bluuebunny/crossref_metadata_2025_split huggingface dataset:
Critical illness and intensive care
Authors: Duggan Maria Carlo , Frimpong Kwame , Ely E. Wesley 
Published: December 2017

Abstract
Older adults constitute the majority of intensive care unit (ICU) patients, and are increasing in both absolute and relative numbers. Critical care for elderly people should be tailored to their unique physiology, susceptibilities to complications, social circumstances, values, and goals for their care. Knowledge of the short and long-term outcomes of critical illness should guide therapy and goals of care. With a growing number of elderly ICU survivors, the functional, cognitive, and psychological consequences of critical illness and ICU exposure will become a more prominent problem to address. In this chapter, we will discuss morbidity and mortality of elderly ICU patients, provide an evidence-based bundle for the management of pain, agitation, and delirium that has been developed with the vulnerabilities of older patients in mind (though it is also being applied broadly to younger patients as well), and explore the long-term physical, cognitive, and psychological consequences that ICU survivors face.
Preoperative assessment and perioperative management
Authors: Dhesi Jugdeep , Partridge Judith 
Published: December 2017

Abstract
The demographic changes in the surgical population pose a new challenge for geriatricians. Despite symptomatic and survival benefits following surgery, older people consistently suffer from excess medical morbidity, mortality, and adverse functional outcomes. This is predominantly related to physiological change, multimorbidity, and geriatric syndromes. For these reasons, geriatricians are increasingly asked for their medical and rehabilitation expertise in the management of elective and emergency surgical patients. This chapter describes the goals of preoperative risk assessment, modification of risk through medical and functional optimization, and presents different models of care which can be employed in older patients. The evidence behind comprehensive geriatric assessment in the surgical setting is presented, including discussion about collaborative decision-making and effective communication involving older patients, their relatives, surgeons, anaesthetists, physicians, and allied health professionals in the perioperative period. The future challenges in terms of research, education, and service development are discussed.
Long-term care
Authors: Schols Jos M. G. A. , Gordon Adam 
Published: December 2017

Abstract
In this chapter, institutional long-term care for older people is addressed from a European perspective. A short historical overview is followed by some thoughts on how long-term institutional care may develop in the future, including a consideration of the role of informal care as a competing and complementary sector. It then describes the clinical profile of nursing home residents including reason(s) for admission, access issues, and length of stay. Thereafter, the types of care offered to nursing home residents will be described, with particular attention given to staffing and financing issues. Special consideration is given to the medical care of nursing home residents. Finally, we consider quality assurance in long-term care and how this is approached in different legislations before closing with a description of relevant themes and issues for research in the nursing home setting.
Environment and ageing biology
Authors: Karlamangla Arun S. , Seeman Teresa E. 
Published: December 2017

Abstract
Psychosocial factors over the life course and major life events are associated with the health, functional status, and survival of older adults. This chapter discusses the biological mechanisms through which these influences are thought to operate, and how life stresses might accelerate the usual ageing of biological systems. It starts with a brief description of psychosocial determinants of health and functioning before elaborating on the allostatic mechanisms by which the body adapts its internal physiological milieu in response to perceived stressors. The price paid for frequent and recurring adaptation is eventual dysregulation of the mediators of allostasis, or allostatic load. We close with a brief discussion of allostatic load links to health outcomes in older adults and potential interventions that might ameliorate the impact of psychosocial adversities on health.
Inflammation and its role in ageing and disease
Authors: Wang Jintang , Leng Sean X. 
Published: December 2017

Abstract
Ageing is a complex process characterized by progressive loss of homeostasis and physiologic reserve with increased disease susceptibility and vulnerability to adverse health outcomes. It is often accompanied by a low-grade, systemic, unresolved, and smouldering chronic inflammation marked by 2–4-fold increase in circulating levels of multiple inflammatory mediators. This chapter begins with a brief discussion of the basic biology thought to drive chronic inflammation, and then proceeds to provide an overview of current evidence supporting significant contribution of age-related chronic inflammation to frailty and late-life functional decline, neurodegenerative diseases, cardiovascular diseases, and age-related metabolic diseases. It ends with a brief discussion of the anti-inflammatory properties of caloric restriction (CR) and physical exercise, suggesting the possibility of developing interventional strategies to mitigate age-related chronic inflammation and its adverse impact on the health and well being of older adults.
Immune system changes and immunosenescence
Authors: Pawelec Graham , Müller Ludmila , Fülöp Tamas , Dunn-Walters Deborah 
Published: December 2017

Abstract
The immune system defends against infection, but older people paradoxically suffer not only from failing immunity resulting in increased susceptibility to infections and decreased responsiveness to vaccination, but at the same time increased inflammation and immunopathology accompanying immune responses. Interventions to reduce such deleterious effects while enhancing protective immunity are challenging but need to be confronted if we are to deal successfully with the increasing numbers of elderly and frail people in modern societies. To do this, we need to understand the mechanisms responsible for age-associated increased susceptibility to infections and immune-influenced chronic degenerative diseases of ageing. Defining relevant age-associated alterations and identifying reliable biomarkers for monitoring clinically-relevant immune status in the elderly population is crucial to overcoming these problems. Here, we briefly outline age-associated changes to immunity collectively termed ‘immunosenescence’.
Mitochondrial decline and chronic conditions of older adults
Authors: Marzetti Emanuele , Landi Francesco , Martini Francesca , Leeuwenburgh Christiaan , Calvani Riccardo 
Published: December 2017

Abstract
Ageing involves a progressive deterioration of physiological integrity which leads to increased vulnerability to stressors and multisystemic functional decline. Mitochondrial dysfunction is increasingly recognized as a common denominator of ageing and an important causative factor for major age-related conditions. Mitochondrial function becomes perturbed by age-associated accumulation of mtDNA mutations, altered mitochondriogenesis and dynamics, and abnormal regulation of mitophagy. These alterations result in diminished bioenergetic efficacy, enhanced oxidative stress, and eventually loss of cellular viability. This series of events is proposed to be a major mechanism in the ageing process and the development of chronic diseases. This chapter provides an overview on the mechanisms believed to underlie the loss of mitochondrial function with ageing. Special attention is paid to the consequences of mitochondrial dysfunction in postmitotic tissues (i.e. heart, skeletal muscle, and central nervous system), where mitochondrial damage is proposed to be responsible for the appearance of age- and disease-associated phenotypes.
Delirium
Authors: MacLullich Alasdair M. J. , Marcantonio Edward R. , Meagher David J. 
Published: December 2017

Abstract
Delirium is a complex medical emergency affecting at least 15% of older hospitalized patients. It causes considerable patient and carer distress, and is associated with adverse outcomes including falls, increased length of stay, new institutionalization, new and exacerbated long-term cognitive impairment, and mortality. Causes include medical illness, trauma, surgery, psychological stress, and drugs. The mechanisms involve direct effects on the brain such as hypoxia, and likely altered inflammatory and stress pathways. Older age, neurodegeneration, and medical comorbities greatly increase vulnerability. Detection involves eliciting evidence of acute inattention, altered level of arousal, and/or psychosis; brief tools such as the 4AT can improve detection rates. Care involves multiple aspects: treating all precipitating causes, optimizing general care, communicating with patients and carers, preventing complications, and treating distress and agitation. Detection of undiagnosed underlying dementia is important. Risk reduction in vulnerable patients, involving optimizing medical status, the care environment, and patient experience, is effective.
Benign prostatic hyperplasia and prostate cancer
Authors: Savdie Richard , Chedgy Edmund C. P. , Molokwu Chidi 
Published: December 2017

Abstract
The most common pathologic conditions of the prostate are benign prostatic hyperplasia (BPH) and prostate cancer. Both of these conditions have age as a risk factor. Therefore the importance of understanding their impact in the ageing male is clear. In particular, both of these conditions can have an effect on quality of life in the ageing male.
This chapter will aim to evaluate the background and diagnostic differences between the two conditions, with a focus on the benefits and pitfalls of prostate-specific antibody (PSA) testing. Furthermore, the effects of both these common conditions, including their impact on the male lower urinary tract, are explored. Subsequently, a focused outline of the treatment options for both BPH and prostate cancer will be presented. The discussion will focus on mechanisms of optimizing treatment options in an elderly population. Finally, the potential complications of different treatments for prostate cancer will be explored.
Sarcopenia—definitions and epidemiology
Authors: Morais José A. 
Published: December 2017

Abstract
Sarcopenia is a progressive and inevitable loss of skeletal muscle mass and strength associated with ageing that places older adults at high risk for adverse health outcomes. Up to of 15% of older adults suffer negative healthcare consequences because of sarcopenia. Furthermore, it is responsible for two to four times greater risk of disability. Expert groups have proposed clinical oriented criteria based on gait speed &lt;0.8 m/s and low handgrip strength before performing muscle mass assessment. Multiple aetiologies are implicated in the development of sarcopenia including age-related, lifestyle, neurodegeneration, hormonal, and inflammation factors. Resistance exercise training and higher than recommended protein intake are two accessible means to counteract sarcopenia. Hormonal interventions, despite amelioration in muscle and fat masses, have not led to significant gains in function. Sarcopenia shares many features with frailty and can be considered as one of its underlying mechanisms.
Sarcopenia
Authors: Robledo Luis Miguel F. Gutiérrez , Pérez-Zepeda Mario Ulises 
Published: December 2017

Abstract
Sarcopenia is a muscle wasting condition that develops gradually during ageing and results in a loss of muscle mass and strength, leading to impairment in physical performance ability with loss of mobility and function, falls, and mortality. Diagnostic criteria include measurements of physical performance, muscle strength, and body composition. Sarcopenia is a treatable malady of ageing. It is clear that both aerobic and resistance exercise can improve muscle function. Furthermore, there is increasing evidence that high-quality protein supplementation can enhance muscle mass and function. Also, low 25(OH) vitamin D levels requires replacement therapy. Aside from exercise and nutritional supplementation, the pharmaceutical approach to sarcopenia is still under development. A specific well-directed programme of lifelong training could preserve body balance, muscle structure, and contractile properties up to old age, which in turn would improve quality of life and reduce risk of undue functional impairment.
From nutritional screening to assessment and nutritional planning in community, acute, and long-term care
Authors: Gioia Gianfranco , Molfino Alessio , Fanelli Filippo Rossi , Muscaritoli Maurizio 
Published: December 2017

Abstract
Age-related malnutrition is the result of age-related metabolic derangements. Sarcopenia in older people is also the result of malnutrition-related metabolic changes determining the lack of long-term muscle anabolic response to nutrient intake. Frailty is associated with the presence of nutritional derangements. Nutritional screening tools and nutritional assessment in ageing take into account diagnostic parameters for detecting the risk or the presence of protein-energy malnutrition in its different forms and stages. Nutritional screening represents the first step in the nutritional care process. A full nutritional assessment is necessary if the risk of malnutrition is detected during a nutritional screening. Nutritional and metabolic interventions are recommended for all those patients identified by screening and assessment as at risk for malnutrition or malnourishment. Nutritional plans offer several options to the patients according to the clinical setting (i.e. nutritional counselling, food fortification, oral nutritional supplements, and artificial nutrition).
Management of common fractures in older adults
Authors: Sanguineti V. Ana , Wild Jason R. , Joseph Bellal , Fain Mindy J. 
Published: December 2017

Abstract
Falls account for nearly 75% of all geriatric trauma, and are the most common cause of fractures in older people. Most falls occur from standing height or less, resulting in fragility fractures in older adults who often have multiple comorbidities and functional impairments. These fractures can lead to functional decline, institutionalization, and death. Fragility fractures are seen in the hip, spine, and wrist, pelvis, humerus, rib, and ankle. This fracture pattern identifies groups at increased risk for future falls and fractures, and those who can benefit from targeted programmes to prevent falls and optimize bone health. Management depends upon the site of fracture, the risks and benefits of non-surgical versus surgical intervention, and the patient’s goals of care.
Low back pain in older adults
Authors: O’Sullivan Kieran , Fersum Kjartan Vibe , Dankaerts Wim , O’Sullivan Peter 
Published: December 2017

Abstract
Low back pain (LBP) is one of the most common reasons for enduring long-term disability and difficulty with activities of daily living. The assessment of LBP in older adults should first carefully rule out the rare possibility that the pain represents a serious spinal or systemic pathology. Thereafter, a clinical reasoning framework can be used to identify the specific mix of biopsychosocial factors which are most relevant in the pain presentation of each individual patient. A cognitive functional approach for each patient should then address those specific factors for each person, with a view to enhancing pain control, maintaining participation in valued activities, and reducing dependence on the health service.
Infective endocarditis
Authors: Müller-Werdan Ursula , Werdan Karl 
Published: December 2017

Abstract
Infective endocarditis (IE) can involve native and prosthetic valves but also prosthetic surfaces of the heart like pacemakers and defibrillators. At least one-fourth of IE patients are aged &gt;70 years. In the aged patient, healthcare-associated IE plays a prominent role, not only in patients with pre-existing valve disease, but also in those without. Blood culture and echocardiography are the cornerstones of diagnostics, antibiotics and—in 50%—valve surgery are the cornerstones of therapy. The geriatrician should cooperate with an Endocarditis Team—infectious disease specialist, cardiologist, and cardiac surgeon—when taking care of these patients, which have a mortality of 15–20%, with patients aged ³70 years having a 60% higher risk of dying.
Healthcare-associated infections and emergence of antibiotic resistance
Authors: Huttner Benedikt , Harbarth Stephan 
Published: December 2017

Abstract
Healthcare-associated infections (HAI) present a significant challenge to the safe delivery of healthcare. The pool of patients at increased risk for HAI—such as chronically ill and immunosuppressed individuals—has been steadily growing due to the ageing of the population and advances in medicine. At the same time, pathogens resistant to multiple antimicrobials have become increasingly prevalent, complicating the management of HAI and increasing their associated morbidity and mortality. Older people are especially affected by these trends. Limitation of the use of invasive devices, preventing transmission through hand hygiene and other measures, and the appropriate use of antimicrobials for treatment and prophylaxis have all been recognized as key strategies for the control of HAI and antimicrobial resistance.
Healthcare-associated infections and infection control
Authors: Astagneau Pascal , Seringe Elise , Bricaire François 
Published: December 2017

Abstract
Healthcare-associated infections (HAI) in older people frequently occur in mid or long-term cares facilities. The most frequent infections are those of the urinary tract, respiratory tract, skin/soft tissue, and gastrointestinal tract. The spectrum of pathogens are different in epidemic and endemic situations. Outbreaks occurring in long-term care frequently involve seasonal viruses such influenza, scabies, and multidrug-resistant bacteria such as Clostridium difficile. Ageing is a risk factor for HAI, which impairs immunological, metabolical, and neurological functions. Indwelling devices, poor nutritional status, and lack of mobility also increase the infection risk in the cared-for elderly. Infection control measures have to be implemented according to standard recommendations, including the use of alcohol-based hand rubs. Control measures should be adapted to the organization of healthcare facilites for older people, in particular environment and poor staff ressources. Focus should be made on vaccination programme of healthcare staff, especially against influenza.
Epidemiology of cancers in older adults
Authors: O’Hanlon Shane , Gosney Margot 
Published: December 2017

Abstract
Increasing life expectancy has led to a higher incidence and prevalence of cancer in older people, with the largest increase in the 75 and over age group. This group is much more likely to develop cancer than younger people. The incidence rate is higher for older males and varies by cancer type. The rate begins to decline in the 85 and over age group, however mortality continues to rise with age. Older people with cancer are undertreated compared to younger people. Overall survival rates are improving, but there is a widening gap in outcomes between younger and older people. The United Kingdom has poorer outcomes than the United States and other European countries. This chapter discusses recent trends in cancer epidemiology and outlines modern approaches towards assessment and care, including consideration of frailty and comprehensive geriatric assessment.
Screening for cancer
Authors: Horgan Anne , Alibhai Shabbir M. H. 
Published: December 2017

Abstract
Cancer screening is the early identification of an asymptomatic malignancy. The aim of screening is to identify cancer at a stage where it can be more effectively treated and ideally with curative intent. Guidelines regarding screening in the older population differ widely across countries, in part due to the underrepresentation of older adults in the large screening trials on which the recommendations are based. In this chapter, we present the screening recommendations for colorectal, lung, breast, and prostate cancer from four international groups. The benefits of screening in the overall population are highlighted, and the data supporting screening in older adults outlined. Factors to be considered in screening decisions are discussed, including remaining life expectancy and patient and physician wishes. Potential methods to overcome these challenges along with supportive evidence are highlighted.
Physical factors in arterial ageing
Authors: Hashimoto Junichiro , O’Rourke Michael F. 
Published: December 2017

Abstract
Arterial structure and function change progressively with advancing age. Owing to long-lasting repetitive stretch with intermittent cardiac contraction, elastic fibres in the tunica media of large arteries progressively degenerate and are replaced by collagenous fibres. Such degeneration causes elastic arteries to stiffen and dilate. Stiffening of the large arteries not only increases amplitude of the incident pressure wave but also hastens the return of the reflected pressure wave, thereby widening the pulse pressure in the central aorta. This widening increases the cardiac afterload during systole, while it decreases coronary flow during diastole, thus predisposing to heart failure and coronary ischaemia. Also, the excessive pulsatile pressure is transmitted deeply into the renal and cerebral microvasculature causing microalbuminuria and lacunar infarction. Although arterial ageing is considered an inevitable and irreversible process, it can be delayed through optimal blood pressure control.
Aneurysmal diseases
Authors: Gemayel Gino , Kalangos Afksendiyos 
Published: December 2017

Abstract
Abdominal aortic aneurysm (AAA) is a pathology commonly observed in older adults with an estimated incidence of around 5% of men older than 65 years. The precise aetiology of this disease is still not fully uncovered; most aneurysms are classified as degenerative with complex interaction between genetic predisposition and environmental factors. Most AAA remain asymptomatic until they rupture. At this stage, they have a 90% mortality rate. Screening programmes are the best method to detect AAA and thus treating them electively. Open repair was once the gold standard of treatment, as no medical treatment has proven a clear benefit in reducing or stopping AAA growth. Recently endovascular repair; a new less invasive approach; has emerged and is rapidly replacing open repair with better mortality and morbidity rates.
Management of tachyarrhythmias
Authors: Harrison James L. , O’Neill Mark D. 
Published: December 2017

Abstract
The process of ageing is associated with an increased incidence of cardiac tachyarrhythmias, 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. However, the molecular mechanisms underlying tachyarrhythmias are not fully understood and there is a lack of evidence to guide treatments in older adults. Ventricular tachyarrhythmias are a major cause of unexpected death in older adults, especially in people with coronary artery disease. Sudden cardiac death is responsible for 13% of all natural deaths and 50% of cardiovascular deaths in older adults. The prevalence of asymptomatic and symptomatic supraventricular tachycardias also increases with age. With careful consideration of risks and benefits, age should not be seen as a contraindication to invasive device or ablation therapy for cardiac tachyarrhythmias.