Table Of ContentCURRENT
Diagnosis & Treatment
Geriatrics
This page intentionally left blank
a LANGE medical book
CURRENT
Diagnosis & Treatment
Geriatrics
Second Edition
Editors
New York Chicago San Francisco Athens London Madrid
Mexico City Milan New Delhi Singapore Sydney Toronto
Cyrus Ahalt, MPP
Clinical Research Coordinator
Division of Geriatrics
University of California, San Francisco
San Francisco, California
Helen Chen, MD
Chief Medical Officer
Hebrew SeniorLife Health Care Services
and Hebrew Rehabilitation Center
Boston, Massachusetts
Clinical Professor of Medicine
Division of Geriatrics
University of California, San Francisco
San Francisco, California
Rebecca Conant, MD
UCSF Housecalls Physician
Medical Director, UCSF Home Health
Associate Clinical Professor of Medicine
Division of Geriatrics
University of California, San Francisco
San Francisco, California
C. Seth Landefeld, MD
Spencer Chair of Medical Science
Leadership
Chair, Department of Internal Medicine
University of Alabama at Birmingham
Birmingham, Alabama
Christine Ritchie, MD, MSPH
Professor of Medicine
Harris Fishbon Distinguished Professor
University of California, San Francisco
The Jewish Home of San Francisco
The San Francisco VA Medical Center
San Francisco, California
Michi Yukawa, MD, MPH
Medical Director of the Community
Living Center
San Francisco VA Medical Center
Associate Clinical Professor of Medicine
Division of Geriatrics
University of California, San Francisco
San Francisco, California
Brie A. Williams, MD, MS
Associate Professor of Medicine
Associate Director, Program for the Aging Century
Division of Geriatrics
University of California, San Francisco
Medical Director, Geriatrics Clinic
San Francisco VA Medical Center
San Francisco, California
Anna Chang, MD
Associate Professor of Medicine
Associate Director, Program for the Aging Century
Division of Geriatrics
Department of Medicine
Director, Foundations of Patient Care
University of California, San Francisco
San Francisco, California
Copyright © 2014 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part
of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior
written permission of the publisher.
ISBN: 978-0-07-179209-7
MHID: 0-07-179209-0
The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-179208-0,
MHID: 0-07-179208-2.
eBook conversion by codeMantra
Version 1.0
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name,
we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where
such designations appear in this book, they have been printed with initial caps.
McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corporate
training programs. To contact a representative, please visit the Contact Us page at www.mhprofessional.com.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy
are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information
that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human
error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or
publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all
responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are
encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product
information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is
accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation
is of particular importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject
to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not
decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell,
publish or sublicense the work or any part of it without McGraw-Hill Education’s prior consent. You may use the work for your own
noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to
comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR
WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING
THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTH-
ERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT IMITED TO IMPLIED
WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill Education and its licensors do
not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted
or error free. Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission,
regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no responsibility for the content of any
information accessed through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect,
incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has
been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim
or cause arises in contract, tort or otherwise.
v
Contents
Authors
xiii
Preface
xxv
Section I. Principles of Geriatric Care
1. Transforming the Care of Older Adults:
Knowledge, Skills, & System Change
1
Anna Chang, MD & Brie A. Williams, MD, MS
Guiding Principles
1
2. Consideration of Function
& Functional Decline
3
Susan E. Hardy, MD, PhD
Geriatric Principles
3
Epidemiology of Functional Limitations
3
Assessment of Functional Status
4
Risk Factors for Functional Decline
5
Prevention of Functional Decline
6
Rehabilitation: The Treatment
of Functional Decline
7
3. Goals of Care & Consideration
of Prognosis
9
Eric W. Widera, MD &
Alexander K. Smith, MD, MS, MPH
Goals of Care Discussions
9
A Practical Guide to Goals of
Care Discussions
9
Importance of Surrogate Decision Makers
10
Prognostication
10
Prognosis Related to Specifi c Diseases
12
Communicating Prognosis to Patient
or Surrogate
13
4. The Social Context of Older Adults
15
Helen Chen, MD
Financial Issues in the Third Age
15
Food Insecurity and Older Adults
16
Medicare
16
Housing and Long-Term Care
16
Caregiving
18
Recommendations for Clinicians
18
5. The Interprofessional Team
19
Josette A. Rivera, MD,
Scott Reeves, PhD,
& Louise Aronson, MD, MFA
Key Defi nitions and Concepts
19
Interprofessional Team Innovations
in Geriatrics
20
Evidence of Interprofessional Teams
in the Care of Older Adults
21
Resources and Tools for Teamwork
21
Barriers to the Advancement
of Teamwork
22
Future Steps
22
6. Geriatric Assessment
24
Bree Johnston, MD, MPH
& David B. Reuben, MD
Teams and Clinical Sites of Care
24
Prognosis
24
Patient Goals
25
Functional Assessment
25
Preventive Services
25
Falls and Gait Impairment
26
Vision Impairment
26
Hearing Impairment
26
Dementia
26
Incontinence
26
Depression
27
Nutrition
27
Medication Use
27
Caregiver Support
27
Financial, Environmental
and Social Resources
27
Abuse
27
Geriatric Assessment in
Primary Care
28
7. Atypical Presentations
of Illness in Older Adults
30
Carla M. Perissinotto, MD, MHS
& Christine Ritchie, MD, MSPH
Defi ning Atypical Presentations
30
Identifying Patients at Risk
30
vi
CONTENTS
8. Prevention & Health Promotion
35
Dandan Liu, MD
& Louise C. Walter, MD
Screening Issues for the Geriatric
Population
35
Geriatric Syndromes
35
Health-Related Behaviors
39
Immunizations
40
Endocrine Disorders
41
Cardiovascular Disease
42
Cancer
43
9. Principles of Prescribing for
Older Adults
46
Michael A. Steinman, MD
& Holly M. Holmes, MD
Geriatric Principles
46
Drug Metabolism and Physiologic
Effects in Older Adults
46
Geriatric Therapeutics
47
Prescribing for Older Adults
53
Adherence
55
Managing Complexity
56
Prescribing Across the Care Continuum
57
10. Addressing Multimorbidity
in Older Adults
59
Cynthia M. Boyd, MD, MPH
& Christine Ritchie, MD, MSPH
Background and Defi nitions
59
Multimorbidity and Health Outcomes
59
Clinician Challenges in the Care of
Older Adults with Multimorbidity
59
General Considerations in the Care
of Multimorbid Older Adults
60
11. Geriatrics & Palliative Care
63
John G. Cagle, PhD, MSW
& Eric W. Widera, MD
Overview of Palliative Care
63
Psychological, Spiritual, and Social Issues
63
Communication, Decision Making,
and Advance Care Planning
63
Challenges to Providing Palliative Care
in Long-Term Care Settings
64
Caring for Family Members:
Grief and Bereavement
67
12. Ethics & Informed Decision Making
69
Alexander K. Smith, MD, MS, MPH
& Bernard Lo, MD
Ethical Issues in the Care of Older Adults
69
Decision-Making Capacity and Informed
Decision Making
69
Advance Care Planning and
Advance Directives
71
Surrogate Decision Making
71
Balancing Promotion of Independence
and Patient Safety
72
Section II. Care Settings
13. Transitions and Continuity of Care
75
Lynn A. Flint, MD
General Principles in Older Adults
75
Defi nitions
75
Background
75
Adverse Events During Transitions
76
Barriers to Successful Care Transitions
76
Overcoming the Barriers: Best Practices
77
Evidence-Based Interventions
77
Innovations
78
Conclusion
78
14. Ambulatory Care & the
Patient-Centered Medical Home
80
Helen Kao, MD
General Principles in Older Adults
80
Personal Physician
80
Physician Directed Medical Practice
81
Whole-Person Orientation
81
Care Coordination and Integration
81
Quality and Safety
81
Enhanced Access
82
15. Providing Quality Care to Older
Adults in the Emergency Department
83
Gallane D. Abraham, MD
& Corita R. Grudzen, MD, MSHS, FACEP
General Principles
83
Models of Emergency Care
83
Structural Enhancements
84
Financing
84
Clinical Care
84
Future of Emergency Care
85
vii
CONTENTS
16. Hospital Care
87
Kathryn J. Eubank, MD, Edgar Pierluissi, MD,
& C. Seth Landefeld, MD
General Principles in Older Adults:
Hazards of Hospitalization
87
Successful Models of Care
88
Approach to the Hospitalized Older Adult
89
Therapy
91
Prevention
92
Transitioning from Hospital to Home
93
17. Perioperative Care in Older
Surgical Patients
95
Lawrence Oresanya, MD
& Emily Finlayson, MD, MS
General Principles in Older Adults
95
Surgical Risk in the Older Adult
95
Clinical Care
96
Models of Surgical Care
98
18. Long-Term Care, Nursing Home,
& Rehabilitation
99
Theresa A. Allison, MD, PhD
General Principles in Older Adults
99
Long-Term Care in the Community
99
Institutional Long-Term Care
100
Hospice and End-of-Life Care
102
19. Home-Based Care
104
Jessica L. Colburn, MD,
Jennifer L. Hayashi, MD,
& Bruce Leff, MD
Preventive Home Care/
Geriatric Assessment
104
Medical House Calls
104
Posthospitalization Case Management
& Transitional Care Models
104
Home Rehabilitation
104
Hospital at Home
104
Eligibility Requirements
105
Payment Denials
106
Innovations in Care Delivery
106
Medicaid
107
Area Agencies on Aging
107
Postacute Hospitalization &
Home Rehabilitation Care
107
Home Care & Assessments
107
House Calls & Home-Based Primary Care 107
20. The Aging Traveler
109
Gerald Charles, MD
General Principles in Older Adults
109
Overview of Travel Problems
109
Risk of Venous Thromboembolism
Due to Travel
109
Resources About Travel Risks
110
Ship Travel
110
Air Travel
111
Section III. Common Conditions
in Geriatrics
21. Delirium
115
Tammy Ting Hshieh, MD
& Sharon K. Inouye, MD, MPH
22. Cognitive Impairment & Dementia
123
Kaycee M. Sink, MD, MAS & Kristine Yaffe, MD
23. Cerebrovascular Disease
135
Daniel Antoniello, MD
24. Parkinson Disease & Essential Tremor 141
Nicholas B. Galifianakis, MD, MPH
& A. Ghazinouri, MD
Parkinson Disease
141
Essential Tremor
148
25. Falls & Mobility Disorders
150
Deborah M. Kado, MD, MS
& Daniel Slater, MD, FAAFP
26. Osteoarthritis
159
C. Kent Kwoh, MD & Yong Gil Hwang, MD
27. Osteoporosis & Hip Fractures
169
Rubina A. Malik, MD, MSc
28. Coronary Disease
178
Sanket Dhruva, MD & Melvin Cheitlin, MD
Acute Coronary Syndrome
180
Chronic Coronary Heart Disease
185
viii
CONTENTS
29. Heart Failure & Heart
Rhythm Disorders
190
Susan M. Joseph, MD, Jane Chen, MD,
& Michael W. Rich, MD
Heart Failure
190
Bradyarrhythmias
195
Tachyarrhythmias—Atrial Fibrillation
& Atrial Flutter
196
Ventricular Arrhythmias
199
30. Hypertension
202
Quratulain Syed, MD
& Barbara Messinger-Rapport, MD, PhD
31. Valvular Disease
213
Margarita M. Sotelo, MD,
Michael W. Rich, MD,
& G. Michael Harper, MD
Aortic Stenosis
213
Aortic Insuffi ciency
216
Mitral Stenosis
217
Mitral Regurgitation
218
32. Peripheral Arterial Disease
& Venous Thromboembolism
222
Teresa L. Carman, MD
& Sik Kim Ang, MB, BCh, BAO
Peripheral Arterial Disease
222
Venous Thromboembolism
226
33. Chronic Venous Insufficiency
& Lymphedema
230
Teresa L. Carman, MD
& Sik Kim Ang, MB, BCh, BAO
Chronic Venous Insuffi ciency
230
Lymphedema
233
34. Chronic Obstructive
Pulmonary Disease
236
Brooke Salzman, MD
& Danielle Snyderman, MD
35. Gastrointestinal &
Abdominal Complaints
244
Karen E. Hall, MD, PhD
Gastroesophageal Refl ux Disease
244
Dysphagia
246
Motility Disorders
247
Peptic Ulcer Disease
248
Dyspepsia
248
Diarrhea
249
Diverticular Disease
251
Infl ammatory Bowel Disease
251
Fecal Incontinence
252
Colonic Ischemia
253
Abdominal Pain
254
36. Constipation
256
Alayne Markland, DO, MSc
37. Fluid & Electrolyte Abnormalities
261
Mariko Koya Wong, MD
& Kellie Hunter Campbell, MD, MA
Hyponatremia
261
Hypernatremia
263
Potassium Disorders
264
Hypokalemia
264
Hyperkalemia
265
Nocturnal Polyuria
267
38. Chronic Kidney Disease
269
C. Barrett Bowling, MD, MSPH
& Katrina Booth, MD
39. Urinary Incontinence
275
Julie K. Gammack, MD
40. Benign Prostatic Hyperplasia
& Prostate Cancer
284
Serena Chao, MD, MSc
& Ryan Chippendale, MD
Benign Prostatic Hyperplasia
284
Prostate Cancer
287
41. Thyroid, Parathyroid, & Adrenal
Gland Disorders
291
Steven R. Gambert, MD, Ravi Kant, MD,
& Myron Miller, MD
Subclinical Hypothyroidism
291
Subclinical Hyperthyroidism
292
Hypothyroidism
292
Myxedema Coma
293
Hyperthyroidism
294
Nodular Thyroid Disease & Neoplasia
297
Acute Adrenal Insuffi ciency
300
Cushing Syndrome
301
Hyperparathyroidism
302
ix
CONTENTS
42. Diabetes
305
Josette A. Rivera, MD,
Jessamyn Conell-Price, MS,
& Sei Lee, MD, MAS
43. Anemia
314
Gary J. Vanasse, MD
44. Common Cancers
321
Joanne E. Mortimer, MD, FACP
& Janet E. McElhaney, MD
Breast Cancer
321
Lung Cancer
323
Colorectal Cancer
324
Pancreatic Cancer
324
Ovarian Cancer
325
Leukemia
325
Lymphoma
325
45. Depression & Other Mental
Health Issues
328
David Liu, MD, MS,
Mary A. Norman, MD,
Bobby Singh, MD,
& Kewchang Lee, MD
Depression
328
Suicide
333
Bipolar Disorder
333
Anxiety & Stress Disorders
334
Schizophrenia & Psychotic Disorders
337
46. Sexual Health & Dysfunction
340
Angela Gentili, MD
& Michael Godschalk, MD
47. Common Infections
347
Lona Mody, MD, MSc,
James Riddell IV, MD,
Keith S. Kaye, MD, MPH,
& Teena Chopra, MD, MPH
Urinary Tract Infections
348
Respiratory Tract Infections
352
Gastrointestinal Infections
353
Skin and Soft-Tissue Infections
354
Prosthetic Joint Infections
and Osteomyelitis
355
HIV/AIDS
356
48. Pressure Ulcers
359
David R. Thomas, MD, FACP, AGSF, GSAF
49. Common Skin Disorders
367
Christine O. Urman, MD
& Daniel S. Loo, MD
Seborrheic Keratosis
367
Epidermal Inclusion Cyst
367
Warts (Verruca Vulgaris
& Verruca Plantaris)
368
Onychomycosis
369
Dry Skin, Pruritus, & Asteatotic
Dermatitis
370
Seborrheic Dermatitis
372
Stasis Dermatitis
372
Psoriasis
373
Rosacea
374
Contact Dermatitis
375
Drug Eruption (Morbilliform)
376
Herpes Zoster
376
Scabies
378
Bullous Pemphigoid
379
Actinic Keratosis
380
Basal Cell Carcinoma
381
Squamous Cell Carcinoma
382
Melanoma
382
50. Sleep Disorders
384
Diana V. Jao, MD & Cathy A. Alessi, MD
Insomnia
384
Sleep Apnea
388
Periodic Limb Movement During Sleep
& Restless Legs Syndrome
388
Narcolepsy
389
Circadian Rhythm Sleep Disorders
390
REM Behavior Disorder
390
Sleep Problems in Special Populations
390
51. Oral Diseases & Disorders
392
Dick Gregory, DDS, FASGD,
Bonnie Lederman, DDS, BSDH,
& Susan Hyde, DDS, MPH, PhD, FACD
Section IV. Common Clinical
Scenarios in Geriatrics
52. Evaluating Confusion in Older Adults
399
Caroline Stephens, PhD, MSN
x
CONTENTS
53. Addressing Polypharmacy &
Improving Medication Adherence
in Older Adults
404
David Sengstock, MD, MS
& Jonathan Zimmerman, MD, MBA, FACP
Problems Caused by Polypharmacy
404
Unprescribing: Intervening
to Reduce Polypharmacy
405
Adherence
407
54. Managing Persistent Pain
in Older Adults
410
Vyjeyanthi S. Periyakoil, MD
55. Considering Anticoagulation
in Older Adults
417
Anita Rajasekhar, MD, MS
& Rebecca J. Beyth, MD, MSc
Available Classes of Anticoagulant
Therapy
417
Management of Bleeding in Older
Patients on Anticoagulants
423
56. Assessing Antiaging Therapies
for Older Adults
425
Milta O. Little, DO & John E. Morley, MB, BCh
Antiaging Therapies
425
Ethical and Legal Issues with
Antiaging Therapies
425
57. Considering Complementary &
Alternative Medicines for Older Adults 430
Milta O. Little, DO & John E. Morley, MB, BCh
Massage and Chiropractic Therapy
430
Herbs & Supplements
431
Other Forms of Alternative or
Complementary Medicine
434
58. Managing Misuse of Alcohol
& Psychoactive Prescription
Medications in Older Adults
436
Frederic C. Blow, PhD & Kristen L. Barry, PhD
Health Risks Associated with Hazardous
and Harmful Use in Older Adults
436
Psychoactive Medications
437
Defi nitions to Guide Screening
and Interventions
437
Brief Interventions
441
59. Assessing Older Adults for
Syncope Following a Fall
443
Natalie A. Sanders, DO, FACP
& Mark A. Supiano, MD
General Approach to the Patient
with Falls or Syncope
443
How Falls and Syncope Overlap
444
When to Consider Syncope
as a Cause of Falls
444
Common Diagnostic Categories
to Consider
445
60. Treating Headaches in Older Adults
447
Katherine Anderson, MD & Jana Wold, MD
61. Managing Vision Impairment
in Older Adults
451
Meredith Whiteside, OD
Normal Changes in the Aging Eye
451
Cataracts
452
Age-Related Macular Degeneration
453
Diabetic Retinopathy
454
Glaucoma
455
Systemic Medications and Glaucoma
458
Visual Symptoms Indicating
Need for Urgent Referral to
an Eye-Care Specialist
458
62. Managing Hearing Impairment
in Older Adults
460
Dane J. Genther, MD & Frank R. Lin, MD, PhD
63. Addressing Chest Pain in Older Adults 468
Christina Paruthi, MD
& Miguel Paniagua, MD, FACP
64. Addressing Dyspnea in Older Adults
472
Leslie Kernisan, MD, MPH
65. Managing Joint Pain in Older Adults
478
Lisa Strano-Paul, MD
Gout
478
Calcium Pyrophosphate Crystal Disease
479
Polymyalgia Rheumatica
480
66. Managing Back Pain in Older Adults
482
Una E. Makris, MD & Leo M. Cooney Jr, MD
xi
CONTENTS
67. Determining the Appropriate Use
of Exercise for Older Adults
487
Sara J. Francois, PT, DPT, MS,
Jennifer S. Brach, PhD, PT,
& Stephanie Studenski, MD, MPH
68. Defining Adequate Nutrition
for Older Adults
494
Michi Yukawa, MD, MPH
69. Helping Older Adults with
Low Health Literacy
502
Anna H. Chodos, MD, MPH
& Rebecca L. Sudore, MD
Unique Health Literacy Considerations
in Older Adults
502
Screening
504
Clear Health Communication Strategies
504
Systems Approaches
506
70. Understanding the Effects of
Homelessness and Housing
Instability on Older Adults
507
Rebecca Brown, MD, MPH & Margot Kushel, MD
Pathways to Homelessness
Among Older Adults
507
Strategies to Prevent Homelessness
Among Older Adults
508
Health Status of Older Homeless Adults
509
Interaction Between Health Status
and Environment
509
Conclusions & Next Steps
511
71. Understanding the Effects of Criminal
Justice Involvement on Older Adults
513
Lisa C. Barry, PhD, MPH
& Brie A. Williams, MD, MS
Epidemiology
513
The Clinical Encounter
514
72. Detecting, Assessing, & Responding
to Elder Mistreatment
517
Tessa del Carmen, MD
& Mark S. Lachs, MD, MPH
73. Meeting the Unique Needs
of LGBT Older Adults
524
Mark Simone, MD
& Manuel Eskildsen, MD, MPH
Defi nitions
524
Health Issues for LGBT Older Adults
525
Biopsychosocial Aspects of Care
527
Conclusion
528
Section V. Broadening Clinical Practice
74. Applying Evidence-Based
Medicine to Older Patients
529
Kenneth E. Covinsky, MD, MPH
The Challenges with Current Evidence
529
Applying the Evidence to
Your Older Patients
530
75. International Perspectives
in Geriatric Care
532
Sandra Y. Moody, MD, BSN, AGSF
& Miwako Honda, MD
Jochanan Stessman, MD
& Jeremy M. Jacobs, MBBS
Shuang Wang, MD & Joseph H. Flaherty, MD
Gunnar Akner, MD, PhD
Challenges for the Future of China’s
Aging Population
537
76. Public Policy Intersecting with
an Aging Society
543
Gretchen E. Alkema, PhD
& Bruce Allen Chernof, MD, FACP
Three Spheres of Aging with Dignity
and Independence
543
Key Programs and Services for
Older Adults
543
Opportunities in the Patient Protection
and Affordable Care Act
546
Where Do We Go from Here?
547
Index
551
This page intentionally left blank
xiii
Authors
Gallane D. Abraham, MD
Assistant Professor
Department of Emergency Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
Providing Quality Care to Older Adults in the
Emergency Department
Gunnar Akner, MD, PhD
Professor in Geriatric Medicine
Senior Physician Specialized in Geriatric Medicine
Internal Medicine and Clinical Nutrition
School of Health and Medical Sciences
Örebro University
Örebro, Sweden
International Perspectives in Geriatric Care (Sweden)
Cathy A. Alessi, MD
Professor of Medicine
Director, Geriatric Research, Education and
Clinical Center (GRECC)
Chief, Division of Geriatrics
VA Greater Los Angeles Healthcare System
Department of Medicine
VA Greater Los Angeles Healthcare System
David Geffen School of Medicine at University of
California, Los Angeles
Los Angeles, California
Sleep Disorders
Gretchen E. Alkema, PhD
Vice President, Policy and Communications
The SCAN Foundation
Long Beach, California
Public Policy Intersecting with an Aging Society
Theresa A. Allison, MD, PhD
Associate Professor of Medicine and Family
& Community Medicine
Division of Geriatrics
University of California, San Francisco
San Francisco, California
Long-Term Care, Nursing Home, & Rehabilitation
Katherine Anderson, MD
Assistant Professor
Division of Geriatrics
Department of Internal Medicine
University of Utah
Salt Lake City, Utah
Treating Headaches in Older Adults
Sik Kim Ang, MB, BCh, BAO
Consultant in Geriatric and Palliative Medicine
Department of Internal Medicine
RIPAS Hospital
Bandar Seri Begawan, Brunei Darussalam
Peripheral Arterial Disease & Venous Thromboembolism;
Chronic Venous Insufficiency & Lymphedema
Daniel Antoniello, MD
Assistant Professor of Neurology
Department of Neurology
Montefiore Hospital/Albert Einstein College of Medicine
Bronx, New York
Cerebrovascular Disease
Louise Aronson, MD, MFA
Associate Professor of Medicine
Division of Geriatrics
Department of Medicine
University of California, San Francisco
San Francisco, California
The Interprofessional Team
Kristen L. Barry, PhD
Research Professor
Department of Psychiatry
University of Michigan
Ann Arbor, Michigan
Managing Misuse of Alcohol & Psychoactive
Prescription Medications in Older Adults
Lisa C. Barry, PhD, MPH
Assistant Professor
Department of Psychiatry
UCONN Center on Aging at the University
of Connecticut Health Center
Farmington, Connecticut
Understanding the Effects of Criminal Justice
Involvement on Older Adults
xiv
AUTHORS
Rebecca J. Beyth, MD, MSc
Associate Professor of Medicine
Department of Medicine
North Florida/South Georgia GRECC,
and the University of Florida
Gainesville, Florida
Considering Anticoagulation in Older Adults
Frederic C. Blow, PhD
Professor
Department of Psychiatry
University of Michigan
Ann Arbor, Michigan
Managing Misuse of Alcohol & Psychoactive Prescription
Medications in Older Adults
Katrina Booth, MD
Assistant Professor
Division of Gerontology, Geriatrics, and Palliative Care
University of Alabama at Birmingham
Birmingham, Alabama
Chronic Kidney Disease
C. Barrett Bowling, MD, MSPH
Assistant Professor
Division of General Medicine & Geriatrics
Emory University
Birmingham, Alabama
Chronic Kidney Disease
Cynthia M. Boyd, MD, MPH
Associate Professor, Health Policy and Management
Geriatric Medicine and Gerontology
Department of Medicine
Johns Hopkins Center on Aging and Health
Baltimore, Maryland
Addressing Multimorbidity in Older Adults
Jennifer S. Brach, PhD, PT
Associate Professor
Department of Physical Therapy
University of Pittsburgh
Pittsburg, Pennsylvania
Determining the Appropriate Use of Exercise for Older Adults
Rebecca Brown, MD, MPH
Assistant Adjunct Professor of Medicine
Division of Geriatrics
University of California, San Francisco/San Francisco
Veterans Affairs Medical Center
San Francisco, California
Understanding the Effects of Homelessness and Housing
Instability on Older Adults
John G. Cagle, PhD, MSW
Assistant Professor
University of Maryland, Baltimore School of Social Work
Baltimore, Maryland
Geriatrics & Palliative Care
Kellie Hunter Campbell, MD, MA
Assistant Professor of Medicine
Geriatrics and Palliative Medicine
Department of Medicine
University of Chicago Medicine
Chicago, Illinois
Fluid & Electrolyte Abnormalities
Teresa L. Carman, MD
Director, Vascular Medicine
Assistant Professor of Medicine
Division of Cardiovascular Medicine
University Hospitals Case Medical Center
Case Western Reserve University School of Medicine
Cleveland, Ohio
Peripheral Arterial Disease & Venous Thromboembolism;
Chronic Venous Insufficiency & Lymphedema
Tessa del Carmen, MD
Assistant Professor of Medicine
Division of Geriatrics and Gerontology
Weill Cornell Medicine College
New York, New York
Detecting, Assessing, & Responding to Elder Mistreatment
Anna Chang, MD
Associate Professor of Medicine
Associate Director, Program for the Aging Century
Division of Geriatrics
Department of Medicine
Director, Foundations of Patient Care
University of California, San Francisco
San Francisco, California
Transforming the Care of Older Adults: Knowledge,
Skills, & System Change
Serena Chao, MD, MSc
Assistant Professor
Section of Geriatrics, Department of Medicine
Boston University School of Medicine
Boston, Massachusetts
Benign Prostatic Hyperplasia & Prostate Cancer
