Evidence-Based Geriatric Medicine: A Practical Clinical Guide

203 Pages·2012·4.567 MB·English

by  Jayna Holroyd-Leduc, Madhuri Reddy

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Evidence-Based
Geriatric Medicine
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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
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• Click on the icon to access the website
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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
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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)
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1 2012
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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
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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
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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
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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
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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