The Care Of The Older Person

An Invaluable Resource for Care Providers
 

Crucial information for those who care, provide, create, and build for our rapidly growing—and cherished—senior population

“….the aging of the population is an unprecedented phenomenon in human history….it is in fact a triumph of humankind over the adversities of the environment.”

 

Jose Morais , MD

Director, Division of Geriatric Medicine, McGill University

LEARNING TO WORK WITH AN INCREASINGLY AGED SOCIETY

Society, as a whole is getting older. Thanks to the extraordinary advances in technology and medicine, humans are now living longer than ever before, and are shifting the demographic make-up on a worldwide scale.

As a result, more and more of us are living and engaging with an aging population in both our personal and professional lives, and there’s a heightened demand for concrete research and advice for how to effectively provide care for this growing demographic.

The Care of the Older Person brings together some of today’s most experienced researchers to provide concrete answers for care providers of all kinds—doctors, nurses, therapists, pharmaciststhose who build, run, and staff the facilities and housing for all of the aging population, as well as spouses and children of the elderly. Most importantly, this information is for seniors themselves, who want to feel empowered in their stage of life. 

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EXPLORING A BROAD ARRAY OF ISSUES

FOR ELDER CARE 

“We are living in an age of rapidly advancing technology. We are undergoing a revolution in communication and information availability. The human genome is known, disease is understood at a metabolic level, and drugs are created to target the mechanisms of disease. All these factors complement one another so that in our industrialized, computerized and linked world people have the ability to live much longer.”

Ronald M. Caplan, MD

“It takes one minute to prescribe a medication but years to discontinue it.”

Louise Mallet, Pharm.D

The Care of the Older Person is broken up into chapters written by an esteemed group of doctors and researchers, each covering a different aspect of elder care:

Overview of the Field (by Jose Morais, MD) presents an in-depth overview of the current state of geriatric medicine, including the unique challenges and opportunities characterizing this growing field today.

Frailty (by Sathya Karunananthan, PhD and Howard Bergman, MD) explores the increasing vulnerability of our bodies and organs as we age and what care providers can do to diagnose and treat individuals.

Physical Activity as a Countermeasure to Frailty (by Guy Hajj Boutros, MSc and Antony D. Karelis, Phd) makes a compelling case for avoiding the sedentary state when possible, and demonstrates interventions that can potentially reverse frailty.

“Doctor, My Wife is Getting Forgetful” (by Serge Gauthier, MD) explores the natural decline in memory, and how to diagnose and address dementia in your patients, clients, or family.

Update on Alzheimer’s Disease Diagnosis and Management (by Serge Gauthier, MD) is a synopsis of the diagnosis and management of AD, as well as its natural history and progression, by one of the acknowledged leaders in the field.

How to Diagnose and Manage Delirium (by Haibin Yin, MD). Among elderly patients who come into the ER, 15% suffer from delirium or “acute brain failure.” This chapter explores the signs and treatments.

Why Does My Patient Have Gait & Balance Disorders? (by Olivier Beauchet, MD, PhD) explores the main causes and best treatments for the broad category of walking and balance problems.

Could My Patient Be Malnourished? (by Jose Morais, MD) explores the prevalence of malnutrition in older populations, how to diagnose it, and how to treat it.

Are the Immunizations of My Patient Up to Date? (by Dominique Tessier, MD) stresses the importance of immunizations in our vulnerable older population, with details of the various immunizations that may be necessary.

Management of Older Patients in the Emergency Department (By Cyrille Launay, MD, PhD) provides an overview of the unique challenges facing ER staff in diagnosing and working with older patients.

How to Manage Type 2 Diabetes in Frail Elderly Patients (by Young-Sang Kim, MD, PhD, and Jose A. Morais, MD) explores this important disease condition that is highly prevalent in older adults, and stresses the differences in treatment and approach that are necessary in the older population.

Cancer in Older Adults (by Doreen Wan-Chow-Wah, MD) brings the relatively young subspecialty of Geriatric Oncology to the forefront. Particularities of older persons with cancer are noted, including fitness for treatment. Life expectancy is factored in.

Cancer Screening in the Older Adult (by Catalina Hernandez-Torres, MD, and Tina Hsu, MD) discusses the sometimes controversial role of cancer screening in older adults. Screening recommendations are covered in the light of treatment options and patient preference.

Psycho oncology: Living with the Fear of Death (by Norman Straker, MD) is a discussion of the emotional and psychiatric care of cancer patients and their families by one of the originators of the subspecialty. The relationship between various psychiatric disorders and cancer is examined.

Incontinence in Older Adults (by Samer Shamout  MD and Lysanne Campeau, MD) explores the risks, diagnosis, and treatment of urinary incontinence.

Polypharmacy and Deprescribing in the Elderly (by Louise Mallet, Pharm.D). Polypharmacy is taking multiple medicines for chronic issues at the same time and is common among the elderly. This chapter explores the risks of polypharmacy and how to “deprescribe” unnecessary medications.

After the Menopause (by Ronald M. Caplan, MD) brings to the fore the fact that, with dramatically increasing lifespan, the postmenopausal years represent a very significant proportion of a woman’s productive life. Physiologic changes, screening for possible problems, prevention and possible treatments are discussed.

Elder Abuse (by Mark J. Yaffe, MD). Unfortunately, elder abuse is far too common in our society, and takes on many forms. This chapter helps care providers to identify elder abuse and learn how to address it.

An Overview of Late-Life Depression (By Artin Mahdanian, MD, and Silvia Monti De Flores, MD) explores the importance of understanding late-life depression for care professionals, including tools for diagnosis and treatment.

Assessment of Decision-Making Capacity (By Catherine Ferrier, MD) provides an important analysis of how to determine a patient’s ability to make key decisions about their medical treatment, living situation, finances, and more.

How Do I Protect My Patient? (By Randy S. Perskin, Esq., JD) explores the important legal issues facing elderly patients and how care providers can best support them.

Financial Guidance for Seniors (by Karen C. Altfest, PhD, CFP) recognizes that, among the paramount concerns of older persons is financial stability. Financial concerns can affect mental and physical health, wellbeing, and even lifespan. Advice is offered to caregivers, including family, and to the older individual on how to anticipate and overcome these problems.

The Role of Religious Belief in the End-of-Life Care of Older Persons (by A. Mark Clarfield, MD,) compassionately shows that we cannot treat older persons near the end of life, and their families, without an understanding of their religious beliefs, and appropriately responding to their needs and concerns in ways that respect those beliefs.

Medical Glossary (by Ronald M. Caplan, MD). A highly researched glossary of medical definitions that will help you to understand what you’re reading and navigate the often-confusing world of scientific terminology. Includes forward-looking research that gives you a sense of where the advances in geriatrics are going in the future.

A TEAM OF EXPERTS

The contributors to The Care for the Older Person are literally an all-star team of researchers, doctors, and clinical professionals. Their research-based advice is informed by decades of experience working in the fields that they write about.

EDITORS

Olivier Beauchet, MD, PhD

MD, PhD, Professor of Geriatrics, Dr. Joseph Kaufmann Chair in Geriatric Medicine, Director of centre of excellence on aging and chronic diseases, McGill University


Dr. Beauchet holds a MD degree from the University of St-Etienne University (1999) and completed a specialty in Neurology and Internal Medicine and Geriatrics at St-Etienne University (France). In parallel, he holds a master of science in neuropsychology and a PhD in Human Motricity and handicap at St-Etienne University (France).  Read More 

 

Ronald M. Caplan, MD

MD, CM, FACS, FACOG, FRCS(C), Clinical Associate Professor Emeritus Obstetrics and Gynecology, Weill Medical College of Cornell University


Ronald M. Caplan MD is an Obstetrician Gynecologist and medical author.

He did his medical and postgraduate training at McGill University, where his interest in renal disease in pregnancy and homotransplantation culminated in the first delivery of a baby from a mother who had received a deceased donor kidney transplant. Read More

Serge Gauthier, MD

CM, CQ, MD, FRCP(C), Director, Alzheimer Disease Research Unit, McGill Center for Studies in Aging , Professor, Departments of Neurology & Neurosurgery, Psychiatry, Medicine, McGill University


Medical studies at Université de Montréal, Neurology training at McGill University, Research Fellowship at Prof. Theodore L. Sourkes laboratory, Allen Memorial Institute, Montreal. Clinical investigator and staff neurologist at the Montreal Neurological Hospital and Institute (1976-1986), Director of the McGill Centre for Studies in Aging (1986-1996), Senior Scientist of the CIHR-Rx&D program (1997-2007). Read More

José A. Morais, MD

MD, FRCP(C), Associate Professor and Director, Division of Geriatric Medicine, McGill University, Associate Director, Quebec Network for Research on Aging


Dr. Morais holds a MD degree from the University of Montreal (1987) and completed a specialty in Internal Medicine and Geriatrics at McGill University, Canada. He went on to complete a 3-year Research Fellowship in Nutrition and Metabolism at McGill Nutrition Centre. Since 1996, he is an independent clinician-investigator based at the Research Institute of the McGill University Health Centre (MUHC) – Crabtree Nutrition Laboratory, Montreal, Canada. He is since 2008 Associate Professor of Medicine, McGill University. Read More

Howard Bergman, MD

MD, FCFP, FRCP(C), Chair, Department of Family Medicine, Professor, Departments of Family Medicine, Medicine, and Oncology, McGill University


Professor Bergman is Chair of the Department of Family Medicine and Professor of Family Medicine, Medicine, and Oncology at McGill University where he was the first Dr. Joseph Kaufmann Professor of Geriatric Medicine from 2001-2015. He is Special Advisor (International) to the Dean of the Faculty of Medicine. He is a Fellow of the Canadian Academy of Health Sciences (CAHS). Read More

Abraham Fuks, MD

MD, CM, FRCP(C), Professor, Department of Medicine, McGill University


Dr. Abraham Fuks is a graduate of the Faculty of Medicine at McGill University where he obtained his M.D.,C.M. in 1970 and where he is currently a Professor in the Departments of Medicine, Pathology and Oncology.His research interests have included the immunogenetics of diabetes, the biology of tumor-associated antigens and cell adhesion molecules, and ethical aspects of the design of trials involving human subjects. Read More

Phil Gold, MD, PhD

CC, OQ, MD, PhD, FRSC, DSc (Hon), MACP, FRCP(C), Douglas G. Cameron Professor of Medicine, Professor of Physiology and Oncology, McGill University, Executive Director Clinical Research Center (MGH) McGill University Health Centre


Phil Gold is the Douglas G. Cameron Professor of Medicine, and Professor of Physiology and Oncology, at McGill University. He has served as the Inaugural Director of the McGill (now Goodman) Cancer Centre, Chairman of the Department of Medicine at McGill and Physician-in-Chief at the Montreal General Hospital. He is presently the Executive Director of the Clinical Research Centre of the McGill University Health Centre at The Montreal General Hospital. Read More

CONTRIBUTORS

Karen C. Altfest, PhD, CFP

Phd, CFP®, Principal Advisor and Executive Vice President, Altfest Personal Wealth Management


Karen C. Altfest, PhD, CFP® is a Principal Advisor and Executive Vice President Altfest Personal Wealth Management, a 36-year-old fee-only wealth management firm in New York City. She helps many of the firm’s clients on a variety of investment and financial planning issues, and specializes in helping retired clients, women clients and widows. Read More 

Guy Hajj Boutros, MSc

MSc, Research Assistant, Research Institute, McGill University Health Center, Crabtree Nutrition Laboratories


Guy Hajj Boutros holds a Masters in Exercise Physiology from the University of Quebec in Montreal. Over the last few years, he has been involved in several research programs on exercise and obesity and has published several papers on defining and assessing the usefulness of exercise as a clinical tool in older healthy adults and with frailty. Read More 

Lysanne Campeau, MD, PhD

MDCM, PhD, FRCS(C), Assistant Professor of Surgery, Division of Urology, McGill University


Dr. Lysanne Campeau completed her medical degree in 2005 and her urology residency in 2010 at McGill University, when she became a Fellow of the Royal College of Surgeons of Canada in Urology. She then went on to pursue her clinical and research interest in voiding dysfunction at Wake Forest Institute for Regenerative Medicine in North Carolina, where she obtained a Doctorate of Philosophy in the Department of Physiology and Pharmacology in 2013. Read More 

A. Mark Clarfield, MD

MD, FRCPC, Professor Emeritus, Geriatrics, Ben-Gurion University, Israel


Dr. Clarfield received his MD from the University of Toronto in 1975 going on to specialize in Family Medicine, Community Medicine and Public Health and finally in Geriatrics. He was with the Faculty of Medicine at McGill University in Montreal from 1978-1992 during which time he was head of the University Division of Geriatric Medicine and Assistant Dean of Students. Read More

Catherine Ferrier, MD

MD, Assistant Professor, Department of Family Medicine, Faculty of Medicine, McGill University


Dr. Ferrier is Assistant Professor, Department of Family Medicine at McGill University and holds a Certificate of Special Competence in Care of the Elderly from the College of Family Physicians of Canada. She works as a consultant in Geriatric Medicine, as well as in primary care Family Medicine. Read More 

Catalina Hernandez-Torres, MD

MD, FRCP(C) Medical Oncologist, Northwest Permanente


Dr. Hernandez-Torres is a medical oncologist. She obtained her medical degree at McGill University followed by Internal Medicine and Medical Oncology residency at the University of Ottawa.  She completed a fellowship in Geriatric Oncology working with Dr. Tina Hsu at The Ottawa Hospital Cancer Center. Read More 

Tina Hsu, MD

MD, FRCPC, Assistant Professor, Division of Medical Oncology, University of Ottawa


Tina Hsu is a medical oncologist at the Ottawa Hospital Cancer Centre. She completed a CAMO/CIHR-funded research fellowship in geriatric oncology under the mentorship of Dr. Arti Hurria at City of Hope where she studied caregivers of older adults with cancer admitted to hospital. Read More 

Antony Karelis, PhD

PhD, Professor, Department of Exercise Science, Universite du Quebec, Montreal; Researcher, Centre du recherche de l’Institut universitaire de geriatre de Montreal


Dr. Karelis received a PhD in Sciences de l’activité physique from the Department of Kinesiology, University of Montreal. His specialization was in muscle fatigue. He did a Post Doctoral Fellowship at the Faculty of Medicine, Department of Nutrition, University of Montreal, specializing in the characterization of subgroups of obesity. Read More 

Sathya Karunananthan, PhD

PhD, Postdoctoral Fellow, Ottawa Hospital Research Institute


Sathya Karunananthan holds a PhD in epidemiology from McGill University. Over the last decade, she has been involved in several international research programs on frailty and has co-authored a number peer-reviewed papers on defining and assessing the usefulness of frailty as a clinical tool. Read More

Young-Sang Kim, MD, PhD

MD, PhD, Associate Professor, Department of Family Medicine, CHA Bundang Medical Center, CHA University in Korea


Young-Sang Kim, MD, PhD, is Associate Professor, Department of Family Medicine, CHA Bundang Medical Center, CHA University in Korea.vHe is currently a Visiting Professor, McGill University, working in the laboratory of Dr. Jose Morais, the Director of the Division of Geriatric Medicine. Read More

Cyrille Launay, MD, PhD

MD, PhD, Department of Medicine, Division of Geriatrics, University Hospital of Lausanne, Switzerland


Dr. Launay was a geriatrician at the University Hospital of Angers, France until 2015, when he joined the division of geriatrics, University of Lausanne. His PhD thesis described the Brief Geriatric Assessment, a tool to predict prolonged length of hospital stay. Read More

Artin A. Mahdanian, MD

MD, MSc. Psychiatry Resident, McGill University


Artin Mahdanian, MD Tehran University, received an MSc in psychiatric research from McGill University, where he is currently completing his psychiatric residency. He is a Diversity Leadership Fellow, American Psychiatric Association. Read More

Louise Mallet, Pharm.D

B.Sc. Pharm., Pharm.D., BCGP, FESCP, FOPQ, Professor in Clinical Pharmacy, Faculty of Pharmacy, University of Montreal, Pharmacist in Geriatrics, McGill University Health Center


Louise Mallet is currently a full Professor of Pharmacy at the Faculty of Pharmacy at the University of Montreal. She is also a clinical pharmacist with the interdisciplinary team in geriatrics in the emergency room at McGill University Health Center.  Read More

Silvia Monti De Flores, MD

FRCPC, DFAPA, Staff Psychiatrist, McGill University Health Centre, McGill University Lecturer


Dr. Silvia Monti De Flores is a McGill Psychiatry graduate and Attending Staff Psychiatrist in Psychogeriatrics, attached to the Mood Disorders Program at McGill University Health Centre, psychiatry outpatient. She is a consultant to the Geriatric Medicine Clinic at the Montreal General Hospital. Read More

Randy S. Perskin, Esq., JD

BA, JD, Elder Law Attorney, New York


Randy Perskin received her BA degree from Barnard College (Columbia University), and her JD from Fordham Law School. She is a long experienced and well-recognized Elder Law Attorney. Read More

Samer Shamout, MD

MD, MSc, Fellow, Division of Urology, McGill University


Dr. Samer Shamout earned his M.B.B.S in medical studies in 2005 at Jordan University of Science and Technology and completed his clinical MSc. training in Urology in 2010 at the Alexandria University of Egypt. Dr. Shamout has been practicing since 2010, the first 5 years in United Arab Emirates, at the Ministry of Health Hospital. Selected as one of the top hospitals in the United Arab Emirates. Read More

Norman Straker, MD

MD, DLFPAPA, Clinical Professor of Psychiatry, Weill Cornell University College of Medicine; Consultant, Sloan Kettering Cancer Center; member of the faculty, New York Psychoanalytic Institute


Dr. Straker is a distinguished life fellow of the APA. He graduated from medical school at McGill University in1966 and completed a rotating internship at The Royal Victoria Hospital in 1967, before moving to New York for residency training in Adult and Child Psychiatry at Mt Sinai Hospital. He did a postgraduate research fellowship in psychosomatic medicine at Mount Sinai Hospital and pursued psychoanalytic training at the New York Psychoanalytic Institute. Read More

Dominique Tessier, MD

MD, Clinical Instructor, Family Medicine Department, University of Montreal; Medical Director, Travel Health Group, Montreal, Canada


Dr. Tessier is a Family Doctor with over thirty years of experience. She is well known in the field of Travel Medicine and Immunizations and HIV care. Her practice has always focused on immunizations and the prevention of infectious diseases, including HIV/AIDS and STI. She is actively involved in clinical research. Read More

Doreen Wan-Chow-Wah, MD

MD, FRCPC, Assistant Professor, Division of Geriatric Medicine, Department of Medicine, McGill University; Associate member, Department of Oncology, McGill University


Dr. Wan-Chow-Wah is a geriatrician-internist practicing mainly at the Royal Victoria Hospital (Glen site). In 2007, she pioneered the field of Geriatric Oncology in Canada by co-founding the first Geriatric Oncology Clinic at the Segal Cancer Center of the Jewish Hospital. As the Medical Director since its inception, her expertise serves to improve the care of older cancer patients through multidimensional comprehensive assessments and personalized interventions. Read More 

Mark Yaffe, MD

MDCM, Professor of Family Medicine, Department of Family Medicine, St Mary’s Hospital Center


Mark Yaffe is a tenured Full Professor in the McGill University Department of Family Medicine and at St. Mary’s Hospital Center in Montreal, Canada. In 2007 he was awarded the Inaugural Prix d’Excellence for Advancement of Teaching of Family Medicine by the Quebec College of Family Physicians. Read More 

Haibin Yin, MD

MD, CCFP (COE) Assistant Professor, Director of Undergraduate Medical Education, Division of Geriatric Medicine, McGill University


Dr. Haibin Yin is an attending staff member in the Division of Geriatric Medicine at Jewish General Hospital since 2014. He is an Assistant Professor in the Faculty of Medicine at McGill University. He is actively involved in clinical teaching of medical students and residents. Read More

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Disclaimer 

The contents of this book and e-book and all materials contained in this book and e-book are for informational purposes only. The materials and information contained in this book and e-book are not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should always seek the advice of your physician or other qualified health provider if you have questions regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you may have read in this book and e-book. Medical professionals should not rely on any drug , drug dosage, or other information in this e-book and book, which is for informational purposes only.

If you think you may have a medical emergency, call your doctor or 911 immediately. The authors do not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned in this book and e-book. Reliance on any information provided in this book and e-book is solely at you own risk.

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