Ham’s Primary Care Geriatrics: A Case-Based Approach

✍ Scribed by Richard J. Ham, Philip D. Sloane, Gregg A. Warshaw, Jane F. Potter, Ellen Flaherty

• Publisher: Saunders
• Year: 2013
• Tongue: English
• Leaves: 768
• Edition: 6th Edition
• Category: Library

✦ Synopsis

Employing a unique case-based approach, Ham's Primary Care Geriatrics continues to be your comprehensive source of clinical solutions for this challenging population. This gerontology medical reference book features an interdisciplinary perspective that empowers you with team-oriented knowledge on the best diagnosis, treatment, and management strategies available to address the complex needs of older adults.

"Overall this is a useful, well written, practical elderly medicine book, ideal for use in primary care. It is reasonable priced and an excellent addition to the bookshelf, virtual or real".
Reviewed by: Dr Harry Brown, July 2014

Key Features
Effectively treat your geriatric patients, and provide helpful guidance to their families, through engaging geriatric case studies that illustrate the principles and key clinical information you need.
Form a definitive diagnosis and create the best treatment plans possible using the evidence-based medicine guidelines throughout.
Find the information you need quickly and efficiently with a 2-color layout and consistent format, and test your knowledge with USMLE-style questions in every chapter.

✦ Table of Contents

Ifc......Page 2
Ibc......Page 3
Ham’s primary care geriatrics......Page 4
Copyright......Page 5
Dedication......Page 6
Contributors......Page 8
Preface......Page 14
Acknowledgments......Page 16
A note on level of evidence ratings......Page 17
Unit 1 Principles and Practice
......Page 18
Objectives......Page 20
Normal physiologic changes......Page 21
Functional reserve......Page 22
Increased physiologic diversity......Page 23
Immobility......Page 24
Ageism......Page 25
Cognitive impairment and worry......Page 26
Relationships and family are crucial to health and survival......Page 27
Multiple morbidity and the geriatric syndromes......Page 28
Slow medicine......Page 29
Polypharmacy......Page 30
Transitions in care are dangerous......Page 31
Interprofessional nature of geriatric care......Page 32
A generalist is often the best clinician for a geriatric patient......Page 33
Web resources......Page 34
Test question answers......Page 35
Objectives......Page 37
Teams in different geriatric care settings......Page 38
Roles of core team members......Page 39
Team leadership......Page 44
Mutual support......Page 45
Communication......Page 47
Role of the patient and family in the team......Page 48
Summary......Page 49
Test question answers......Page 51
Objectives......Page 52
Aspects of care unique to older adults......Page 53
Pre-encounter preparation......Page 54
Medications......Page 55
Social history......Page 56
Functional screen......Page 57
Review of systems......Page 59
Geriatric-specific physical exam......Page 60
Goals of care......Page 62
Caregiver support......Page 63
Key references......Page 64
Test question answers......Page 65
Essentials of health promotion for aging adults......Page 67
Immunizations......Page 68
Screening for alcohol use/abuse......Page 69
Guidelines for physical activity......Page 70
Fats......Page 71
Assessment of nutritional health and approach to obesity......Page 72
Beta-blockers......Page 73
Bisphosphonates......Page 74
Putting prevention into practice......Page 75
Patient facilitators......Page 76
Summary......Page 79
Key references......Page 80
Test answers......Page 81
Defining cultural competency......Page 84
Dementia, personhood, and culture......Page 85
Palliative care and “giving up”......Page 86
Talking about dying......Page 87
Discussing prognosis: Offering truth......Page 88
Experience and expectations shape doctor-patient interactions......Page 89
Summary......Page 91
Key references......Page 92
Test question answers......Page 93
Pharmacokinetic changes in the elderly......Page 96
Distribution......Page 97
Elimination......Page 98
General guidelines for safe prescribing......Page 99
Explicit criteria for prescribing......Page 100
Adherence AIDS......Page 103
Medicare part d......Page 104
Key references......Page 105
Test question answers......Page 106
Objectives......Page 108
Autonomy......Page 109
Structure for deliberating ethical dilemmas......Page 110
Informed consent......Page 112
Disclosure of medical error......Page 114
Advance directives......Page 115
Futility......Page 118
Do-not-resuscitate orders......Page 119
Assisted suicide and the double effect......Page 120
Cultural and religious considerations......Page 121
Key references......Page 122
Test question answers......Page 123
Unique financial challenges of older adults......Page 126
Fundamentals of public funding of health care for older adults......Page 127
Community-based services......Page 128
Federal insurance coverage for older americans......Page 129
Patient’s perspective on payment for health care......Page 130
Post-acute rehabilitation.......Page 131
Medicare advantage (part c)......Page 132
Assisted living......Page 133
Medicaid waiver programs......Page 134
Web resources......Page 135
Test question answers......Page 136
Coding systems......Page 138
Knowing payer, benefits, medicare contractor, specialty/licensure, and group rules......Page 139
Evaluation and management services......Page 140
Documentation guidelines and current procedural terminology (CPT) definitions......Page 141
Time and face-to-face services......Page 142
Working as a team—”incident to,” shared visits, and teaching......Page 143
Participation status......Page 144
Web resources......Page 145
Objectives......Page 147
Hospital design and systems change to benefit older adults......Page 148
The admission process: Opportunities for health status updates......Page 149
Establishing goals of care......Page 150
Active cardiac conditions......Page 151
Perioperative pulmonary complications......Page 153
Interventions to reduce pulmonary complications......Page 154
Postoperative anemia......Page 155
Delirium prevention......Page 156
Skin care......Page 157
Preventing infections in the hospital......Page 158
Maintaining nutrition......Page 159
Glycemic control in the hospital......Page 160
The coleman care transitions intervention......Page 161
The ideal discharge for the elderly patient......Page 162
Key references......Page 163
Test question answers......Page 164
Objectives......Page 168
Nursing homes......Page 169
Residential care / assisted living (rc/al) communities......Page 171
Medical care provider practice patterns long-term care......Page 172
Residential care communities......Page 174
Common clinical challenges......Page 175
Common ethical dilemmas......Page 177
Federal structures that promote nursing home quality......Page 178
Enhancing quality of care and quality of life through individualized (“person-centered”) care......Page 179
Innovative models......Page 180
Key references......Page 182
Test question answers......Page 184
What is home care?......Page 187
How is home care delivered?......Page 189
Does home care work?......Page 190
Summary......Page 191
Key references......Page 192
Test question answers......Page 193
Rehabilitation and the older individual......Page 195
Rehabilitation settings......Page 197
Rehabilitation team......Page 199
Prevention of deconditioning during acute illness......Page 200
Gait rehabilitation, hip replacements, and fractures......Page 201
Stroke rehabilitation......Page 203
Cardiac rehabilitation......Page 204
Aging with a long-standing disability......Page 205
Rehabilitation and cognitive problems......Page 206
Assistive devices......Page 207
Key references......Page 210
Test question answers......Page 211
What is palliative care?......Page 216
Pain assessment......Page 218
Treatment of pain......Page 219
Opioid medications......Page 220
Management of nonpain symptoms......Page 222
Communicating with patients and families......Page 224
Key references......Page 226
Test question answers......Page 227
Unit 2 Geriatric Syndromes and
Common Special Problems
......Page 229
Objectives......Page 231
Primary care and the emergency department......Page 232
Systems-based practice (sbp)......Page 233
“the abcs”......Page 234
COPD exacerbations......Page 235
Treatment: Interventions that require transfer to the closest ed......Page 236
Management of syncope......Page 237
Overview......Page 238
Under-referral to trauma centers......Page 239
Urgency of stroke care......Page 240
Stroke center management......Page 241
Assessment......Page 242
Summary: Sepsis......Page 243
Management......Page 244
Transitions of care......Page 245
Key references......Page 246
Test question answers......Page 247
Definition and pathogenesis of delirium......Page 252
Prevalence and impact of delirium......Page 253
Risk factors and precipitating factors......Page 254
Diagnosis and assessment of delirium......Page 256
Management of delirium......Page 258
Key references......Page 259
Test question answers......Page 260
Prevalence and impact......Page 263
Differential diagnosis......Page 264
Screening for cognitive impairment......Page 265
Diagnostic evaluation of the person with a positive screen for cognitive impairment......Page 266
Making a specific diagnosis in persons with dementia......Page 267
Evaluating for delirium and depression......Page 268
Treatment of vascular risk factors......Page 269
Management of dementia......Page 270
Management of behavioral symptoms......Page 272
Working with families and community resources......Page 273
Acknowledgment......Page 274
Key references......Page 275
Test question answers......Page 276
Prevalence and impact......Page 279
Diagnosis of late life depression......Page 280
Depression and cognitive impairment......Page 281
Depression secondary to a general medical condition......Page 282
Assessment......Page 283
Suicide......Page 285
Management......Page 286
Ssris......Page 287
Tcas. ......Page 288
Other treatment considerations......Page 289
Other somatic treatments......Page 290
Key references......Page 291
Test question answers......Page 292
Prevalence and impact......Page 296
Differential diagnosis and assessment......Page 297
History and physical examination......Page 299
Usual and maximal gait speed......Page 300
Exercise and gait training......Page 301
Surgical management......Page 302
Key references......Page 303
Test question answers......Page 304
Prevalence and impact......Page 307
Precipitating causes and risk factors for falls......Page 308
Assessing the patient who has fallen......Page 310
Assessing a person for future fall risk......Page 311
Management of the acute faller......Page 312
Prevention of future falls......Page 313
Key references......Page 314
Test question answers......Page 315
Prevalence and impact......Page 317
Clinical history......Page 318
Medications......Page 319
Orthostatic hypotension (oh).......Page 323
Causes of dizziness that often do not fit neatly into a subtype......Page 324
Importance of determining the episodic or continuous nature of dizziness......Page 325
Physical examination......Page 326
Laboratory testing......Page 327
Management......Page 328
Vestibular rehabilitation......Page 329
Web resources......Page 330
Key references......Page 331
Test question answers......Page 332
Prevalence and impact......Page 335
Neurally mediated syncope......Page 336
Drug-induced syncope......Page 338
Evaluation......Page 339
Ruling out cardiac causes......Page 340
Psychiatric evaluation......Page 342
Treatment of cardiac syncope......Page 343
Summary......Page 344
Key references......Page 345
Test question answers......Page 346
Prevalence and impact......Page 348
Risk factors and pathophysiology......Page 349
Differential diagnosis and assessment......Page 351
Management......Page 354
Pharmacologic therapy......Page 355
Surgery......Page 358
Test question answers......Page 360
References......Page 361
Prevalence, impact, and definitions......Page 363
Primary and secondary causes of constipation and fecal incontinence......Page 364
Treatment of constipation......Page 366
Pharmacologic treatments (including over-the-counter preparations)......Page 368
Dietary and behavioral interventions for fi......Page 369
Pharmacologic treatment......Page 370
Treatment of incontinence-associated dermatitis......Page 371
Key references......Page 372
Test question answers......Page 373
Prevalence and impact......Page 375
Aging changes......Page 376
Conductive hearing loss......Page 377
Screening......Page 378
Hearing disability self-report measures......Page 379
Counseling older adults about hearing health services......Page 380
Types of hearing AIDS......Page 381
Managing feedback in hearing AIDS......Page 382
Audiologic rehabilitation courses......Page 383
Key references......Page 384
Visual impairment with age......Page 387
Management......Page 388
Prevalence and impact......Page 389
Risk factors and pathophysiology......Page 390
Key references......Page 391
Test question answers......Page 392
Prevalence and impact......Page 394
Pain assessment......Page 395
Pain quantitation......Page 396
Nonsteroidal antiinflammatory drugs (nsaids)......Page 397
Topical agents......Page 398
Opioids......Page 399
Anticonvulsants......Page 400
Nonpharmacologic strategies......Page 401
Key references......Page 402
Test question answers......Page 403
Prevalence and impact......Page 405
Normal aging changes......Page 406
Nutrition screening and assessment......Page 407
Nutrition evaluation tools......Page 408
Swallowing problems......Page 409
Treatment of common feeding and swallowing problems......Page 410
Nutrition support......Page 411
Key references......Page 412
Test question answers......Page 413
Objectives......Page 415
Etiology of frailty......Page 416
Models of frailty......Page 417
Is recognition of frailty helpful to the clinician?......Page 418
Transitions to frailty......Page 419
Treatment options for frailty......Page 420
Falls and frailty......Page 421
Cultural considerations......Page 422
Coordination of care......Page 423
Key references......Page 424
Test question answers......Page 425
Epidemiology and differential diagnosis......Page 428
Risk factors and prevention......Page 429
Preventive measures......Page 430
Staging......Page 432
Treatment strategies......Page 434
Pressure offloading......Page 435
Diagnosing and managing infection......Page 436
Key references......Page 437
Test question answers......Page 438
Prevalence and impact......Page 440
Risk factors and pathophysiology......Page 441
Differential diagnosis and assessment......Page 442
Sleep-disordered breathing (sleep apnea)......Page 443
Management......Page 444
Behavioral treatment of insomnia......Page 445
Pharmacologic treatment......Page 446
Other sleep disorders......Page 447
Key references......Page 448
Test question answers......Page 449
Erectile physiology and dysfunction......Page 451
Evaluation of erectile dysfunction......Page 453
Treatment of erectile dysfunction......Page 454
Female sexuality: Definition and epidemiology......Page 455
Evaluation and treatment......Page 456
Key references......Page 458
Test question answers......Page 459
Objectives......Page 462
Incidence and impact......Page 463
Barriers to diagnosis......Page 464
Assessment......Page 465
Key references......Page 466
Test question answers......Page 467
Definition......Page 469
Impact of alcohol use......Page 470
Screening and detection......Page 471
Alcoholism and other illnesses......Page 473
Detoxification......Page 474
Key references......Page 475
Test question answers......Page 476
Prevalence and impact......Page 478
Cognitive function......Page 479
Medical conditions and medications......Page 480
Diagnosis and assessment......Page 482
Legal and ethical issues......Page 483
Key references......Page 484
Test question answers......Page 485
Unit 3 Selected Clinical Problems
of the Organ Systems
......Page 488
Adverse outcomes......Page 490
Rationale for treatment......Page 491
Risk factors and pathophysiology......Page 493
Markedly elevated blood pressures......Page 494
Past medical history......Page 495
Weight loss......Page 496
Physical activity......Page 497
Overview of medications......Page 498
Uncomplicated hypertension.......Page 499
Coronary artery disease.......Page 500
Dementia.......Page 501
Web resources......Page 502
Key references......Page 503
Test question answers......Page 504
Prevalence and impact......Page 508
Angina pectoris......Page 509
Diagnosis and assessment of acute coronary syndrome......Page 512
Unstable angina......Page 513
Role of the pcp in the care of the patient in ICU......Page 514
Atrial fibrillation (AF)......Page 515
Rate control for atrial fibrillation......Page 516
Anticoagulation and atrial fibrillation......Page 517
AF......Page 518
Risk factors and pathophysiology......Page 522
Precipitating factors......Page 523
Management......Page 524
Treatment......Page 527
Test question answers......Page 528
Peripheral vascular disease......Page 531
History......Page 532
Da......Page 533
Indications for diagnostic study......Page 534
MRI......Page 535
Indications for diagnostic study......Page 536
MRI......Page 537
Outcomes......Page 538
Key references......Page 539
Test question answers......Page 540
References......Page 541
Pathophysiology......Page 542
Transient ischemic attacks (tias)......Page 544
Modifiable risks......Page 546
Hyperacute management......Page 547
Subacute management......Page 548
Summary......Page 549
Key references......Page 550
Test question answers......Page 551
Prevalence and impact......Page 553
Presenting symptoms......Page 554
Screening for and confirming the diagnosis......Page 555
Management......Page 556
Sulfonylureas......Page 557
Insulin......Page 558
Osteoporosis......Page 559
Diabetes education......Page 560
Key references......Page 561
Impact......Page 564
Subclinical hypothyroidism......Page 565
Screening of the asymptomatic patient......Page 566
Management......Page 567
Key references......Page 568
Test question answers......Page 569
Objectives......Page 571
Risk factors and pathophysiology......Page 572
Fracture history......Page 573
Identification of secondary causes and risk factors......Page 574
Universal recommendations......Page 575
Pharmacologic therapy......Page 576
Calcitonin......Page 578
Estrogen......Page 579
Summary......Page 580
Test question answers......Page 581
Osteoarthritis......Page 584
Gout......Page 588
Role of arthrocentesis......Page 589
Osteoarthritis......Page 590
Rheumatoid arthritis......Page 591
Summary......Page 592
Test question answers......Page 593
Primary care considerations in the older patient......Page 596
Changes in the foot in relation to age......Page 597
Diabetes and foot care......Page 598
Onychia......Page 600
Ingrown toenails (onychocryptosis)......Page 601
Hyperkeratotic lesions......Page 602
Foot deformities......Page 603
Key references......Page 604
Cancer in the elderly......Page 607
Cancer biology and aging......Page 608
Evidence-based treatment......Page 609
Staging the aging......Page 610
Hormonal therapy......Page 612
Cytotoxic chemotherapy......Page 613
Targeted therapy......Page 614
Metastatic carcinoma of the breast......Page 616
Prostate cancer......Page 618
Colon cancer......Page 619
Key references......Page 621
Definition of anemia......Page 627
Causes of anemia (box 47-1)......Page 628
Consequences of anemia......Page 630
Treatment of anemia......Page 631
Key references......Page 632
Pulmonary physiology and aging......Page 636
Assessment of pulmonary diseases based on signs and symptoms......Page 637
Diagnosis......Page 638
Treatment......Page 639
Definition and epidemiology......Page 643
Treatment......Page 644
Restrictive pulmonary diseases in the older adult......Page 646
Diagnosis......Page 647
Methacholine bronchoprovocation challenge test......Page 648
Pulmonary imaging......Page 649
Key references......Page 650
General prevalence and impact......Page 653
General principles of diagnosis, assessment, and management......Page 654
Empiric therapy versus culture-based treatment......Page 655
Antibiotic resistance......Page 657
Pathophysiology and risk factors......Page 660
Uncomplicated uti. ......Page 661
Complicated uti. ......Page 662
Differential diagnosis, assessment, and management......Page 664
Atypical pneumonia......Page 665
Management and treatment......Page 666
Pathophysiology and risk factors......Page 667
Diagnosis.......Page 668
Diagnosis.......Page 669
Prevalence and impact......Page 670
Toxin-mediated diarrheas.......Page 671
Management and treatment of toxin-mediated diarrheas. ......Page 672
Differential diagnosis, assessment, and management......Page 673
Management and treatment......Page 674
Key references......Page 675
Risk factors and pathophysiology......Page 681
Differential diagnosis and assessment......Page 682
Laboratory testing......Page 683
Management......Page 684
Patient–clinician discussions......Page 685
Outcomes after operative management......Page 686
Key references......Page 687
Incidence and prevalence......Page 690
Overview of anatomy and physiology including age-related changes......Page 691
Clinical manifestations......Page 692
Bph: Differential diagnosis and assessment......Page 693
Lifestyle interventions and self-management......Page 694
Alpha-blockers......Page 696
5-alpha-reductase inhibitors......Page 697
Surgical therapy......Page 698
Prostatitis: Differential diagnosis and assessment......Page 699
Acute bacterial prostatitis......Page 700
Key references......Page 701
Pathology......Page 706
Levodopa responsiveness......Page 707
Nonmotor features......Page 708
Differential diagnosis......Page 709
Management......Page 710
Motor fluctuations......Page 711
Management of tremor......Page 712
Management of the secondary effects of parkinson’s disease......Page 713
Key references......Page 714
Test question answers......Page 715
References......Page 716
Oral–systemic linkages......Page 717
Differential diagnosis and assessment......Page 718
Prevalence and impact......Page 719
Management......Page 720
Differential diagnosis and assessment......Page 721
Low utilization of dental services......Page 722
Oral health screening......Page 723
Preventing infective endocarditis......Page 724
Summary......Page 725
Acknowledgments......Page 726
Key references......Page 727
References......Page 728
Dermatologic examination: Challenges and practical approaches......Page 730
Four-point dermatologic description......Page 731
Eczematous dermatoses......Page 733
Benign cutaneous processes......Page 734
Cutaneous malignancies......Page 735
Basal cell carcinoma......Page 736
Pruritus......Page 737
Rosacea......Page 739
Herpes zoster (shingles) and postherpetic neuralgia......Page 742
Key references......Page 744
A......Page 750
C......Page 752
D......Page 754
F......Page 756
G......Page 757
H......Page 758
L......Page 759
M......Page 760
O......Page 761
P......Page 762
R......Page 764
S......Page 765
T......Page 766
Z......Page 767
Clinical key......Page 768

✦ Subjects

Geriatrics; Family & General Practice; Health and Aging