bluuebunny/crossref_metadata_2025_split huggingface dataset:
Legal and ethical issues in care of older adults
Authors: Tilvis Reijo 
Published: December 2017

Abstract
Widely accepted ethical principles are taken into account in several international declarations and recommendations, but national legislations of care for old people are characterized by wide diversity. Ethical considerations go further than pure clinical assessments and include all consequences of starting and/or withholding of cure and care. The oldest Hippocratic principles—beneficence (doing good) and non-maleficence (not harming)—are obligations of physicians to act in the best interest of the patients. Autonomy, the existence and feeling of freedom of choice and self-governance, has replaced paternalism, and is cherished in Western culture. Sufficient information and capacity of the patient are preconditions for giving informed consent before any treatment is undertaken. In cases of lacking capacity, the healthcare providers must consult family members or other proxy persons to find out what the patient’s wish might have been. Advanced statements of wishes or advanced directives can help to avoid surrogate decisions.
Integrating geriatrics principles into primary care
Authors: Cruz-Jentoft Alfonso J. 
Published: December 2017

Abstract
Care of older people living in the community relies on primary care physicians. When the accumulation of ageing, chronic conditions, or acute problems has an impact on physical or mental function, comprehensive geriatric care has to be incorporated in usual primary care to understand, coordinate, manage, and prevent diseases and disabilities.
Primary care physicians play key roles in the care of older subjects, including prevention and screening for diseases and geriatric problems, management of chronic disease and multimorbidity, detection and management of frailty and early disability, home, end-of-life and nursing home care, and continuity and customization of care. Incorporation of geriatric principles may improve performance and outcomes in each of these tasks.
In addition, using some elements of comprehensive geriatric assessment in primary care management of older patients may help to improve outcomes.
Older people presenting to acute care hospitals
Authors: Wong Roger Y. M. 
Published: December 2017

Abstract
Older people presenting to acute care hospitals are at risk of developing adverse events. Comprehensive geriatric assessment (CGA) in acute care provides standardized assessment and management of geriatric problems. The emergency department is a common point of entry, and strategies that focus on enhancing expertise, equipment, policies, and protocols are helpful. The geriatric consultation service model is commonly deployed, and the geriatric evaluation and management unit (GEMU) is a common ward-based model. The acute care for elders (ACE) unit model is associated with fewer adverse events, less functional decline, shorter hospital length of stay, lower institutionalization risk, and lower cost. The senior friendly hospital (SFH) model requires further studies to confirm its effectiveness. A number of geriatric post-discharge liaison services can smooth the transition of older people returning to the community. Overall these models of care are not mutually exclusive, but together they comprise the best practice for older people.
Post-acute care and intermediate care
Authors: Chen Liang-Kung 
Published: December 2017

Abstract
Post-acute care (PAC), interchangeable with intermediate care, is the key to the success of healthcare services for older people. Due to the need for longer periods of recovery from acute insults, PAC provides the opportunities for these patients to regain functional independence, as well as reduction in hospital readmission and premature long-term care placement. Moreover, the functional recovery obtained from PAC services is associated with the reduction in one-year mortality by 62%. Different models of PAC services have been developed internationally, including home care models, community hospitals, day hospitals, nurse-led units, and community rehabilitation teams. The success of PAC depends on person-centred care with a multidisciplinary approach and comprehensive geriatric assessment, which is consistent in different PAC models. Some specific clinical conditions occurring in PAC possess unique characteristics and impact on PAC outcomes. These conditions are not exclusive to PAC, but their presence may strongly influence quality of care.
Transitions between care settings until death
Authors: Gundersen Elizabeth C. , Bensadon Benjamin A. , Ouslander Joseph G. 
Published: December 2017

Abstract
The problem of poor care transitions in geriatric patients is complex and challenging, and one which has become a priority across healthcare systems. Various interventions have shown success in improving transitions in care, but there is no one solution and more progress must yet be made, especially in the care of our most vulnerable patients, including those with dementia or at the end of life. Perhaps the most commonly recurring themes, however, are the need for multifaceted interventions and increased patient- and family-centred care. It is essential to discuss goals of care with patients and families, and then form treatment plans—including discharge plans—which respect those goals. Geriatric and palliative care clinicians are uniquely suited to contribute their skills in this area to improve care transitions.
Why do organisms age?
Authors: Kirkwood Thomas B. L. 
Published: December 2017

Abstract
The study of the underpinnings of ageing provides insight not only into the kinds of genetic factors that influence the ageing process, but also into the physiological mechanisms influencing ageing and longevity. Notions that ageing was necessary to create living space for future generations, or to facilitate turnover of the population, are generally unsound. Instead, ageing is thought to have its evolutionary origins in how the force of natural selection declines with age, the later portions of the lifespan being under indirect evolutionary control. The most widely supported explanation of why organisms age is the disposable soma theory. This posits that, under pressure of selection to make the best use of available resources, genomes evolved to put only enough effort into cellular maintenance to keep the individual in sound condition through the period that it might normally have been expected to survive and reproduce in ancestral, wild environments.
Age-related physiologic declines
Authors: Fabbri Elisa , Zoli Marco , Ferrucci Luigi 
Published: December 2017

Abstract
‘How and why living organisms age?’ This question has puzzled and challenged philosophers and scientists for centuries. Ageing can be defined as a progressive loss of anatomic and physiological integrity across multiple systems and organs, leading to impaired function and higher vulnerability to adverse health outcomes and death. Although the biological mechanisms that trigger and accelerate ageing are still not understood, enormous steps forward in delineating the effects of ageing has been made in recent years. Ageing induces morphological and physiological changes across multiple organs and systems, which result in progressive loss of resilience, increased vulnerability to stressors, disease susceptibility, and development of physical and cognitive frailty, disability, and adverse outcomes.
Biological significance of gut microbiota changes associated with ageing
Authors: Horgan Kevin , Shanahan Fergus , O’Toole Paul W. 
Published: December 2017

Abstract
The concept that the commensal gut microbiota might influence the ageing process is not new. Awareness of the gastrointestinal microbiota and its potential role in host health was recognized in the late nineteenth century. Metchnikoff was a proponent of the value of fermented foods in promoting healthy ageing and proposed that the beneficial effect was a consequence of modulation of the resident colonic bacterial ‘flora’. His conviction could not be substantiated because of the lack of tools necessary to address the issue rigorously in that era. A century later, advanced technology has established the role of the human microbiota in health and disease. Emerging information is leading to a fundamentally revised understanding of many aspects of human development and disease that takes into account the role of the microbiota. This chapter addresses current knowledge of the relationship of the microbiome to human ageing, and outlines the prospects for monitoring and modulating the gut microbiota to promote healthy ageing.
Conceptualizing geriatric syndromes
Authors: Rikkert Marcel G. M. Olde 
Published: December 2017

Abstract
Geriatric syndromes, such as falling, delirium, and malnutrition, are common in older patients, and characterized by the presence of several disorders at the same time. These geriatric syndromes can be divided into acute (e.g. delirium) and non-acute (e.g. dizziness, falls) geriatric syndromes. The main criterion of multicausality is directly linked to frailty in older patients, as frailty results in a closer linkage and increased interaction between organ functions, which explains why several organs, diseases, and stressors are involved in each geriatric syndrome. There is interesting preliminary evidence for the existence of generic warning signals for the recurrence of acute geriatric syndromes, of which the most important is slowing down of recovery after a perturbation of the organ functions involved in a geriatric syndrome. All these pathophysiological mechanisms have important implications for diagnostic work up and treatment of geriatric syndromes, which together makes up the main part of geriatric patient care.
Urinary incontinence
Authors: Wagg Adrian 
Published: December 2017

Abstract
Lower urinary tract symptoms and urinary incontinence are highly prevalent in older persons. The physiological changes which occur in the ageing lower urinary tract, combined with neurological alterations in control of continence and micturition conspire to impair control of continence in older persons. In addition to the impact of coexisting medical comorbidities and lower urinary tract disease, this makes urinary incontinence and the ability to successfully toilet a typical geriatric syndrome, requiring multicomponent intervention to achieve the best possible outcome. There are emerging data on the efficacy of treatments in older and frail older persons which, if appropriately applied with regard to the individual, should result in amelioration of symptoms and bother, or socially contained continence for the most medically complex older person.
Pressure injuries in the ageing population
Authors: Kiely Cindy , Pupiales Magdalena 
Published: December 2017

Abstract
The prevalence of pressure ulcers has been reported to range from 4.1 to 32.2% in the older adult population. Pressure ulcers, also known as decubitus ulcers, bedsores, and pressure sores, are defined as localized injury to the skin and/or underlying structures, usually over a bony prominence as result of pressure or pressure in combination with shear. Within the geriatric population, prevalence and incidence rates tend to be high due to multifactorial risk factors such as comorbidities, changes in functional status, nutritional habits, medications affecting the skin, and physiological changes. The impact of pressure ulcers spans physical, emotional, social, and economic dimensions, and is of concern throughout the healthcare continuum. The aim of this chapter is to illustrate the aetiologic complexity of pressure ulcers in the geriatric population and summarize a comprehensive approach to prevention and management of pressure ulcers.
Pathophysiology of sarcopenia
Authors: Benard Townsend , Fielding Roger A. 
Published: December 2017

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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.