Geriatrics: Merck Manual Professional

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Geriatrics

Introduction to Approach to the Geriatric Patient
Physical Changes With Aging
Evaluation of the Elderly Patient
			Multiple disorders
			Missed or delayed diagnosis
			Polypharmacy
			Caregiver problems
	History
			Interview
			Medical history
			Drug history
			Alcohol, tobacco, and recreational drug use history
			Nutrition history
			Mental health history
			Functional status
			Social history
		Key Points
	Physical Examination
		Vital Signs
		Skin
		Head and Neck
			Face
			Nose
			Eyes
			Ears
			Mouth
			Temporomandibular joint
			Neck
		Chest and Back
			Breasts
			Heart
		GI System
		Male GU System
		Female Reproductive System
		Musculoskeletal System
		Feet
		Neurologic System
			Cranial nerves
			Motor function
			Muscle strength
			Coordination
			Gait and posture
			Reflexes
			Sensation
			Mental status
		Nutritional Status
		Key Points
	Comprehensive geriatric assessment
		Assessment Domains
Unusual Presentations of Illness in the Elderly

Introduction to Drug Therapy in the Elderly
Pharmacokinetics in the Elderly
		Absorption
		Distribution
		Hepatic metabolism
		Renal elimination
Pharmacodynamics in the Elderly
Drug-Related Problems in the Elderly
	Reasons for Drug-Related Problems
		Inappropriate drugs
		Overdosage
		Underprescribing
		Drug-disease interactions
		Drug-drug interactions
		Inadequate monitoring
		Poor communication
		Lack of patient adherence
	Prevention
		Before starting a new drug
		After starting a drug
		Ongoing
Drug Categories of Concern in the Elderly
		Analgesics
		Anticoagulants
		Antidepressants
		Antihyperglycemics
		Antihypertensives
		Antiparkinsonian drugs
		Antipsychotics
		Anxiolytics and hypnotics
		Digoxin
		Diuretics

Overview of Prevention in the Elderly
		Patient and caregiver issues
Prevention of Disease in the Elderly
	Primary and Secondary Prevention
	Tertiary Prevention
		Arthritis
		Osteoporosis
		Diabetes
		Vascular disorders
		Heart failure
		Chronic obstructive pulmonary disease (COPD)
Prevention of Frailty
Prevention of Injuries in the Elderly
		Falls
		Driving hazards
		Home hazards
Prevention of Iatrogenic Complications in the Elderly
	Risk Factors
		Multiple chronic diseases
		Multiple physicians
		Multiple drugs (polypharmacy) and inappropriate drugs
		Hospitalization
	Prevention
		Care management
		Geriatric interdisciplinary team
		Pharmacist consultation
		Acute Care for the Elderly (ACE) units
		Advance directives
Prevention of Psychosocial Problems in the Elderly

Quality of Life in the Elderly
	Health-Related Quality of Life
		Influences
	Assessment
		Barriers to assessment
		Method
Therapeutic Objectives in the Elderly

Elder Abuse
	Risk Factors
	Diagnosis
		History
		Physical examination
		Laboratory tests
		Documentation
	Prognosis
	Treatment
		Intervention
		Nursing and social work issues
		Reporting
		Caregiver issues
	Prevention

Overview of Geriatric Care
			Health care settings
	Geriatric Interdisciplinary Teams
			Patient and caregiver participation
Home Health Care
			Reimbursement
Day Care for the Elderly
			Reimbursement
Respite Care
Hospital Care and the Elderly
	Emergency department care
			Communication among practitioners
			Disposition
	Hospitalization
			Improving outcomes
		Adverse Drug Effects
			Prevention
		Bed Rest Effects
			Prevention
		Falls
			Prevention
		Incontinence
		Mental Status Changes
			Prevention
		Pressure Ulcers
			Prevention
		Undernutrition
			Prevention
		Discharge Planning and Transfers
			To home
			To another health care facility
Nursing Homes
			Supervision of care
			Hospitalization
			Costs
			Problems related to reimbursement
			Nursing home placement
			Selection
Board-and-Care Facilities
Assisted-Living Programs
Life-Care Communities
Program of All-Inclusive Care for the Elderly
Pharmacists and the Elderly
			Patient adherence
			Settings

Falls in the Elderly
	Etiology
		Intrinsic factors
		Extrinsic factors
		Situational factors
		Complications
	Evaluation
		History and physical examination
		Performance tests
		Laboratory tests
	Prevention
		Exercise
		Assistive devices
		Medical management
		Environmental management

Gait Disorders in the Elderly
	Normal Age-Related Changes in Gait
	Abnormal Changes in Gait
		Causes
		Manifestations
	Evaluation
		History
		Physical examination
		Gait assessment
		Testing
	Treatment
		Strength training
		Balance training
		Assistive devices
	Prevention

Introduction to Funding Health Care for the Elderly
Medicare
	Part A
		Inpatient hospital care
		Inpatient care in a skilled nursing facility
		Home health care
		Hospice services
		Custodial care
	Part B
		Covered services
		Physician reimbursement
	Part C (Medicare Advantage Plans)
	Part D
		Covered drugs
		Benefits and costs
Medicaid
		Covered services
		Eligibility
		Medicaid estate recovery
		Medicare Savings Programs
Other Federal Programs Affecting the Elderly
		Veterans Health Administration
		Tricare
		Older Americans Act (OAA)
		Social Security
		Title XX of the Social Security Act
Private Insurance for the Elderly
		Medigap
		Long-term care insurance
Models for Comprehensive Health Care Coverage for the Elderly
		Social health maintenance organizations (SHMOs)
		Program of All-Inclusive Care for the Elderly (PACE)
		Extended care communities

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