Table Of ContentClassic Papers in Geriatric Medicine
with Current Commentaries
Aging Medicine
Robert J. Pignolo, MD, PhD; Mary Ann Forciea, MD;
Jerry C. Johnson, MD,
Series Editors
Age-Related Changes of the Human Eye, edited by Carlo A. Cavallotti and
Luciano Cerrulli,2008
Classic Papers in Geriatric Medicine with Current Commentaries, edited by
Robert J. Pignolo, Monica K. Crane, and Mary Ann Forciea, 2008
Eldercare Technology for Clinical Practitioners, edited by Robin Felder and
Majd Alwan, 2008
Handbook of Pain Relief in Older Adults: An Evidence Based Approach,
edited by Michael F. Gloth, 2004
Classic Papers in
Geriatric Medicine
with Current
Commentaries
Edited by
Robert 1. Pignolo, MD, PhD
Division ofGeriatric Medicine
University ofPennsylvania School ofMedicine
Philadelphia, Pennsylvania, USA
Monica K. Crane,
MD
Geriatric Medicine, Memory Health Clinic
Carolina Health Care System
Charlotte, North Carolina, USA
Mary Ann Forciea,
MD
Division ofGeriatric Medicine
University ofPennsylvania Health System
Philadelphia, Pennsylvania, USA
Editors
Robert1.Pignolo,MD,PhD Monica K.Crane, MD
Assistant ProfessorofMedicine Medical Director
Division of Geriatric Medicine GeriatricMedicine
University of Pennsylvania Memory Health Clinic
School of Medicine AttendingSenior Health Connection
Philadelphia,PA CarolinaHealth Care System
USA Charlotte,NC
USA
MaryAnn Forciea, MD
ClinicalAssociate ProfessorofMedicine
Division of GeriatricMedicine
University ofPennsylvania Health System
Philadelphia,PA
USA
Series Editors
Robert1.Pignolo,MD,PhD MaryAnn Forciea, MD
Assistant Professorof Medicine ClinicalAssociate ProfessorofMedicine
Division of GeriatricMedicine Division ofGeriatricMedicine
University of Pennsylvania University of Pennsylvania Health
School of Medicine System
Philadelphia,PA Philadelphia,PA
USA USA
Jerry C.Johnson, MD
Professor and Chief,GeriatricMedicine
Division
University of Pennsylvania School of
Medicine
Philadelphia,PA
USA
ISBN:978-1-58829-998-7 e-ISBN:978-1-59745-428-5
001:10.1007/978-1-59745-428-5
LibraryofCongressControl Number:2007941270
©2008Humana Press,apartofSpringerScience+BusinessMedia,LLC
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Preface: What Makes a Classic?
Classic Papers in Geriatric
Medicine with Current
Commentaries
"Who said so?" "Why do we do that?" Just as in life, an awareness of our
"ancestry" in the form of landmark papers and observations that guide our
practice and thinking givesusafoundation and abaseforfurther inquiry. The
field of geriatrics is a relative newcomer as an organized specialty, but its
foundations are rooted in the classicpapers ofearly descriptions ofagingand
age-related diseases, as well as in more recent studies on the physiologic
mechanisms and possible clinical interventions in these often-chronic pro
cesses.Easy accesstothose landmarkpaperscanhelp usinour ownreflections
on our clinical practices, in achieving a more thorough understanding of the
backgroundofresearch,and inteachingthe richness ofour intellectualhistory
for our trainees and students. In this book, the editors focus on the clinical
discipline of geriatric medicine and some of the classic papers that have
changed the waywe think about and practice the care of elderly people.
In choosing the "classic" papers, we have used a combination of expert
opinion and objective assessment. In most cases, these criteria were inagree
ment, but in some cases they were not, nor were they alwaysexpected to be.
For example, it would be difficult to assign an impact factor to the original
description of an age-related disease, but certainly there can be no doubt of
itshistoric importance. Similarly, papers that have shown a clinicalimpact on
patient care are surely at least as well read, if not more, by practitioners as
researchers who continue to work in the field;and yet there islittle objective
means toquantitatethiseffect.The 15areaschosenforinclusioninthisvolume
represent the beginnings ofpractice and thoughts about the best waysto care
for older patients. Many other contributions fell victim to space limitations.
We have often chosen early or representative examples ofpapersthat have
substantially contributed to care of the aged. We have selected papers in
disease-specific areas (dementia),health systems (home care),and education.
In general, despite the plethora of review articles in geriatric medicine, and
also accepting that some of these papers represent clear and compelling
thought in the field, we have chosen to exclude review articles, preferring
primary source material wherever possible.The exceptions are those papers
that have contributed sentinel ideas and hypotheses on which current work is
so closely based;for example, Finucane's summary of evidence of the utility
of tube feeding in patients with dementia.
Each paper isintroduced by a commentary. These commentaries describe
the singular contributionsofthe chosen paper,giveashortlistofotherimpor
tant early papers in that area,and, in many cases, reflect on progress in that
particular field. The commentaries are personal statements by the authors
v
vi Preface: What Makes a Classic?
about the influence of the papers chosen;the commentaries are not meant to
be exhaustive reviews of the clinicalarea in question.
An accepted measure ofthe importance ofa paperisitsability to retain its
impact overtime.Whilemanyofthe classicpapersinthiscollectionhavestood
the test of time, others have gained classicstatus by virtue of their profound
influence in relatively quick measure or because of timeliness in fillinga void
in knowledge.
Clinical impact, citation frequency, historical value, timeliness or
timelessness-these are the attributes that we assign these landmark papers
in geriatrics. We hope that their rediscovery or first-time reading will sur
prise and motivate the reader to continue the clinicaland research endeavors
undoubtedly induced by these classicsin their original readers.
RobertJ. Pignolo, MD, PhD
Monica K. Crane, MD
Mary Ann Forciea, MD
Acknowledgments
We thank Yamina Hayman-Pratt for her technical help in putting the manu
script for this book together. We appreciate the supportfor this projectgiven
tousfrom RichardLansingofHumanaPress.Weespeciallythankourfamilies
for their encouragement throughout the writing and editing process.
RobertJ. Pignolo, MD,PhD
Monica K. Crane, MD
Mary Ann Forciea, MD
vii
Contents
Preface:What Makes a Classic?ClassicPapers in
Geriatric Medicinewith Current Commentaries ................... v
Acknowledgments. ............................................ vii
Contributors Xl
1 Perspectiveson General Aging 1
RobertJ. Pignolo
2 History of Geriatric Medicine 9
Mary Ann Forciea
3 PalliativeCare of Older Patients ............................ 21
Jennifer Kapo
4 Home-Based Care ofthe Older Patient 27
Mary Ann ForcieaandJean Yudin
5 Education for Health Professionals .......................... 33
Kathy L. Egan
6 Dementia. ..... ........ ............. ... .... ..... ... ...... 47
Jason H. Karlawish
7 Delirium ..... ........ ..... ...... .............. ..... ...... 61
Jerry C. Johnson
8 Falls. ......... ..... .... .... ............ ... ..... ... ..... .. 81
Lesley S. Carson
9 Urinary Incontinence. ..................................... 89
Mary Ann Forciea
10 Osteoporosis .......... ..... ...... ...... ................. . 95
RobertJ. Pignolo
11 Nutrition...... ..... .......... ...... ..... ............. .... 105
Joan Weinryb
12 Health Screeningand Disease Prevention. ................... 113
Vivian S. Argento
13 Osteoarthritis 123
Edna P. Schwab
14 Pressure Ulcers ........................................... 145
Mary Ann Forciea
15 Depression. ..... ... ...... ............ ....... .......... ... 153
Monica K. Crane
Index........ .... ... .............. ........ .. ................ . 167
ix
Contributors
Vivian S.Argento, MD
Chief, Section of Geriatrics, Bridgeport Hospital Center for Geriatric
Medicine,YaleNew Haven Health Systems,New Haven,CT,USA
Lesley S. Carson,MD
Clinical Associate Professor of Medicine, Division of Geriatric Medicine,
Universityof Pennsylvania Health System,Philadelphia,PA,USA
Monica K. Crane, MD
Memory Health Clinic, Medical Director, Geriatric Medicine, Attending
Senior Health Connection, Carolina Health Care System, Charlotte, NC,
USA
Kathy L. Egan, PhD
Director,Geriatric Education,Division of Geriatric Medicine,University of
Pennsylvania School of Medicine,Philadelphia,PA,USA
Mary Ann Forciea, MD
Clinical Associate Professor of Medicine, Division of Geriatric Medicine,
University ofPennsylvania Health System,Philadelphia,PA,USA
Jerry C.Johnson, MD
Professor of Medicine, Chief, Geriatric Medicine Division, University of
Pennsylvania School of Medicine,Philadelphia,PA,USA
Jennifer Kapo, MD
Assistant Professor of Clinical Medicine, Department of Medicine, Division
of Geriatric Medicine, University of Pennsylvania Health System, Philadel
phia,PA,USA
Jason H. Karlawish, MD
Associate Professor of Medicine,Division of Geriatric Medicine, University
of Pennsylvania School of Medicine,Philadelphia,PA,USA
RobertJ Pignolo, MD,PhD
AssistantProfessorofMedicine,Division ofGeriatric Medicine,Universityof
Pennsylvania School of Medicine,Philadelphia,PA,USA
XI
