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“Besides more or less obvious physical changes in old age, physiological investigation may reveal increasing limitation of the effectiveness of homeostatic devices which keep the bodily conditions stable.”

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Walter Bradford Cannon (1871–1945)

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Elderly patients present the clinician with many unique challenges. Many of these issues are fully discussed in chapters that address care of older adults in the context of individual organ systems and diseases (Chapters 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, and 130). However, some of the most common, debilitating and costly clinical problems seen in geriatrics are extremely challenging because they defy conventional medical wisdom by crossing traditional organ- and discipline-based boundaries. Termed “geriatric syndromes,” conditions such as frailty (Chapter 52), delirium (Chapter 53), falls (Chapter 54), sleep disorders (Chapter 55), dizziness (Chapter 56), syncope (Chapter 57), pressure ulcers (Chapter 58), incontinence (Chapter 59), and elder mistreatment (Chapter 60) are discussed individually. Nevertheless, given the central importance of these diverse conditions to the practice and science of geriatric medicine, it is also important to address their common features.

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In addition to being highly prevalent in the frail elderly, geriatric syndromes also exert a substantial impact on quality of life and disability. Moreover, these are complex multifactorial conditions in which large numbers of underlying and provocative risk factors involving different organ systems interact in influencing ultimate clinical presentation, course, and outcome. These unusual features present important challenges for the clinician since the patient's chief complaint may point away from, rather than toward, the specific pathologic condition, which actually underlies the change in health status. At times, the two processes may involve distinct and distant organs with a disconnect between the site of the underlying insult and the site highlighted by the resulting clinical symptom. For example, when an infection involving the urinary tract precipitates delirium, it is the altered neural function in the form of cognitive and behavioral changes, which permits the diagnosis of delirium and which determines many functional outcomes.

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Grouping distinct conditions together as geriatric syndromes also highlights ...

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