such as frailty, assess-
ment tools, delirium, dementia, pharmacology, and perioperative care, while allowing authors
to describe in detail where these concepts fit specifically within that discipline and relevant
related literature.
vii
viii Preface to the Second Edition
Parts II and III: The surgical (Part II) and medical (Part III) parts of the book are a series of
chapters addressing the major selected surgical and medical disciplines; important related spe-
cialties (e.g., rehabilitation) are included in the surgical part.
The editors developed the table of contents reflecting the state of knowledge and then
recruited specialty authors who are active in clinical care, teaching, and research in geriatrics.
The editors then worked with the authors to ensure that the focus of the book was practical,
timely, and clear so it could be a reliable resource in everyday practice.
Background
The editors acknowledge the work of many over two decades and in particular the inspiration
of the late Drs. Dennis Jahnigen and T. Franklin Williams. Dr. Jahnigen initiated the geriatric
surgical and related specialties movement in the 1990s, and Dr. Williams inspired much of the
work to embed geriatric principles into the subspecialties of internal medicine. Both of these
individuals were prominent geriatricians: Dr. Jahnigen was a past president of the American
Geriatrics Society (AGS), and Dr. Williams was a past director of the National Institute on
Aging. While Drs. Jahnigen and Williams initiated this work, the major developments that fol-
lowed fell to their successors. The surgical and related specialty work was initiated within the
AGS and was led by the late Dr. David Solomon and Dr. John Burton, who were joined by Dr.
Andrew Lee and others, including Dr. Jane F. Potter and Dr. Michael Harper, both of whom
served in leadership positions in the program. The work related to the development of geriat-
rics in the medical specialties was led by Drs. William Hazzard and Kevin High and became a
program of the Association of Specialty Professors (ASP). The strategy behind this collabora-
tive effort was to recruit and nurture promising young faculty and trainees in the geriatric
aspects of their specialty. This investment over the last almost three decades in medical and
surgical specialists is a unique national success resulting in a robust body of knowledge related
to specialty care of older adults.
Critical to the success of this effort was the AGS leadership, notably Nancy Lundebjerg,
whose dedication and hard work have moved the inspiration of its founders into a growing
focus within the American Geriatrics Society and in American medicine. None of this work
would have been possible without the encouragement and support of the John A. Hartford
Foundation and its president until 2015, Corinne H. Rieder, EdD. The program director,
Christopher Langston, and senior project officers (Laura Robbins, Donna Regenstrief, and
Marcus Escobedo) of the John A. Hartford Foundation for the two programs (surgical and
related specialties within the AGS and the medical specialties within the ASP) were full part-
ners throughout the development and operation of these programs. Their dedication, vision,
and commitment ensured success and inspired all involved in the projects. Collectively, they
formed a critical force behind the work that made this book possible. Within the AGS, the
effort became known as the Geriatrics for Specialists Initiative (GSI). The GSI has evolved
into an active group of physician specialists, geriatricians, and health professionals from other
disciplines. The GSI fosters geriatric principles in education and research broadly in medical
centers and within specialty societies and governing and regulatory bodies. The sustained
effort within the AGS of the GSI has evolved into the Section for Enhancing Geriatric
Understanding and Expertise Among Surgical and Medical Specialists (SEGUE). The leader-
ship of SEGUE is now entirely specialists. This book is a natural succession of the work of the
GSI and SEGUE within the AGS and the geriatrics program of the ASP. The career develop-
ment programs, originally sponsored by the specialty organizations, were subsumed by the
National Institute on Aging with the initiation of their program in 2011: Grants for Early
Medical and Surgical Specialists Transitioning to Aging Research (GEMSSTAR). Many of the
Preface to the Second Edition ix
chapters are written by the new cohort of geriatric specialty scholars and their mentors and
trainees associated with the GSI/SEGUE program of the AGS and the geriatrics program of the
ASP. I am happy to turn over the leadership reins for SEGUE to Tom Robinson, MD, and Mike
Harper, MD, who will carry our organization to new heights.
Houston, TX, USA Andrew G. Lee
Acknowledgment
Dr. Andrew Lee would like to acknowledge and thank his mentor (and friend) in geriatrics, Dr.
John Burton. Dr. Burton has inspired a generation of geriatricians but also geriatric specialists
(including me) to listen harder, to move faster, and to see further in geriatric surgical and
related medical specialty care. It is rare that one gets to thank one’s personal heroes in print and
so I am grateful for the opportunity now to recognize my friend, my colleague, and my role
model and mentor, John Burton. Dr. Lee also would like to recognize and thank his older and
wiser parents, Alberto C. Lee, MD, and Rosalind Lee, MD, for proving that “getting older isn’t
the same thing as getting old” and that “only young people worry about getting old.” He would
like to thank his perpetually patient and loving wife, Hilary A. Beaver, MD, for her years of
service in her own right to the cause of geriatric ophthalmology and for not just tolerating but
embracing her “old man” and his academic and personal quirks and idiosyncrasies. Dr. Lee is
also grateful for the love and comfort of his two wonderful daughters, Rachael E. Lee and
Virginia A. Lee whom he hopes will have learned to value the wisdom of elders and to his
siblings Amy Lee Wirts, MD, and Richard Lee to whom he owes a lifetime of sibling wit,
shenanigans, and life experience. Finally, Dr. Lee thanks his colleagues and peers in ophthal-
mology, Neil R. Miller, MD, Anthony Arnold, MD, and Paul Brazis, MD, who have shown him
that the path to academic retirement means that although there will be no answers, that there
will be stories and the journey does not end at Professor Emeritus.
Houston, TX, USA Andrew G. Lee
xi
Contents
1 Frailty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Jeremy D. Walston
2 Delirium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Thomas N. Robinson
3 Preoperative Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Mark R. Katlic, Susan E. Wozniak, and Jo Ann Coleman
4 Psychiatric Disorders in Older Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Kelly L. Dunn and Robert Roca
5 Medication Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Nicole J. Brandt and Hedva Barenholtz Levy
6 Palliative Care and End-of-Life Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Danielle J. Doberman and Elizabeth L. Cobbs
7 Hospital Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Serena Jain Scott, Tejo K. Vemulapalli, and Mindy J. Fain
8 Screening Tools for Geriatric Assessment by Specialists . . . . . . . . . . . . . . . . . . . . . 87
Jane F. Potter and G. Michael Harper
9 Cardiothoracic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Joseph C. Cleveland Jr
10 Emergency Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101
Teresita M. Hogan, Thomas Spiegel, and Jonathan Oskvarek
11 Geriatric Trauma and Emergency General Surgery . . . . . . . . . . . . . . . . . . . . . . . .117
Bellal Joseph, Omar Obaid, and Mindy J. Fain
12 Special Evidence-Based Considerations in Geriatric Gynecologic Care:
Pelvic Floor Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137
Kyle P. Norris, Jana D. Illston, Joseph M. Malek, David R. Ellington,
and Holly E. Richter
13 Geriatric Cross-Cutting Issues in Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . .159
Andrew G. Lee and Hilary A. Beaver
14 Geriatric Orthopedic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169
Stephen L. Kates, Jason S. Lipof, and Stephen D. Wahl
15 Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183
Dale C. Strasser
16 Urology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193
Tomas L. Griebling
xiii