Contemporary Geriatric Medicine: Volume 1

ISBN-13: 9781468445169 / Angielski / Miękka / 2012 / 412 str.

Steven Gambert

Opis

This volume marks the first of a new series, Contemporary Geriatric Medicine, joining the ever growing "Contemporary" family. As with the other "Contem porary" volumes, our goal is to assist the reader in maintaining currency in a rapidly changing field. Perhaps no field has shown such major advances in such a short time as geriatrics. Over the last several years, the "demographic impera tive" has become a source of concern for many, including clinicians, scientists, econ omists, and health planners. Our geriatric knowledge base continues to grow, often making it difficult to keep abreast of advances and current therapeutic modalities. Contemporary Ger iatric Medicine presents the state-of-the-art thinking regarding a variety of topics all of major concern to the health practitioner caring for the elderly person. The authors, for the most part serving as members of a stable editorial board, have chosen topics that should have immediate interest to the readership. By having a stable editorial board, continuity is ensured in successive volumes. Every two years, a subsequent issue will either address new thoughts on already presented topics or focus on new topics of current interest. As with the other "Contempo rary" series volumes, the every other year interval is intended to allow new find ings to develop and be tested. It also provides the authors with time to provide the highest quality of work."

Spis treści

1 Geriatric Cardiology and Blood Pressure.- 1.1. Cardiovascular Morbidity-Mortality.- 1.2. Cardiovascular Anatomy and Physiology.- 1.2.1. Anatomic Changes.- 1.2.2. Intrinsic Cardiac Function.- 1.2.3. Autonomic Reflexes.- 1.2.4. Pulse Wave Characteristics.- 1.3. Clinical Evaluation.- 1.4. Laboratory Investigations.- 1.4.1. Electrocardiogram.- 1.4.2. Exercise Cardiography.- 1.4.3. Nuclear Cardiology.- 1.4.4. Echocardiography.- 1.4.5. Ambulatory Electrocardiography.- 1.4.6. Computerized Tomography.- 1.4.7. Invasive Procedures.- 1.4.7.1. Catheterization and Angiography.- 1.4.7.2. Electrophysiology.- 1.5. Coronary Artery Disease.- 1.5.1. Presentation and Diagnosis.- 1.5.2. Therapy.- 1.5.2.1. Beta-Blockers.- 1.5.2.2. Nitrate and Calcium Channel Blockers.- 1.5.2.3. Antiplatelet Agents.- 1.5.3. Unstable Angina.- 1.5.4. Coronary Artery Surgery.- 1.5.5. Myocardial Infarction.- 1.6. Cardiomyopathy.- 1.6.1. Amyloidosis.- 1.6.2. Hypertrophic Cardiomyopathy.- 1.7. Dissection of the Aorta.- 1.7.1. Diagnosis.- 1.7.2. Therapy.- 1.8. Valvular Heart Disease.- 1.8.1. Aortic Valve Disease.- 1.8.2. Mitral Valve Disease.- 1.8.3. Valve Surgery.- 1.8.4. Endocarditis.- 1.9. Atrial Septal Defect.- 1.10. Syncope.- 1.10.1 Heart Block.- 1.10.2. Sick Sinus Syndrome.- 1.10.3. Ventricular Arrythmias.- 1.10.4. Diagnosis and Treatment.- 1.11. Cardiovascular Pharmacology.- 1.11.1. Digitalis.- 1.11.2. Antiarrhythmics.- 1.11.3. Propranolol.- 1.11.4. Vasodilators.- 1.12. Preoperative Evaluation.- 1.13. Blood Pressure and Aging.- 1.13.1. Blood Pressure: Determinants and Effects of Age.- 1.13.1.1. Cardiac Influences.- 1.13.1.2. Neurohumoral Influences.- 1.13.2. Population Studies.- 1.13.3. Hypertension: Definition.- 1.13.4. Approach to the Patient.- 1.13.4.1. History.- 1.13.4.2. Physical Examination.- 1.13.4.3. Laboratory Evaluation.- 1.13.5. Essential Hypertension in the Aged.- 1.13.6. Therapeutic Decision Making.- 1.13.6.1. Systolic Hypertension.- 1.13.6.2. Combined Systolic Diastolic Hypertension.- 1.13.7. Treatment.- 1.13.7.1. Nonmedical Treatment.- 1.13.7.2. Medical Therapy.- 1.13.8. Hypotension.- 1.13.8.1. Definitions.- 1.13.8.2. Management.- 1.13.9. Conclusion.- References.- 2 Pulmonary Aspects of Aging.- 2.1. Introduction.- 2.2. The Aging Lung.- 2.2.1. Introduction.- 2.2.2. Physiologic Changes.- 2.2.2.1. Lung Volumes.- 2.2.2.2. Flow Rates.- 2.2.2.3. Respiratory Mechanics.- 2.2.2.4. Gas Exchange.- 2.2.2.5. Diffusing Capacity.- 2.2.2.6. Respiratory Muscle Function.- 2.2.2.7. Control of Breathing.- 2.2.3. Effects of Cigarette Smoking.- 2.3. Aging and Physical Performance.- 2.3.1. Introduction.- 2.3.2. Normal Physiologic Responses to Exercise.- 2.3.3. Effects of Age on Exercise Performance.- 2.3.3.1. Oxygen Consumption.- 2.3.3.2. Cardiac Function.- 2.3.3.3. Ventilation.- 2.3.3.4. Oxygen Extraction.- 2.3.4. Physical Conditioning and Aging.- 2.4. Chronic Obstructive Pulmonary Disease.- 2.4.1. Introduction.- 2.4.2. Definitions and Differentiation of Diseases.- 2.4.2.1. Asthma.- 2.4.2.2. Chronic Bronchitis.- 2.4.2.3. Emphysema.- 2.4.3. Diagnosis of Airway Obstruction.- 2.4.3.1. Pulmonary Function Testing.- 2.4.3.2. Assessment of Airway Reversibility.- 2.4.4. Physical Examination.- 2.4.5. Laboratory Studies.- 2.4.5.1. Blood Tests.- 2.4.5.2. Sputum Analysis.- 2.4.5.3. Arterial Blood Gases.- 2.4.5.4. Chest Radiography.- 2.4.6. Mechanisms Limiting Exercise Performance.- 2.4.6.1. Diminished Ventilatory Capacity.- 2.4.6.2. Hypoxemia.- 2.4.6.3. Respiratory Muscle Fatigue.- 2.4.6.4. Right Ventricular Dysfunction Secondary to Pulmonary Hypertension.- 2.4.7. Therapeutic Strategies.- 2.4.7.1. Smoking Cessation.- 2.4.7.2. Bronchodilator Therapy.- 2.4.7.3. Oxygen Therapy.- 2.4.7.4. Respiratory Muscle Training.- 2.4.7.5. Pulmonary Vasodilator Therapy.- 2.4.8. Management of Complications.- 2.4.8.1. Upper Respiratory Infections.- 2.4.8.2. Pulmonary Hypertension and Cor Pulmonale.- 2.5. Pneumonia in the Elderly.- 2.5.1. Introduction.- 2.5.2. Pathogenesis of Pneumonia.- 2.5.3. Respiratory Defenses.- 2.5.4. Clinical Pneumonia Syndrome.- 2.5.4.1. Typical Bacterial Pneumonias.- 2.5.4.2. Aspiration Pneumonia.- 2.5.4.3. Atypical and the “New” Pneumonias.- 2.5.5. Diagnostic Approach.- 2.5.5.1. Sputum.- 2.5.5.2. Blood.- 2.5.5.3. Other Fluids and Tissue.- 2.5.6. Antibiotic Therapy.- 2.5.6.1. Typical Bacterial Pneumonias.- 2.5.6.2. Aspiration Pneumonia.- 2.5.6.3. Atypical and the “New” Pneumonias.- 2.5.7. Prophylactic Immunization.- 2.5.7.1. S. pneumoniae Pneumonia.- 2.5.7.2. Influenza Pneumonia.- References.- 3 Gastroenterology and the Elderly.- 3.1. Esophagus.- 3.1.1. Dysphagia.- 3.1.2. Pre-esophageal Dysphagia.- 3.1.3. Dysfunction of the Gricopharyngus Muscle.- 3.1.3.1. Diagnosis.- 3.1.3.2. Complications.- 3.1.3.3. Treatment.- 3.1.3.4. Esophageal Dysphagia.- 3.1.4. Achalasia of the Lower Esophagus.- 3.1.4.1. Clinical Findings.- 3.1.4.2. Diagnosis.- 3.1.4.3. Treatment.- 3.1.5. Diffuse Esophageal Spasm.- 3.1.5.1. Diagnosis.- 3.1.5.2. Presbyesophagus.- 3.1.5.3. Treatment for DES.- 3.1.6. Structural Lesions.- 3.1.7. Esophagitis.- 3.1.7.1. Infectious Esophagitis.- 3.1.7.2. Reflux Esophagitis.- 3.1.7.3. Pathogenesis.- 3.1.7.4. Clinical Findings.- 3.1.7.5. Diagnosis.- 3.1.7.6. Treatment.- 3.2. Stomach.- 3.2.1. Upper Gastrointestinal Bleeding.- 3.2.1.1. Early Endoscopy—Pro and Con.- 3.2.1.2. Therapeutic Endoscopy.- 3.2.2. Peptic Ulcer Disease.- 3.2.2.1. Incidence.- 3.2.2.2. Etiology.- 3.2.2.3. Diagnosis.- 3.2.2.4. Clinical Course.- 3.2.2.5. Treatment of Ulcer Disease.- 3.2.2.6. Long-Term Therapy with Cimetidine.- 3.2.2.7. Side Effects.- 3.2.2.8. Antacids.- 3.2.2.9. Side Effects of Antacids.- 3.2.3. New Drugs.- 3.2.3.1. Predicators of Ulcer Healing.- 3.2.3.2. Complications.- 3.2.3.3. Bleeding.- 3.2.3.4. Factors Predisposing to Rebleeding.- 3.2.3.5. Diagnosis of Bleeding Ulcers.- 3.2.3.6. Endoscopy versus Barium Radiologic Studies.- 3.2.3.7. Rebleeding.- 3.2.3.8. Treatment of Bleeding Ulcers.- 3.2.3.9. Prognosis.- 3.2.4. Giant Duodenal Ulcer.- 3.2.4.1. Obstruction.- 3.2.4.2. Surgery.- 3.2.5. Gastritis.- 3.2.5.1. Etiology.- 3.2.5.2. Clinical Findings.- 3.2.5.3. Diagnosis.- 3.2.5.4. Treatment.- 3.3. Hepatobiliary Disease.- 3.3.1. Cirrhosis.- 3.3.1.1. Etiology.- 3.3.1.2. Clinical Findings.- 3.3.1.3. Treatment.- 3.3.2. Viral Hepatitis.- 3.3.3. Chronic Active Hepatitis.- 3.3.3.1. Etiology.- 3.3.3.2. Clinical Findings.- 3.3.3.3. Diagnosis.- 3.3.3.4. Treatment.- 3.3.3.5. Prognosis.- 3.4. Cholelithiasis.- 3.4.1. Incidence.- 3.4.1.1. Etiology.- 3.4.1.2. Prognosis.- 3.4.1.3. Treatment.- 3.4.1.4. Gallstone Dissolution.- 3.4.2. Acute Cholecystitis.- 3.4.2.1. Etiology.- 3.4.2.2. Clinical Findings.- 3.4.2.3. Diagnosis.- 3.4.2.4. Treatment.- 3.4.3. Choledocholithiasis.- 3.5. Acute Pancreatitis.- 3.5.1. Incidence.- 3.5.2. Alcoholic Pancreatitis.- 3.5.3. Gallstone Pancreatitis.- 3.5.4. Diagnosis.- 3.5.5. Prognosis.- 3.5.6. Treatment.- 3.5.6.1. Medical.- 3.5.6.2. Surgical.- 3.5.7. Complications.- 3.6. The Colon.- 3.6.1. Diverticulosis.- 3.6.1.1. Incidence.- 3.6.1.2. Etiology.- 3.6.1.3. Clinical Findings.- 3.6.1.4. Diagnosis.- 3.6.1.5. Prognosis.- 3.6.2. Diverculititis.- 3.6.2.1. Etiology.- 3.6.2.2. Diagnosis.- 3.6.2.3. Clinical Findings.- 3.6.2.4. Treatment.- 3.6.2.5. Complications.- 3.6.3. Polyposis.- 3.6.3.1. Incidence.- 3.6.3.2. Etiology.- 3.6.3.3. Multiple Adenomas.- 3.6.3.4. Relation to Cancer.- 3.6.3.5. Clinical Findings.- 3.6.3.6. Treatment.- 3.6.4. Superior Mesenteric Artery Occlusion.- 3.6.4.1. Incidence.- 3.6.4.2. Etiology.- 3.6.4.3. Nonocclusive Disease.- 3.6.4.4. Clinical Findings.- 3.6.4.5. Prognosis.- 3.6.4.6. Treatment.- 3.6.5. Ischemic Colitis.- 3.6.5.1. Etiology.- 3.6.5.2. Acute Transitory Colitis.- 3.6.5.3. Acute Nongangrenous Colitis.- 3.6.5.4. Gangrenous Colitis.- 3.6.5.5. Diagnosis.- 3.6.5.6. Treatment.- 3.6.6. Constipation.- 3.6.6.1. Etiology.- 3.6.6.2. Secondary Constipation.- 3.6.6.3. Diagnosis.- 3.6.6.4. Treatment.- 3.6.6.5. Major Complications.- 3.6.6.6. Fecal Impaction.- 3.6.6.7. Treatment.- 3.6.7. Diarrhea.- 3.6.7.1. Etiology.- 3.6.7.2. Pathogenesis of Diarrhea.- 3.6.7.3. Diagnosis.- 3.6.7.4. Treatment.- 3.6.8. Flatus.- 3.6.8.1. Etiology.- 3.6.8.2. Diagnosis.- 3.6.8.3. Treatment.- 3.6.9. Irritable Bowel Syndrome.- 3.6.9.1. Etiology.- 3.6.9.2. Clinical Findings.- 3.6.9.3. Diagnosis.- 3.6.9.4. Treatment.- 3.7. Lower Gastrointestinal Bleeding.- 3.7.1. Etiology.- 3.7.1.1. Vascular Ectasias (Angiodysplasias).- 3.7.1.2. Diverticulosis.- 3.7.1.3. Cancer.- 3.7.1.4. Diagnosis.- 3.7.1.5. Treatment.- 3.8. Cancer.- 3.8.1. Cancer of the Esophagus.- 3.8.1.1. Etiology.- 3.8.1.2. Clinical Findings.- 3.8.1.3. Diagnosis.- 3.8.1.4. Treatment.- 3.8.2. Cancer of the Stomach.- 3.8.2.1. Etiology.- 3.8.2.2. Clinical Findings.- 3.8.2.3. Diagnosis.- 3.8.2.4. Treatment.- 3.8.3. Colorectal Cancer.- 3.8.3.1. Etiology.- 3.8.3.2. Diagnosis.- 3.8.3.3. Treatment.- 3.8.4. Cancer of the Pancreas.- 3.8.4.1. Clinical Findings.- 3.8.4.2. Diagnosis.- 3.8.4.3. Treatment.- 3.8.5. Hepatoma.- 3.8.5.1. Etiology.- 3.8.5.2. Clinical Findings.- 3.8.5.3. Diagnosis.- 3.8.5.4. Treatment.- 3.8.6. Cancer of Gallbladder.- 3.8.6.1. Clinical Findings.- 3.8.6.2. Treatment.- 3.8.7. Summary.- References.- 4 Rheumatology in Geriatrics.- 4.1. Age-Related Changes in the Immune System.- 4.2. Laboratory Evaluation in the Rheumatic Diseases.- 4.2.1. Erythrocyte Sedimentation Rate.- 4.2.2. Rheumatoid Factor.- 4.2.3. Antinuclear Antibody.- 4.3. Rheumatoid Arthritis.- 4.3.1. Epidemiology.- 4.3.2. Clinical Manifestations.- 4.3.3. Management.- 4.4. Systemic Lupus Erythematosus.- 4.4.1. Epidemiology.- 4.4.2. Clinical Manifestations.- 4.4.3. Management.- 4.4.4. Drug-Induced Systemic Lupus Erythematosus.- 4.4.4.1. Clinical Manifestations.- 4.4.4.2. Management.- 4.5. Sjogren’s Syndrome.- 4.5.1. Epidemiology.- 4.5.2. Diagnosis.- 4.5.3. Clinical Associations.- 4.5.4. Clinical Manifestations.- 4.5.4.1. Natural History.- 4.5.4.2. Immunologic Correlates.- 4.5.4.3. Management.- 4.6. Amyloidosis.- 4.6.1. Biochemistry of Amyloid.- 4.6.2. Clinical Amyloid Syndromes.- 4.6.2.1. Primary Generalized Amyloidosis.- 4.6.2.2. Amyloidosis of Aging.- 4.6.3. Diagnosis.- 4.6.4. Management.- 4.7. Crystal-Induced Arthropathies.- 4.7.1. Hyperuricemia and Gout.- 4.7.1.1. Epidemiology.- 4.7.1.2. Clinical Manifestations.- 4.7.1.3. Management.- 4.7.2. Calcium Pyrophosphate Dihydrate Crystal Deposition Disease.- 4.7.2.1. Epidemiology.- 4.7.2.2. Clinical Manifestations.- 4.7.2.3. Etiology and Pathogenesis.- 4.7.2.4. Associated Disorders.- 4.7.2.5. Management.- 4.7.3. Hydroxyapatite Deposition Disease.- 4.8. Osteoarthritis.- 4.8.1. Epidemiology.- 4.8.2. Biology of Normal Cartilage.- 4.8.3. Pathology of OA and Age-Related Changes in Cartilage.- 4.8.4. Pathogenesis.- 4.8.5. Clinical Manifestations.- 4.8.6. Management.- 4.9. Seronegative Spondyloarthropathies.- 4.10. Polymyalgia Rheumatica and Giant-Cell Arteritis.- 4.10.1. Clinical Manifestations.- 4.10.2. Diagnosis.- 4.10.3. Management.- 4.11. Malignancies and Rheumatic Diseases.- 4.11.1. Hypertrophic Osteoarthropathy.- 4.11.2. Malignancy-Related Polyarthritis.- 4.11.3. Polymyositis and Dermatomyositis.- 4.11.4. Metastatic Disease.- 4.11.5. Leukemia.- 4.11.6. Carcinoma of the Pancreas.- 4.12. Medications for the Treatment of Rheumatic Diseases.- 4.12.1. General Principles of Drug Therapy.- 4.12.2. Nonsteroidal Antiinflammatory Drugs.- 4.12.2.1. Mechanisms of Action.- 4.12.2.2. Metabolism.- 4.12.2.3. Side-Effects and Hypersensitivity Reactions.- 4.12.2.4. Drug Interactions.- 4.12.2.5. Drug Administration.- 4.12.3. Corticosteroids.- 4.12.4. Gold Therapy.- 4.12.5. Allopurinol.- References.- 5 Genitourinary Problems in the Elderly.- 5.1. Renal Function.- 5.1.1. Renal Changes with Aging.- 5.1.2. Acute Renal Failure.- 5.1.2.1. Prerenal Azotemia.- 5.1.2.2. Acute Parenchymal Renal Failure.- 5.1.2.3. Postrenal (Obstructive) Uropathy.- 5.1.3. Management of Acute Renal Failure.- 5.1.4. Electrolytes in Renal Failure.- 5.1.5. Neurologic Manifestations of Renal Failure.- 5.1.6. Chronic Renal Failure.- 5.1.7. Hemodialysis.- 5.1.8. Peritoneal Dialysis.- 5.1.9. Rehabilitation on Dialysis.- 5.2. Bladder Physiology.- 5.2.1. Anatomy and Physiology of Micturition.- 5.2.2. Urodynamics.- 5.2.3. Neurogenic Bladder.- 5.2.4. Treatment of Neurogenic Bladder.- 5.2.5. Intermittent Catheterization and Diversion.- 5.3. Carcinoma of the Bladder.- 5.3.1. Etiology and Natural History of Bladder Cancer.- 5.3.2. Staging of Bladder Cancer.- 5.3.3. Treatment of Bladder Cancer.- 5.3.4. Topical Chemotherapy of Bladder Cancer.- 5.3.5. Systemic Chemotherapy for Bladder Cancer.- 5.4. Physiology of the Prostate Gland.- 5.4.1. The Normal Prostate.- 5.4.2. The Aging Prostate.- 5.4.3. Relief of Prostatic Obstruction.- 5.4.4. Infection of the Prostate Gland.- 5.5. Prostatic Carcinoma.- 5.5.1. Etiology and Natural History of Prostatic Carcinoma.- 5.5.2. Current Treatment of Prostatic Carcinoma.- 5.5.3. Screening for Prostatic Cancer.- 5.5.4. Spread of Prostatic Cancer to Bone.- 5.5.5. Pattern of Metastatic Spread of Prostatic Cancer.- 5.5.6. Host Response to Metastatic Prostatic Cancer.- 5.5.7. Calcium Metabolism in Patients with Metastatic Prostatic Cancer.- 5.5.8. Assessment of Bone Metastases.- 5.5.9. Treatment of Bone Metastases.- References.- 6 Endocrinology and Metabolism in the Elderly.- 6.1. Osteoporosis.- 6.1.1. Introduction.- 6.1.2. Definition.- 6.1.3. Pathogenesis.- 6.1.4. Natural History.- 6.1.5. Diagnosis.- 6.1.6. Treatment.- 6.1.7. Summary.- 6.2. Osteomalacia.- 6.2.1. Pathophysiology and Natural History.- 6.2.2. Diagnosis.- 6.2.3. Treatment.- 6.2.4. Summary.- 6.3. Paget’s Disease of Bone.- 6.3.1. Definition.- 6.3.2. Pathophysiology.- 6.3.3. Diagnosis.- 6.3.4. Treatment.- 6.3.5. Summary.- 6.4. Age-Related Changes in Thyroid Hormone Economy.- 6.4.1. Introduction.- 6.4.2. Thyroid Function Testing.- 6.4.3. Effect of Age on Hypothalamic-Pituitary-Thyroid Interrelationships.- 6.5. Hyperthyroidism in the Elderly.- 6.5.1. Introduction.- 6.5.2. Clinical Presentation.- 6.5.3. Treatment.- 6.6. Hypothyroidism.- 6.6.1. Introduction.- 6.6.2. Clinical Presentation.- 6.6.3. Treatment.- 6.7. Clinical Aspects of Gonadal and Sexual Function in Elderly Men ..- 6.7.1. Introduction.- 6.7.2. Sexual Function in the Elderly.- 6.7.2.1. The Physiology of the Male Sexual Response.- 6.7.2.2. Effects of Aging on Sexual Activity in Men.- 6.7.2.3. Alterations in the Physiological Sexual Response with Age.- 6.7.3. The Hypothalamic-Pituitary-Testicular Axis.- 6.7.3.1. Brief Review of Hormonal Physiology.- 6.7.3.2. Hormonal Changes in Aging Men.- 6.7.3.3. Pituitary Function in Aging Men.- 6.7.4. Testosterone and Sexual Activity.- 6.7.5. Other Causes of Impotence in the Elderly.- 6.7.6. Evaluating Impotence.- 6.7.7. Conclusions.- 6.8. Menopause.- 6.8.1. Introduction.- 6.8.2. Hormonal Changes in the Peri- and Postmenopausal Period.- 6.8.3. Sex Steroids.- 6.9. Clinical Problems of the Climacteric.- 6.9.1. Introduction.- 6.9.2. Vasomotor Symptoms.- 6.9.3. Osteoporosis.- 6.9.4. Atrophy of the Genitalia.- 6.9.5. Cardiovascular Disease.- 6.10. Estrogen Use in Postmenopausal Women.- 6.10.1. Benefits and Risks.- 6.10.2. Conclusions.- References.- 7 Neuropsychiatric Problems in the Elderly.- 7.1. Introduction.- 7.2. Psychiatric Problems.- 7.2.1. Thought Disorders.- 7.2.1.1. Schizophrenia.- 7.2.1.2. Late-Occurring Paranoid States.- 7.2.1.3. Thought Disorders Secondary to an Organic Mental Disorder.- 7.2.2. Affective Disorders.- 7.2.2.1. Depression.- 7.2.2.2. Mania.- 7.2.3. Neurotic Disorders.- 7.2.3.1. Anxiety Neurosis.- 7.2.3.2. Compulsive Neurosis.- 7.2.3.3. Hysterical Neurosis.- 7.2.3.4. Chronic Fatigue.- 7.2.3.5. Hypochondriasis.- 7.2.4. Special Problems.- 7.2.4.1. Sleep Disturbances.- 7.2.4.2. Stress.- 7.2.4.3. Relationship between Functional Disorder and Physical Illness.- 7.2.4.4. Suicide.- 7.3. Drugs of Abuse.- 7.3.1. Introduction.- 7.3.2. Comparison of Drugs of Abuse-Young versus Aged.- 7.3.3. The Elderly Abuser.- 7.3.4. Thought on Causation of Alcohol Abuse in the Elderly.- 7.4. Organic Mental Disorders.- 7.4.1. Introduction.- 7.4.2. Causes of Dementia.- 7.4.3. Dementia as a Biopsychosocial Problem.- 7.4.4. Differential Diagnosis.- 7.4.5. Specifics Regarding Diagnosis of Dementia.- 7.4.6. Alzheimer’s Disease.- 7.4.6.1. Epidemiology.- 7.4.6.2. Etiological/Risk Factors.- 7.4.6.3. Pathological Correlations.- 7.4.6.4. Pick’s Disease—The Clinical/Pathological Comparison with Alzheimer’s.- 7.4.6.5. Treatment.- 7.5. Neurologic Diseases.- 7.5.1. Huntington’s Disease.- 7.5.2. Parkinson’s Disease.- 7.6. Conclusion.- References.- 8 Nutritional Problems in the Elderly.- 8.1. Statement of Purpose.- 8.2. Introduction.- 8.3. Aging Influences on Nutritional Data Interpretation.- 8.3.1. Metabolic Change.- 8.3.2. Physical Activity.- 8.4. Nutritional Assessment in the Elderly.- 8.4.1. Dietary History.- 8.4.1.1. Nutritional Interview and History-Taking in the Elderly.- 8.4.1.2. Geriatric Nutritional History.- 8.4.1.3. Major Tools of Dietary History.- 8.4.2. Clinical Evaluation.- 8.4.2.1. Introduction.- 8.4.2.2. Anthropometric Indicators of Nutritional Status.- 8.4.2.3. Clinical Evaluation: Summary.- 8.4.3. Biochemical and Laboratory Evaluations of Nutritional Status.- 8.5. Nutritional Surveys.- 8.5.1. Introduction.- 8.5.2. Major Nutritional Surveys.- 8.5.2.1. Introduction.- 8.5.2.2. Details.- 8.5.2.3. Summary.- 8.5.3. Detailed, but Limited, Nutritional Surveys.- 8.5.3.1. Introduction.- 8.5.3.2. Details of Surveys.- 8.5.3.3. Summary.- 8.6. Nutrient Recommendations for Older Americans.- 8.7. Drug-Diet Interactions in the Aged.- 8.8. The Kitchen: A Geriatric Health Hazard.- 8.9. Final Summary and Nutritional Research Imperative for the Elderly.- References.- 9 Preventive Medicine for the Elderly.- 9.1. Introduction.- 9.2. Primary Prevention.- 9.2.1. Anticipatory Guidance for the Elderly Patient.- 9.2.2. Nutrition in the Elderly.- 9.2.3. Exercise for the Elderly.- 9.2.4. Smoking and the Elderly.- 9.2.5. Promoting the Safe Use of Drugs in the Elderly.- 9.2.6. Mental Health of the Elderly.- 9.2.7. Alcoholism in the Elderly.- 9.2.8. Environmental Geriatrics.- 9.2.9. Geriatric Dentistry.- 9.3. Secondary Prevention.- 9.3.1. Introduction.- 9.3.2. Assessment of Psychosocial and Physical Function.- 9.4. Tertiary Prevention.- 9.4.1. General Rehabilitation for the Geriatric Patient.- 9.4.1.1. Preventive Aspects of Rehabilitation.- 9.4.1.2. Potential Problems with Rehabilitating the Elderly.- 9.4.2. Cardiac Rehabilitation.- 9.4.3. Pulmonary Rehabilitation.- 9.5. Summary.- References.