Contemporary Geriatric Medicine: Volume 2

ISBN-13: 9781468450026 / Angielski / Miękka / 2012 / 566 str.

Steven R. Gambert; Steven R. Gambert

Opis

In the last two years, a wealth of new information has accumulated regarding both clinical and research aspects of health care for the elderly. Although many controversial issues have been resolved, many still remain. Volume 2 of Contemporary Geriatric Medicine is once again dedicated to the clinician who cares for the elderly on a continuing basis. Although, for the most part, general topics first introduced in Volume 1 have been retained, all infor mation in this volume is new and represents the current state of the art. In addi tion, several new topics-including falls, interpretation of laboratory data, and oral health care-have been introduced to enhance this volume's usefulness to the busy clinician. Through these easy-to-read essays, we attempt once again to keep the non geriatrician abreast of the current state of the art regarding the special needs and problems of the elderly. Each chapter is not meant to be an exhaustive review of all topics in the field, but rather to focus on issues receiving a great deal of atten tion. Our goal is to create an exciting approach to contemporary issues in gerIatric medicine."

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 Electrocardiography.- 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. Nitrates.- 1.5.2.2. Beta-Blockers.- 1.5.2.3. Calcium Channel Blockers.- 1.5.2.4. Antiplatelet Agents.- 1.5.3. Unstable Angina.- 1.5.4. Myocardial Infarction.- 1.5.5. Angioplasty.- 1.5.6. Coronary Artery Surgery.- 1.6. Congestive Heart Failure.- 1.6.1. Amyloidosis.- 1.6.2. Hypertrophic Cardiomyopathy.- 1.6.3. Thyroid Disease.- 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. Endocarditis.- 1.8.4. Valve Surgery.- 1.9. Atrial Septal Defect.- 1.10. Syncope.- 1.10.1. Heart Block.- 1.10.2. Sick Sinus Syndrome.- 1.10.3. Ventricular Arrhythmias.- 1.10.4. Diagnosis and Treatment of Problem Cases.- 1.11. Cardiovascular Pharmacology.- 1.11.1. Digoxin.- 1.11.2. Antiarrhythmics.- 1.11.3. 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.- References.- 2 Respiratory Problems in the Elderly.- 2.1. Introduction.- 2.2. Cigarette Smoking.- 2.2.1. Introduction.- 2.2.2. Noxious Components of Cigarette Smoke.- 2.2.3. Effects of Smoking on the Respiratory Tract.- 2.2.3.1. Voluntary Smoking.- 2.2.3.2. Involuntary Smoking.- 2.2.4. Behavioral Aspects.- 2.2.5. Strategies for Smoking Cessation.- 2.2.5.1. Acupuncture.- 2.2.5.2. Aversive Methods.- 2.2.5.3. Multicomponent Programs.- 2.2.5.4. Nicotine Gum.- 2.2.5.5. Physician Intervention.- 2.3. Pleural Effusions.- 2.3.1. Introduction.- 2.3.2. Anatomy.- 2.3.3. Physiology.- 2.3.4. Clinical Presentation of Pleural Disease.- 2.3.4.1. Symptoms.- 2.3.4.2. Radiographic Signs.- 2.3.4.3. Physical Examination.- 2.3.5. Examination of Pleural Fluid.- 2.3.6. Specific Diseases.- 2.3.6.1. Chylothorax.- 2.3.6.2. Heart Disease.- 2.3.6.3. Malignancy.- 2.3.6.4. Parapneumonic Effusion.- 2.3.6.5. Pulmonary Embolism.- 2.3.6.6. Tuberculous Effusions.- 2.4. Tuberculosis.- 2.4.1. Introduction.- 2.4.2. Pathogenesis of Tuberculosis.- 2.4.3. Sites of Disease.- 2.4.3.1. Kidney.- 2.4.3.2. Bone.- 2.4.3.3. Peritoneum.- 2.4.3.4. Pericardium.- 2.4.3.5. Meninges.- 2.4.4. Radiographic Patterns.- 2.4.4.1. Multinodular Infiltrate with or without Cavitation.- 2.4.4.2. Interstitial (Miliary) Lung Infiltrate.- 2.4.4.3. Tuberculoma.- 2.4.4.4. Pleural Effusion.- 2.4.5. Diagnosis.- 2.4.5.1. Clinical Manifestations.- 2.4.5.2. Tuberculosis in Nursing Homes.- 2.4.5.3. Bacteriologic Diagnosis.- 2.4.5.4. Tuberculin Skin Testing.- 2.4.6. Treatment.- 2.4.6.1. Disease.- 2.4.6.2. Preventive Therapy.- References.- 3 The Gastrointestinal System and the Elderly.- 3.1. Introduction.- 3.2. Esophagus.- 3.2.1. Dysphagia.- 3.2.2. Preesophageal Dysphagia.- 3.2.2.1. Dysfunction of the Cricopharyngeus Muscle.- 3.2.2.2. Diagnosis and Complications.- 3.2.2.3. Treatment.- 3.2.3. Esophageal Dysphagia.- 3.2.3.1. Achalasia of the Lower Esophagus.- 3.2.3.2. Clinical Findings.- 3.2.3.3. Diagnosis.- 3.2.3.4. Treatment.- 3.2.4. Diffuse Esophageal Spasm.- 3.2.4.1. Diagnosis.- 3.2.4.2. Treatment for Diffuse Esophageal Spasm.- 3.2.4.3. Structural Lesions.- 3.2.5. Esophagitis.- 3.2.5.1. Reflux Esophagitis—Pathogenesis.- 3.2.5.2. Clinical Findings.- 3.2.5.3. Diagnosis.- 3.2.5.4. Treatment.- 3.3. Stomach.- 3.3.1. Upper Gastrointestinal Bleeding.- 3.3.1.1. Early Endoscopy—Con.- 3.3.1.2. Early Endoscopy—Pro.- 3.3.1.3. Therapeutic Endoscopy.- 3.3.2. Peptic Ulcer Disease.- 3.3.2.1. Incidence.- 3.3.2.2. Etiology Ill.- 3.3.2.3. Diagnosis.- 3.3.2.4. Clinical Course.- 3.3.2.5. Treatment of Ulcer Disease.- 3.3.2.6. Long-Term Therapy with Cimetidine and Ranitidine.- 3.3.2.7. Side Effects.- 3.3.2.8. Complications.- 3.3.2.9. Surgery.- 3.3.3. Gastritis.- 3.3.3.1. Etiology.- 3.3.3.2. Clinical Findings.- 3.3.3.3. Diagnosis.- 3.3.3.4. Treatment.- 3.4. Hepatobiliary Tract.- 3.4.1. Viral Hepatitis.- 3.4.2. Chronic Active Hepatitis.- 3.4.2.1. Etiology.- 3.4.2.2. Clinical Findings.- 3.4.2.3. Treatment.- 3.4.3. Cholelithiasis.- 3.4.3.1. Incidence.- 3.4.3.2. Etiology.- 3.4.3.3. Prognosis.- 3.4.3.4. Treatment.- 3.4.3.5. Gallstone Dissolution.- 3.4.4. Acute Cholecystitis.- 3.4.4.1. Etiology.- 3.4.4.2. Clinical Findings.- 3.4.4.3. Diagnosis.- 3.4.4.4. Treatment of Acute Cholecystitis.- 3.4.5. Choledocholithiasis.- 3.5. Pancreas.- 3.5.1. Acute Pancreatitis.- 3.5.1.1. Etiology.- 3.5.1.2. Alcholic Pancreatitis..- 3.5.1.3. Gallstone Pancreatitis.- 3.5.1.4. Diagnosis.- 3.5.1.5. Prognosis.- 3.5.1.6. Treatment—Medical.- 3.5.1.7. Treatment—Surgical.- 3.5.1.8. Complications.- 3.6. Appendix.- 3.6.1. Appendicitis.- 3.7. Colon.- 3.7.1. Diverticulosis.- 3.7.1.1. Incidence.- 3.7.1.2. Etiology.- 3.7.1.3. Clinical Findings.- 3.7.1.4. Prognosis.- 3.7.2. Diverticulitis.- 3.7.2.1. Etiology.- 3.7.2.2. Clinical Findings.- 3.7.2.3. Treatment.- 3.7.2.4. Complications.- 3.7.3. Polyposis.- 3.7.3.1. Incidence.- 3.7.3.2. Etiology.- 3.7.3.3. Clinical Findings.- 3.7.3.4. Treatment.- 3.7.4. Superior Mesenteric Artery Occlusion.- 3.7.4.1. Incidence.- 3.7.4.2. Etiology.- 3.7.4.3. “Nonocclusive” Disease.- 3.7.4.4. Clinical Findings.- 3.7.4.5. Prognosis.- 3.7.4.6. Treatment.- 3.7.5. Ischemic Colitis.- 3.7.5.1. Etiology.- 3.7.5.2. Acute Transitory Colitis.- 3.7.5.3. Acute Nongangrenous Colitis.- 3.7.5.4. Gangrenous Colitis.- 3.7.5.5. Diagnosis.- 3.7.5.6. Treatment.- 3.7.6. Constipation.- 3.7.6.1. Primary Constipation.- 3.7.6.2. Secondary Constipation.- 3.7.6.3. Treatment.- 3.7.6.4. Fecal Impaction.- 3.7.7. Diarrhea.- 3.7.7.1. Bowel Fluid and Electrolyte Absorption and Secretion with Diarrhea.- 3.7.7.2. Etiology.- 3.7.7.3. Pathogenesis of Diarrhea.- 3.7.7.4. Diagnosis.- 3.7.7.5. Treatment.- 3.7.8. Flatus.- 3.7.8.1. Etiology.- 3.7.8.2. Diagnosis.- 3.7.8.3. Treatment.- 3.7.9. Irritable Bowel Syndrome.- 3.7.9.1. Etiology.- 3.7.9.2. Clinical Findings.- 3.7.9.3. Diagnosis.- 3.7.9.4. Treatment.- 3.8. Lower Gastrointestinal Bleeding.- 3.8.1. Etiology.- 3.8.2. Vascular Ectasias (Angiodysplasias).- 3.8.3. Diverticulosis.- 3.8.4. Cancer.- 3.8.5. Diagnosis.- 3.8.6. Treatment.- 3.9. Cancer.- 3.9.1. Cancer of the Esophagus.- 3.9.1.1. Etiology.- 3.9.1.2. Clinical Findings.- 3.9.1.3. Treatment.- 3.9.2. Cancer of the Stomach.- 3.9.2.1. Etiology.- 3.9.2.2. Clinical Findings.- 3.9.2.3. Treatment.- 3.9.3. Colorectal Cancer.- 3.9.3.1. Etiology.- 3.9.3.2. Diagnosis.- 3.9.3.3. Treatment.- 3.9.4. Cancer of the Pancreas.- 3.9.4.1. Clinical Findings.- 3.9.4.2. Diagnosis.- 3.9.4.3. Treatment.- 3.9.5. Hepatoma.- 3.9.5.1. Etiology.- 3.9.5.2. Clinical Findings.- 3.9.5.3. Treatment.- 3.9.6. Cancer of the Gallbladder.- 3.9.6.1. Clinical Findings.- 3.9.6.2. Treatment.- 3.9.7. 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. Sjögren’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.- 4.6.3. 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. Classification.- 4.7.1.3. Clinical Manifestations.- 4.7.1.4. Diagnosis.- 4.7.1.5. 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. Polymyalgia Rheumatica and Giant-Cell Arteritis.- 4.8.1. Clinical Manifestations.- 4.8.2. Diagnosis.- 4.8.3. Management.- 4.9. Spondylarthropathies.- 4.10. Malignancies and Rheumatic Diseases.- 4.10.1. Hypertrophic Osteoarthropathy.- 4.10.2. Malignancy-Related Polyarthritis.- 4.10.3. Polymyositis and Dermatomyositis.- 4.10.4. Metastatic Disease.- 4.10.5. Leukemia.- 4.10.6. Carcinoma of the Pancreas.- 4.10.7. Palmar Fasciitis and Reflex Sympathetic Dystrophy…..- 4.11. Osteoarthritis.- 4.11.1. Epidemiology.- 4.11.2. Biology of Normal Cartilage.- 4.11.3. Normal Age-Related Changes in Articular Cartilage…..- 4.11.4. Biochemical and Histopathologic Changes in Osteoarthritis.- 4.11.5. Pathogenesis.- 4.11.6. Clinical Manifestations.- 4.11.7. Management.- 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. Antimalarials.- 4.12.5. Gold Therapy.- 4.12.6. Other Remittative Agents and Immunosuppressives.- 4.12.7. Allopurinol.- 4.12.8. Colchicine.- 4.13. Raynaud’s Phenomenon.- References.- 5 Genitourinary Problems in the Elderly.- 5.1. Renal Lithiasis.- 5.1.1. Incidence of Calcium Stone Formation.- 5.1.2. Etiology of Calcium Stone Formation.- 5.1.3. Diagnosis.- 5.1.4. Medical Treatment.- 5.1.5. Destruction of Renal Stones.- 5.1.6. Management of Ureteral Stones.- 5.2. Infection Stone Disease.- 5.2.1. Etiology of Struvite Formation.- 5.2.2. The Natural History of Struvite Stones.- 5.2.3. Medical Treatment.- 5.2.4. Dissolution Techniques.- 5.3. Uric Acid Stone Disease.- 5.3.1. Etiology.- 5.3.2. Diagnosis.- 5.3.3. Treatment.- 5.4. Bladder Stones.- 5.4.1. Etiology.- 5.4.2. Treatment.- 5.5. Urinary Infections.- 5.5.1. Incidence.- 5.5.2. Etiology.- 5.5.3. Bladder Defense Mechanisms.- 5.5.4. Diagnosis, Localization, and Classification of Urinary Infections.- 5.5.5. Antimicrobial Sensitivity Testing and Bacterial Resistance.- 5.5.6. Treatment.- References.- 6 Endocrinology and Metabolism in the Elderly.- 6.1. Introduction.- 6.2. Diabetes in the Elderly.- 6.2.1. Glucose Tolerance with Aging.- 6.2.2. Diagnosis.- 6.2.3. Treatment.- 6.2.3.1. Diet.- 6.2.3.2. Oral Agents.- 6.2.3.3. Insulin.- 6.3. Treatment of Hyperlipidemia in the Elderly.- 6.3.1. Introduction.- 6.3.2. Classification.- 6.3.2.1. Primary Hyperlipidemias.- 6.3.2.2. Secondary Hyperlipidemias.- 6.3.2.3. The Significance of HDL.- 6.3.3. Diagnosis.- 6.3.4. Treatment.- 6.3.4.1. Lipid Levels.- 6.3.4.2. Diet.- 6.3.4.3. Triglycerides.- 6.3.4.4. Cholesterol.- 6.3.4.5. Alcohol.- 6.3.4.6. Fiber.- 6.3.4.7. Drugs.- 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 Physiologic 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. 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 Biopsychosociocultural 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. Etiologic/Risk Factors.- 7.4.6.3. Pathologic Correlations.- 7.4.6.4. Pick’s Disease—The Clinicopathologic Comparison with Alzheimer’s Disease.- 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 Support of the Geriatric Patient.- 8.1. Statement of Purpose.- 8.2. Introduction.- 8.3. Causes of Malnutrition in the Elderly.- 8.3.1. Physical Impairments Contributing to Malnutrition.- 8.3.2. Physiologic Changes Affecting Nutrition.- 8.3.3. Disease States Contributing to Malnutrition.- 8.3.4. Social Factors Contributing to Malnutrition.- 8.3.5. Iatrogenic Causes of Malnutrition.- 8.3.6. Summary.- 8.4. Enteral Nutritional Support of the Elderly.- 8.4.1. Introduction.- 8.4.2. Methods of Nutrient Delivery.- 8.4.3. Enteral Supplements.- 8.4.4. Complications during Enteral Nutrition.- 8.5. Parenteral Nutritional Support of the Elderly.- 8.5.1. Introduction.- 8.5.2. Techniques of Nutrient Delivery.- 8.5.3. Composition of Parenteral Formulas.- 8.5.4. Complications of TPN.- 8.6. Conclusion.- References.- 9 Contemporary Issues in Geriatric Medicine.- 9.1 Geriatric Falls.- 9.1.1. The Problem.- 9.1.2. Etiology.- 9.1.3. Physiologic Changes Related to Falling (Table I).- 9.1.3.1. Vision.- 9.1.3.2. Hearing.- 9.1.3.3. Smell and Taste.- 9.1.3.4. Balance and Gait.- 9.1.3.5. Reaction Time.- 9.1.4. Pathologic Diseases Responsible for Falls.- 9.1.4.1. Extracranial Artery Disease.- 9.1.4.2. Orthostatic Hypotension.- 9.1.5. Disorders of Vagal Response.- 9.1.5.1. Low Vision.- 9.1.5.2. Arrhythmia.- 9.1.5.3. Seizure.- 9.1.5.4. Impaired Gait.- 9.1.5.5. Drugs.- 9.1.5.6. Dizziness.- 9.1.5.7. Premonitory Falls.- 9.1.5.8. Psychologic Factors.- 9.1.6. Devices.- 9.1.7. Other Causes of Falling.- 9.1.7.1. Cervical Spondylosis.- 9.1.7.2. Drop Attacks.- 9.1.7.3. Osteoporosis.- 9.1.7.4. Osteomalacia.- 9.1.7.5. Thyroid Disease.- 9.1.8. Environmental Factors.- 9.1.8.1. Falls in the Home.- 9.1.8.2. Falls in the Institution.- 9.1.9. Research Imperatives.- References.- 9.2 Ethical Considerations in the Elderly Population.- 9.2.1. Introduction.- 9.2.2. Medical Care.- 9.2.3. Informed Consent and Decision Making.- 9.2.3.1. General Considerations.- 9.2.3.2. Informed Consent.- 9.2.3.3. Competence in the Impaired Individual.- References.- 9.3 Diagnosis and Treatment of Malignant Lymphomas in the Elderly.- 9.3.1. Introduction.- 9.3.2. Immunotyping.- 9.3.3. Autoimmune Phenomena.- 9.3.4. Hodgkin’s Disease.- 9.3.4.1. Epidemiology and Etiology.- 9.3.4.2. Pathology.- 9.3.4.3. Clinical Features.- 9.3.4.4. Staging.- 9.3.4.5. Treatment.- 9.3.5. Non-Hodgkin’s Lymphoma.- 9.3.5.1. Epidemiology and Etiology.- 9.3.5.2. Pathology.- 9.3.5.3. Clinical Features.- 9.3.5.4. Staging.- 9.3.5.5. Therapy.- 9.3.6. Mycosis Fungoides.- 9.3.7. Multiple Myeloma.- 9.3.7.1. Introduction.- 9.3.7.2. Clinical Features.- 9.3.7.3. Diagnosis.- 9.3.7.4. Therapy.- 9.3.8. Waldenstrom’s Macroglobulinemia.- 9.3.9. Conclusion.- References.- 9.4 Aging and Oral Function.- 9.4.1. Introduction.- 9.4.2. Dental Demography and Aging.- 9.4.3. Normal Effects of Aging on Oral Status and Function.- 9.4.3.1. Lip Posture.- 9.4.3.2. Muscles of Mastication.- 9.4.3.3. Alterations in Physiology of the Tongue.- 9.4.3.4. Changes in Oral Mucosa.- 9.4.3.5. Salivary Function.- 9.4.3.6. The Dentition in Normal Aging.- 9.4.4. Regional Evaluation of the Mouth and Its Adnexae.- 9.4.5. Common Oral Pathology in the Elderly.- 9.4.6. Oral Cancer.- 9.4.7. Medical-Dental Interactions in the Care of the Geriatric Patient.- 9.4.7.1. General Considerations.- 9.4.7.2. Cardiovascular Disorders.- 9.4.7.3. Vascular Proliferative Disorders.- 9.4.7.4. Diseases of the Arteries.- 9.4.7.5. Hypertension.- 9.4.7.6. Postural Hypotension.- 9.4.7.7. Stroke.- 9.4.7.8. Parkinson’s Disease.- 9.4.7.9. Diabetes.- 9.4.8. Dental Management of the Patient with Alzheimer’s Disease….- 9.4.9. Dental Care in Nursing Homes.- References.- 9.5 Geriatric Continuum of Care: The Veterans Administration.- 9.5.1. Introduction.- 9.5.2. Historical Developments.- 9.5.3. A Philosophy Emerges: The Health Care Continuum.- 9.5.4. Staffing Issues.- 9.5.5. Architectural Concerns.- 9.5.6. New Program Development.- 9.5.7. Concerns for the Future.- References.- 9.6 Interpretation of Laboratory Values in the Elderly.- 9.6.1. Introduction.- 9.6.2. Normal Values.- 9.6.2.1. General Considerations.- 9.6.2.2. Sensitivity and Specificity.- 9.6.2.3. Summary and Conclusions.- 9.6.3. Hematologic Tests.- 9.6.3.1. Red Blood Cells.- 9.6.3.2. White Blood Cells.- 9.6.3.3. Erythrocyte Sedimentation Rate.- 9.6.4. Serum Chemistries.- 9.6.4.1. Electrolytes.- 9.6.4.2. Renal Function Tests.- 9.6.4.3. Hepatic Function Tests.- 9.6.4.4. Serum Proteins.- 9.6.5. Endocrine Tests.- 9.6.5.1. Glucose Tolerance.- 9.6.5.2. Glucocorticoid Tests.- 9.6.5.3. Thyroid Function Tests.- 9.6.5.4. Parathyroid Hormone Tests.- 9.6.5.5. Gonadal Function Tests.- 9.6.6. Summary and Conclusions.- References.