bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathophysiology of sarcopenia
Authors: Benard Townsend , Fielding Roger A.
Published: December 2017

A number of mechanisms have been proposed to contribute to the accelerated loss of muscle mass and/or function in sarcopenia. Ageing induces a loss of the anabolic nature of food and muscle contraction, failing to adequately stimulate muscle protein synthesis. Reductions in protein intake and/or blunting of vasodilation in muscle may contribute to this impairment, though conclusive evidence is still lacking. Increasing adiposity, particularly within muscle, has been associated with physical and functional declines in ageing. Short-term disuse, such as hospitalization or injury, appears to disproportionately accelerate muscle mass loss in older people. Age-induced, low-level, chronic elevations in NF-kβ-mediated pro-inflammatory cytokines (TNF-α, IL-6 & IL-1) have shown robust relationships with sarcopenia. Accelerated reactive oxygen species generation brought on by mitochondrial dysfunction may stimulate myocyte apoptosis, though this mechanism is still debated. Age-induced neuromuscular adaptations appear to contribute to sarcopenia, particularly for changes in muscular function.
Micronutrients
Authors: Annweiler Cédric , Beauchet Olivier
Published: December 2017

Micronutrients are nutrients required by organism throughout life in small quantities to orchestrate a range of physiological functions. They are composed by vitamins, minerals, and trace elements. Micronutrient deficiencies are common in older adults, even in highly developed industrial nations. They result from insufficient supply and/or increase in micronutrient requirements. Micronutrient deficiencies can accelerate the physiological ageing process and aggravate the decline of cell renewal processes, immune defence, eyesight and hearing, and cognition. It is thus crucial to ensure that older adults receive an optimal supply of vitamins, minerals, and trace elements. We reviewed here the needs, main effects, and current research directions of the micronutrients of interest among older adults. There is a constantly growing certainty that improving the micronutrient supply to older adults, whether via nutrient-dense culturally appropriate diets or via multivitamin-mineral supplements, may be helpful to prevent or at least contain diseases observed with ageing.
Obesity
Authors: Zamboni Mauro , Fantin Francesco , Mazzali Gloria
Published: December 2017

The prevalence of obesity is growing progressively even among older age groups. Weight gain or fat redistribution in older age may still confer adverse health risks. In older ages central fat and relative loss of fat-free mass become relatively more important than body mass index (BMI) in determining the health risk associated with obesity. The risks of obesity in older people have been underestimated due to several confounders such as survival effect, competing mortalities, shortened life expectancy in older persons, smoking, weight change, and unintentional weight loss. Identification of elderly subjects with sarcopenic obesity is clinically relevant and is associated with increased morbidity and mortality. Although scarce, studies on the effect of voluntary weight loss in older people suggest that even small amounts of weight loss may be beneficial.
Management of diabetes in older adults
Authors: Mañas Leocadio Rodríguez , Rodríguez Marta Castro , Sinclair Alan J.
Published: December 2017

Diabetes mellitus is a highly prevalent chronic disorder that compromises physical and cognitive function, well-being, and quality of life in older adults and is often accompanied by several comorbid conditions. It shares some pathophysiological characteristics with the ageing process and increases the risk of several adverse outcomes such as frailty, sarcopenia, disability, and vascular dysfunction. Management involves an integrated, continued, coordinated diagnostic and therapeutic approach that takes into account total and healthy (free of disability) life expectancy, comorbidities, access to care, and is focused on achieving and maintaining the best functional status attainable. Physical exercise, based on resistance training programmes, a nutritional approach oriented to avoid malnutrition, and a drug treatment based on the functional and cognitive status of the patient are the cornerstones of treatment.
Secondary prevention of fragility fractures
Authors: Masud Tahir , Mitchell Paul J.
Published: December 2017

People who have already suffered from a low trauma fragility fracture are at a significantly increased risk of further fractures with their associated morbidity, mortality, and cost to health and social services. It is vital therefore that secondary prevention is provided in a timely fashion to these patients. Many areas are failing to meet this important objective due to gaps in services and a lack of appropriate pathways. Successful secondary prevention requires both treating osteoporosis with evidence-based treatments and measures to prevent falls and injury. Guidelines exist for secondary prevention of both falls and fractures. Falls prevention requires a multidisciplinary approach and a comprehensive geriatric assessment should form the basis for evaluating individuals. This chapter outlines examples of innovative developments that have occurred since the start of the millennium which have improved care by allowing these essential components of secondary prevention to be brought together in a coordinated manner.
Osteoarthritis
Authors: Blanco Francisco J.
Published: December 2017

Osteoarthritis (OA) is the most common joint disease related to ageing involving cartilage degradation, synovial inflammation, subchondral bone sclerosis, degeneration of ligaments and, in the knee, the menisci and hypertrophy of the joint capsule. Other alterations, in periarticular muscles, nerves, bursa, and local fat pads, also contribute to OA. Some risk factors are associated with OA and it is possible to differentiate between risk factors that confer a generalized susceptibility to OA, such as age, osteoporosis, heredity, and gender, and the differing local biomechanical factors of joints, such as trauma, anatomical variance of the articulation, occupational exposures, and obesity. The treatment of osteoarthritis should be individualized and adjusted to the joint affected. The objectives are to control pain, maintain function, and to slow progression. Treatment of OA can be considered in symptom-modifying and structure-modifying treatments.
Foot problems
Authors: Menz Hylton B.
Published: December 2017

Foot problems affect one in four people aged over 65 years and have a major detrimental impact on mobility and quality of life. With advancing age, the foot undergoes several cutaneous, vascular, neurological, and musculoskeletal changes, all of which may impair this important weight bearing function and predispose the older person to the development of foot symptoms. This chapter provides an overview of the prevalence and impact of foot problems in older people, and briefly discusses the management of common foot problems in older people including skin and nail disorders, vascular disorders, and structural deformities. The important role of footwear in the management of foot problems is also highlighted.
Orthogeriatrics
Authors: Close Jaqueline
Published: December 2017

Orthogeriatric care involves an integrated and multidisciplinary approach to the care of fracture patients requiring surgical intervention. Effective orthogeriatric care requires a mutual respect, trust, and understanding of roles between geriatric medicine and orthopaedic surgery. Hip fracture care is the area where the evidence base for orthogeriatrics is strongest but the principles and guidelines for hip fracture care can frequently be extrapolated to care of other fracture types. Benefits of this integrated approach to care include fewer postoperative complications, better functional outcomes, and reduced mortality. Pathways and protocols can facilitate a more consistent and reliable approach to the delivery of care and ensure that care requirements beyond the acute episode of care are identified and addressed. Patient level audit against key indicators allows for benchmarking of performance at a national and international level and the evidence suggests that using data in this way can drive improvements in care.
Immunosenescence and infectious diseases
Authors: Moutschen Michel , Martens Henri , Geenen Vincent
Published: December 2017

In this chapter, we briefly review the principal modes of interactions taking place between the host’s immune system and the principal groups of microorganisms. One of the principal features of immunosenescence is its links to thymus involution, with subsequent loss of diversity of the repertoire of naïve T-cells. This has a major impact on the adaptative immune responses developed against newly encountered pathogens. Interestingly, more ubiquitous mechanisms associated with the ageing process itself could also have an impact on innate immunity. Defective autophagy impairs the clearance of intracellular pathogens and age-related defects of the ubiquitination-proteasome pathway concur to blunt antiviral responses. In summary, healthy ageing is associated with subtle impairments of innate and adaptive immunity directed against all groups of pathogens. The presence of comorbid states often extorts a synergistic effect on the susceptibility to infectious diseases.
Pneumonia and respiratory tract infections
Authors: Liapikou Adamantia , Torres Antoni
Published: December 2017

Acute lower respiratory infections, such as acute bronchitis and pneumonia, are a leading cause of death worldwide and a primary source of morbidity and mortality in older adults. Clinically, elderly patients with community-acquired pneumonia often have non-specific clinical symptoms, altered mental status, or subtle functional decline, making an accurate diagnosis and early antimicrobial treatment difficult, and further worsening the prognosis. Older frail patients living in nursing homes have a high frequency of aspiration pneumonia caused by gram-negative bacilli and anaerobic pathogens.

Over the last few years there has been a controversy over whether the higher mortality of pneumonia is due to inappropriate therapy or the poor functional status of these patients. Prevention strategies of respiratory infections in older people include the prevention and management of aspiration, reduction in the use of neuroleptic medication, influenza vaccination, and possibly the use of the newer antiviral drugs.
Tuberculosis in old age
Authors: Dey Aparajit Ballav , Kandel Ramesh
Published: December 2017

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. It is a common cause of death in the developing world among older persons. HIV/AIDS pandemic has led to rise in TB cases, development of drug resistance, and higher incidence of extrapulmonary disease. TB in old age can result from acquisition of new infection or reactivation of latent infection and progression to disease due to immunosenescence. It is a multisystem infection affecting virtually every organ system in the body, though pulmonary TB is the commonest manifestation. TB presents atypically in old age. The gold standard for diagnosis is isolation of the infective organism in culture, which is often difficult to achieve. The diagnostic strategies have improved with newer techniques based on nucleic acid amplification. Older patients have a higher risk of adverse drug reaction and poor treatment outcome. Control of TB requires efficiency in early detection and completion of treatment.
Bone and periprosthetic joint infections in older adults
Authors: Zimmerli Werner , Sendi Parham
Published: December 2017

Most bone and joint infections are more prevalent in older adults, mainly because of their decreasing host defence and their increasing comorbidity. The main challenge is rapid diagnosis of such infections, because they often manifest with only subtle signs and symptoms in older adults. In this population, the prevalence of vertebral osteomyelitis, diabetic foot osteomyelitis, pressure ulcer osteomyelitis, and periprosthetic joint infections is increasing. For all these infections, rapid diagnostic work-up is needed, because prognosis, including the functional outcome, depends on early and adequate treatment. However, in older adults, quality of life is also crucial. Therefore, in frail individuals, a palliative procedure (e.g. lifelong suppressive therapy) should be sometimes preferred to curative treatment requiring burdening surgical interventions.
Haemopoietic diseases: leukaemias and myelomas
Authors: Mina Roberto , Larocca Alessandra , Palumbo Antonio
Published: December 2017

The demographic revolution driven by the ageing of the general population is rapidly changing the therapeutic landscape in the onco-haematological setting. Acute and chronic leukaemias and myeloma are typical disorders of older people, and their incidence is expected to rise in the near future. The introduction of new targeted drugs has led to a survival improvement, which is still significantly inferior in elderly patients as compared with younger ones. The current approach to older patients, based on chronological age and performance status, is no longer sufficient to fully characterize patients, whereas comprehensive geriatric assessment (CGA) is a better tool to make a thorough evaluation (physical and cognitive) and to tailor treatment according to patients’ fitness. Since there is evolving consensus about the optimal tools for a geriatric evaluation in the haematological setting, studies aimed at validating CGA are necessary to stratify patients and guide physicians in the choice of treatment.
Dyslipidemias and other cardiometabolic risk factors in older adults
Authors: Arai Hidenori
Published: December 2017

Dyslipidemia is a major risk factor for atherosclerotic cardiovascular disease (ASCVD) in older people. In spite of the higher absolute risk in older patients, plasma lipids lose their ability to predict the development of ASCVD along with ageing, especially over 80 years old. However, lipid-lowering agents like statins can significantly inhibit the development of ASCVD in older patients as well as in younger patients. Current consensus about the lipid-lowering treatment in older patients is that we should treat early old patients (75 years old and younger) with or without ASCVD and in patients more than 75 years old with ASCVD as in the non-elderly by taking care of the drug-induced adverse effects. However, the treatment of the oldest patients without ASCVD with statins should be individualized and the statin treatment for those over 85 years old is under discretion of the physician.
Peripheral vascular disease in older adults: diagnostic and treatment considerations
Authors: Lim Chung S. , Onida Sarah , Davies Alun H.
Published: December 2017

Peripheral vascular disease, or peripheral arterial disease (PAD), is a common condition, particularly prevalent in the older adult population. The condition is caused by narrowing of the arteries, which causes numerous signs and symptoms, usually affecting the lower limb. The sequelae of PAD can lead to difficulty mobilizing, ulceration, and the need for intervention. As the general population is living longer, general practitioners and care of the elderly physicians are increasingly caring for older adults with PAD. The diagnostic principles and treatment considerations in older adults with PAD are similar to those for the general population, although additional attention must be paid to several factors including fitness for intervention, medications, mobility, and quality of life. These factors cause a significant burden to patients in terms of their quality of life. In this chapter we discuss PAD with resect to its history, presentation, diagnosis, and treatment modalities.
Pulmonary thromboembolism
Authors: Wärntges Simone , Schäfer Katrin , Konstantinides Stavros V.
Published: December 2017

Venous thromboembolism (VTE) is the third most frequent acute cardiovascular syndrome; its annual incidence may reach 1200 cases per 100,000 population aged ≥80 years. Besides age-related increases in predisposing conditions, the ageing process itself shifts the balance between pro and anticoagulant pathways towards a propensity to thrombosis. Evaluation of symptoms and clinical signs of suspected VTE in older adults should take into account ‘physiologic’ age-related cardiopulmonary changes. Using age-adjusted (in patients older than 50 years) D-dimer cut-off levels in combination with low or intermediate clinical probability increases the number of patients in whom PE can reliably be excluded without imaging tests. Age is a key determinant of the bleeding risk under fibrinolytic and anticoagulation treatment. Overall, the new oral anticoagulants are effective and safe in older adults; however, age-related changes in renal and other organ function and drug pharmacokinetics mandate regular monitoring and possible dose adjustments.
Syncope and neurocardiovascular instability
Authors: Kenny Rose Anne , Cunningham Conal
Published: December 2017

The prevalence of syncope rises with age and is challenging because of atypical presentation, overlap with falls, and poor recall of events. Cardiac causes and multiple comorbidities are more common, and related morbidity and mortality are higher than in younger patients. Hence, a high index of suspicion for cardiovascular causes of falls and dual pathology will increase successful diagnosis and intervention. Age-related neurohumoral and physiological changes plus chronic diseases and medications often contribute to syncope. Orthostatic hypotension, carotid sinus syndrome, vasovagal syncope, postprandial syncope, sinus node disease, atrioventricular block, and ventricular tachycardia are other common causes. Management is often based on removing or reducing the predisposing or precipitating factors through medication adjustments, behavioural strategies, and more invasive cardiac interventions if indicated. It is often not possible to identify a single cause of syncope in older persons, hence apragmatic management of each diagnosis is recommended.
Management of atrial fibrillation and anticoagulant therapies
Authors: O’Neill Mark , Whitaker John , Birns Jonathan , Wright Matthew
Published: December 2017

Atrial fibrillation (AF) is a common supraventricular arrhythmia which is commonly found in older adults. It is associated with an increased risk of stroke and has a detrimental effect on quality of life. Management of AF involves an attempt to reduce the increased risk of stroke and to treat the symptoms that result from a high (or low) ventricular rate as well as, in some cases, the atrial rhythm itself. The management of AF involves a comprehensive assessment of a patient’s individual stroke and bleeding risk and a careful documentation of the impact of their symptoms on quality of life. Treatment options range from conservative to highly invasive. Selecting the appropriate combination from the range of options necessitates an understanding of the risks and benefits of each, so that the patient and physician can jointly identify the most appropriate management strategy.
Management of bradyarrhythmias
Authors: Harrison James L. , O’Neill Mark D.
Published: December 2017

The process of ageing is associated with an increased incidence of cardiac bradyarrhythmias, which are responsible for significant morbidity and mortality. Structural and functional changes, both mechanical and electrical, occur in the ageing heart, together with alterations in cardiac energetics and metabolism. By the age of 75, the number of functioning pacemaker cells is less than 10%, compared with a young adult. A reduction in automaticity and a slowing of conduction are both common, exacerbated by comorbidities and polypharmacy. Over 80% of pacemakers are implanted in those over 65 years of age. The main indication in these patients is symptomatic bradycardia, due to degenerative sinus node dysfunction or disease of the atrioventricular (AV) node and His-Purkinje system. With careful consideration of risks and benefits, age should not be seen as a contraindication to pacemaker therapy for cardiac bradyarrhythmias.
Valvular heart disease: state of the art and treatment perspectives
Authors: Cribier Alain , Eltchaninoff Helene
Published: December 2017

Decision-making for the management of valvular disease (VHD) is rapidly evolving with advances in surgical and interventional techniques. The main causes of VHD has moved from rheumatic to degenerative, more particularly in industrial countries. In this chapter will be briefly discuss the aetiologies, presentation, and natural history of VHD in adults. The medical and surgical options available to date and the threshold for intervention will be then described. The role of a multidisciplinary Heart Valve Team working together with a geriatrician has become crucial to determine the optimal therapeutic option for VHD in older adults. Surgical valve replacement has been for decades the only possible option for the three leading VHDs in developed countries: aortic stenosis (AS), aortic regurgitation (AR) and mitral regurgitation (MR). Mitral stenosis (MS) has almost disappeared in Western countries while its prevalence remains high in the developing world.
Cardiac rehabilitation
Authors: Maiorana Andrew , Neubeck Lis , Williams Sian , Hill Keith
Published: December 2017

Cardiac rehabilitation is a multifactorial approach to supporting patients in their recovery from a cardiovascular event and reducing their risk of recurrent events (secondary prevention) through risk factor modification and adherence to evidence-based therapy. Although the incidence of cardiovascular disease increases with age, and the ageing demographic of industrialized societies means that many older people are living with cardiovascular disease, older people have historically been underrepresented in cardiac rehabilitation programmes. A challenge faced by contemporary cardiac rehabilitation providers is to offer flexible options to suit the requirements of different patient groups, including older people. This chapter explores best-practice cardiac rehabilitation and how it can be applied to suit the requirements of the geriatric patient, as well as the important role that physicians hold as an essential member of the multidisciplinary cardiac rehabilitation team.
Parkinsonism, Parkinson’s disease, and related conditions
Authors: Hindle John V. , Jones Sion , Davies Glesni
Published: December 2017

Parkinson’s disease (PD) is a progressive neurodegenerative condition characterized clinically by fatiguable bradykinesia, rigidity and tremor and pathologically by deposition of Lewy bodies and cell loss in the substantia nigra and other brain regions. Parkinsonism is the term used to describe the clinical features of conditions resembling PD. Their management requires specialist assessment and a multidisciplinary approach. Levodopa remains the mainstay of treatment for PD. Although other treatments are used, older people are more sensitive to their side effects. Non-motor symptoms, particularly neuropsychiatric problems, significantly impact quality of life and need special consideration in older people. Towards the later stage of the disease, management can be complex, and should involve advanced care planning.
Stroke: epidemiology of different types of strokes
Authors: Hoang Uy , Douiri Abdel , Ayis Salma , Wang Yanzhong , Rudd Anthony , Wolfe Charles
Published: December 2017

This chapter describes the epidemiology of stroke, a major cause of disability and premature death worldwide. The accurate classification of strokes is critical in conducting research and guiding clinical management. There are a number of classifications in clinical use, although a precise delineation of stroke subtypes requires the integration of clinical features, findings from diagnostic tests, and knowledge about potential aetiologic factors. Variations in incidence and mortality rates after stroke represent complex interactions between changing population demographics and risk factors, the availability and accessibility of preventative and curative measures, and differences in methods of case ascertainment worldwide. However, the widening gap between low- and high-income countries remains a significant challenge for long-term stroke strategies and this must be addressed before a true worldwide reduction in stroke incidence and mortality can be demonstrated.
Management of acute stroke within the stroke pathway and stroke clinics
Authors: Birns Jonathan , Bhalla Ajay
Published: December 2017

There have been considerable advances in stroke research leading to translation of drug therapy for stroke into the clinical arena. Thrombolysis for ischaemic stroke is a key advance that significantly reduces disability. This has revolutionized the manner in which acute stroke is treated as a medical emergency. The use of advanced imaging techniques and adjuncts to thrombolysis could potentially improve selection of patients who may benefit from reperfusion therapy such as mechanical thrombectomy and allow treatment decisions to be based on individual brain pathophysiology, rather than arbitrary time windows. It is likely that reconfiguration of stroke services may be required to accommodate further delivery of hyperacute interventions for acute stroke.
Normal cognition and ageing: structure, function, and cognitive reserve
Authors: Starr John
Published: December 2017

Defining normative trajectories of cognitive ageing is essential to determine what is abnormal. Normative cognitive ageing, in itself, correlates highly with changes in everyday function, and thus impacts on the lives of the majority of older adults who do not develop dementia. What is normative depends on: 1) the degree of cognitive change; 2) the pattern of change across cognitive domains; and 3) the concurrence of non-cognitive features, such as changes in activities of daily living. Cognitive reserve influences the third of these predicates and comprises both static and dynamic components. Social context determines the dementia threshold, hence also contributing to the definition of what can be considered as normative cognitive change. Life course studies are essential for the identification of factors that influence normative cognitive ageing to avoid drawing false inferences due to reverse causation.
Epidemiology of Alzheimer’s disease: a relevant challenge for long-term follow-up of a population-based cohort
Authors: Dartigues Jean François , Grasset Leslie , Maturin Tabue Teguo , Foubert Alexandra , Pérès Karine , Helmer Catherine , Amieva Hélène
Published: December 2017

The epidemiology of Alzheimer’s disease (AD) is difficult for several reasons: lack of operational criteria for AD; majority of incident cases occurring in very old people with multiple comorbidities; long prodromal phase before the dementia phase; large proportion of undiagnosed cases; and strong competition with death. There is no clear operational definition of cognitive decline and of impairment in social function related to this decline, and these clinical manifestations are the core of the clinical diagnosis of AD. Diagnosis is left to the the clinician’s subjectivity, which is influenced by the cultural context, the social context, and the expected efficacy of the treatment at the early phase of dementia. Several published papers are presented and conclusions discussed, including the protective effect of playing board games, the effect of changes in leisure activities with age, natural history of cognitive decline before AD according to education, and predictive score for dementia.
Mild cognitive impairment
Authors: Visser Pieter Jelle , Legdeur Nienke , Kate Mara ten , Bertens Daniela
Published: December 2017

The concept of mild cognitive impairment (MCI) has been introduced to describe cognitive impairment in non-demented subjects. Subjects with MCI are of major clinical importance because they have an increased risk to develop dementia. MCI is a frequent condition with a prevalence of 10–20% in the elderly population. Alzheimer’s disease is the most common cause, but any somatic, neurological, or psychiatric disorder and drug that influence brain functioning could cause it as well. A clinical assessment can identify several of the underlying causes and biomarkers may also be useful. Treatment is available for some of the underlying causes of MCI. The development of novel biomarkers, such as tau PET, and novel treatments may increase opportunities to diagnose the underlying pathology and give disease-specific treatments in the future.
The diagnosis of Alzheimer’s disease: assessment and criteria
Authors: Dubois Bruno , Filippi Massimo , Waldemar Gunhild
Published: December 2017

Alzheimer’s disease (AD) is the most prevalent form of dementia: it accounts for 70% of cases of progressive cognitive impairment in aged individuals, age being the single most important risk factor. The disease is linked with ageing, but it is not due to ageing, as exemplified by early onset cases. AD has characteristic clinical features, usually including various combinations of memory impairment, executive deficits, impaired instrumental functions, and behavioural/neuropsychiatric disturbances that may interfere with functioning of activity of daily living. Detailed neuropsychological testing with standardized assessment is required for quantifying the deficits of AD and may aid distinguishing AD from other degenerative dementias. The clinical diagnosis of AD has traditionally required exclusion of alternative explanations for cognitive decline using blood testing and brain neuroimaging techniques. A new conceptual framework based on pathophysiological biomarkers has been recently proposed that includes the prodromal (predementia) stage in the diagnostic algorithm.
Evidence-based management of behavioural and psychological symptoms of dementia
Authors: Corbett Anne , Ballard Clive , Creese Byron
Published: December 2017

Behavioural and psychological symptoms of dementia (BPSD) are common in people with Alzheimer’s disease (AD). They include agitation, aggression, psychosis and depression, and can cause great distress for the individual and their caregivers. Dementia represents a considerable challenge for treatment and care due to the complex needs of people with the condition. Management of BPSD is particularly challenging due to the lack of effective pharmacological treatments, and current clinical guidance is complex. This chapter outlines the causes and impacts of BPSD in people with AD. In particular, it explores the evidence supporting the use of both pharmacological and non-pharmacological treatments and the role they play in the prevention and treatment of BPSD.
Caregivers in dementia: role and empowerment
Authors: Reynish Emma , Thomson Nicola , Robertson Jane
Published: December 2017

The roles of the caregiver, the healthcare professional, and the healthcare system are critical in order to maximize the potential of this relationship and minimize the harm which results when this fails. In doing so, an understanding of the challenges associated with caring, its knock-on effect on caregivers’ well-being, and situations that cause this to decline are examined. By understanding the factors that detrimentally affect the caregiver’s well-being, the concept of increasing resilience in the lives of these individuals leading to their empowerment is highlighted. Ultimately, the aim for this attention is to bring about improvements in the quality of life and well-being of people with dementia by enabling healthcare professionals to work effectively in partnership with fully empowered caregivers.
Sleep disorders
Authors: Endeshaw Yohannes , Bliwise Donald L.
Published: December 2017

The chapter describes age-related changes in sleep and sleep disorders that are commonly encountered among older adults. In general, the sleep quality of older adults is described as lighter (increase in stage N1 and N2 non-rapid eye movement sleep) and associated with more frequent arousals. Despite these age-related changes, healthy older adults do not report sleep-related problems. Previous studies have indicated that sleep-related complaints among older adults are associated with medical, neurological, and psychiatric diseases. Older adults with primary sleep disorders such as insomnia, obstructive sleep apnoea and hypopnea, restless legs syndrome, and periodic leg movement disorder also report sleep-related complaints. These findings imply that sleep-related complaints among older adults are not due to normal age-related changes, but are associated with potentially treatable conditions. Hence, appropriate work-up for and treatment of these underlying disorders is indicated for successful management of sleep-related complaints among older adults.
Mood and anxiety disorders
Authors: Ulbricht Christine M. , Hunnicutt Jacob , Hume Anne , Pimentel Camilla B. , Tjia Jennifer , Lapane Kate L.
Published: December 2017

Mood and anxiety disorders, such as major depressive disorder and generalized anxiety disorder, are prevalent among older adults but are often undiagnosed and untreated. Older adults commonly experience factors that can increase risk for having these disorders, including comorbid medical conditions, frailty, and stressful major life events. The recognition and treatment of these disorders may be challenging due to issues associated with ageing. The risks and benefits of treatment options must be carefully considered since many older adults have comorbid conditions and concomitant medications which can exacerbate the likelihood for adverse effects of pharmacological treatments. Screening for these conditions and careful monitoring after treatment initiation is warranted. This chapter focuses on risk factors, presentation, assessment issues, and treatment of major depression, anxiety disorders, and suicide in older adults.
Management of acute kidney injury and chronic kidney disease
Authors: Ebert Natalie , Schaeffner Elke
Published: December 2017

Both acute and chronic states of kidney disease have considerable healthcare impact as they can produce enormous disease burden and costs. To classify chronic kidney disease into the CKD staging system, glomerular filtration rate as an index of kidney function, as well as albuminuria as a marker of kidney damage have to be assessed as correctly as possible. Misclassification is a serious concern due to the difficulties in precise GFR assessment and correct interpretation of results. Differentiating between pure senescence and true disease among older adults can be a delicate issue. To find the right renal replacement option for individuals that progress to end-stage renal disease can be challenging, and some older patients may even benefit from conservative care without dialysis. To prevent acute kidney injury as a frequent and potentially life-threatening complication, clinicians need to develop an understanding of the common vulnerability to kidney damage among older adults.
Common age-related eye diseases and visual impairment
Authors: Chua Jacqueline , Cheng Ching-Yu , Wong Tien Yin
Published: December 2017

General physicians have an essential role in preventing vision loss in older people. However, most vision-threatening eye disorders are initially asymptomatic and often go underdiagnosed. Therefore screening, early detection, and timely intervention are important in their management. The most common cause of visual impairment is uncorrected or undercorrected refractive error, followed by cataract, age-related macular degeneration, glaucoma, and diabetic retinopathy. Spectacles and cataract surgery can successfully restore sight for uncorrected refractive error and cataract, respectively. Visual impairment as a result of age-related macular degeneration, glaucoma, and diabetic retinopathy can be prevented with appropriate treatment if they are identified early enough. This chapter provides an overview of common age-related eye disease and visual impairment.
Hearing impairments and their treatments
Authors: Mamo Sara K. , Chisolm Theresa H. , Lin Frank R.
Published: December 2017

Hearing loss is highly prevalent and increases as a function of age. Although hearing loss affects many aspects of ageing and communication, it is often overlooked and treated as a rather inconsequential side effect of ageing. The purpose of this chapter is to introduce age-related hearing loss, the broader implications of age-related hearing loss as it relates to healthy ageing, and practical strategies for primary care management of hearing loss. A majority of the cases of age-related hearing loss remain untreated. Primary and/or geriatric care clinics may serve as the entry point for many older adults with hearing loss. Including questions about hearing loss or screening for hearing loss at other health encounters may increase access for older adults to hearing loss treatment.
Eating and drinking in later life
Authors: Martin Finbarr C. , Abyad Abdulrazzak , Arai Hidenori , Arcand Marcel , Balubaid Hashim Hasan , Beattie B. Lynn , Berner Yitshal N. , Kaushik Rajeev Mohan , Marín Pedro Paulo , Ouchi Yasuyoshi , Ramadan Marwan , Taboada Paulina
Published: December 2017

Food and drink are vital to life and have a special place in human culture: providing and receiving food has significance beyond sustaining body physiology. Sudden premature death is becoming less common and people experiencing a slow decline before death with frailty and/or dementia is more common. When patients develop swallowing difficulties and disinterest in food and drink, this presents challenges to healthcare workers and families. Should medically assisted (artificial) nutrition and hydration be started? Evidence suggests that it usually makes little or no impact on physical comfort or clinical outcomes but its emotional and cultural role may be great and ethical decision-making must take this into account. In the chapter we discuss various cultural, ethical, and legal perspectives on this situation and the judgements and practical decisions that arise, specifically focusing on those different standpoints from parts of the world where Buddhism, Christianity, Hinduism, Islam, and Judaism are predominant.
Advance care planning for older people
Authors: De Vleminck Aline , Deliens Luc
Published: December 2017

It has been suggested that end-of-life care for older people is currently inadequately adapted to their needs. Engaging early in the exploration of their wishes and preferences is of particular importance in this population. Since communication can be difficult for patients at the end of life, especially for those suffering from cognitive deficiencies such as dementia, it is important to become aware of wishes or preferences regarding care in advance and engage in advance care planning (ACP). ACP discussions can play a major role in facilitating adaptation to illness realities by providing patients with information about diagnosis and prognosis, by leading to appropriate decision-making, by alleviating anxiety, and by improving quality of life throughout the trajectory of the illness. ACP initially began as a movement to establish advance directives (ADs), but we have seen a shift to more emphasis being put on the process of communication and interaction.
Empowerment of the ageing population: a contribution to active ageing
Authors: Voelcker Ina , Kalache Alexandre
Published: December 2017

Empowerment is fundamental to release the potential generated by the longevity revolution and to actualize the concept of active ageing. It is a key component in the promotion and maintenance of health, the fostering of lifelong learning and social participation, as well as in the safeguarding of protection until the end of life. The definition of empowerment becomes more complex in the context of increasing numbers of the very old, with its frequent association with dementia and limited functional capacity. Active ageing highlights that ageing is a lifelong process firmly rooted in the ideas of health prevention and health promotion. Implicit to it, is the view that actions at both the personal and the public policy level are essential to optimize opportunities for people as they age.
Optimizing physical activity across the lifespan
Authors: Anton Stephen D. , Corbett Duane B. , Manini Todd M.
Published: December 2017

Regular engagement in exercise has been found to improve multiple aspects of physical and psychological health, yet the majority of adults do not exercise at levels recommended by current guidelines. Although physical exercise is the only intervention consistently demonstrated to attenuate functional decline among seniors, an even smaller percentage of older adults engage in regular physical activity. Regular engagement in physical activity across the lifespan is strongly encouraged, as adoption of physical activity at an early age has the potential to modify the trajectory of physical decline. In this chapter, we review the various factors that can affect long-term adherence to engagement in regular physical activity, as well as considerations for special clinical populations. Regardless of programme type, most individuals will need assistance in changing their lifestyle. Healthcare providers can play an important role in promoting healthy levels of physical activity through the use of empirically supported behavioural skills.
Nanosciences and the medicine of ageing
Authors: Podrebarac James , Edin Joel , Suuronen Erik J. , Alarcon Emilio I. , Griffith May
Published: December 2017

Age-associated diseases are becoming more prevalent as the worldwide population is getting older. This chapter reviews the current developments in nanotechnology directed at combating the rise of diseases and ailments stemming from ageing. The major complications that are discussed are cancers, cardiovascular disease, and neurodegeneration. Medical strategies based on nanotechnology include nanostructures surfaces, nanoparticles, nanoelectronics, aptamers, and nanoscale functional polymeric coatings. With nanotechnological tools now at our disposal, novel solutions are being developed for compatibility of implants, regeneration of tissues, destruction of malignancies, and replacement of organs or tissues as well as for diagnostics. As new types of therapeutics and diagnostics are being developed, diverse disciplines meet; this chapter attempts to give a comprehensive overview of the field for both clinicians and researchers.
Pathogenesis of fungal disease
Authors: Odds Frank C.
Published: December 2017

The pathogenesis of fungal disease involves an interplay between fungal virulence factors and host immune responses. Most fungal pathogens are opportunists that preferentially invade hosts with immune defects, but the fact that relative pathogenicity varies between fungal species (and even between different strains within a species) is evidence that fungi have evolved multiple, different molecular virulence factors. Experiments in which genes encoding putative virulence attributes are specifically disrupted and the resulting mutants are tested for virulence in a range of vertebrate and invertebrate hosts have identified or confirmed many gene products as significant for the pathogenesis of various types of fungal disease. These include factors determining fungal shape in vivo, biofilm formation, and a plethora of surface components, including adhesins and hydrolytic enzymes. This chapter provides an overview of fungal virulence attributes.
Immunology of fungal disease
Authors: Dambuza Ivy M. , Wagener Jeanette , Brown Gordon D. , Gow Neil A.R.
Published: December 2017

Advances in modern medicine, such as organ transplantations and the appearance of HIV (human immunodeficiency virus), have significantly increased the patient cohort at risk of developing chronic superficial and life-threatening invasive fungal infections. To tackle this major healthcare problem, there is an urgent need to understand immunity against fungal infections for the purposes of vaccine design or immune-mediated interventions. In this chapter, we give an overview of the components of the innate and adaptive immune system and how they contribute to host defence against fungi. The various cell types contributing to fungal recognition and the subsequent stimulation of phagocytosis, the activation of inflammatory and B- and T-cell responses, and fungal clearance are discussed using the major fungal pathogens as model systems.
Candida species
Authors: Hube Bernhard , Kurzai Oliver
Published: December 2017

Most pathogenic Candida species are members of the microbiota, but also cause superficial or invasive infections. C. albicans is predominant, followed by C. glabrata, C. parapsilosis, and C. tropicalis. C. albicans is polymorphic and grows as yeast, pseudohyphae, or hyphae. The cell wall has multiple functions in pathogenesis. Metabolism and nutrient up-take strategies facilitate growth in multiple niches within the host. Drug resistance is an intrinsic property of C. glabrata and C. krusei, but can be developed by C. albicans and other Candida species during antifungal therapy. Pathogenicity mechanisms include host cell attachment, invasion, and destructive activities; immune evasion; and biofilm production. A disbalanced microbiota and impaired immunity favour superficial infections, and disturbance of the mucosal barriers, together with compromised immunity, enables Candida to invade the human bloodstream and cause invasive infection. Even with antifungal therapy (e.g. azoles or echinocandins), disseminated candidiasis has a high mortality (40–50%).
Hyaline moulds
Authors: Johnson Elizabeth M.
Published: December 2017

Hyaline moulds are fungi that grow predominantly in a filamentous form with colourless hyphae. This is not a taxonomic grouping and encompasses many thousands of different fungal genera. However, there is a small subset of environmental saprobes or plant pathogenic moulds, currently comprising at least 75 species from 30 different genera, that are opportunistic human pathogens and have been implicated in invasive infections referred to as hyalohyphomycosis. In addition they may cause less invasive cutaneous, subcutaneous, mucous membrane, and corneal infections. This group of organisms includes Fusarium, Sarocladium, Paecilomyces, Purpureocillium, Scedosporium, Rasamsonia, and Scopulariopsis spp., and it is these that form the focus of this chapter. Aspects of taxonomy, cell biology, pathogenesis, epidemiology, incidence, risk factors, presentation, diagnosis, and treatment are discussed with particular reference to those features that are specific to hyaline moulds.
Fungal central nervous system infections
Authors: Bicanic Tihana , Harrison Thomas S.
Published: December 2017

Infections of the central nervous system (CNS) are amongst the most severe of all fungal infections. Cryptococcus neoformans is the commonest cause of adult meningitis in many countries with high HIV prevalence. C gattii is usually seen in the tropics in apparently immunocompetent patients. Meningitis is also caused by Candida in premature babies, and by the dimorphic fungi in endemic areas. CNS infections with Aspergillus, the mucormycetes, and less common moulds usually present as intracranial mass lesions in immunocompromised hosts. Early suspicion, prompt imaging, and appropriate samples for culture, histology, and antigen and molecular tests are all critical for early diagnosis. Organism-specific antifungal therapy relies largely on liposomal amphotericin B and voriconazole, with therapeutic drug monitoring for the latter. Amphotericin B plus flucytosine is recommended for cryptococcal meningitis. Management of underlying conditions is also critical. Targeted prophylaxis in highest risk groups and pre-emptive therapy for HIV-associated cryptococcosis hold promise for prevention and improved outcome.