Since we wrote the original text almost 30 years ago, geriatrics has
gone through a number of transitions. The world has become increasingly
aware of the centrality of chronic disease and people have begun to
recognize that the principles of geriatrics are eminently suited to
addressing this challenge. Sadly and ironically, just as the need for more
and better primary care and comprehensive care has grown, interest in
primary care and geriatrics has waned. The concepts and practices embodied
in this book have never been more salient. If society fails to embrace these
ideas and to find ways to implement them, we will face a medical
There is growing appreciation that
our medical care system is not structured to effectively address complex
chronic disease and multimorbidity, which are both common in the geriatric
population. Proposals for changes are endemic. At their heart is
coordination and broader accountability, principles embraced by geriatrics.
Stated simply, geriatrics stands at the intersection of three forces:
1. Gerontology (both basic and applied)
2. Chronic disease management, especially multimorbidities
3. End-of-life care
of gerontology can help to explain insights of geriatric care. For example,
the atypical presentation of disease in older persons occurs because a
hallmark of aging is a decreased ability to respond to stress, and the
body's stress response is what typically generates the symptoms of an
illness. Older people fail to respond as actively. Hence, they may not spike
fevers or show elevated white counts in the face of an infection. Heart
disease may be silent.
Chronic disease management
is difficult on its own. It is much more difficult when an older patient
suffers from multiple simultaneous diseases. Basic care guidelines may not
work. Indeed, they make pose a threat. Guidelines are disease specific, and
application of guidelines may result in recommendations for a plethora of
nonpharmacological and pharmacological interventions that are unrealistic,
unacceptable, expensive, and hazardous. Much of the emphasis in geriatric
care planning is directed at containing disease and maintaining function.
Moreover, geriatrics recognizes that medical issues can interact with other
social and environmental issues, mandating comprehensive approaches to care.
Death is a part of old age. Geriatrics must deal with that
reality and help patients and families deal with end of life, helping them
to make informed decisions that reflect their goals and priorities. But
geriatrics cannot focus exclusively on end-of life-care. One compromise has
been the evolution of palliative care (discussed in Chapter 18 of this
To this list, one might also add
appropriate attention to prevention. Healthy aging remains a goal.
This seventh edition of Essentials of Clinical
Geriatrics represents a timely tome that combines practical information
to help clinicians and other practitioners from a variety of disciplines to
more effectively address the challenges posed by the grey tsunami. But a
thoughtful reading will also reveal many tips for better chronic care
practice in general.
It is organized to provide
linear exposition on salient topics but also as a rapid reference guide with
many tables and figures that summarize and simplify complex areas. The goal
of the book remains to help people do a better job of caring for older
As ever, we welcome ideas and
suggestions about how we can make the book more useful.