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This case-based approach to geriatric medicine is suitable for all health professionals and trainees who provide care for the elderly, including interns, residents, geriatric fellows, physicians in practice, and nurse practitioners. Illustrated with more than 40 cases based on the authors' experience in clinical practice, the examples range from the healthy elderly to those with advanced cognitive or physical impairments. Discussions are evidence based with extensive references, emphasizing differential diagnosis, atypical presentations in late life, age-appropriate medical management, interdisciplinary methods, and care in the context of different health care settings. The authors have distilled a wealth of practical and clinical experience in this area to produce a user-friendly guide to geriatric medicine. This is the ideal study guide for certifying examinations and highly suitable as a textbook for courses in geriatric medicine and gerontology.
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Geriatric is a topic of great interest in medicine and among the general public. Population aging is an inevitable and irreversible demographic reality that is associated with welcome improvements in health care. The increase in life expectancy has led the very old to become the fastest-growing segment. The geriatric population experiences significant alterations of numerous organ systems as a result of the aging process. Normally, functional reserve and organ functions are declined in geriatric patients. The care of geriatric patients can be complex and will be a growing task. A balance between physiological and psychological alterations is required in these patients. Geriatric patients also have several co-morbidities including hypertension, cardiac disease, diabetes, cerebrovascular disease, and renal dysfunction.
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Older adults are living longer with more chronic disease and functional impairment than at any other time in history. Office-based practice is inadequate to meet the needs of patients who have difficulty leaving their homes for routine or urgent visits, and health care clinicians must choose between trying to manage their problems via telehealth or sending them to the emergency room via ambulance. Indeed, many clinicians receive little or no training in home-based medical care and are unable to consider a home visit that might avert a health crisis or an emergency room visit. Other clinicians know that house calls are possible but may not know how to work them into day-to-day practice. In recent years, a growing number of clinicians have focused their practice on home-based medical care to meet the rising need. In fact, there has been a substantial increase in house calls provided to Medicare beneficiaries. In 2023, over 750,000 traditional Medicare beneficiaries, and in 2022, over 680,000 Medicare Advantage beneficiaries received longitudinal home-based medical care. While the number of house calls has increased rapidly, the number of clinicians providing those visits has markedly decreased, suggesting that clinicians who are providing such care are making it the sole focus of their practice. This book is intended to be a practical reference for any clinician who has struggled to care for an older adult who has difficulty getting to the office. By describing fundamental principles of geriatric house call medicine and application to specific diseases and conditions, we hope to provide clinicians with the tools they need to provide timely, compassionate, and high-quality care for their older adult patients. The second edition has been updated to reflect changes in the healthcare system and approaches to care since the publication of the first edition.
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