Ham's Primary Care Geriatrics: A Case-Based Approach (Expert Consult: Online and Print) (Ham, Primary Care Geriatrics)

Employing a unique case-based approach, Ham's Primary Care Geriatrics continues to be your comprehensive source of clinical solutions for this challenging population. This gerontology medical reference book features an interdisciplinary perspective that empowers you with team-oriented knowledge on the best diagnosis, treatment, and management strategies available to address the complex needs of older adults. "Overall this is a useful, well written, practical elderly medicine book, ideal for use in primary care. It is reasonable priced and an excellent addition to the bookshelf, virtual or real". Reviewed by: Dr Harry Brown, July 2014 Key Features Effectively treat your geriatric patients, and provide helpful guidance to their families, through engaging geriatric case studies that illustrate the principles and key clinical information you need. Form a definitive diagnosis and create the best treatment plans possible using the evidence-based medicine guidelines throughout. Find the information you need quickly and efficiently with a 2-color layout and consistent format, and test your knowledge with USMLE-style questions in every chapter. Ifc......Page 2 Ibc......Page 3 Ham’s primary care geriatrics......Page 4 Copyright......Page 5 Dedication......Page 6 Contributors......Page 8 Preface......Page 14 Acknowledgments......Page 16 A note on level of evidence ratings......Page 17 Unit 1 Principles and Practice ......Page 18 Objectives......Page 20 Normal physiologic changes......Page 21 Functional reserve......Page 22 Increased physiologic diversity......Page 23 Immobility......Page 24 Ageism......Page 25 Cognitive impairment and worry......Page 26 Relationships and family are crucial to health and survival......Page 27 Multiple morbidity and the geriatric syndromes......Page 28 Slow medicine......Page 29 Polypharmacy......Page 30 Transitions in care are dangerous......Page 31 Interprofessional nature of geriatric care......Page 32 A generalist is often the best clinician for a geriatric patient......Page 33 Web resources......Page 34 Test question answers......Page 35 Objectives......Page 37 Teams in different geriatric care settings......Page 38 Roles of core team members......Page 39 Team leadership......Page 44 Mutual support......Page 45 Communication......Page 47 Role of the patient and family in the team......Page 48 Summary......Page 49 Test question answers......Page 51 Objectives......Page 52 Aspects of care unique to older adults......Page 53 Pre-encounter preparation......Page 54 Medications......Page 55 Social history......Page 56 Functional screen......Page 57 Review of systems......Page 59 Geriatric-specific physical exam......Page 60 Goals of care......Page 62 Caregiver support......Page 63 Key references......Page 64 Test question answers......Page 65 Essentials of health promotion for aging adults......Page 67 Immunizations......Page 68 Screening for alcohol use/abuse......Page 69 Guidelines for physical activity......Page 70 Fats......Page 71 Assessment of nutritional health and approach to obesity......Page 72 Beta-blockers......Page 73 Bisphosphonates......Page 74 Putting prevention into practice......Page 75 Patient facilitators......Page 76 Summary......Page 79 Key references......Page 80 Test answers......Page 81 Defining cultural competency......Page 84 Dementia, personhood, and culture......Page 85 Palliative care and “giving up”......Page 86 Talking about dying......Page 87 Discussing prognosis: Offering truth......Page 88 Experience and expectations shape doctor-patient interactions......Page 89 Summary......Page 91 Key references......Page 92 Test question answers......Page 93 Pharmacokinetic changes in the elderly......Page 96 Distribution......Page 97 Elimination......Page 98 General guidelines for safe prescribing......Page 99 Explicit criteria for prescribing......Page 100 Adherence AIDS......Page 103 Medicare part d......Page 104 Key references......Page 105 Test question answers......Page 106 Objectives......Page 108 Autonomy......Page 109 Structure for deliberating ethical dilemmas......Page 110 Informed consent......Page 112 Disclosure of medical error......Page 114 Advance directives......Page 115 Futility......Page 118 Do-not-resuscitate orders......Page 119 Assisted suicide and the double effect......Page 120 Cultural and religious considerations......Page 121 Key references......Page 122 Test question answers......Page 123 Unique financial challenges of older adults......Page 126 Fundamentals of public funding of health care for older adults......Page 127 Community-based services......Page 128 Federal insurance coverage for older americans......Page 129 Patient’s perspective on payment for health care......Page 130 Post-acute rehabilitation.......Page 131 Medicare advantage (part c)......Page 132 Assisted living......Page 133 Medicaid waiver programs......Page 134 Web resources......Page 135 Test question answers......Page 136 Coding systems......Page 138 Knowing payer, benefits, medicare contractor, specialty/licensure, and group rules......Page 139 Evaluation and management services......Page 140 Documentation guidelines and current procedural terminology (CPT) definitions......Page 141 Time and face-to-face services......Page 142 Working as a team—”incident to,” shared visits, and teaching......Page 143 Participation status......Page 144 Web resources......Page 145 Objectives......Page 147 Hospital design and systems change to benefit older adults......Page 148 The admission process: Opportunities for health status updates......Page 149 Establishing goals of care......Page 150 Active cardiac conditions......Page 151 Perioperative pulmonary complications......Page 153 Interventions to reduce pulmonary complications......Page 154 Postoperative anemia......Page 155 Delirium prevention......Page 156 Skin care......Page 157 Preventing infections in the hospital......Page 158 Maintaining nutrition......Page 159 Glycemic control in the hospital......Page 160 The coleman care transitions intervention......Page 161 The ideal discharge for the elderly patient......Page 162 Key references......Page 163 Test question answers......Page 164 Objectives......Page 168 Nursing homes......Page 169 Residential care / assisted living (rc/al) communities......Page 171 Medical care provider practice patterns long-term care......Page 172 Residential care communities......Page 174 Common clinical challenges......Page 175 Common ethical dilemmas......Page 177 Federal structures that promote nursing home quality......Page 178 Enhancing quality of care and quality of life through individualized (“person-centered”) care......Page 179 Innovative models......Page 180 Key references......Page 182 Test question answers......Page 184 What is home care?......Page 187 How is home care delivered?......Page 189 Does home care work?......Page 190 Summary......Page 191 Key references......Page 192 Test question answers......Page 193 Rehabilitation and the older individual......Page 195 Rehabilitation settings......Page 197 Rehabilitation team......Page 199 Prevention of deconditioning during acute illness......Page 200 Gait rehabilitation, hip replacements, and fractures......Page 201 Stroke rehabilitation......Page 203 Cardiac rehabilitation......Page 204 Aging with a long-standing disability......Page 205 Rehabilitation and cognitive problems......Page 206 Assistive devices......Page 207 Key references......Page 210 Test question answers......Page 211 What is palliative care?......Page 216 Pain assessment......Page 218 Treatment of pain......Page 219 Opioid medications......Page 220 Management of nonpain symptoms......Page 222 Communicating with patients and families......Page 224 Key references......Page 226 Test question answers......Page 227 Unit 2 Geriatric Syndromes and Common Special Problems ......Page 229 Objectives......Page 231 Primary care and the emergency department......Page 232 Systems-based practice (sbp)......Page 233 “the abcs”......Page 234 COPD exacerbations......Page 235 Treatment: Interventions that require transfer to the closest ed......Page 236 Management of syncope......Page 237 Overview......Page 238 Under-referral to trauma centers......Page 239 Urgency of stroke care......Page 240 Stroke center management......Page 241 Assessment......Page 242 Summary: Sepsis......Page 243 Management......Page 244 Transitions of care......Page 245 Key references......Page 246 Test question answers......Page 247 Definition and pathogenesis of delirium......Page 252 Prevalence and impact of delirium......Page 253 Risk factors and precipitating factors......Page 254 Diagnosis and assessment of delirium......Page 256 Management of delirium......Page 258 Key references......Page 259 Test question answers......Page 260 Prevalence and impact......Page 263 Differential diagnosis......Page 264 Screening for cognitive impairment......Page 265 Diagnostic evaluation of the person with a positive screen for cognitive impairment......Page 266 Making a specific diagnosis in persons with dementia......Page 267 Evaluating for delirium and depression......Page 268 Treatment of vascular risk factors......Page 269 Management of dementia......Page 270 Management of behavioral symptoms......Page 272 Working with families and community resources......Page 273 Acknowledgment......Page 274 Key references......Page 275 Test question answers......Page 276 Prevalence and impact......Page 279 Diagnosis of late life depression......Page 280 Depression and cognitive impairment......Page 281 Depression secondary to a general medical condition......Page 282 Assessment......Page 283 Suicide......Page 285 Management......Page 286 Ssris......Page 287 Tcas. ......Page 288 Other treatment considerations......Page 289 Other somatic treatments......Page 290 Key references......Page 291 Test question answers......Page 292 Prevalence and impact......Page 296 Differential diagnosis and assessment......Page 297 History and physical examination......Page 299 Usual and maximal gait speed......Page 300 Exercise and gait training......Page 301 Surgical management......Page 302 Key references......Page 303 Test question answers......Page 304 Prevalence and impact......Page 307 Precipitating causes and risk factors for falls......Page 308 Assessing the patient who has fallen......Page 310 Assessing a person for future fall risk......Page 311 Management of the acute faller......Page 312 Prevention of future falls......Page 313 Key references......Page 314 Test question answers......Page 315 Prevalence and impact......Page 317 Clinical history......Page 318 Medications......Page 319 Orthostatic hypotension (oh).......Page 323 Causes of dizziness that often do not fit neatly into a subtype......Page 324 Importance of determining the episodic or continuous nature of dizziness......Page 325 Physical examination......Page 326 Laboratory testing......Page 327 Management......Page 328 Vestibular rehabilitation......Page 329 Web resources......Page 330 Key references......Page 331 Test question answers......Page 332 Prevalence and impact......Page 335 Neurally mediated syncope......Page 336 Drug-induced syncope......Page 338 Evaluation......Page 339 Ruling out cardiac causes......Page 340 Psychiatric evaluation......Page 342 Treatment of cardiac syncope......Page 343 Summary......Page 344 Key references......Page 345 Test question answers......Page 346 Prevalence and impact......Page 348 Risk factors and pathophysiology......Page 349 Differential diagnosis and assessment......Page 351 Management......Page 354 Pharmacologic therapy......Page 355 Surgery......Page 358 Test question answers......Page 360 References......Page 361 Prevalence, impact, and definitions......Page 363 Primary and secondary causes of constipation and fecal incontinence......Page 364 Treatment of constipation......Page 366 Pharmacologic treatments (including over-the-counter preparations)......Page 368 Dietary and behavioral interventions for fi......Page 369 Pharmacologic treatment......Page 370 Treatment of incontinence-associated dermatitis......Page 371 Key references......Page 372 Test question answers......Page 373 Prevalence and impact......Page 375 Aging changes......Page 376 Conductive hearing loss......Page 377 Screening......Page 378 Hearing disability self-report measures......Page 379 Counseling older adults about hearing health services......Page 380 Types of hearing AIDS......Page 381 Managing feedback in hearing AIDS......Page 382 Audiologic rehabilitation courses......Page 383 Key references......Page 384 Visual impairment with age......Page 387 Management......Page 388 Prevalence and impact......Page 389 Risk factors and pathophysiology......Page 390 Key references......Page 391 Test question answers......Page 392 Prevalence and impact......Page 394 Pain assessment......Page 395 Pain quantitation......Page 396 Nonsteroidal antiinflammatory drugs (nsaids)......Page 397 Topical agents......Page 398 Opioids......Page 399 Anticonvulsants......Page 400 Nonpharmacologic strategies......Page 401 Key references......Page 402 Test question answers......Page 403 Prevalence and impact......Page 405 Normal aging changes......Page 406 Nutrition screening and assessment......Page 407 Nutrition evaluation tools......Page 408 Swallowing problems......Page 409 Treatment of common feeding and swallowing problems......Page 410 Nutrition support......Page 411 Key references......Page 412 Test question answers......Page 413 Objectives......Page 415 Etiology of frailty......Page 416 Models of frailty......Page 417 Is recognition of frailty helpful to the clinician?......Page 418 Transitions to frailty......Page 419 Treatment options for frailty......Page 420 Falls and frailty......Page 421 Cultural considerations......Page 422 Coordination of care......Page 423 Key references......Page 424 Test question answers......Page 425 Epidemiology and differential diagnosis......Page 428 Risk factors and prevention......Page 429 Preventive measures......Page 430 Staging......Page 432 Treatment strategies......Page 434 Pressure offloading......Page 435 Diagnosing and managing infection......Page 436 Key references......Page 437 Test question answers......Page 438 Prevalence and impact......Page 440 Risk factors and pathophysiology......Page 441 Differential diagnosis and assessment......Page 442 Sleep-disordered breathing (sleep apnea)......Page 443 Management......Page 444 Behavioral treatment of insomnia......Page 445 Pharmacologic treatment......Page 446 Other sleep disorders......Page 447 Key references......Page 448 Test question answers......Page 449 Erectile physiology and dysfunction......Page 451 Evaluation of erectile dysfunction......Page 453 Treatment of erectile dysfunction......Page 454 Female sexuality: Definition and epidemiology......Page 455 Evaluation and treatment......Page 456 Key references......Page 458 Test question answers......Page 459 Objectives......Page 462 Incidence and impact......Page 463 Barriers to diagnosis......Page 464 Assessment......Page 465 Key references......Page 466 Test question answers......Page 467 Definition......Page 469 Impact of alcohol use......Page 470 Screening and detection......Page 471 Alcoholism and other illnesses......Page 473 Detoxification......Page 474 Key references......Page 475 Test question answers......Page 476 Prevalence and impact......Page 478 Cognitive function......Page 479 Medical conditions and medications......Page 480 Diagnosis and assessment......Page 482 Legal and ethical issues......Page 483 Key references......Page 484 Test question answers......Page 485 Unit 3 Selected Clinical Problems of the Organ Systems ......Page 488 Adverse outcomes......Page 490 Rationale for treatment......Page 491 Risk factors and pathophysiology......Page 493 Markedly elevated blood pressures......Page 494 Past medical history......Page 495 Weight loss......Page 496 Physical activity......Page 497 Overview of medications......Page 498 Uncomplicated hypertension.......Page 499 Coronary artery disease.......Page 500 Dementia.......Page 501 Web resources......Page 502 Key references......Page 503 Test question answers......Page 504 Prevalence and impact......Page 508 Angina pectoris......Page 509 Diagnosis and assessment of acute coronary syndrome......Page 512 Unstable angina......Page 513 Role of the pcp in the care of the patient in ICU......Page 514 Atrial fibrillation (AF)......Page 515 Rate control for atrial fibrillation......Page 516 Anticoagulation and atrial fibrillation......Page 517 AF......Page 518 Risk factors and pathophysiology......Page 522 Precipitating factors......Page 523 Management......Page 524 Treatment......Page 527 Test question answers......Page 528 Peripheral vascular disease......Page 531 History......Page 532 Da......Page 533 Indications for diagnostic study......Page 534 MRI......Page 535 Indications for diagnostic study......Page 536 MRI......Page 537 Outcomes......Page 538 Key references......Page 539 Test question answers......Page 540 References......Page 541 Pathophysiology......Page 542 Transient ischemic attacks (tias)......Page 544 Modifiable risks......Page 546 Hyperacute management......Page 547 Subacute management......Page 548 Summary......Page 549 Key references......Page 550 Test question answers......Page 551 Prevalence and impact......Page 553 Presenting symptoms......Page 554 Screening for and confirming the diagnosis......Page 555 Management......Page 556 Sulfonylureas......Page 557 Insulin......Page 558 Osteoporosis......Page 559 Diabetes education......Page 560 Key references......Page 561 Impact......Page 564 Subclinical hypothyroidism......Page 565 Screening of the asymptomatic patient......Page 566 Management......Page 567 Key references......Page 568 Test question answers......Page 569 Objectives......Page 571 Risk factors and pathophysiology......Page 572 Fracture history......Page 573 Identification of secondary causes and risk factors......Page 574 Universal recommendations......Page 575 Pharmacologic therapy......Page 576 Calcitonin......Page 578 Estrogen......Page 579 Summary......Page 580 Test question answers......Page 581 Osteoarthritis......Page 584 Gout......Page 588 Role of arthrocentesis......Page 589 Osteoarthritis......Page 590 Rheumatoid arthritis......Page 591 Summary......Page 592 Test question answers......Page 593 Primary care considerations in the older patient......Page 596 Changes in the foot in relation to age......Page 597 Diabetes and foot care......Page 598 Onychia......Page 600 Ingrown toenails (onychocryptosis)......Page 601 Hyperkeratotic lesions......Page 602 Foot deformities......Page 603 Key references......Page 604 Cancer in the elderly......Page 607 Cancer biology and aging......Page 608 Evidence-based treatment......Page 609 Staging the aging......Page 610 Hormonal therapy......Page 612 Cytotoxic chemotherapy......Page 613 Targeted therapy......Page 614 Metastatic carcinoma of the breast......Page 616 Prostate cancer......Page 618 Colon cancer......Page 619 Key references......Page 621 Definition of anemia......Page 627 Causes of anemia (box 47-1)......Page 628 Consequences of anemia......Page 630 Treatment of anemia......Page 631 Key references......Page 632 Pulmonary physiology and aging......Page 636 Assessment of pulmonary diseases based on signs and symptoms......Page 637 Diagnosis......Page 638 Treatment......Page 639 Definition and epidemiology......Page 643 Treatment......Page 644 Restrictive pulmonary diseases in the older adult......Page 646 Diagnosis......Page 647 Methacholine bronchoprovocation challenge test......Page 648 Pulmonary imaging......Page 649 Key references......Page 650 General prevalence and impact......Page 653 General principles of diagnosis, assessment, and management......Page 654 Empiric therapy versus culture-based treatment......Page 655 Antibiotic resistance......Page 657 Pathophysiology and risk factors......Page 660 Uncomplicated uti. ......Page 661 Complicated uti. ......Page 662 Differential diagnosis, assessment, and management......Page 664 Atypical pneumonia......Page 665 Management and treatment......Page 666 Pathophysiology and risk factors......Page 667 Diagnosis.......Page 668 Diagnosis.......Page 669 Prevalence and impact......Page 670 Toxin-mediated diarrheas.......Page 671 Management and treatment of toxin-mediated diarrheas. ......Page 672 Differential diagnosis, assessment, and management......Page 673 Management and treatment......Page 674 Key references......Page 675 Risk factors and pathophysiology......Page 681 Differential diagnosis and assessment......Page 682 Laboratory testing......Page 683 Management......Page 684 Patient–clinician discussions......Page 685 Outcomes after operative management......Page 686 Key references......Page 687 Incidence and prevalence......Page 690 Overview of anatomy and physiology including age-related changes......Page 691 Clinical manifestations......Page 692 Bph: Differential diagnosis and assessment......Page 693 Lifestyle interventions and self-management......Page 694 Alpha-blockers......Page 696 5-alpha-reductase inhibitors......Page 697 Surgical therapy......Page 698 Prostatitis: Differential diagnosis and assessment......Page 699 Acute bacterial prostatitis......Page 700 Key references......Page 701 Pathology......Page 706 Levodopa responsiveness......Page 707 Nonmotor features......Page 708 Differential diagnosis......Page 709 Management......Page 710 Motor fluctuations......Page 711 Management of tremor......Page 712 Management of the secondary effects of parkinson’s disease......Page 713 Key references......Page 714 Test question answers......Page 715 References......Page 716 Oral–systemic linkages......Page 717 Differential diagnosis and assessment......Page 718 Prevalence and impact......Page 719 Management......Page 720 Differential diagnosis and assessment......Page 721 Low utilization of dental services......Page 722 Oral health screening......Page 723 Preventing infective endocarditis......Page 724 Summary......Page 725 Acknowledgments......Page 726 Key references......Page 727 References......Page 728 Dermatologic examination: Challenges and practical approaches......Page 730 Four-point dermatologic description......Page 731 Eczematous dermatoses......Page 733 Benign cutaneous processes......Page 734 Cutaneous malignancies......Page 735 Basal cell carcinoma......Page 736 Pruritus......Page 737 Rosacea......Page 739 Herpes zoster (shingles) and postherpetic neuralgia......Page 742 Key references......Page 744 A......Page 750 C......Page 752 D......Page 754 F......Page 756 G......Page 757 H......Page 758 L......Page 759 M......Page 760 O......Page 761 P......Page 762 R......Page 764 S......Page 765 T......Page 766 Z......Page 767 Clinical key......Page 768

Employing a unique case-based approach, Ham's Primary Care Geriatrics continues to be your comprehensive source of clinical solutions for this challenging population. This gerontology medical reference book features an interdisciplinary perspective that empowers you with team-oriented knowledge on the best diagnosis, treatment, and management strategies available to address the complex needs of older adults.

"Overall this is a useful, well written, practical elderly medicine book, ideal for use in primary care. It is reasonable priced and an excellent addition to the bookshelf, virtual or real". Reviewed by: Dr Harry Brown, July 2014

• Effectively treat your geriatric patients, and provide helpful guidance to their families, through engaging geriatric case studies that illustrate the principles and key clinical information you need.
• Form a definitive diagnosis and create the best treatment plans possible using the evidence-based medicine guidelines throughout.
• Find the information you need quickly and efficiently with a 2-color layout and consistent format, and test your knowledge with USMLE-style questions in every chapter.

• Offer your geriatric patients the most up-to-date treatment options available with six new chapters addressing Principles of Primary Care of Older Adults, Interprofessional Team Care, Billing and Coding, Frailty, Pressure Ulcers, and Anemia.
• Access the complete geriatric text online anytime, anywhere at Expert Consult, along with an online Cognitive Status Assessment with four tests and patient teaching guides, a dermatology quiz, and informative videos on Gait and Balance and Dizziness.

Employing a unique case-based approach, Ham's Primary Care Geriatrics continues to be a comprehensive source of clinical solutions for this challenging population. This gerontology medical reference book features an interdisciplinary perspective that empowers you with team-oriented knowledge on the best diagnosis, treatment, and management strategies available to address the complex needs of older adults. Effectively treat your geriatric patients, and provide helpful guidance to their families, through engaging geriatric case studies that illustrate the principles and key clinical information you need. Form a definitive diagnosis and create the best treatment plans possible using the evidence-based medicine guidelines throughout. Find the information you need quickly and efficiently with a 2-color layout and consistent format, and test your knowledge with USMLE-style questions in every chapter. Offer your geriatric patients the most up-to-date treatment options available with six new chapters addressing Principles of Primary Care of Older Adults, Interprofessional Team Care, Billing and Coding, Frailty, Pressure Ulcers, and Anemia