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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 catastrophe.

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

Principles 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 edition).

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 patients.

As ever, we welcome ideas and suggestions about how we can make the book more useful.

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