bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bone and periprosthetic joint infections in older adults
Authors: Zimmerli Werner , Sendi Parham 
Published: December 2017

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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.
Normal cognition and ageing: structure, function, and cognitive reserve
Authors: Starr John 
Published: December 2017

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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.
Hearing impairments and their treatments
Authors: Mamo Sara K. , Chisolm Theresa H. , Lin Frank R. 
Published: December 2017

Abstract
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.