Geriatric Medicine: An Evidence-Based Approach - Tapa dura

From the Third Edition: "The third edition ¿covers basic gerontoloic concepts, contexts of care, clinical approaches to the geriatric patient, medical disorders, and ethics and health policy¿consistent effort throughout the chapters to address how the site of care, coexisting conditions and the health status of the patient influence management. The book offers an approach to serving as a knowledgeable advocate for older adults, ranging from the vigorous 80-year-old in whom prevention and assertive intervention may be appropriate to the elderly person who is dying and needs a provider with extensive skills in comfort care and communication with patients. Other perspectives unique to geriatrics are demonstrated in chapters on the determination of decision-making capacity, screening for cancer, nutrition, and pain management. Geriatrics is and will continue to be a predominant part of the daily practice of most generalists. I recommend [this book] for thoughtful reading about rational and compassionate management of geriatric problems." -- New England Journal of Medicine

Since the publication of the third edition of Geriatric Medicine,extraordinary advances have occurred in the science of aging and the potential for biomedical research to give us answers to many, if not most, of the age-related disorders that threaten the quality of life in older years. At the most basic level, the successful mapping of the human genome was declared complete in the fall of 2000. Understanding the map of the human genome is as important as understanding the map of genomes of important laboratory species, ranging from the microscopic worms and fruit?ies used in most classic genetic studies to rodents such as laboratory mice, and eventually to primates, on which much of the research on the aging human brain is done. The genetic maps of all of these species,including our own,does not answer clinical questions,but it does open the door to dramatic, rapid, and ef?cient answers to questions about the genetic polymorphisms related to diseases in humans. The telomerase story also unfolded since the third edition. Telomerase is an enzyme responsible for maintaining the telomeres―the redundant DNA portions at the end of chromosomes―whose shortening seems to be linked directly to cell senescence,ap- tosis,and the control over cell death,which,at the level of the individual cell,seems to be linked to the decline of organ function and eventually aging and death within the org- ism.