Geriatric Clinical Advisor: Instant Diagnosis and Treatment

584 Pages·2006·5.81 MB·English

by  Tom J. Wachtel MD

1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
GERIATRIC CLINICAL ADVISOR: INSTANT DIAGNOSIS AND TREATMENT ISBN-13: 978-0-323-04195-9
ISBN-10: 0-323-04195-7
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved.No part of this publication may be reproduced or transmitted in any form or by
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Notice
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or
appropriate. Readers are advised to check the most current information provided (i) on procedures
featured or (ii) by the manufacturer of each product to be administered, to verify the recommended
dose or formula, the method and duration of administration, and contraindications. It is the
responsibility of the practitioner, relying on his or her own experience and knowledge of the
patient, to make diagnoses, to determine dosages and the best treatment for each individual patient,
and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher
nor the Editor assumes any liability for any injury and/or damage to persons or property arising out
of or related to any use of the material contained in this book.
The Publisher
International Standard Book Number 0-323-04195-7
International Standard Book Number (PDA online) 0-323-04356-9
Acquisitions Editor:Rolla Couchman
Developmental Editor:Mary Beth Murphy
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
The editors would like to dedicate this book to their families and friends.

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Associate Editors
FRED F. FERRI, M.D., F.A.C.P. JOHN B. MURPHY, M.D.
Clinical Professor Division of Geriatrics
Department of Community Health Rhode Island Hospital
Brown Medical School Providence, Rhode Island
Providence, Rhode Island APPENDIX 1: SYSTEMS OF GERIATRIC CARE
SECTION I: DISEASES AND DISORDERS,
AMAN NANDA, M.D., C.M.D.
SECTION II: DIFFERENTIAL DIAGNOSIS,
SECTION III: CLINICAL ALGORITHMS, Assistant Professor in Medicine
SECTION IV: LABORATORY TESTS AND INTERPRETATION Brown Medical School
OF RESULTS Providence, Rhode Island
APPENDIX 2: TOOLS OF GERIATRIC ASSESSMENT
CYNTHIA HOLZER, M.D, C.M.D.
Director, Geriatric Education TOM J. WACHTEL, M.D., F.A.C.P.
Roger Williams Medical Center Division of Geriatrics
Providence, Rhode Island Rhode Island Hospital
Assistant Professor of Medicine Professor of Community Health and Medicine
Boston University School of Medicine Brown Medical School
Boston, Massachusetts Providence, Rhode Island
SECTION V: CLINICAL PREVENTIVE SERVICES SECTION I: DISEASES AND DISORDERS,
SECTION II: DIFFERENTIAL DIAGNOSIS,
LYNN MCNICOLL, M.D. SECTION III: CLINICAL ALGORITHMS,
Division of Geriatrics SECTION IV: LABORATORY TESTS AND INTERPRETATION
Rhode Island Hospital OF RESULTS,
Providence, Rhode Island APPENDIX 1: SYSTEMS OF GERIATRIC CARE
SECTION I: DISEASES AND DISORDERS
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Contributors
PHILIP J. ALIOTTA, M.D., M.S.H.A., F.A.C.S. JOHN E. CROOM, M.D., PH.D.
Clinical Instructor Clinical Fellow in Neurology
Department of Urology Harvard Medical School
School of Medicine and Biomedical Sciences Beth Israel Deaconess Medical Center
State University of New York at Buffalo Boston, Massachusetts
Buffalo, New York
Medical Director
CLAUDIA L. DADE, M.D.
Center for Urologic Research of Western New York
Attending Physician
Williamsville, New York
Division of Infectious Diseases
GEORGE O. ALONSO, M.D. Elmhurst Hospital Center
Elmhurst, New York
Director
Instructor in Medicine
Department of Infection Control
Mount Sinai School of Medicine
Elmhurst Hospital Center
New York, New York
Elmhurst, New York
Instructor in Medicine
Mount Sinai School of Medicine GEORGE T. DANAKAS, M.D., F.A.C.O.G.
New York, New York Clinical Assistant Professor
Department of Obstetrics and Gynecology
MEL L. ANDERSON, M.D., F.A.C.P.
State University of New York at Buffalo
Clinical Assistant Professor of Medicine
Buffalo, New York
Brown Medical School
Providence, Rhode Island
AMAR DESAI, M.D., M.P.H.
PATRICIA AREAN, PH.D. Resident Physician
Associate Professor Department of Internal Medicine
Department of Psychiatry University of California, San Francisco
University of California, San Francisco San Francisco, California
San Francisco, California
MICHAEL G. BENATAR, M.B.CH.B., D.PHIL. JEFFREY S. DURMER, M.D., PH.D.
Assistant Professor of Neurology Assistant Professor, Department of Neurology
Department of Neurology Director, Emory Sleep Laboratory
Emory University Director, Egleston Children’s Hospital Sleep Clinic
Atlanta, Georgia Emory University School of Medicine
Atlanta, Georgia
SUSAN BERNER, M.D.
Geriatrics Fellow, Department of Family Medicine
GARY EPSTEIN-LUBOW, M.D.
University of Cincinnati College of Medicine
Postdoctoral Research Fellow
Cincinnati, Ohio
Department of Psychiatry and Human Behavior
Brown Medical School
LYNN BOWLBY, M.D.
Staff Psychiatrist
Attending Physician
Butler Hospital
Division of General Internal Medicine
Providence, Rhode Island
Rhode Island Hospital
Clinical Instructor of Medicine
Brown Medical School MARK J. FAGAN, M.D.
Providence, Rhode Island Director
Medical Primary Care Unit
MARIA A. CORIGLIANO, M.D., F.A.C.O.G.
Rhode Island Hospital
Clinical Assistant Professor
Associate Professor of Medicine
Department of Obstetrics and Gynecology
Brown Medical School
State University of New York at Buffalo
Providence, Rhode Island
Buffalo, New York
STEPHEN CORREIA, PH.D. GIL M. FARKASH, M.D.
Dementia Research Fellow Assistant Clinical Professor
Department of Psychiatry and Human Behavior State University of New York at Buffalo
Brown Medical School School of Medicine
Providence, Rhode Island Buffalo, New York
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Contributors
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MITCHELL D. FELDMAN, M.D., M.PHIL. CYNTHIA HOLZER, M.D., C.M.D.
Associate Professor of Clinical Medicine Director, Geriatric Education
University of California, San Francisco Roger Williams Medical Center
Division of General Internal Medicine Providence, Rhode Island
San Francisco, California Assistant Professor of Medicine
Boston University School of Medicine
FRED F. FERRI, M.D., F.A.C.P. Boston, Massachusetts
Clinical Professor
Department of Community Health JASON IANNUCCILLI, M.D.
Brown Medical School Department of Medicine
Providence, Rhode Island Brown Medical School
Providence, Rhode Island
GLENN G. FORT, M.D., M.P.H.
RICHARD S. ISAACSON, M.D.
Clinical Associate Professor of Medicine
Brown Medical School Director, Research Unit in Medical Education
Chief Associate Medical Director
Infectious Diseases Wien Center for Memory Disorders and Alzheimer’s Disease
Our Lady of Fatima Hospital Assistant Professor of Medicine
North Providence, Rhode Island University of Miami—Leonard M. Miller School of Medicine
Departments of Medical Education, Internal Medicine, and
MICHAEL P. GERARDO, D.O., M.P.H. Neurology
Post-Doctoral Research Fellow Mount Sinai Medical Center
Brown Medical School, Center for Gerontology and Health Miami Beach, Florida
Care Research
BREE JOHNSTON, M.D., M.P.H.
Brown University Geriatric Medicine Fellow
Associate Professor of Medicine
Rhode Island and Miriam Hospitals
Division of Geriatrics
Providence, Rhode Island
Department of Medicine
Veterans Affairs Medical Center
SUSAN E. HARDY, M.D., PH.D.
University of California, San Diego
Assistant Professor
San Diego, California
Geriatric Medicine
University of Pittsburgh School of Medicine
MELVYN KOBY, M.D.
Pittsburgh, Pennsylvania
Associate Clinical Professor of Medicine
Department of Ophthalmology
MIKE HARPER, M.D.
University of Louisville School of Medicine
Associate Professor of Medicine
Louisville, Kentucky
Division of Geriatrics
Department of Medicine E. GORDON MARGOLIN, M.D.
San Francisco Veterans Affairs Medical Center
Professor, Internal Medicine and Geriatrician
University of California, San Diego
University of Cincinnati College of Medicine
San Diego, California
Cincinnati, Ohio
TAYLOR HARRISON, M.D. DANIEL T. MATTSON, M.D., M.S.C.(MED.)
Neuromuscular Fellow Clinical Fellow in Neurology
Department of Neurology Beth Israel Deaconess Medical Center
Emory University Harvard Medical School
Atlanta, Georgia Boston, Massachusetts
SHARON S. HARTMAN, M.D., PH.D. LYNN MCNICOLL, M.D.
Clinical Associate Division of Geriatrics
Department of Neurology Rhode Island Hospital
Emory University Providence, Rhode Island
Atlanta, Georgia
LONNIE R. MERCIER, M.D.
HOLLY M. HOLMES, M.D. Clinical Instructor
Instructor Department of Orthopedic Surgery
University of Chicago Creighton University School of Medicine
Chicago, Illinois Omaha, Nebraska
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Contributors
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DENNIS J. MIKOLICH, M.D., F.A.C.P., F.C.C.P. SEAN I. SAVITZ, M.D.
Chief Clinical Fellow in Neurology
Division of Infectious Diseases Harvard Medical School
VA Medical Center Chief Resident in Neurology
Clinical Associate Professor of Medicine Beth Israel Deaconess Medical Center
Brown Medical School Boston, Massachusetts
Providence, Rhode Island
JOSEPH W. SHEGA, M.D.
RAM R. MILLER, M.D.C.M., M.S., F.R.C.P.C. Assistant Professor, Division of Hematology/Oncology
Northwestern University
Assistant Professor
The Feinberg School of Medicine
University of Maryland School of Medicine
Chicago, Illinois
Division of Gerontology
Department of Epidemiology and Preventive Medicine
CLIFFORD MILO SINGER, M.D.
Baltimore, Maryland
Associate Professor of Psychiatry
Director, Insomnia and Chronobiology Clinic
ARVIND MODAWAL, M.D., M.P.H., M.R.C.G.P.
Vermont Regional Sleep Center
Associate Professor
University of Vermont College of Medicine
Department of Family Medicine, Section of Geriatrics
Burlington, Vermont
University of Cincinnati College of Medicine
Cincinnati, Ohio U. SHIVRAJ SOHUR, M.D., PH.D.
Clinical Fellow in Neurology
JOHN B. MURPHY, M.D. Harvard Medical School
Division of Geriatrics Chief Resident in Neurology
Rhode Island Hospital Beth Israel Deaconess Medical Center
Providence, Rhode Island Boston, Massachusetts
JOHN A. STOUKIDES, M.D., R.PH.
AMAN NANDA, M.D., C.M.D.
Director of Geriatrics
Assistant Professor in Medicine
Roger Williams Medical Center
Brown Medical School
Providence, Rhode Island
Providence, Rhode Island
Clinical Assistant Professor of Medicine
Boston University School of Medicine
TAKUMA NEMOTO, M.D.
Boston, Massachusetts
Research Associate Professor of Surgery
Adjunct Associate Professor of Pharmacy and Nursing
State University of New York at Buffalo
University of Rhode Island
Buffalo, New York
Kingston, Rhode Island
PRANAV M. PATEL, M.D. JULIE ANNE SZUMIGALA, M.D.
Clinical Associate Instructor, Division of Cardiology Clinical Instructor
Department of Medicine Department of Obstetrics and Gynecology
Brown Medical School State University of New York at Buffalo
Providence, Rhode Island Buffalo, New York
LAURA TRICE, M.D.
PETER PETROPOULOS, M.D.
Medical Director
Department of Veterans Affairs
Trihealth SeniorLink
Providence, Rhode Island
California, Kentucky
ARUNDATHI G. PRASAD, M.D.
EROBOGHENE E. UBOGU, M.D.
Clinical Instructor
Assistant Professor of Neurology
Department of Obstetrics and Gynecology/Resident Education
Case Western Reserve University School of Medicine
State University of New York at Buffalo
Staff Neurologist
Women’s and Children’s Hospital
Louis Stokes Cleveland Veterans Affairs Medical Center
Buffalo, New York
Cleveland, Ohio
HARLAN G. RICH, M.D. TOM J. WACHTEL, M.D., F.A.C.P.
Director of Endoscopy Division of Geriatrics
Rhode Island Hospital Rhode Island Hospital
Associate Professor of Medicine Professor of Community Health and Medicine
Brown Medical School Brown Medical School
Providence, Rhode Island Providence, Rhode Island
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Contributors
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WEN-CHIH WU, M.D. MADHAVI YERNENI, M.D.
Assistant Professor of Medicine Staff Physician, Academic Medical Center
Brown Medical School Miriam Hospital
Cardiologist Pawtucket, Rhode Island
Providence VA Medical Center
Providence, Rhode Island
CINDY ZADIKOFF, M.D.
BETH J. WUTZ, M.D. Fellow, Movement Disorders
Clinical Assistant Professor of Medicine Morton and Gloria Shulman Movement Disorders Center
Division of Internal Medicine/Pediatrics Toronto Western Hospital
Kajeida Health–Buffalo General Hospital Toronto, Ontario
State University of New York at Buffalo
Buffalo, New York