Care of the older patient is characterized by increasing incidence of chronic and acute diseases, with many patients suffering from several conditions simultaneously. The susceptibility to disease increases not only because of physiological factors relating to the aging process, but also due to changes in lifestyle, such as decreased mobility. Issues relating to polypharmacy are exacerbated by concerns about compliance, for example in patients experiencing cognitive decline. Decisions about appropriate medical care are complicated by the fact that many of the normal values that can be relied upon as a guide in younger individuals, do not apply in the older patient.
These factors are particularly true for women, who tend to live longer and who undergo more dramatic physiologic changes, such as those associated with the menopause.
This book is designed to educate gynecologists about these issues. It draws upon the experience of specialists in a variety of clinical and non-clinical specialties, reviews current knowledge of the problems encountered in caring for the elderly female patient, and suggests guidelines for best practice.
Section 1: Epidemiology and scope of problem 1. Worldwide population changes 2. New social structures (divorce, widowhood, rural and urban) 3. Mortality and climate change Section 2: Conditions affecting the elderly (Pathology, impact on daily living, investigations, contribution to ill health management strategies) 4. Balance, falls and mortality 5. Vision 6. Audition 7. Dementia 8. Depression and mood changes (care at home, in residential care, hospital, drug/ECT/cognitive therapy) 9. Dentition 10. Continence 11. Sex (couple and single-sex relationships, heterosexual and same-sex, at home, living alone, residential care) 12. Sleep disorders Section 3: Managing the problem 13. Setting up a one-step gerontology service 14. Investigations BP, BMI, Hb, biochemistry,immunology (what are the normative values, what does the physician need to ask?) 15. Diet and micronutrients: living alone and residential care 16. Polypharmacy getting prescriptions, compliance, drug interactions, drug metabolism changes with age 17. Alternative and complementary therapies 18. Designing living places independent and residential 19. Palliative care: location, chemotherapy, analgesia 20. Caring for carers: professional and non-professional Index & Bibliographies