College London, London, UK
Ulrich von Oppell Cardiff and Vale University Health Board; Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
Laura M. Wagner Department of Community Health Systems, University of California San Francisco, San Francisco, California, USA
Stefan Walter*
* deceased
Rey Juan Carlos University, Department of Medicine and Public Health, Alcorcón, Madrid, Spain
Jeremy Whyman Division of Aging, Section of Palliative Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
Richard Wilson Geriatric and Stroke Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
Sarah A. Wingfield Division of Geriatrics, University of Texas Southwestern, Dallas, Texas, USA
Serena P. Wong Duke University School of Medicine, Durham, NC
Kahli E. Zietlow University of Michigan Department of Medicine, Ann Arbor, MI
Max Zubatsky Medical Family Therapy Program, Saint Louis University School of Medicine, St Louis, Missouri, USA
Preface to the Fifth Edition
The Fifth Edition of this widely known international textbook incorporates the latest evidence of research into the often complex management of common clinical problems in older people. We as Editors embarked on this edition with the knowledge that John Pathy would be there to guide us with all his wisdom and incredible grasp of the discipline of Geriatric Medicine. His untimely departure from this world left a major gap for us, but we have worked very closely as an editorial team, supported by Wiley‐Blackwell, and hope that this edition fulfils all the expectations and objectives that were set when we originally sat down with John Pathy to discuss the textbook. We pay tribute to John Pathy as a tremendous role model for aspiring geriatricians all over the world and hope that his textbook will continue to educate all those who seek enlightenment in caring for older people.
We have used, wherever possible, an evidence‐based approach to developing each chapter and asked all authors to think hard on what are the key messages. Chapters that have been revised and updated were edited closely to ensure that the clinical pathway is still highly relevant and that the references also reflected an in‐depth revision process. A new layout of chapters will be apparent and is based on grouping chapters with similar clinical relevance and where similar pathophysiological mechanisms may be operating. In a majority of chapters, we have leading international authors who are experts in the field.
Wide clinical experience is the hallmark of a sound geriatrician or other healthcare specialist who claims expertise in managing older people who are hospitalized or who have clinically deteriorated in the community. This may take many years of training, although at an early stage of their careers, recognition of the varying nature of illness in old age and how both simple and focused interventions can lead to health gain are prerequisites for enhancing clinical care. This textbook should complement these activities irrespective of the status of the practitioner but, as always, reading a book and acquiring knowledge must be accompanied by a practical clinical care approach aligned with compassion and understanding of the critical issues affecting older people.
Professor Alan Sinclair would like to thank Caroline Sinclair, and Professor John Morley would like to thank Susan Brooks, for their tremendous assistance in helping them to complete their editorial tasks, and the Editors would like to express their appreciation of the incredible patience and support from Gill Whitley and Robyn Lyons at Wiley‐Blackwell.
Alan J. Sinclair
John E. Morley
Bruno Vellas
Preface to the Sixth Edition
The Sixth Edition of this acclaimed international textbook of geriatric medicine continues the fine traditions of previous editions by including the latest insights into the often complex illness scenarios of old age, each of which is supported by laying the principles of care and building practical management guidance from this foundation. As before, we have attempted to provide an up‐to‐date, evidenced‐based approach to developing chapters and including only relevant tables and figures along with four or more key points in each. Many chapters are new versions, and others are updated. All authors either have an international reputation in their field of study or have been identified as up‐and‐coming geriatricians and scientists who in the years to come will continue to lead the campaign for better high‐quality medical care for all older people globally.
This Sixth Edition has been positively facilitated by the addition of two new editors: Matteo Cesari from Italy and Medha Munshi from the United States. Both are international experts with significant university appointments and strong reputations for excellent clinical science. We have also been generously supported for this Sixth Edition by the tremendous backing of four new associate editors: Ahmed Hafiz (UK), Milta Little (US), Julien Delrieu (France), Beatrice Arosio (Italy), and Suzanne Salamon (US). They have tirelessly undertaken their roles and responsibilities with great professionalism and skill.
This international textbook has been particularly challenging not only because of the immense field it covers in two volumes with more than 130 chapters, but also because of the impact of the Covid‐19 pandemic. Whilst the textbook prides itself on ensuring that the majority of chapters are written by practising clinicians, this has created dilemmas on many occasions for those clinicians wishing to complete chapters when their whole day or week was taken up with Covid‐related duties. It is a real tribute that those authors affected by Covid‐19 managed to complete their writing tasks.
Modern geriatric medicine is a discipline that has now universally established itself as distinct and separate from general internal medicine. Although many of the clinical and scientific principles are similar, geriatric medicine requires a greater understanding of ageing and age‐related pathophysiology in order to understand the varied presentation of disease in old age and deliver targeted medical care. It also requires a remarkable commitment to examining how environmental and social factors influence care and prognosis. In the future, of course, there will be a need for a greater emphasis on preventative care. We hope this textbook will influence and inspire future geriatricians to strive for excellence as always.
Alan J. Sinclair
John E. Morley
Bruno Vellas
Matteo Cesari
Medha Munshi
Foreword
This Sixth Edition of Pathy’s Principles and Practice of Geriatric Medicine, first published in 1990, continues to be a valuable and authoritative resource for healthcare professionals involved in the care of older patients. Each subsequent edition has been revised and reorganized, always with the goal to provide an accessible, updated, practical source of consultation. Although particularly intended for geriatricians and gerontologists, this book is also a resource not easily obtained elsewhere for anyone whose work connects with the field of ageing and/or who cares for older people.
This edition of the textbook has been deeply revised; new chapters have been added to reflect the recent enormous increase in the knowledge base of gerontology, as well as in clinical medicine and healthcare systems. Although its main focus is geriatric medicine, the first part of the book deals with the biological, psychological and social aspects