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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Lecture Notes
- Sprache: Englisch
GERIATRIC MEDICINE AND ELDERLY CARE
Lecture Notes
Ninth Edition
An essential resource for meeting the needs of an ageing patient population
As the global population ages, geriatric medicine is steadily becoming one of the most important areas of medical research and care. Healthcare systems in developed countries are adapting to this shift in the population, and doctors are finding that a larger and larger proportion of their patients are older. Current medical training often does not include adequate coverage of geriatric medicine, and students may well find they require more extensive resources for meeting older patients’ needs.
Lecture Notes: Geriatric Medicine and Elderly Care meets this need with a set of comprehensive but straightforward introductions to the foundational concepts of geriatric medicine. Combining a user-friendly format with extensive high-quality figures and illustrations, it is a must-have resource for medical students looking to deepen their knowledge of a widening area of essential care. Now thoroughly revised and updated to reflect the latest research and medical knowledge of ageing and elder care, this is an essential contribution to the popular Lecture Notes series.
Readers of the ninth edition of Lecture Notes: Geriatric Medicine and Elderly Care will also find:
- New chapters on the ‘science of ageing’ including immunosenescence and rejuvenation research, and geriatric oncology
- Full coverage of the British Geriatrics Society and European undergraduate curriculums
- A companion website with appendices, key revision points for each chapter and further readings
Lecture Notes: Geriatric Medicine and Elderly Care is ideal for medical students and Foundation Year doctors in most specialties who are treating frail older people. It also provides a starting point for revision for higher specialty examinations in geriatric medicine.
Anki Revision Cards
A set of ‘Anki App’ digital revision cards is available to go with this textbook. The cards contain the material from the self-test questions in the book. Anki App is a cross-platform mobile and desktop flashcard app that can support your studies (see www.ankiapp.com). It uses an algorithm to present cards you know less well more frequently. You can keep the cards on your mobile device and study them in your downtime. Visit www.lecturenoteseries/paediatrics to download the card set to your device.
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Veröffentlichungsjahr: 2025
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Preface
Note about the cover
Note about doses
Acknowledgments
Abbreviations
About the companion website
1 Global ageing
Introduction
Changes in the global population
Population growth
Population ageing
International migration
Urbanisation
Typical patterns of health and social care
Ageing in India in 2023
Ageing in Africa
Ageing in Brazil
The climate emergency
Global poverty
Inter‐generational strife
Social aspects of ageing
Losses in old age
Some myths of ageing
REFERENCES AND FURTHER READING
2 Health and social care in the UK
Population figures
Characteristics of the older population
Health status
Disability
Income
Housing
The organisation of care for older people
Health care
Social care for older people
Regulation of health and social care
Informal carers
Paying for care
Financial allowances and benefits (rates in 2024–2025 in England)
REFERENCES AND FURTHER READING
WEBSITES OF USEFUL ORGANISATIONS
3 The science of ageing
Ageing scenarios
What is ageing?
Reliability models
The ageing process
Genetic theories
The contribution of stochastic events to ageing
Effects of the environment and lifestyle
Psychosocial theories of ageing
Effects of disease
The ageing cell
Hallmarks of ageing
Ageing tissues
Declining function
Endpiece
REFERENCES AND FURTHER READING
4 Core geriatric medicine
Distinctive features of illness in older patients
Altered response to disease
Consequences of immobility
The clinical assessment of the older patient
Comprehensive geriatric assessment
Rehabilitation
The discharge process
WHO International Classification of Functioning, Disability and Health
Ethical issues and ageism
Sources of information
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND FAMILIES
5 Drugs and prescribing
Key physiological changes of ageing that affect drugs
Pharmacokinetics and pharmacodynamics
Other ageing changes
Trends in drug prescribing
Polypharmacy
Terminology
Hospital admissions due to adverse drug reactions
Medicine wastage
Prescribing tools
The evidence base for prescribing in older people
Empowering your patient
Summary: the overall picture
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND FAMILIES
6 Surgery
Introduction
Emergency or elective surgery
Assessment of the risks of surgery
Improving outcomes for frail older patients
Pre‐surgical optimisation
Anaesthetic care
Postoperative care
The future
REFERENCES AND FURTHER READING
7 Neurology
Age changes and clinical examination
Symptomatic classification of neurological disease in older people
Conditions seen in older patients
Vascular disease
Trauma
Degenerative diseases
Epilepsy
Infectious diseases of the CNS
Intracranial neoplasms
Deficiency/toxicity states
Neuropathies
Autoimmune conditions
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND FAMILIES
8 Old‐age psychiatry
Age‐related changes
The organisation of mental health services for older people
The effects of the COVID‐19 pandemic
Loneliness
Depression
Anxiety
Late‐onset delusional disorders
Cognitive changes with ageing
Confusion
Delirium
Dementia
Transient global amnesia
Sleep disorders
Alcohol excess
Substance abuse
Self‐neglect and hoarding
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND FAMILIES
9 Stroke
Notes on stroke services in the UK
Importance
Definitions
Aetiology and pathology
Risk factors for ischaemic stroke
Transient ischaemic attacks
Stroke presentation
Immediate management
Acute treatments for ischaemic stroke
Stroke audits
Early care on the stroke unit
Rehabilitation
Discharge from hospital
Haemorrhagic stroke
Posterior circulation stroke
Outcomes following stroke
Other stroke syndromes
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND FAMILIES
10 Musculoskeletal
Bone metabolism
Bone ageing
Osteoporosis
Osteomalacia
Paget's disease of the bone
Primary hyperparathyroidism
Hypercalcaemia
Osteomyelitis
Joints
Osteoarthritis
Rheumatoid arthritis
Polymyalgia rheumatica
Differential diagnosis for a single painful joint
Crystal arthropathies
Septic arthritis
Back pain
Muscles
Sarcopenia
Myopathies
Myositis
Myasthenia gravis
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND FAMILIES
11 Falls and immobility
Falls
Immobility
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND FAMILIES
12 Cardiovascular medicine
Ageing changes
Prevalence of cardiovascular disease
Managing cardiovascular disease in older people
Heart failure
Atrial fibrillation
Atrial flutter
Cardiac pacemakers
Valvular heart disease
Infective endocarditis
Hypertension
Vascular disease
Venous disease
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND FAMILIES
13 Respiratory medicine
Age‐related changes
The burden of respiratory disease
Upper respiratory tract infections
Lower respiratory tract infections
Airflow obstruction
Diseases of the pleura
Lung cancer
Interstitial lung disease
Miscellaneous
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND FAMILIES
14 Gastroenterology
Age‐related changes
Investigations for GI disease
Abnormalities of the mouth
Oesophageal disease
Gastric disease
Liver disease
Biliary disease
Pancreatic disease
Small bowel disease
Large‐bowel disease
Diseases affecting any part of the GI tract
Nutrition in older age
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND FAMILIES
15 Genitourinary medicine
Age‐related changes
Acute kidney injury
Chronic kidney disease
Intrinsic kidney disease
Drugs and the kidney
Blood pressure and the kidney
Urinary tract infection
Obstructive uropathy
Prostate cancer
Haematuria
Renal cell carcinoma
Bladder cancer
Urinary incontinence
Vaginal bleeding
Gynaecological malignancies
Vaginal prolapse
Disease of the vulva
Sex in later life
REFERENCES AND FURTHER READING
ADVICE FOR PATIENTS
16 Homeostasis and endocrinology
Ageing changes
Fluid and electrolyte imbalance
Diabetes mellitus
Thyroid disease
Adrenal disease
Paraneoplastic syndromes
Autonomic nervous system
Accidental hypothermia
Other dangers of extreme weather
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND FAMILIES
17 Haematology
Age‐related changes
Anaemia
Haematological malignancies
Disorders of coagulation
Iron overload disorders
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND FAMILIES
18 Oncogeriatrics
Treatments for cancer
Cancer in old age
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS (AND NON‐SPECIALIST DOCTORS)
19 Dermatology
Age‐related skin changes
Vascular damage
Pressure injury
Moisture‐associated skin damage
Cellulitis
Burns
Pruritus (itch)
Other important skin conditions in geriatric medicine
Malignant diseases of the skin
Hair and nails
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS
20 Eyes and ENT
The Eyes
Examination of the retina
Loss of vision
Giant‐cell arteritis
Management
Dry eyes
Painful eyes
Ear, Nose, and Throat
Loss of hearing
Tinnitus
Vertigo (dizziness)
The nose
The Throat
MDT approach to improving the voice
Oropharyngeal dysphagia
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND RELATIVES
INFORMATION FOR PATIENTS AND RELATIVES
21 Legal and ethical aspects
Introduction
Confidentiality
Consent
Age discrimination
Driving in later life
Notifiable diseases
The Human Rights Act
The Mental Health Act
The Mental Capacity Act
The Court of Protection
Independent mental capacity advocates
Testamentary capacity
Deprivation of Liberty Safeguards
Liberty Protection Safeguards
The Care Act
Safeguarding
Elder abuse
Restraint of confused patients
Ethical issues relating to life‐supporting interventions
Euthanasia
Death certification and the role of the coroner
Medical devices to remove prior to cremation
REFERENCES AND FURTHER READING
22 Palliative care
What is palliative care?
Five priorities for the care of the dying person
Statistics about UK deaths
Recognising the last year of life: the role of the Gold Standards Framework
Breaking bad news
Advance care planning
Hospice care
Symptom control
Enabling people to die at home
Diagnosing dying
Using a syringe driver
Emotional support
Spiritual and religious support
Care after death
Bereavement
REFERENCES AND FURTHER READING
INFORMATION FOR PATIENTS AND FAMILIES
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Percentage of people aged 65+ and median age in 2019 (Our World i...
Table 1.2 Mean life expectancy at different ages (UN 2019).
Table 1.3 Life expectancy for older people in India (UN 2019).
Chapter 2
Table 2.1 Broad ethnic composition of the population in London by age.
Table 2.2 Ethnic groups and their age structure in Greater London.
Table 2.3 Health state life expectancies for 2018–2020 at birth in the leas...
Table 2.4 Health state life expectancies in years at age 65 in England 2016–...
Chapter 4
Table 4.1 Probable causes of fits and jaundice in different age groups.
Table 4.2 Domains of CGA.
Table 4.3 ICF Framework for Intervention and Prevention.
Chapter 5
Table 5.1 Risk of cardiovascular events in a cohort study of statins for pr...
Chapter 7
Table 7.1 Drug management for Parkinson's disease.
Chapter 8
Table 8.1 The phases and stages of Alzheimer's disease.
Chapter 9
Table 9.1 Oxford classification of ischaemic stroke.
Table 9.2 Modifiable risk factors.
Table 9.3 The components of the CHA
2
DS
2
VASc score.
Table 9.4 The one‐year risk of an embolic event in AF depends on the CHA
2
DS
Chapter 10
Table 10.1 Summary of types of treatment for osteoporosis.
Table 10.2 Patient consulting rate per 1000 persons (by age in years) for p...
Table 10.3 Table of clinical features, precipitating factors, and treatment...
Table 10.4 Back pain in older people.
Chapter 11
Table 11.1 Causes, investigations, and management of types of syncope.
Table 11.2 Types of response to tilt‐testing.
Table 11.3 Common fall‐risk‐increasing drugs.
Table 11.4 Causes of dizziness.
Table 11.5 Causes of reduced mobility.
Table 11.6 A comparison of types of walking and transfer aids.
Chapter 12
Table 12.1 Summary of the main differences between HFpEF and HFrEF.
Chapter 13
Table 13.1 GOLD groups guiding the treatment of COPD.
Chapter 14
Table 14.1 Summary of oral problems.
Table 14.2 Causes of dysphagia.
Table 14.3 Common causes, investigation, and treatment of malabsorption in ...
Table 14.4 Non‐gastrointestinal manifestations of coeliac disease and cause...
Table 14.5 Assessing the severity of
C. difficile
disease.
Table 14.6 Summary of medication for constipation.
Table 14.7 Causes, mechanisms, examples, and management of faecal incontine...
Chapter 15
Table 15.1 Prerenal, renal, and post‐renal causes of acute kidney injury co...
Table 15.2 Stages of CKD.
Table 15.3 Medications that increase the risk of UTIs.
Table 15.4 Overview of antibiotics for urinary tract infections (see local ...
Table 15.5 Comparing storage and voiding symptoms.
Table 15.6 Causes, investigations, and management of haematuria.
Table 15.7 Treatable causes, examination, investigations, and management of...
Table 15.8 Comparing advantages and disadvantages of containment strategies...
Chapter 16
Table 16.1 Causes of leg swelling.
Table 16.2 Clinical presentations of paraneoplastic syndromes.
Chapter 17
Table 17.1 The interpretation of iron studies.
Table 17.2 Causes of macrocytosis.
Chapter 18
Table 18.1 Age‐standardised 5‐year net survival for colon cancer according ...
Table 18.2 Aspects of treatment for breast cancer according to age in Engla...
Table 18.3 Common performance scores used in oncology.
Chapter 19
Table 19.1 Differences between arterial and venous leg ulcers.
Table 19.2 Causes, clinical features, and treatments of itch in older peopl...
Chapter 20
Table 20.1 Differences between dry and wet AMD.
Table 20.2 Differences between acute and chronic glaucoma.
Table 20.3 Degree of hearing impairment in people aged over 70 years (range...
Chapter 21
Table 21.1 Sections under the Mental Health Act.
Chapter 22
Table 22.1 Place of death of people aged 85 and above.
Table 22.2 Causes and treatment of nausea and vomiting.
List of Illustrations
Chapter 1
Figure 1.1 World population from 10,000
BCE
to 2019 (BCE is before the commo...
Figure 1.2 Demographic transition.
Figure 1.3 World population pyramids for 1952 and 2022.
Figure 1.4 Global population and projections
Figure 1.5 The changing proportions of different age bands within the global...
Figure 1.6 Projected world population aged 80 and over.
Figure 1.7 The changing life expectancy at birth in the UK and Sweden over s...
Figure 1.8 Life expectancy in a wider range of countries showing convergence...
Figure 1.9 OADRs calculated from numbers of people aged 65+ per 100 persons ...
Figure 1.10 Population growth with and without migration: in Sweden, where m...
Figure 1.11 Most people now live in urban areas.
Figure 1.12 Top ten causes of death in high‐income countries.
Figure 1.13 Top ten causes of death in low‐income countries.
Figure 1.14 Life expectancy in India is now higher in women than men. The di...
Figure 1.15 India population pyramid 2023.
Figure 1.16 The increasing proportion of older and very old people in India....
Figure 1.17 Distribution of disease burden across India in 1990 and 2017, by...
Figure 1.18 Top 10 causes of death in India. COPD, chronic obstructive pulmo...
Figure 1.19 The relationship between gross domestic product and life expecta...
Chapter 2
Figure 2.1 Age structure of the UK population in mid‐2020 and mid‐2030.
Figure 2.2 Changes in life expectancy at different ages in England and Wales...
Figure 2.3 Population aged 65 and over, 2021, local authorities in England a...
Figure 2.4 Percentage of the population aged 65+ who live alone by age group...
Figure 2.5 Percentage of the population reporting disability in England by a...
Figure 2.6 Impairment types reported by disabled people by age group, UK....
Figure 2.7 Indoor adaptations most often needed in 2019/20.
Figure 2.8 Percentage of working age (WA) and pensioner households (P) in po...
Figure 2.9 Average weekly gross income of pensioners by age, gender, and typ...
Figure 2.10 Households by tenure and age of head of household.
Figure 2.11 The change in the number of care home beds between 2012 and 2021...
Figure 2.12 Life expectancy by age band and sex (England and Wales) 2021/22 ...
Figure 2.13 Representative profile for health spending with age in the UK....
Figure 2.14 Requests for support from new clients aged 65 and over by what h...
Figure 2.15 Percentage of people receiving care by age and gender.
Figure 2.16 People providing informal care by age and gender.
Chapter 3
Figure 3.1 Theoretical ageing scenarios after Tallis.
Figure 3.2 Substrates and disciplines for studies on ageing. CVS, cardiovasc...
Figure 3.3 Components in a system.
Chapter 4
Figure 4.1 Interaction between disease, ageing physiology and the individual...
Figure 4.2 The importance of thresholds.
Figure 4.3 Number of chronic conditions by age group – Schiøtz et al. (2017)...
Figure 4.4 The complex interaction between ageing physiology, social factors...
Figure 4.5 Rockwood clinical frailty scale.
Figure 4.6 ‘Lear's beard’.
Figure 4.7 Restoring functional independence with rehabilitation and prehabi...
Figure 4.8 Aids to help with ADLs. (a) toilet frame, (b) grab rail, (c) plug...
Figure 4.9 The role of simple changes in promoting independence.
Figure 4.10 The ICF schema.
Figure 4.11 The ICF describing the effect of back pain from vertebral fractu...
Chapter 5
Figure 5.1 Distribution of the number of medicines by age.
Figure 5.2 Proportion of adults receiving a prescription in 2017–2018, by ag...
Chapter 6
Figure 6.1 The effect of the number of comorbidities on death after surgery ...
Figure 6.2 Impact of frailty on surgical outcomes. EAAA ‐ endovascular abdom...
Figure 6.3 30‐day ONS mortality after emergency laparotomy by age and Rockwo...
Figure 6.4 CT scan of the chest with contrast showing major bilateral pulmon...
Chapter 7
Figure 7.1 Bilateral subdural collections with acute on chronic appearances....
Figure 7.2 The classification of parkinsonian syndromes. DLB ‐ dementia with...
Figure 7.3 Immunohistochemistry for alpha‐synuclein showing positive stainin...
Figure 7.4 Strategies for treating the transmitter imbalance in PD. MAO‐B, m...
Figure 7.5 Peripheral nerve.
Chapter 8
Figure 8.1 Age‐specific suicide rates for men in the UK since the 1980s.
Figure 8.2 The interplay between the brain and the environment.
Figure 8.3 Cognitive change with ageing.
Figure 8.4 How neurotransmitter imbalance may contribute to the pathogenesis...
Figure 8.5 Prevalence of dementia in Europe 2018 by age band and sex.
Figure 8.6 Top five causes of death in England and Wales overall and by sex ...
Figure 8.7 The metabolism of APP. N and C are the N and C terminus of the po...
Figure 8.8 The metabolism of acetylcholine.
Figure 8.9 Brain showing frontal degeneration.
Figure 8.10 Overlap between Alzheimer’s disease pathology (AD) and pathology...
Figure 8.11 Sleep stages through the night. REM, rapid eye movement.
Figure 8.12 Age‐specific death rates in UK per 100,000 from alcohol in 2001 ...
Chapter 9
Figure 9.1 Campaign poster to encourage people to act FAST in suspected stro...
Figure 9.2 CT scan showing a left temporoparietal bleed in a 71‐year‐old man...
Figure 9.3 CT head scan of a 92‐year‐old woman presenting with left hemipare...
Figure 9.4 Imaging in an 82‐year‐old man who developed sudden‐onset left hem...
Figure 9.5 Equipment for mirror therapy. The patient sits with their paretic...
Chapter 10
Figure 10.1 Bone from a healthy 37‐year‐old male on the left and bone from a...
Figure 10.2 Radiograph of a comminuted intertrochanteric fracture of the lef...
Figure 10.3 A simplified outline of the types of hip fractures and the usual...
Figure 10.4 X‐ray of fractured right inferior pubic ramus.
Figure 10.5 CT scan shows a fracture of the T8 vertebral body contributing t...
Figure 10.6 The mechanism of action of denosumab. Osteoblasts build bone and...
Figure 10.7 Radiograph of the right hip showing a severe loss of joint space...
Figure 10.8 Severe rheumatoid arthritis of the left hand. Note ulnar deviati...
Figure 10.9 X‐ray of the left knee showing chondrocalcinosis in the medial a...
Figure 10.10 Pathogenesis and consequences of sarcopenia. CHF, chronic heart...
Chapter 11
Figure 11.1 CT of the head shows an acute‐to‐chronic subdural haematoma. Not...
Figure 11.2 ECG shows atrial fibrillation, left axis deviation and left bund...
Figure 11.3 X‐ray showing partially displaced fracture of the right neck of ...
Figure 11.4 Onychogryphosis.
Figure 11.5 Downward cycle of deconditioning.
Figure 11.6 End PJ Paralysis https://endpjparalysis.org/downloads
Chapter 12
Figure 12.1 ECG shows acute STEMI. Note hyperacute ‘tombstone’ elevation of ...
Figure 12.2 Chest radiograph demonstrating acute pulmonary oedema. Note: por...
Figure 12.3 Placement of an EVAR stent in an infrarenal aneurysm. (a) Deploy...
Figure 12.4 Gangrene of the toes in a diabetic.
Figure 12.5 Management of lower limb ischaemia.
Chapter 13
Figure 13.1 Changes in lung volumes with age.
Figure 13.2 Normal values for peak expiratory flow (PEF) with age.
Figure 13.3 Age‐standardised and age‐specific mortality rates for deaths due...
Figure 13.4 CXR shows right upper lobe and left lower lobe consolidation, su...
Figure 13.5a Non‐UK‐born TB case reports and rates by age.
Figure 13.5b UK‐born TB case reports and rates by age.
Figure 13.6 The initial management of COPD based on NICE and GOLD 2023.
Figure 13.7 CXR with bilateral pleural plaques.
Figure 13.8 Average annual number of deaths from lung cancer and age‐specifi...
Chapter 14
Figure 14.1 Histology of Coeliac Disease.
Figure 14.2 Number of
C. difficile
infections in acute trusts in England 200...
Figure 14.3 CT scan of a patient with pan‐colonic diverticular disease showi...
Figure 14.4 CT scan showing pneumoperitoneum due to perforation of sigmoid c...
Figure 14.5 Colonoscopic view of adenocarcinoma in the colon.
Figure 14.6 Abdominal radiograph showing small bowel obstruction due to adhe...
Figure 14.7 CXR shows a nasogastric tube inserted into the right main bronch...
Chapter 15
Figure 15.1 ECG in hyperkalaemia.
Figure 15.2 Causes of Obstructive Uropathy.
Figure 15.3 CT scan shows a large left‐sided RCC with hydronephrosis. It is ...
Figure 15.4 Example of a part of a bladder diary.
Figure 15.5 CT scan shows a large cystic endometrial cancer that is causing ...
Chapter 16
Figure 16.1 Mechanism of action of ADH at the collecting duct.
Figure 16.2 shows the effect of age on the prevalence of diabetes in England...
Chapter 17
Figure 17.1 Mechanisms for acquired causes of anaemia.
Figure 17.2 Frequency of underlying cause of anaemia in older people.
Figure 17.3 Investigation of anaemia depending on the MCV (MDS, myelodysplas...
Figure 17.4 The estimated total annual cases of haematological malignancy in...
Figure 17.5 CT scans with contrast in a 79‐year‐old male with CLL (with than...
Chapter 18
Figure 18.1 Diagram shows how monoclonal antibodies can block the binding of...
Figure 18.2 Incidence of all cancers (excluding non‐melanoma skin cancer) Ca...
Figure 18.3 Percentage of patients receiving palliative radiotherapy relativ...
Figure 18.4 Publications in PubMed for the search query ‘frailty, cancer and...
Chapter 19
Figure 19.1 The ASSKING model (NHS England).
Figure 19.2 Common pressure‐relieving equipment.
Figure 19.3 Dressings for ulcers.
Figure 19.4 Larval therapy (free‐range) for a malleolar ulcer in a diabetic ...
Figure 19.5 Application of a KCI wound vac dressing to a large sacral wound ...
Chapter 20
Figure 20.1 Main causes of blindness in people in the UK (by percentage). RNIB. ...
Figure 20.2 Widely available aids for people with impaired vision.
Figure 20.3 Cataract in right eye with loss of red reflex: National Health S...
Figure 20.4 One type of aid for using eye drops – The AutoSqueeze™.
Figure 20.5 Smoke detector with wireless connection to strobe light and vibr...
Figure 20.6 Behind‐the‐ear analogue (right) and digital hearing (left) heari...
Figure 20.7 Correct insertion of a behind‐the‐ear hearing aid. Watch the vid...
Chapter 21
Figure 21.1 System for death certification. MCCD, medical certificate of cau...
Chapter 22
Figure 22.1 Trajectories of dying.
Figure 22.2 Advance care planning process. ReSPECT, recommended summary plan...
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Preface
Note about the cover
Note about doses
Acknowledgments
Abbreviations
About the companion website
Begin Reading
Index
Wiley End User License Agreement
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Geriatric Medicine and Elderly Care
Lecture Notes
Claire G. Nicholl
MB FRCP
Consultant Geriatrician (Emerita)
K. Jane Wilson
MB FRCP
Consultant Geriatrician
Shaun D’Souza
MB MRCP
Consultant Geriatrician
All of:Department of Medicine for the ElderlyAddenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridge, UK
Ninth Edition
This ninth edition first published in 2025© 2025 John Wiley & Sons Ltd.
Edition History[8e, 2012, by Wiley‐Blackwell]
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Library of Congress Cataloguing-in-Publication Data applied forPaperback ISBN: 9781119627593
Cover Design: WileyCover Image: © Francesca DB Photography
Preface
The ninth edition was commissioned before COVID‐19, but the pandemic and its aftermath diverted attention from book writing, and the landscape of medicine has changed since the previous edition in 2012. Much of the text has been completely rewritten to reflect this.
Whatever branch of medicine you are studying or working in, with a few exceptions such as obstetrics or paediatrics, most of your patients will be older, or very old. Apart from Africa, this is now true across the world. Geriatricians have always promoted treating a person's ‘biological age’ rather than their ‘chronological age’, but this was difficult to define. The concept of frailty and simple ways to assess it are making this a reality. Outcomes across a range of specialties are linked to frailty rather than age, and older people who are likely to benefit are getting better access to new drugs and surgical procedures. All 21st century doctors need a solid grounding in geriatric medicine to be comfortable treating the majority of the patients they will see.
The biggest change for UK undergraduates is the upcoming Medical Licensing Assessment. Some medical schools still teach a ‘geriatrics‐light’ version of the medical curriculum, but the General Medical Council content map focuses on topics that doctors are likely to encounter during the UK Foundation Programme. This obviously includes medicine that is relevant to older people, the biggest users of the health service.
The British Geriatrics Society published an updated curriculum for undergraduates in 2023, and this book covers this as well as the current European version. Global aspects of ageing are explained, and there is some detail on the organisation and delivery of health care in the UK. This can be difficult for students to grasp and will be particularly helpful for overseas‐trained doctors taking the Professional and Linguistic Assessments Board (PLAB) examinations to work here. With increasing differences across the four nations, most detail is given about England, but the main differences are highlighted. The content will also provide a useful starting point for trainees revising for their Specialty Certificate Examination.
When so much information is instantly available online, is there still a place for textbooks? We believe so! The clue is the amount of information. Consider a well‐defined topic such as ‘Parkinson’s disease' (PD). The National Institute for Health and Care Excellence (NICE) website currently lists 18 ‘products’ about PD, with hundreds of pages, dating back to 2003. NICE Clinical Knowledge Summaries are shorter but also run to tens of pages, require multiple clicks to navigate, and sometimes give different advice to NICE guidelines. Then there are multiple ‘best practice’ sites, specialist society guidelines and finally the vast resource of primary literature. The advantage of a book is that we have provided a synthesis of the most important points that are relevant to our clinical practice and highlighted areas of controversy. Once you have a basic grasp of an area, exploring it online will be more rewarding.
This book, like the population, is a little fatter than its predecessors. This is the result of both more advances in medicine being offered to older people (there is a new chapter on geriatric oncology) and a decision to include more explanation in the text. For example, there is enough detail about bone metabolism to understand, rather than just memorise, the drugs for osteoporosis. Our approach to medicine that empowers patients, and values working with the multidisciplinary team is relevant to patients of any age with chronic disease. For simplicity, when describing the prevalence of disease, female sex is used when referring to those assigned female at birth.
A typical older patient is more complex than a younger patient because of the interaction between their unique long‐life experience and various comorbidities. Therefore, geriatric medicine is the medicine of complexity – interesting, varied, and challenging. If you enjoy using clinical acumen, leading and working in a team, and thinking about what really matters to an individual patient rather than following guidelines, consider a career in geriatric medicine. In addition to their core inpatient and community work, geriatricians are in demand across a wide and expanding range of clinical areas, for example in orthopaedics, surgical liaison, acute assessment, falls and syncope and movement disorders.
Geriatricians provide a large proportion of the examiners for PACES, the Practical Assessment of Clinical Examination Skills examination for the Royal College of Physicians. They are often excellent teachers, successful as medical managers and there are numerous opportunities for basic, epidemiological, and clinical research. There are many options for working overseas. After retiring from full‐time work, CN had an enjoyable and satisfying time working and teaching in Botswana and teaching the European geriatrics curriculum as a visiting professor at the University of Pavia in Italy.
For years, geriatricians may have felt a little overshadowed by their single‐organ specialty colleagues. In a world where patients are told they must present a single problem in a consultation with their GP and guideline medicine prevails in hospitals, the value of a comprehensive but individualised approach is increasingly recognised by patients, families, and colleagues. This edition has reverted to its original name, Lecture Notes in Geriatric Medicine.
Claire G. Nicholl
K. Jane Wilson
Shaun D'Souza
Cambridge, October 2024
Note about the cover
Cover image by Francesca DB Photography.
Isabella Mastantuono with her first great‐granddaughter, Sofia.
Isabella had a very prolonged hospital stay. Her medical team began to wonder if they should keep on with burdensome rounds of treatment, striving to try to get her better. Isabella and her family had a very different perspective. Four months after her discharge, they sent the team this photograph of Isabella, who was doing well and especially enjoying spending time with Sofia.
Published with permission from Isabella, Sofia’s parents, and Francesca.
Note about doses
We have given doses of common drugs to help with familiarity and have tried to ensure that there are no errors, but please always check with a primary source such as the BNF or product literature before prescribing.
Acknowledgments
Thanks to Dr Matthew Butler for his input to the cardiology chapter, Prof. Liz Warburton for her contribution to the stroke chapter and Dr James Tanner for providing images.
We would also like to thank Nigel, Jo, and Hettie for their patience and support.
Abbreviations
5‐HT
5 hydroxytryptamine (serotonin)
5‐HT
2A
5‐HT2A receptor
A&E
accident and emergency, usually now known as the emergency department
AA
alcoholics anonymous
AA
attendance allowance
AAA
abdominal aortic aneurysm
AADC
aromatic amino acid decarboxylase
AAFB
acid and alcohol fast bacilli
AaPO
2
alveolar‐arterial oxygen tension difference
AAV
adeno‐associated virus
Aβ
amyloid beta‐peptide
ABCDE
approach for resuscitation: airway, breathing, circulation, disability, exposure
ABG
arterial blood gas
ABL‐1
tyrosine protein kinase proto‐oncogene
ABPI
arterial brachial pressure index
ACA
anterior cerebral artery
ACB
anticholinergic burden
ACE
angiotensin‐converting enzyme
ACEi
ACE inhibitor
AChE
acetylcholinesterase
AChEi
acetylcholinesterase inhibitor
AChR
acetylcholine receptor
ACiS
anterior circulation ischaemic stroke
ACP
advanced care planning
ACR
albumin : creatinine ratio
ACS
acute coronary syndrome
ACS
anterior circulation stroke (context essential)
ACS NSQIP
American College of Surgeons national surgical quality improvement program
ACTH
adrenocorticotrophic hormone
AD
advance decision
AD
Alzheimer's disease
ADH
antidiuretic hormone
ADL
activities of daily living
ADORE
drug trial of edaravone in ALS
ADR
adverse drug reaction
ADRT
advance decision to refuse treatment
ADT
androgen deprivation therapy
AEDs
anti‐epileptic drugs, now known as ASMs, see below
AF
atrial fibrillation
AFO
ankle‐foot orthosis
AIDP
acute inflammatory demyelinating polyradiculoneuropathy
AIDS
acquired immune deficiency syndrome
AIHA
autoimmune haemolytic anaemia
AIP
acute interstitial pneumonia
AJGP
Australian Journal of General Practice
AKI
acute kidney injury
AKT
a serine/threonine protein kinase, also known as protein kinase B, PKB
ALD
alcoholic liver disease
ALL
acute lymphoblastic leukaemia
ALP
alkaline phosphatase
ALS
amyotrophic lateral sclerosis
AMD
age‐related macular degeneration
AMHP
approved mental health practitioner
AML
acute myeloid leukaemia
AMP/ADP/ATP
adenosine mono di and triphosphate
AMPA
α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid, a receptor for glutamate
AMP‐K
adenosine monophosphate activated protein kinase
AMTS
abbreviated mental test score
ANH
artificial nutrition and hydration
ANS
autonomic nervous system
anti‐CCP/ACPA
anticitrullinated peptide antibody
AP
antero‐posteriorly
APOE
apolipoprotein E
APP
amyloid precursor protein
ARB
angiotensin receptor blocker
ARDS
acute respiratory distress syndrome
ARIA
amyloid‐related imaging abnormalities
ARNI
ARB/ neprilysin inhibitor combination e.g. valsartan/ sacubitril
AS
Alzheimer's society
AS
aortic stenosis
ASA
American Society of Anesthesiology
ASM
anti‐seizure medication, previously anti‐epileptic drugs
ATN
acute tubular necrosis
AV
atrioventricular
AVP
arginine vasopressin
AXR
abdominal X‐ray
BACE
β‐secretase enzyme that cleaves transmembrane APP
BAFTA
Birmingham atrial fibrillation treatment of the aged study
BAME
Black, Asian and ethnic minorities
BC
breast cancer
BCC
basal‐cell carcinoma
BCE
before common era
BCG
bacille Calmette Guérin
BD
twice a day
BiTEs
bispecific T cell engagers
BMA
British Medical Association
BMD
bone mineral density
BMI
body mass index
BMJ
British Medical Journal
BNF
British National Formulary
BNP
brain natriuretic peptide
BOO
bladder outflow obstruction
BOOP
bronchiolitis obliterans organizing pneumonia
BP
blood pressure
BPH
benign prostatic hyperplasia
BPI
bactericidal/permeability‐increasing protein fold gene
BPL
below the poverty line (households in India)
BPPV
benign paroxysmal positional vertigo
BPSD
behavioural and psychological symptoms of dementia
BRAF
a serine/threonine protein kinase proto‐oncogene with a critical role in MAPK cell signalling pathway.
BRAN
questions to ask about a new drug ‐ benefits, risks, alternatives, do nothing?
BRCA
breast cancer genes 1 and 2 (also increase risk of other cancers including ovary, pancreas, prostate)
BTS
British Thoracic Society
BZD
benzodiazepine
CAA
cerebral amyloid angiopathy
CABG
coronary artery bypass graft
CAD
coronary artery disease
CADASIL
cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
CAG
cytosine, adenine, guanine triplet repeats found in high numbers in Huntington's
CAGE
screen for problem alcohol use
CAM
confusion assessment method
CAP
community acquired pneumonia
CAPD
continuous ambulatory peritoneal dialysis
CAR
chimeric antigen receptor
CASSR
council with adult social services responsibility
CAT
COPD assessment test
CAUTI
catheter‐associated UTI
CBD
corticobasal degeneration
CBT
cognitive behavioural therapy
CBTI
cognitive behavioural therapy for insomnia
CCK
cholecystokinin
CCL5
chemokine ligand 5
CCP
cyclic citrullinated peptide
CCU
coronary care unit
CDAD
Clostridioides difficile‐associated diarrhoea
CDK
cyclin dependent kinase
CFH
complement factor H
CFS
clinical frailty score (Rockwood)
CGA
comprehensive geriatric assessment
CGM
continuous glucose monitoring
CHA
2
DS
2‐
VASc
score for risk of stroke in atrial fibrillation
CHARM
candesartan in heart failure assessment of reduction in morbidity and mortality study
CHART
continuous hyperfractionated accelerated ratdiotherapy
CHC
continuing healthcare funding
CHF
chronic heart failure
CI
confidence interval
CIDP
chronic inflammatory demyelinating polyradiculoneuropathy
CIWA
clinical institute withdrawal assessment ‐ alcohol
CK
creatine kinase
CKD
chronic kidney disease
CKM
conservative kidney management
CK‐MB
creatine kinase with muscle and brain subunits
CKS
clinical knowledge summary
CLL
chronic lymphocytic leukaemia
CMA
chaperone‐mediated autophagy
CMC
carpometocarpal
CML
chronic myeloid leukaemia
CNS
central nervous system
CO
carbon monoxide
CO
2
carbon dioxide
COHb
carboxyhaemoglobin
COMT
catechol‐O‐methyltransferase
COP
cryptogenic organizing pneumonia
COPD
chronic obstructive pulmonary disease
COX‐2
cyclo‐oxygenase‐2
CPAP
continuous positive airways pressure
CPN
community psychiatric nurse
CPPD
calcium pyrophosphate deposition disease
CPR
cardiopulmonary resuscitation
CQC
Care Quality Commission
CREST
acronym for calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia
CRHT
crisis resolution and home treatment team
CRP
C‐reactive protein
CRT
conformal radiotherapy
CRT‐P
cardiac resynchronisation therapy ‐ pacemaker
CSF
cerebrospinal fluid
CSM
carotid sinus massage
CSS
carotid sinus syndrome
CT
computerized tomography
CTPA
computerized tomography pulmonary angiogram
CTZ
chemoreceptor trigger zone
CUH
Cambridge University Hospitals (Addenbrooke's)
CVA
cerebrovascular accident
CVP
central venous pressure
CVS
cardiovascular system
CVT
central venous thrombosis
CXR
chest X‐ray
DA
dopamine
DAA
direct acting antiviral
DAME
acronym for causes of falls (drugs, ageing, medical and environmental causes ‐ female preponderance)
DAMPs
damage‐associated molecular patterns
DAN
diabetic autonomic neuropathy
DAPT
dual antiplatelet therapy
DAT
dopamine transporter
DBS
deep brain stimulation
DBS
disclosure and barring service
DC
direct current
DE
dementia (elderly) ‐ in the context of care home provision
DESH
disproportionately enlarged subarachnoid space hydrocephalus
DFLE
disability‐free life expectancy
DGH
district general hospital
DHSC
Department of Health and Social Care
DI
diabetes insipidus
DIC
disseminated intravascular coagulation
DIP
distal interphalangeal
DLB
dementia with Lewy bodies
DLCO
diffusing capacity for carbon monoxide
DLUHC
Department for Levelling Up, Housing and Communities
DM
dermatomyositis
DM
diabetes mellitus
DMARD
disease‐modifying anti‐rheumatic drug
DMT1
divalent metal transporter1
DNA
deoxyribonucleic acid
DNACPR
do not attempt cardiopulmonary resuscitation
DOAC
direct oral anticoagulant
DOLS
deprivation of liberty safeguards
DORA
dual orexin receptor antagonists
DPLD
diffuse parenchymal lung disease
DPP
dipeptidyl peptidase
DRD
Daratumumab + Revlimid (lenalidomide) + dexamethasone, an immunotherapy regimen for myeloma
DRE
digital rectal examination, sometimes abbreviated as PR (per rectum) which is also a route for drug administration
DSPN
diabetic sensorimotor polyneuropathy
DVLA
Driver and Vehicle Licensing Authority
DVT
deep vein thrombosis
DWI
diffusion weighted imaging (MRI)
DXA
dual‐energy X‐ray absorptiometry
E&W
England and Wales
ECG
electrocardiogram
ECMO
extracorporeal membrane oxygenation
ECOG
Eastern Cooperative Oncology Group
ECT
electroconvulsive therapy
ED
emergency department
EEG
electroencephalogram/graphy
eGFR
estimated glomerular filtration rate
EGFR
epidermal growth factor receptor
EuGMS
European Geriatric Medicine Society
EIBC
early invasive breast cancer
ELISA
enzyme‐linked immunosorbent assay
EMA
endomysial antibodies
EMG
electromyogram/electromyography
ENT
ear, nose and throat
EOFAD
early‐onset familial Alzheimer's disease
EPO
erythropoietin
ER
(o)estrogen receptor
ER
endoplasmic reticulum
ERAD
endoplasmic reticulum‐associated degradation
ERCP
endoscopic retrograde cholangiopancreatography
ESC
European Society of Cardiology
ESKD
end stage kidney disease
ESR
erythrocyte sedimentation rate
ET
essential tremor
ET
essential thrombocythaemia
EU
European Union
EVAR
endovascular aneurysm repair
EWGSOP2
European Working Group on Sarcopenia in Older People 2
FaME programme
fitness and mobility exercise programme
FAST
face, arms, speech, time, score for stroke
FBC
full blood count
FDA
Food and Drug Administration (US)
FDG
fluorodeoxyglucose
FEV1
forced expiratory volume in 1 s
FGFR
fibroblast growth factor receptor
FIMDT
feeding issues multidisciplinary team
FIT
faecal immunochemical test
FLAIR
fluid‐attenuated inversion recovery, MRI sequence that shows grey matter as bright and CSF as dark
FNC
NHS funded nursing care
FOCUS
fluoxetine on functional outcomes after acute stroke trial
FOXO
forkhead box O: transcription factors with key roles in insulin signalling and ageing
FRAX
fracture risk tool advocated by NOGG and NICE
FRIDS
falls‐risk increasing drugs
FRS
family research survey
FSH
follicle stimulating hormone
FTD
frontotemporal dementia
FTLD
frontotemporal lobar degeneration
FUS
focused ultrasound
FVC
forced vital capacity
GABA
gamma‐aminobutyric acid
GARS
glycyl‐tRNA synthetase
GBS
Guillain–Barré syndrome
GCA
giant‐cell arteritis
GCS
Glasgow coma score
G‐CSF
granulocyte colony stimulating factor
GDNF
glial cell‐line derived nerve growth factor
GDP
gross domestic product
GDS
geriatric depression score
GFR
glomerular filtration rate
GH
growth hormone
GI
gastrointestinal
GIP
glucose‐dependent insulinotropic polypeptide
GLP‐1
glucagon‐like peptide 1
GLUT4
glucose transporter ‐ a rate‐limiting step in insulin‐stimulated glucose uptake in muscle and adipocytes
GMC
General Medical Council
GnRH
gonadotrophin releasing hormone
GORD
gastro‐oesophageal reflux disease
GP
general practitioner
GPCOG
general practice cognitive screening test for dementia
GRACE
global registry of acute coronary events
GSF
gold standards framework
GSK
a pharma company, previously GlaxoSmith Kline
GSM
genitourinary syndrome of menopause (new term for vulvovaginal atrophy)
GTN
glyceryl trinitrate
GU
genitourinary tract
GWAS
genome‐wide association study
h
hour
HALE
health‐adjusted life expectancy
HASBLED
score for predicting bleeding risk of anticoagulation for AF, superseded by ORBIT
HCM
hypertrophic cardiomyopathy
HDU
high dependency unit
HPC
haemoprogenitor cell
HSC
haemopoietic stem cell
HER2
human epidermal growth factor receptor 2
HERMES
outcomes of thrombectomy : highly effective reperfusion evaluated in multiple endovascular stroke trials
HFE
high iron (Fe)/ human homeostatic iron regulator protein/ gene (mutations cause haemochromatosis)
HFmrEF
heart failure with mildly reduced ejection fraction
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
HHS
hyperosmolar hyperglycaemic syndrome
HINTS test
head impulse, nystagmus, test of skew test in vertigo
HIV
human immunodeficiency virus
HL
Hodgkin's lymphoma
HLA
human leucocyte antigen
HLE
healthy life expectancy
HLY
health‐adjusted life expectancy
HMRN
Haematological Malignancy Research Network
HOOF
home oxygen order form
HPC
haematoprogenitor cell
HPV
human papilloma virus
HRCT
high resolution computerized tomography scan
HRT
hormone replacement therapy
HSC
haematopoietic stem cells
HSMN
hereditary motor and sensory neuropathy
HSV
Herpes simplex virus
HUT
head‐up tilt
HWB
health and wellbeing board
I131
iodine‐131
IA
intraarticular
IADL
instrumental activities of daily living
IBD
inflammatory bowel disease
IBM
inclusion body myositis
IBS
irritable bowel syndrome
IC
intermediate care
ICA
internal carotid artery
ICB
integrated care board
ICD
implantable cardioverter‐defibrillator
ICH
intracerebral haemorrhage
ICP
intracranial pressure
ICP
integrated care partnership
ICS
inhaled corticosteroids
ICS
integrated care system
ICU
intensive care unit
IDA
iron deficiency anaemia
IE
infective endocarditis
Ig G, M, A, D and E
immunoglobulin classes
IGF‐1
insulin‐like growth factor 1
IHD
ischaemic heart disease
IL
interleukin
ILD
interstitial lung disease
IM
intramuscular
IMCA
independent mental capacity advocate
INR
international normalized ratio
IOP
intraocular pressure
IPF
idiopathic pulmonary fibrosis
IS
ischaemic stroke
ISC
intermittent self‐catheterisation
IU
international units
IV
intravenous
IVT
intravenous thrombolysis
IVU
intravenous urogram
JAK
Janus kinases, cytoplasmic tyrosine kinases and their genes
JVP
jugular venous pressure
KRT
kidney replacement therapy
LA
local authority
LAA
left atrial appendage
LABA
long‐acting beta
2
agonist
LACI
lacunar infarct
LAMA
long‐acting muscarinic antagonist
LASI
longitudinal aging study in India
LBBB
left bundle branch block
LBD
Lewy body disease, an umbrella term including DLB and PDD
LCP
Liverpool care pathway for the dying patient
LDH
lactate dehydrogenase
LDL‐C
low density lipoprotein cholesterol
LE
life expectancy
LED
levodopa equivalent dose
LFT
liver function test
LGBTQ+
lesbian, gay, bisexual, transgender, queer plus other emerging gender and sexual identities
LH
luteinizing hormone
LHRH
luteinizing hormone‐releasing hormone
LMIC
low or middle income country
LMN
lower motor neuron
LMWH
low molecular weight heparin
LOAD
late‐onset Alzheimer’s disease
LOC
loss of consciousness
LP
lumbar puncture
LPA
lasting power of attorney
LPL
lymphoplasmacytic lymphoma
LPS
liberty protection safeguards
LTOT
long‐term oxygen therapy
LUTS
lower urinary tract symptoms
LV
left ventricular
LVEF
left ventricular ejection fraction
LVF
left ventricular failure
LVH
left ventricular hypertrophy
LVO
large vessel occlusion
M
1‐5
muscarinic receptors
M band
monoclonal band
Mab
monoclonal antibody
MAO‐A or B
monoamine oxidase A or B
MAP
mean arterial pressure
MAP‐K
mitogen‐activated protein kinases: serine/threonine‐specific protein kinases that relay signals from the cell surface to the nucleus
MAR
medicines administration record
MASD
moisture‐associated skin damage
MASLD
metabolic dysfunction‐associated steatotic liver disease (replacing the term NAFLD)
MBBS
Bachelor of Medicine, Bachelor of Surgery (UK professional medical qualification)
MCA
Mental Capacity Act
MCA
middle cerebral artery
MCCD
Medical Certificate of Cause of Death
MCI
mild cognitive impairment
MCV
mean corpuscular volume
MDRD
modification of diet in renal disease
MDS
myelodysplastic syndrome
MDT
multidisciplinary team
MEK
mitogen‐activated protein kinase, also known as MAP2K
MFRA
multifactorial falls risk assessment
MG
myasthenia gravis
MGUS
monoclonal gammopathy of unknown significance
MHA
Mental Health Act
MHC
major histocompatibility complex
MHRA
Medicines and Healthcare Products Regulatory Agency (UK)
MI
myocardial infarction
min
minute
MIND
a mental health charity in England and Wales
MMSE
mini‐mental state examination
MNA
mini‐nutritional assessment
MND
motor neuron disease
MoCA
Montreal cognitive assessment
MOVES
Trial of chondroitin and glucosamine for knee pain in osteoarthritis
MPTP
1‐methyl‐4‐phenyl‐1,2,3,4‐tetrahydropyridine
MRA
magnetic resonance angiography
MRC
Medical Research Council
MRCP
magnetic resonance cholangiopancreatography
MRCP
Membership of the Royal College of Physicians
MRgFUS
MRI‐guided focused ultrasound
MRI
magnetic resonance imaging
mRNA
messenger RNA
MRSA
methicillin‐resistant Staphylococcus aureus
MS
multiple sclerosis
MSA
multiple system atrophy
MSU
midstream urine
MT
mechanical thrombectomy
mtDNA
mitochondrial DNA
mTOR
mammalian target of rapamycin: a serine/threonine protein kinase regulating cell growth and proliferation
MTP
metatarso‐phalangeal
MuSK
muscle specific tyrosine kinase
MUST
malnutrition universal screening tool
NA
noradrenaline
NABCOP
national audit of breast cancer in older patients
NAD +
nicotinamide adenine dinucleotide
NAFLD
non‐alcoholic fatty liver disease, now known as MASLD
NAIF
national audit of inpatient falls
NaSSa
serotonin noradrenaline reuptake inhibitor
NBM
nil by mouth
NCEPOD
National Confidential Enquiry into Patient Outcomes and Death
NCS
nerve conduction studies
NCSE
non‐convulsive status epilepticus
NELA
national emergency laparotomy audit
NF‐kB
nuclear factor kappa light chain enhancer of activated B cells
NG
nasogastric
NGO
non‐governmental organisation
NHS
National Health Service
NHS CC
NHS continuing care
NIA‐AA
National Institute on Aging and the Alzheimer's Association (new criteria for diagnosis of AD)
NICE
National Institute for Health and Care Excellence
NICs
national insurance contributions
NIH
National Institutes of Health (Agency of the US Dept. of Health)
NIHSS
National Institutes of Health stroke scale
NIV
non‐invasive ventilation
NKT
natural killer T cells
NMDA
N‐methyl‐D‐aspartate, a receptor for glutamate
NMJ
neuromuscular‐junction
NMS
neurally‐mediated syncope
NNT
number needed to treat
NOF
neck of femur
NOGG
National Osteoporosis Guidelines Group
NPH
normal pressure hydrocephalus
NSAID
non‐steroidal anti‐inflammatory drug
NSCLC
non‐small‐cell lung cancer
NSIP
non‐specific interstitial pneumonia
NSTE‐ACS
non‐ST elevation acute coronary syndromes
NSTEMI
non‐ST elevation myocardial infarction
NT‐proBNP
N‐terminal pro‐B‐type natriuretic peptide
NVH
non‐visible haematuria
NYHA
New York Heart Association
O2
oxygen
OA
osteoarthritis
OADR
old age dependency ratio
OD
once a day
OECD
Organization for Economic Cooperation and Development
OGD
oesophago gastro duodenoscopy
ONS
Office of National Statistics
OPG
osteoprotegerin
ORBIT
acronym for a risk score for bleeding on anticoagulants for AF (older, renal impairment, bled before, iron low, taking antiplatelet drugs)
OSA/HS
obstructive sleep apnoea/hyponoea syndrome
OT
occupational therapy/ therapist
OTC
over‐the‐counter (medicines)
P2Y12
purinergic receptors on platelets (bind clopidogrel family)
PA
pernicious anaemia
PACG
primary angle closure glaucoma
PACI
partial anterior circulation infarct
PAF
paroxysmal atrial fibrillation
PaO2
partial pressure of oxygen
PARP
poly ADP‐ribose polymerase
PBC
primary biliary cirrhosis
PCI
percutaneous coronary intervention
PCiS
posterior circulation ischaemic stroke
PCR
polymerase chain reaction
PCS
posterior circulation stroke
PCT
primary care trust
PD
Parkinson’s disease
PD‐1 inhibitor
programmed cell death protein 1 inhibitor (an immune checkpoint inhibitor)
PDB
Paget's disease of the bone
PDD
Parkinson's disease dementia
PDE
phosphodiesterase
PDK1
phosphoinositide‐dependent kinase 1
PD‐LI inhibitor
programmed cell death ligand inhibitor
PE
pulmonary embolism
PEC
percutaneous endoscopic colopexy
PEFR
peak expiratory flow rate
PEG
percutaneous endoscopic gastrostomy
PEG‐J
percutaneous endoscopic gastrostomy with a jejunal extension
PEJ
percutaneous endoscopic jejunostomy
PET
positron‐emission tomography
PHC
primary health centre (India)
PICC
peripherally inserted central catheter
PICH
primary intracranial haemorrhage
PIM
potentially inappropriate medication
PIP
proximal interphalangeal
PIP2/3
phosphatidylinositol 4,5‐bisphosphate and 3,4,5‐trisphosphate (cell membrane phospholipids)
PJ
slang for pyjama, as in pj paralysis
PLMS
periodic limb movements in sleep
PM
polymyositis
PMF
primary myelofibrosis
PMR
polymyalgia rheumatica
POADR
prospective old age dependency ratio
POAG
primary open angle glaucoma
POCI
posterior circulation infarct
POP
plaster of Paris
POPS
perioperative medicine for older people having surgery
PP
pulse pressure
PPARγ
peroxisome‐proliferator‐activated receptor gamma
PPCs
postoperative pulmonary complications
PPI
proton pump inhibitor
PPI
patient and public involvement
PPO
potential prescribing omissions
PPS
post‐polio syndrome
PRISMA
a self‐reported questionnaire for frailty
PRISMS
potential of rtPA for ischemic strokes with mild symptoms trial
PSA
prostate specific antigen
PSP
progressive supranuclear palsy
PSR
potential support ratio
PT (or physio.)
physiotherapy/ physiotherapist
PTCA
percutaneous transluminal coronary angioplasty
PTH
parathyroid hormone
PTHrP
parathyroid hormone‐related protein
PUVA
psoralen + UVA treatment
PV
polycythaemia vera
PVD
peripheral vascular disease
PVS
persistent vegetative state
QDS
four times a day
Qfracture
fracture risk tool advocated by SIGN and NICE
QOF
quality and outcomes framework
QRISK3
UK cardiovascular risk calculator
QT
the time between the start of the Q wave and end of the T wave on an ECG
RA
rheumatoid arthritis
RA
right atrium
RAAS
renin angiotensin aldosterone system
RAGE/AGE
receptor for advanced glycation endproducts
RANKL
receptor activator of nuclear factor kappa‐B ligand
RAS
renal artery stenosis
Ras
ras proto‐oncogenes: GTPases that act as molecular switches in pathways for cell proliferation and survival
RBBB
right bundle branch block
RBC
red blood cell
RCC
renal cell cancer
RCGP
Royal College of General Practitioners
RCP
Royal College of Physicians
RCT
randomized controlled trial
RDW
red cell distribution width
Rehab.
rehabilitation
REM
rapid eye movement
RGSC
Registrar General's socio‐economic class
RLS
restless legs syndrome
RNA
ribonucleic acid
RNIB
Royal National Institute for Blind people
ROS
reactive oxygen species
ROSIER
recognition of stroke in the emergency room scale
RoSPA
Royal Society for the Prevention of Accidents
RPE
retinal pigment epithelium
RS3PE
remitting seronegative symmetrical synovitis with pitting (o)edema
RSPCA
Royal Society for Prevention of Cruelty to Animals
RTA
road traffic accident
rt‐PA
recombinant tissue‐type plasminogen activator
RUQ
right upper quadrant
SA
sino‐atrial
SABA
hort‐acting beta
2
agonist
SABR
stereotactic ablative radiotherapy
SAE
serious adverse event (with a medical product)
SAH
subarachnoid haemorrhage
SAMA
short‐acting muscarinic antagonist
SaO2
arterial oxygen saturation
SARI
serotonin antagonist‐reuptake inhibitor
SARS‐CoV‐2
severe acute respiratory syndrome coronavirus 2
SASP
senescence‐associated secretory phenotype
SBOT
short‐burst oxygen therapy
SBP
systolic blood pressure
SC
subcutaneous
SCC
squamous‐cell carcinoma
SCLC
small‐cell lung cancer
SCN
suprachiasmatic nucleus
SD
standard deviation
SDH
subdural haematoma
SE
status epilepticus
sec
second
SERM
selective estrogen modulator
Sestamibi or ‘mibi' scan
technetium 99m methoxy isobutyl isonitrile scan
sFLC
serum free light chain
SGLT2i
sodium‐glucose co‐transporter‐2 inhibitor
SIADH
syndrome of inappropriate antidiuretic hormone
SIGN
Scottish intercollegiate guidelines network
SIRT
sirtuins: nicotine adenine dinucleotide‐dependent histone deacetylases regulating critical signalling pathways
SITS‐MOST
safe implementation of treatments in stroke monitoring study
SIVD
subcortical ischaemic vascular disease
SLE
systemic lupus erythematosus
SLT
selective laser trabeculoplasty
SLT
speech and language therapist/ therapy
SN
substantia nigra
SNP
single nucleotide polymorphism (pronounced snip)
SNRI
serotonin and norepinephrine reuptake inhibitor
SNS
sympathetic nervous system
SOD
superoxide dismutase, an enzymatic antioxidant, which catalyses the dismutation of superoxide ions into oxygen and hydrogen peroxide
SOL
space‐occupying lesion
SPA
state pension age
SPECT
single‐photon emission computerized tomography
SPF
sun protection factor
SPLATT
acronym for falls assessment (symptoms, previous falls, location, activity, time, and trauma)
SSNAP
sentinel stroke national audit programme
SSRI
selective serotonin reuptake inhibitor
Stat.
usually a one‐off dose, given immediately, from the Latin statim
STEMI
ST‐elevation myocardial infarction
STOPP/START
screening tool of older persons prescriptions and screening tool to alert doctors to right treatment
SVC
superior vena cava
T1/T2 DM
type 1/type 2 diabetes mellitus
T3
triiodothyronine
T4
thyroxine
TACI
total anterior circulation infarct
TAVI
transcatheter aortic valve insertion
TB
tuberculosis
TCC
transitional cell carcinoma
tDCS
transcranial direct current stimulation
TDP
transactive response DNA‐binding protein
TDS
three times a day
TEDS
thromboembolic deterrent stockings
TENS
transcutaneous electrical nerve stimulation
T
FH
T follicular helper cells
TFTs
thyroid function tests
TGA
transient global amnesia
TH
tyrosine hydroxylase
T
H
subset of T helper cells
TIA
transient ischaemic attack
TIBC
total iron binding capacity
TLOC
transient loss of consciousness
TMJ
temporomandibular joint
Tn
troponin
TNFα
tumour necrosis factor alpha
TOE
transoesophageal echocardiography
tPA
tissue plasminogen activator
TPN
total parenteral nutrition
T
reg
regulatory T cells, a T helper subset with role in immune tolerance
TSH
thyroid stimulating hormone
tTG‐IgA
tissue transglutaminase antibodies
TTT
tilt‐table testing
TUG
timed up and go test
TUIP
transurethral incision of the prostate
TUMT
transurethral microwave therapy
TUNA
transurethral needle ablation
TURBT
transurethral resection of bladder tumour
TURP
transurethral resection of the prostate
TVN
tissue viability nurse
TVT
tension‐free vaginal tape
U&Es
urea and electrolytes
UA
unstable angina
UC
ulcerative colitis
UCL
University College, London
UI
urinary incontinence
UIP
usual interstitial pneumonia
UK
United Kingdom
UKHSA
UK Health Security Agency
UKPDS
UK prospective diabetes study
UMN
upper motor neuron
UN
United Nations
UNHCR
UN High Commissioner for refugees
UPR
unfolded protein response
URTI
upper respiratory tract infection
US
United States
US$
US dollar
UTI
urinary‐tract infection
UV A and B
ultra violet light: A ‐ longer wavelength associated with tanning and ageing, B ‐ causes more sunburn
V/Q
ventilation/perfusion
VA
visual acuity
VAC
vacuum‐assisted wound closure
VaD
vascular dementia
VAT
value added tax
VATS
video‐assisted thoracoscopic surgery
VCSE
voluntary, community and social enterprise sector
VE
vaginal examination
VEGF
vascular endothelial growth factor
VGCC
voltage‐gated calcium channels
VO
2max
the maximum rate of oxygen the body can use during exercise
VTE
venous thromboembolism
WBC
white blood cell
WCC
white cell count
WHO
World Health Organisation
YAG
yttrium aluminium garnet laser
Z drugs
hypnotics in the zopiclone family
ZIO
tradename of a biosensor to detect cardiac arrythmias
