This practical book describes the key features of high-quality care for frail elderly patients in acute hospital settings. With chapters on assessment and the characteristic non-specific ways that patients tend to present. As well as common medical and surgical conditions, it also covers medication management, elder abuse, pressure ulcers and hypothermia, including the physiological changes seen in ageing and ways to define frail patients.
HENRY WOODFORD BSc, FRCP Consultant in Elderly Medicine North Tyneside Hospital, North Shields and JAMES GEORGE MBChB, MMEd, FRCP Consultant in Medicine for the Elderly Cumberland Infi rmary, Carlisle Henry Woodford was born in York and went to school in Yorkshire. He then went to medical school at King's College London. During this time he undertook an intercalated degree incorporating physiology. His elective period was spent in British Columbia, Canada. He did his house jobs in the south- east of England but then moved to the north- east for further training. He did his specialist registrar rotation based around Newcastle upon Tyne. One year was taken out of the programme to work at Westmead Hospital in Sydney, Australia. He worked as a consultant geriatrician in Carlisle from 2006 until 2012, when he moved to take up a post in North Tyneside, UK. He is married and has two daughters. James George was born in Derbyshire and qualifi ed in Liverpool. Aft er early training in Liverpool, Leeds and Bradford he was appointed as a Consultant in 1986 in Carlisle. He is the Clinical Lead for Research for North Cumbria University Hospitals NHS Trust. He was a member of the National Institute for Health and Clinical Excellence (NICE) Clinical Guideline Group for the 2010 NICE guidelines on delirium. He is married and has one daughter, who is an occupational therapist.
Foreword vii Preface x About the authors xi List of abbreviations xii 1 Introduction 1 What is old age? 1 Changes in physiology 3 Frailty 8 Older people in acute hospitals 10 Reasons for attending hospital 13 Outcomes 15 Intensive therapy unit and high dependency unit care 17 Resuscitation 18 Hazards of hospitalisation 19 Rehabilitation 22 Discharge planning 25 Readmissions 26 Alternatives to acute hospitals 27 Care homes 28 2 Assessment 37 Initial rapid assessment 37 Comprehensive geriatric assessment 41 History 42 Physical examination 46 Functional assessment 48 Cognitive assessment 50 Mood assessment 57 Nutritional assessment 58 Investigations 59 3 'Off legs': non-specific functional decline 67 Atypical presentations of disease 67 Malnutrition 68 Dehydration 70 Acute kidney injury 73 Rhabdomyolysis 73 Electrolyte disturbances 74 Constipation 82 Incontinence 84 Pressure ulcers 92 Accidental hypothermia 95 4 Confusion 105 Delirium, dementia or both? 106 Delirium 107 Dementia 115 5 'Collapse query cause': falls and blackouts 125 Falls 125 Blackouts 132 Syncope 132 Epilepsy 138 6 Surgical care 147 Perioperative care 147 Abdominal pain 150 Trauma 160 7 Infection 175 Prognostic markers 175 Bacteraemia 176 Sepsis 177 Antibiotics 178 Pneumonia 179 Influenza 183 Urinary tract infection 184 Clostridium diffi cile infection 189 Methicillin- resistant Staphylococcus aureus 192 Infective endocarditis 193 Meningitis 194 Encephalitis 196 Skin and soft tissue infections 197 8 Cerebrovascular disease 207 Stroke 207 Transient ischaemic attack 208 Ischaemic stroke and transient ischaemic attack 214 Intracerebral haemorrhage 218 9 Chest pain and shortness of breath 225 Acute coronary syndromes 225 Heart failure 228 Cardiac arrhythmias 231 Aortic dissection 233 Pulmonary embolism 235 Chronic obstructive pulmonary disease 237 10 Other presentations 245 Dizziness 245 Acute gastrointestinal haemorrhage 250 Parkinson's disease 253 Depression 261 Diabetes 265 Headache 270 Acute back pain 274 Acute joint infl ammation 278 Elder abuse 282 Palliative care 284 11 Medications 295 Changes in pharmacokinetics 296 Changes in pharmacodynamics 296 Evidence- based medicine 296 Polypharmacy 296 Prescribing for older people 297 Goals of therapy 297 Adverse drug reactions 298 Inappropriate medications 301 Concordance and adherence 307 Medication review 308 Index 317
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