Contemporary Geriatric Medicine

In the last two years, a wealth of new information has accumulated regarding both clinical and research aspects of health care for the elderly. Although many controversial issues have been resolved, many still remain. Volume 2 of Contemporary Geriatric Medicine is once again dedicated to the clinician who cares for the elderly on a continuing basis. Although, for the most part, general topics first introduced in Volume 1 have been retained, all infor mation in this volume is new and represents the current state of the art. In addi tion, several new topics-including falls, interpretation of laboratory data, and oral health care-have been introduced to enhance this volume's usefulness to the busy clinician. Through these easy-to-read essays, we attempt once again to keep the non geriatrician abreast of the current state of the art regarding the special needs and problems of the elderly. Each chapter is not meant to be an exhaustive review of all topics in the field, but rather to focus on issues receiving a great deal of atten tion. Our goal is to create an exciting approach to contemporary issues in gerIatric medicine.

This volume marks the first of a new series, Contemporary Geriatric Medicine, joining the ever growing "Contemporary" family. As with the other "Contem porary" volumes, our goal is to assist the reader in maintaining currency in a rapidly changing field. Perhaps no field has shown such major advances in such a short time as geriatrics. Over the last several years, the "demographic impera tive" has become a source of concern for many, including clinicians, scientists, econ omists, and health planners. Our geriatric knowledge base continues to grow, often making it difficult to keep abreast of advances and current therapeutic modalities. Contemporary Ger iatric Medicine presents the state-of-the-art thinking regarding a variety of topics all of major concern to the health practitioner caring for the elderly person. The authors, for the most part serving as members of a stable editorial board, have chosen topics that should have immediate interest to the readership. By having a stable editorial board, continuity is ensured in successive volumes. Every two years, a subsequent issue will either address new thoughts on already presented topics or focus on new topics of current interest. As with the other "Contempo rary" series volumes, the every other year interval is intended to allow new find ings to develop and be tested. It also provides the authors with time to provide the highest quality of work.

This volume is the third in the Contemporary Geriatric Medicine series. As in previous volumes, information is presented in the form of easy-to read essays to bring the reader up to date on state-of-the-art develop ments in the area of geriatric medicine. Once again, a system approach is utilized. In addition, several new topics-including alcoholism, throm boembolic disease, and decubitus ulcer management-have been intro duced to enhance this volume's usefulness to the busy clinician and student. Each chapter is not meant to be an exhaustive review of all topics in the field, but rather to focus on issues currently receiving a great deal of attention. Our goal continues to be to create an exciting approach to contemporary issues in geriatric medicine. The editors are once again appreciative for having been given the opportunity to develop this series. Appreciation is also expressed to our professional colleagues, families, and administrative assistants, who have enabled this volume to reach fruition. As in the past, we thank, most of all, our elderly patients for providing the inspiration and impetus to improve our knowledge and understanding of the health care needs of the elderly. Steven R. Gambert, M.D. V alhalla, New York ix Contents Chapter 1 Geriatric Cardiology and Blood Pressure 1 Edmund H. Duthie, Jr., and Michael H. Keelan, Jr.

This volume marks the first of a new series, Contemporary Geriatric Medicine, joining the ever growing "Contemporary" family. As with the other "Contem porary" volumes, our goal is to assist the reader in maintaining currency in a rapidly changing field. Perhaps no field has shown such major advances in such a short time as geriatrics. Over the last several years, the "demographic impera tive" has become a source of concern for many, including clinicians, scientists, econ omists, and health planners. Our geriatric knowledge base continues to grow, often making it difficult to keep abreast of advances and current therapeutic modalities. Contemporary Ger iatric Medicine presents the state-of-the-art thinking regarding a variety of topics all of major concern to the health practitioner caring for the elderly person. The authors, for the most part serving as members of a stable editorial board, have chosen topics that should have immediate interest to the readership. By having a stable editorial board, continuity is ensured in successive volumes. Every two years, a subsequent issue will either address new thoughts on already presented topics or focus on new topics of current interest. As with the other "Contempo rary" series volumes, the every other year interval is intended to allow new find ings to develop and be tested. It also provides the authors with time to provide the highest quality of work.

In the previous two volumes of this series, we presented classic problems in internal medicine as illustrated by actual cases cared for in our institution. It has been gratifying for us to see the interest that these volumes have generated with students and trainees. We remain committed to the case method of instruction, and believe that there is no better method to learn medicine than to have an individual patient problem as the basis for study of pathophysiology, natural history, diagnosis and management. We hope that our readers find this third volume as enjoyable and instructive as the editors found it. Juan M. Bowen, MD Ernest L. Mazzaferri, MD, FACP xiii Acknowledgement The editors are grateful to Jeff Smith and Jenny Riegler for their unflagging professionalism and patience. xiv Contents Case 1 Mitral Regurgitation - Chronic Versus Acute: Implications for Timing of Surgery • . • • • . . • . . . . . • . . . . . . . . . . . 1 Harisios Boudoulas, MD Charles F. Wooley, MD Advances and diagnostic imaging in a surgical technique have changed the approach to mitral valve regurgitation. This chapter provides an expert's perspective. Case 2 Cystic Fibrosis in Adults .. • •••••••••••• 36 Andrew Libertin, MD John S. Heintz, MD As children with cystic fibrosis grow into adulthood, the internist assumes a greater role in their care. Case 3 Thrombotic Thrombocytopenic Purpura . . . . . . . . . . 51 . . . Donald E. Thornton, MD Earl N. Metz, MD, FACP Patients with ITP continue to present difficulties in diagnosis and management. Two experts discuss the current approach to ITP.

International appeal: contributions from leading authorities from around the world Presents the latest research as well as innovative new thingking and approaches in aged care The problems linked to the aging population is a hot topic in the UK – ‘the pension crisis’; the allocation of housing and inadequate healthcare for the elderly are issues that affect everyone