Brocklehurst's textbook of Geriatric Medicine and Gerontology

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The eighth edition of our text is the first since the death of John Brocklehurst, whose name it rightly bears, as its originator and longtime editor. In his Guardian obituary (http://www.the, Ray Tallis (himself a former editor of Brocklehurst, in its third to sixth editions) honored John as “the leading geriatrician of his generation,” and a man who “brought scientific gerontology to bear on our understanding of the diseases of old age.” With other early leaders, he organized training programs that helped define the specialty and guide geriatric medicine in its critical adolescent years. Those physicians laid the foundation that allowed geriatric medicine to consist of approaches and procedures that were well enough defined to be tested. This proved fortunate, because medicine was entering the evidence age, which soon demonstrated the merit of the approach. They had a view of geriatric medicine as more than “internal medicine with social work consult.” Even so, understanding just the claim of geriatric medicine continues to evolve. In the seventh edition, and continued here in the eighth, we press ahead with the view of geriatric medicine as the care of frail older adults.1 Anyone who knows the frailty literature will recognize that this is not entirely a settled claim. Still, several points are inarguable.

 First, frailty refers to a state of increased risk compared with others of the same age. This same age comparison is necessary.  The risk of adverse health outcomes increases with age, so without this, everyone past their fifth decade, when the increase in risk becomes noticeable, would be seen as frail.  Second, frailty is related to age. This is one point that all frailty measures have in common.  Frailty becomes more common with age; the absolute variability in risk increases, even as relative variability declines after menopause.3 Both trends indicate systems that are moving closer to failure. The first (increase in absolute  variability) shows that more people are at an increased risk; the second, a decline in relative variability, captured by a reduction in the coefficient of variation, is compatible with a decline in the response repertoire. Older adults have less to fight back with. In other words, their repair processes are less efficient, which is evidenced, among other things, in prolonged recovery times. Third, although the use of dichotomous cut points can obscure the extent of agreement, it is clear that the phenotype definition and the deficit accumulation definition5 bear much in common, as do most current operational definitions, because these typically depend on either or both approaches. Each identifies people who are at increased risk. For example, when people have nothing Of the five phenotypic traits, fewer are defective. Similarly, people with all five phenotypes Existing features (e.g. weight loss, higher activity reduction) fatigue from gardening and heavy housework, decrease in grip strength, decrease in walking speed) is the highest. The total number of deficits. 7 As usual, there are subtle differences. given The risk must not exceed 1 and must be over a certain age.

  indistinguishable from, respectively Weak These details, like many others, require detailed explanation from As a result, giving up the value of understanding is of no benefit. Fragile, even if there is disagreement over accuracy job definition. Why senility is the key to geriatric disease It's convincing. The challenge of aging to medical care lies in the complexity of frailty. As people age, it is not just that any given illness becomes more common—all illnesses become more common. Age-related change, whether it crosses a disease threshold or not, follows, on average, a trajectory of decline. Managing single illnesses is tricky enough, but the complexity imposed by frailty—managing illness in the presence of multiple interacting medical and social problems that each become more common with age—requires a specialized body of knowledge and skills.  This is what constitutes geriatric medicine.  With this focus on frailty in mind, we have continued to revise and evolve the textbook. The current eighth edition includes new entries on gerontechnology, homelessness, emergency and prehospital care, HIV and aging, intensive treatment of older adult patients, telemedicine, and the built environment. We have also added a chapter on frailty, written by two authors with much experience in regard to the various ways to define frailty. Obtaining a nonpartisan view is important because all chapter authors have been encouraged to revise their chapters, not just in relation to developments in their area, but also to ensure a discussion on how it is affected by frailty.

 For our part, we have aimed to advocate for both types of changes, which often have resulted in mutually beneficial exchanges. It shows how the pitch is expands. It's a practical challenge even for textbooks It was from the Internet. The goal is to become a collection of all the latest news Information rather than an account of what is usefully known. We See the role of this text in providing context and meaning Developing a territory This approach can add value in different ways. What is currently up to date may be limited to reading doesn't always happen. This has long been the goal of Brocklehurst. And we want to continue with that.

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