In the United States, the number of the oldest old is expected to double from 4.3 million to 9.6 million by 2030. Sources and parts of quoted places have been indicated in the appropriate places in the text and references.
About the Editors
General Considerationss
Ageing and Longevity
The evolutionary theories of aging are no longer considered the basis for explaining the aging process. Role of the mitochondrial DNA replication machinery in mitochondrial DNA mutagenesis, aging and age-related diseases.
End-of-Life Care in Geriatric Population
Data on the oldest old transitions into place of care at the end of life is scant. Hospital and emergency department use in the last year of life: a baseline for future modifications to end-of-life care.
Elderly Abuse and Neglect
Screening is the most important of the primary intervention strategies for detecting elder abuse [37]. Screening is the most important of the primary intervention strategies for detecting elder abuse [38], followed by thorough abuse assessment.
Decision-Making Capacity and Consent in the Older Adult
The person's choices and views must be elicited, as well as how they came to be explored. Decision-making capacity can be assumed to be present or absent based on the patient's diagnosis.
Comprehensive Geriatric Assessment
In the care of the oldest old, CGA is increasingly used in the determination of appropriate medical intervention. In a large majority of the elderly, care is provided by primary care physicians.
Long-Term Care, Nursing Homes and Support Services
Health and long-term care needs are increasing in these groups and are often met. Place of death of the oldest: >85 years old in the CC75CC population cohort.
Immune System, Immunosenescence and Immunisation in the Elderly
In the elderly, the age-dependent decline in immunity has been attributed to the functional activity of the hematopoietic stem cells (HSC) [38], and there is evidence to suggest that there is a decline in function with aging [39]. In the elderly, changes occur in the innate/natural and clonal-type immunity, and the former is largely preserved.
![Fig. 7.1 The immune system. (Adapted with the permission of Virtual Medical Centre. Other sources Chaudhry [12], Troow and Daha [17], Rus et al](https://thumb-ap.123doks.com/thumbv2/azdoknet/10577282.0/54.892.77.816.80.848/immune-adapted-permission-virtual-medical-centre-sources-chaudhry.webp)
Ortho-geriatric Care
The timing of surgery is one of the most important markers of a patient's outcome after a hip fracture. Restoring mobility is perhaps one of the important goals of hip fracture surgery.
Geriatric Anaesthesia
There are age-related changes in the anatomy, physiology and immunology of the respiratory system that influence perioperative assessment and postoperative care (Box 9.2). Many of the age-related physiological changes in body function and composition result in many pharmacokinetic changes in the elderly [22]. Many of the age-related physiological changes in body functions and composition result in many pharmacokinetic changes in the elderly [22].
Guidelines for general anesthesia in the elderly from the Committee on Quality and Safety in Anesthesia. Addressing the gaps in our knowledge about common postoperative complications in the anesthesiology clinic of the elderly.
Geriatric Diagnostic Imaging
In healthy individuals, the i-123 ioflupan images show comma-shaped structure bilaterally in the region of the corpus striatum [82] (Fig. 10.10). Diffusion tensor magnetic resonance imaging categorizes the microstructural health of the white matter [83] and can be used to detect changes in white matter and is a useful tool for detecting early MCI/. Procedure Exploitation in the oldest Old. 30] reported that very long MR sessions are achievable even in the elderly and are not associated with any serious discomfort.
Disability increases rapidly with age in the oldest old [23] with the highest rates of dementia [24]. Tolerance of MRI procedures in subjects > 90 years with very long MRI sessions is achievable even in the oldest old [30].
Geriatric Care in General Practice
This can cause more problems in the diagnosis in the mild end of the spectrum. Several studies have revealed that 70% of elderly suicide victims saw their primary care physician within a month of death. The demographic characteristics of the oldest old are unique and different from those of the young old.
Several studies have revealed that 10% of elderly suicide victims saw their primary care physician within a month of death. The demographic characteristics of the oldest elderly are unique and different from those of the young elderly [6].
Geriatric Rehabilitation
Disuse causes a decrease in muscle fiber size, while aging results in a reduced number of muscle fibers [21]. Loss of strength in muscles, for example the dorsiflexors of the ankle, is associated with falls in nursing home residents [21]. The majority of participants in general rehabilitation programs are elderly people with stroke and hip fracture [34].
Some of the barriers to recovery include poor motivation, depression, dementia, severe motor impairment, perceptual impairment and communication problems. Disuse causes a reduction in the number of muscle fibers, while aging results in a reduction in muscle fiber size.
Geriatric Palliative Care
Symptom control and improved quality of life can be achieved in incurable malignancies by enabling early access to palliative care. Several studies have drawn attention to the importance of palliative care in the treatment of advanced COPD [43, 44]. Clinicians are often faced with a range of ethical issues related to palliative and end-of-life care.
There is now general acceptance that the palliative care needs of the elderly require special consideration. Symptom control and quality of life can be improved by early access to palliative care.
The Elderly in Intensive Care
Trends show that sepsis and respiratory failure are becoming more pronounced. of the patients over 90 years old were released alive. Short-term mortality was mainly related to the severity of the acute illness, long-term to the individual's preadmission status (cognitive function, functional status and comorbidity). Five of the risk factors (poor nutrition, chronic renal failure, cancer, pneumonia, and ward admission) were evident during admission, and three (active DNR orders, vasopressors, and mechanical ventilation) were related to treatment.
The crude number of older patients worldwide will continue to rise, even as the percentage of older people admitted to intensive care decreases. Short-term mortality was mainly related to the severity of the acute illness, and long-term to the individual's pre-admission status.
Common Diseases in Older Adults
Cardiovascular Diseases in the Very Elderly
Atrial fibrillation (Fig. 15.5) is the most common arrhythmia in the elderly and its incidence increases with age. The most common cause of aortic stenosis in the very elderly is calcific degeneration of the aortic valve. In very elderly patients, the target systolic blood pressure should be 130 mm Hg or less.
Infective endocarditis in the elderly may present atypically with features of anemia, weight loss, heart failure, or fatigue. Major bleeding and warfarin tolerance during the first year of treatment in elderly patients with atrial fibrillation.
Kidney Diseases in the Elderly
Which of the following is NOT true regarding the treatment of end-stage renal failure in the elderly. Chronic kidney disease and end-stage renal disease in the elderly population: current prevalence, future projections and clinical significance. Recovery of renal function after acute kidney injury in the elderly: a systematic review and meta-analysis.
Accuracy of MDRD (Modification of Diet in Renal Disease) and CKD Epidemiology Collaboration (CKD-EPI) equations for estimating GFR in the elderly. Management of end-stage renal disease in the elderly: state of the art, challenges and opportunities.
Mental Illness in the Oldest-Old
Anxiety disorders are prevalent in the elderly at 15%, with even higher rates of less specific anxiety symptoms [56, 57]. Some studies suggest less benefit for late-onset depression in the setting of vascular disease and dementia. Mental illness in the elderly may be due to relapse of early-onset illness or a new late-onset process.
Electroconvulsive therapy is most effective for melancholic or psychotic depression subtypes and can be used safely in the elderly. Co-existing anxiety disorders modify associations with physical disorders in the elderly: a Taiwan cross-sectional nationwide study.
Eye Problems in the Oldest Old
Clinically significant cataract is one of the main reversible causes of visual impairment in the elderly. Although cataract surgery is a widespread problem, it is also one of the most successful surgeries in the world. While the age-related condition is a bilateral condition, cataract surgery is usually performed on one eye at a time.
In its current state, laser-assisted cataract surgery is perhaps a more appropriate description of the procedure. More importantly, at its current cost, laser-assisted cataract surgery is not cost-effective compared to traditional cataract surgery [13].
Dental and Oral Conditions in the Very Elderly
Tooth loss remains an important factor in the extent and location of osteoporosis of the jaws. Lesions of the oral mucosa are common in the elderly and especially in those who use complete dentures. Treatment includes treatment of predisposing causes and antifungals in the form of oral suspension (nystatin), tablets (amphotericin), gel or tablets (miconazole; fluconazole).
It is common in the elderly and the incidence is about two-thirds higher among men than women. Dry mouth is more common in the elderly and it affects the quality of life.
Cancer in the Very Elderly and Management
Furthermore, treatment-related toxicity and mortality are a significant concern in elderly breast cancer patients and should in principle be avoided in the elderly. Breast cancer in older compared with younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Quality of life in breast cancer patients aged over 70 years participating in the EORTC 10850 randomized clinical trial.
Treatment of operable breast cancer in the elderly: a randomized clinical trial EORTC 10851 comparing tamoxifen alone with modified radical mastectomy. Early lung cancer in elderly patients: a population-based study of changes in treatment patterns and survival in the Netherlands.
Geriatric Skin and Dermatosis
The most common skin cancers in the elderly are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and actinic keratoses (AK) which are a precursor to SCC. Malignant melanoma accounts for the largest number of skin cancer-related deaths in the elderly. Rarer tumors such as Merkel cell carcinoma and angiosarcoma also have increased incidence in the elderly population.
Melanoma is an aggressive disease and is responsible for the greatest skin cancer-related mortality in the elderly [39]. The lentigo maligna subtype of melanoma is particularly more common in the elderly population.
Joints and Musculoskeletal Disorders
