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Hazzard’s
Geriatric Medicine and
Gerontology
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes
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administration. This recommendation is of particular importance in connection with new or infrequently used
drugs.
Seventh Edition
Hazzard’s
Geriatric Medicine and
Gerontology
Editors
Jeffrey B. Halter, MD
Professor Emeritus of Internal Medicine
Division of Geriatric and Palliative Medicine
University of Michigan
Ann Arbor, Michigan
Parkway Visiting Professor in Geriatrics
Department of Medicine
Yong Loo Lin School of Medicine
National University of Singapore
Joseph G. Ouslander, MD
Professor and Senior Associate Dean for Geriatric Programs
Chair, Department of Integrated Medical Sciences
Charles E. Schmidt College of Medicine
Professor (Courtesy), Christine E. Lynn College of Nursing
Florida Atlantic University
Boca Raton, Florida
Stephanie Studenski, MD, MPH
Chief, Longitudinal Studies Section
Intramural Research Program
National Institute on Aging
Baltimore, Maryland
Kevin P. High, MD, MS
Executive Vice President, Health System Affairs
Wake Forest Baptist Health
Professor of Internal Medicine–Infectious Diseases
Wake Forest School of Medicine
Winston-Salem, North Carolina
Sanjay Asthana, MD, FACP
Associate Dean for Gerontology
Professor and Head, Division of Geriatrics and Gerontology
Director, NIA/NIH Wisconsin Alzheimer Disease Research Center (ADRC)
Director, Madison VAMC Geriatric Research, Education and Clinical Center (GRECC)
Duncan G. and Lottie H. Ballantine Endowed Chair in Geriatrics
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin
Mark A. Supiano, MD
D. Keith Barnes, MD and Dottie Barnes Presidential Endowed Chair in Medicine
Professor and Chief, Division of Geriatrics
University of Utah School of Medicine
Director, VA Salt Lake City Geriatric Research, Education, and Clinical Center
Executive Director, University of Utah Center on Aging
Salt Lake City, Utah
Christine Ritchie, MD, MSPH
Harris Fishbon Distinguished Professor of Medicine
University of California San Francisco
Department of Medicine, Division of Geriatrics
The Jewish Home of San Francisco
Center for Research on Aging
San Francisco, California
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
Hazzard’s Geriatric Medicine and Gerontology, Seventh Edition
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Contents
Contributors
Foreword
Preface
Part I
Principles of Gerontology
1 Biology of Aging and Longevity
David B. Lombard, Richard A. Miller, Scott D. Pletcher
2 Genetics of Age-Dependent Human Disease
Lital Sharvit, Danielle Gutman, Huda Adwan, Rotem Vered, Gil Atzmon
3 Immunology of Aging
Albert C. Shaw, Thilinie Bandaranayake
4 Chronic Inflammation
Jeremy D. Walston
5 Demography and Epidemiology
Bonnielin Swenor, Jack M. Guralnik, Luigi Ferrucci
6 International Gerontology and Geriatric Medicine
Leonard C. Gray, Graziano Onder, Maysa S. Cendoroglo, AB Dey, Ana Beatriz G. Di Tommaso, Brant E. Fries, Rowan H.
Harwood, Jean Claude Henrard, John Hirdes, Naoki Ikegami, Palmi V. Jonsson, Bruce Leff, John N. Morris, Xiaomei Pei,
Naganath Narasimhan Prem, Roberto Bernabei
7 Psychosocial Aspects of Aging
Steven M. Albert, Daphna Gans
8 Sex Differences in Health and Longevity
Steven N. Austad
Part II
Principles of Geriatrics
SECTION A: Assessment
9 Evaluation, Management, and Decision Making
Daniel D. Matlock, Carmen L. Lewis
10 Principles of Geriatric Assessment
David B. Reuben, Sonja Rosen, Heather B. Schickedanz
11 Mental Status and Neurologic Examination
James E. Galvin
12 Assessment of Decisional Capacity and Competencies
Margaret A. Drickamer
13 Prevention and Screening
Sei J. Lee, Louise C. Walter
SECTION E : Nutrition
34 Nutrition and Obesity
Dennis H. Sullivan, Larry E. Johnson
35 Malnutrition and Enteral/Parenteral Alimentation
Jeffrey I. Wallace
36 Disorders of Swallowing
Nicole Rogus-Pulia, Steven Barczi, JoAnne Robbins
37 Oral Health
Joseph M. Calabrese, Judith A. Jones
Part III
Geriatric Syndromes
45 Aging and Homeostatic Regulation
George A. Kuchel
46 Frailty
Luigi Ferrucci, Elisa Fabbri, Jeremy D. Walston
47 Delirium
Sharon K. Inouye, Matthew Growdon, Tamara Fong
48 Falls
Stephen R. Lord
49 Sleep Disorders
Armand Ryden, Cathy Alessi
50 Dizziness
Aman Nanda, Richard W. Besdine
51 Syncope
R. A. Kenny, Conal Cunningham
52 Pressure Ulcers
Barbara M. Bates-Jensen, Anabel Patlan
53 Incontinence
Camille P. Vaughan, Theodore M. Johnson, II
54 Elder Mistreatment
Mark S. Lachs, Tony Rosen
Part IV
Principles of Palliative Medicine and Ethics
55 Palliative Care and Special Management Issues
Paul Tatum, Shaida Talebreza, Jeanette S. Ross, Eric Widera
56 Pain Management
Bruce A. Ferrell
57 Common Nonpain Symptoms
Christine Ritchie, Alexander K. Smith, Christine Miaskowski
58 Effective Communication Strategies for Patients With Advanced Illness
Brook Calton, Wendy Anderson
59 Palliative Medicine Across the Continuum of Care Including Hospice
Nelia Jain, Alexander K. Smith
60 Spiritual Care
Najmeh Jafari, Katalin Roth, Christina Puchalski
61 Ethics
Elizabeth Vig, Christina Bell, Caroline Vitale
Part V
Organ Systems and Diseases
SECTION D: Nephrology
86 Aging of the Kidney
Jocelyn Wiggins, Sanjeevkumar R. Patel
87 Renal Disease
Markus Bitzer
88 End-Stage Renal Disease
Mark L. Unruh, Pooja Singh
89 Disorders of Fluid and Electrolyte Balance
Eleanor Lederer, Vibha Nayak
SECTION E : Gastroenterology
90 Aging of the Gastrointestinal System
Karen E. Hall
91 Hepatic Disease
Sean G. Kelly, Courtney Barancin, Michael R. Lucey
92 Biliary and Pancreatic Disease
Sean G. Kelly, Justin C. Rice, Mark Benson, Michael R. Lucey
93 Upper Gastrointestinal Disorders
Alberto Pilotto, Marilisa Franceschi
94 Common Large Intestinal Disorders
David A. Greenwald
95 Constipation
Andres Acosta, Eric G. Tangalos, Danielle Harari
SECTION F : Oncology
96 Oncology and Aging: General Principles
Arati V. Rao, Harvey Jay Cohen
97 Breast Disease
Rachel A. Freedman, Hyman B. Muss
98 Prostate Cancer
Mark C. Markowski, Kenneth J. Pienta
99 Lung Cancer
Carolyn Presley, Ronald Maggiore, Ajeet Gajra
100 Gastrointestinal Malignancies
Ryan Nipp, Nadine J. McCleary
101 Intracranial Neoplasms
Clayton L. Haldeman, Robert J. Dempsey
102 Skin Cancer
Kelly L. Harms, Amy Orsini, Timothy M. Johnson,Alison B. Durham
SECTION G : Hematology
103 Aging of the Hematopoietic System
William Tse, Maxwell M. Krem, Jino Park,Nathan A. Berger, Scot C. Remick
104 White Cell Disorders
Heidi D. Klepin, Bayard L. Powell
105 Non-Hodgkin and Hodgkin Lymphomas
Paul A. Hamlin, Colette Owens
106 Coagulation Disorders
Stacy A. Johnson, Matthew T. Rondina
107 Plasma Cell Disorders
Tanya M. Wildes
Index
Contributors
CHAPTER AUTHORS
Numbers in brackets refer to the chapters written or cowritten by the contributor
Cathy Alessi, MD
Director, Geriatric Research, Education and Clinical Center (GRECC)
Chief, Division of Geriatrics; VA Greater Los Angeles Healthcare System
Professor, David Geffen School of Medicine
University of California, Los Angeles
Los Angeles, California [49]
Karen P. Alexander, MD
Professor of Cardiovascular Medicine
Duke University Medical Center
Duke Clinical Research Institute
Durham, North Carolina [77]
Neil B. Alexander, MD
Professor, Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan
Director, VA Ann Arbor Health Care System GRECC
Ann Arbor, Michigan [114]
Danielle L. Anderson, MD
Assistant Professor of Psychiatry and Behavioral Sciences
Division of Geriatric Psychiatry and Neuropsychiatry
Northwestern University
Chicago, Illinois [72]
Jacqueline V. Aredo, BS
Clinical Research Assistant
Rehabilitation Medicine Department
National Institutes of Health
Bethesda, Maryland [124]
Courtney Barancin, MD
Gastroenterologist
Minnesota Gastroenterology
St. Paul, Minnesota [91]
Steven R. Barczi, MD
Professor of Medicine
Division of Geriatrics and Gerontology
Medical Director for Division; Director of Education for GRECC
University of Wisconsin School of Medicine and Public Health
Wm. S. Middleton VA GRECC-Madison
Madison, Wisconsin [36]
Mark Benson, MD
Assistant Professor
Department of Internal Medicine
Division of Gastroenterology and Hepatology
University of Wisconsin
Madison, Wisconsin [92]
Nathan A. Berger, MD
Distinguished University Professor
Hanna-Payne Professor of Experimental Medicine
Professor of Medicine, Biochemistry, Oncology and Genetics
Director, Center for Science, Health and Society
Case Western Reserve University School of Medicine
Cleveland, Ohio [103]
Roberto Bernabei, MD
Professor of Internal Medicine
Director of the Department on Aging,
Neurosciences, Head and Neck, Orthopaedics
Policlinico A. Gemelli, Universita’ Cattolica del Sacro Cuore
Rome, Italy [6]
Cheryl D. Bernstein, MD
Associate Professor
University of Pittsburgh
Department of Anesthesiology and Neurology
Division of Pain Medicine
Pittsburgh, Pennsylvania [124]
Richard W. Besdine, MD
Professor of Medicine
Director, Division of Geriatrics and Palliative Medicine (Medicine)
Greer Professor of Geriatric Medicine
Alpert Medical School of Brown University
Professor of Health Services Policy and Practice
Director, Center for Gerontology and Health Care Research
Brown University School of Public Health
Providence, Rhode Island [50]
Ellen F. Binder, MD
Professor of Medicine
Division of Geriatrics and Nutritional Science
Fellowship Program Director
Washington University School of Medicine
St. Louis, Missouri [119]
Markus Bitzer, MD
Associate Professor of Internal Medicine Division of Nephrology
Director, Geriatric Nephrology Clinic
University of Michigan
Ann Arbor, Michigan [87]
Jacob B. Blumenthal, MD
Assistant Professor of Internal Medicine
Division of Gerontology and Geriatric Medicine
Associate Director (Acting) for Education and Evaluation/Baltimore GRECC
University of Maryland, Baltimore VAMC
Baltimore, Maryland [111]
Kenneth Brummel-Smith, MD
Charlotte Edwards Maguire Professor
Department of Geriatrics
Florida State University
College of Medicine
Tallahassee, Florida [22]
Chandler Caufield, BA
Research Technician
Dorothy P. & Richard P. Simmons Center for Interstitial Lung Diseases Division of Pulmonary Medicine,
Allergy and Critical Care Medicine
McGowan Institute for Regenerative Medicine
University of Pittsburgh
Pittsburgh, Pennsylvania [83]
Jessica L. Colburn, MD
Assistant Professor of Medicine
Division of Geriatric Medicine and Gerontology
Johns Hopkins University School of Medicine
Baltimore, Maryland [21]
A. B. Dey, MD
Professor and Head
Department of Geriatric Medicine
All India Institute of Medical Sciences
New Delhi, India [6]
Margaret A. Drickamer, MD
Clinical Professor
Division of Geriatrics
University of North Carolina School of Medicine
Chapel Hill, North Carolina
Professor Emeritus
Yale School of Medicine
New Haven, Connecticut [12]
Catherine E. DuBeau, MD
Professor of Medicine
Division of Geriatric Medicine
University of Massachusetts Medical School
UMass Memorial Medical Center
Worcester, Massachusetts [44]
Alison B. Durham, MD
Assistant Professor of Dermatology
Division of Cutaneous Surgery and Oncology
University of Michigan
Ann Arbor, Michigan [102]
Elisa Fabbri, MD
PhD Fellow and Resident in Geriatrics
University of Bologna
Bologna, Italy
Special Volunteer, National Institute on Aging (NIH)
Baltimore, Maryland [46]
Bruce A. Ferrell, MD
Professor of Clinical Medicine
Division of Geriatrics
David Geffen School of Medicine
University of California, Los Angeles
Los Angeles, California [56]
Joseph H. Flaherty, MD
Professor of Internal Medicine
Division of Geriatric Medicine
Associate Chair for Clinical Affairs
Saint Louis University School of Medicine
St. Louis, Missouri [25]
Scott A. Flanders, MD
Professor of Medicine
Director, Hospital Medicine Program
Associate Chief, Division of General Medicine
Associate Chair, Quality and Innovation
Department of Medicine
University of Michigan
Ann Arbor, Michigan [16]
Daniel E. Forman, MD
Professor of Medicine
Chair, Geriatric Cardiology Section, University of Pittsburgh Medical Center (Divisions of Geriatrics and Cardiology)
Physician Scientist, Pittsburgh Geriatric, Research, Education, and Clinical Center
University of Pittsburgh
Pittsburgh, Pennsylvania [76]
Kaitlyn Fruin, BS
Research Specialist
Department of Obstetrics and Gynecology
The University of Chicago
Chicago, Illinois [41]
Andrew P. Goldberg, MD
Professor Emeritus
Division of Gerontology and Geriatric Medicine
University of Maryland School of Medicine
Baltimore, Maryland [111]
Paul J. Grant, MD
Assistant Professor of Medicine
Director, Perioperative and Consultative Medicine
Division of General Medicine
Department of Internal Medicine
University of Michigan Health System
Ann Arbor, Michigan [31]
David A. Greenwald, MD
Professor of Medicine
Department of Medicine, Division of Gastroenterology
Icahn School of Medicine at Mount Sinai
Director of Clinical Gastroenterology and Endoscopy
Mount Sinai Hospital
New York, New York [94]
Ryan Greytak, MD
Board-Certified Geriatric Psychiatrist
Private Practice
San Diego, California [73]
David A. Gruenewald, MD
Associate Professor of Medicine
Department of Medicine
Division of Gerontology and Geriatric Medicine
University of Washington School of Medicine
VA Puget Sound Health Care System
Seattle, Washington [108]
Jerry H. Gurwitz, MD
The Dr. John Meyers Professor of Primary Care Medicine
Professor of Medicine, Family Medicine and Community Health, and Quantitative Health Sciences
Chief, Division of Geriatric Medicine
Executive Director, Meyers Primary Care Institute
University of Massachusetts Medical School
Worcester, Massachusetts [24]
Jeffrey B. Halter, MD
Professor Emeritus of Internal Medicine
Division of Geriatric and Palliative Medicine
University of Michigan
Ann Arbor, Michigan
Parkway Visiting Professor in Geriatrics
Department of Medicine
Yong Loo Lin School of Medicine
National University of Singapore [110]
Paul A. Hamlin, MD
Associate Member, Department of Medicine, Lymphoma Service
Division of Hematologic Oncology
Chief, Basking Ridge Medical Oncology Service
Memorial Sloan Kettering Cancer Center,Associate Professor in Medicine
Weill Cornell Medical College
New York Presbyterian Hospital
Department of Medicine
New York, New York [105]
Danielle Harari, MD
Consultant Physician and Senior Lecturer
Kings College London
Department of Ageing and Health
Guy’s and St. Thomas’ NHS Foundation Trust
London, England [95]
Rowan H. Harwood, MD
Consultant Geriatrician and Professor of Geriatric Medicine
Nottingham University Hospitals NHS Trust
Queen’s Medical Centre
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