Paras Medical PublisherHyderabad ■ New Delhi

®

Editor-in-Chief

Pratap Sanchetee, DM

Sanchetee Neurology Research InstitutePal Link Road, JodhpurRajasthan, India

Under the Aegis ofIndian Academy of Geriatrics

Published byDivyesh Arvind Kotharifor Paras Medical Publisher5-1-475, First Floor, PutlibowliHyderabad – 500095, Indiaparasmedpub@hotmail.com

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© 2014, Publisher, IAG

1st edition 2014

ISBN: 978-81-8191-418-7

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PARAS®

Empowering Healthcare Professionals

TEXTBOOK OFGERIATRIC MEDICINETEXTBOOK OFGERIATRIC MEDICINE

FOREWORD

It gives me immense pleasure to write the foreword for the “Textbook on Geriatric Medicine”published by the Indian Academy of Geriatrics. With the longevity of life getting increased, the populationof elders in our country is also mounting steadily.

The whole world is witnessing a steady growth of the ageing population. This stresses theimportance of intensified geriatric service to take care of the elderly in India. This will need thefunctioning of more and more geriatric care units across the nation. To train doctors in this newdiscipline, postgraduate course in Geriatric Medicine (MD Geriatric Medicine) has been started inmany states in India.

Although a lot of books in geriatrics have been authored and published all over the world, theneed of the hour is a comprehensive geriatric textbook based on the Indian scenario. Such a textbookwould serve as a wonderful basic study material for the postgraduate medical students in geriatrics.

Since family physicians and primary healthcare physicians come across a large number of elderlypatients, a basic knowledge on geriatric care is very essential for them.

My hearty congratulations to the Indian Academy of Geriatrics for its wonderful pioneeringefforts in bringing out the first textbook on Indian Geriatrics.

This voluminous textbook with around 150 chapters has been divided into 21 sections. The contentsof this book have been broadly classified under the categories of Gerontology, Geriatric Medicine,Systemic Disorders, Rehabilitation and Preventive Geriatrics. The sections on Clinical Geriatrics andSyndromic Management are sure to help physicians get a clearer outlook on geriatrics. "Caregiverstress and elder abuse" and "Euthanasia" would provide a new outlook to the Indian physician. Geriatricsand stem cell research is a fresh avenue in geriatrics. My personal favourite being the "Preventivegeriatrics" section, for "Prevention is always better than cure," more so when it comes to geriatriccare.

Enormous efforts have been taken to put a complex and complicated subject like geriatrics in asimple, easy to assimilate format. This makes this book a ready reckoner for the paramedical personsas well. The highlight of this book is the inclusion of the latest and most recent developments, particularlyin the therapeutic side.

My heartfelt appreciation to all the editors and authors for having put in their precious time andsincere hardwork in shaping this book. My best wishes to the whole team.

Padmashri Dr VS NatarajanMD, FRCP (Edin), DSc (Hon)

Senior GeriatricianChennai, Tamil Nadu, India

SECTION EDITORS

Gerontology

Section 1: Introduction – AB DeySection 2: Social Gerontology – Alka Ganesh

Section 3: Ethical Issues – Ashish Goel

Geriatric MedicineSection 4: Clinical Geriatrics – B Krishnaswamy

Section 5: Syndromic Management – IS Gambhir

Section 6: Management of Older Patients – Tapas DasSection 7: Issues in Geriatric Care – GS Shanthi

Systemic Disorders

Section 8: Infections – Gita SinhaSection 9: Cardiovascular – Arvind Mathur

Section 10: Respiratory System – Parvaiz A KoulSection 11: Endocrinology and Metabolism – Vinod Kumar

Section 12: Gastroenterology – P Kar

Section 13: Renal system – Manish ChaturvedySection 14: Neurology – Pratap Sanchetee

Section 15: Psychiatry – Pratap SancheteeSection 16: Musculo-skeletal Disorders – Siddarth Kumar Das

Section 17: Hematology – Kuruvilla Prasad MathewsSection 18: Geriatric oncology – Suresh Sanchetee

Section 19: Miscellaneous Disorders – Harish AgarwalSection 20: Rehabilitation – Maria Crotty

Section 21: Preventive Geriatrics – Y Sathyanarayana Raju

PREFACE

Geriatric care has become more relevant in the past few decades than it has ever been in the humanhistory. Unfortunately, there has been a lack of good comprehensive reference material for the same.This book attempts to fill the gap by introducing the intricacies in geriatric care particularly those whichare relevant for developing and underdeveloped areas across the globe.

It does so by playing three roles - as a basic textbook, as a reference source on the myriad issuesrelated to aging and as a supporting material for research. It has been written primarily for postgradu-ates, teachers, researchers and professionals in various discipline of geriatrics.

Scientific writing is a craft and I am proud to be a student of it. The rewards of editing textbookslike this are invaluable and intrinsic and I am indeed fortunate to have been given this task and respon-sibility. The task had its share of challenges too and a risk of losing focus and direction because of thelarge number of authors, and section editors. Anticipating them, I had set a simple and clear goal toserve as a beacon for myself and the team to reach the end avoiding the pitfalls on the way and I hopeit has served the purpose. The goal was and is to - "Provide a sound and comprehensive understandingof geriatric care and medicine and stimulate the reader's mind towards innovative ideas & methodol-ogy."

While aging is an inevitable event after birth, most people dread old age. This is more importantin view of increase in aging population, their diverse medical needs, advances in technology and anincrease in number of related health personnel. The elderly are often challenged by health complica-tions, difficulties in obtaining quality medical care, financial and legal hurdles and psychological orsocial issues. While momentum has picked up in developed countries, in developing countries it is stillin infancy.

To live with dignity and with optimum health are fundamental rights of an individual and elderlyare no exception. Unfortunately, little has been done by medical, social, political and pharmaceuticalcommunities to address this issue. Collapse of conventional social network, rising cost of living andhealth care and changes in family support have further complicated the issue.

This book contains a tremendous amount of information. This is not just a narration of academicdescription. It is a well baked dish with flavour of personal experience, wisdom and newer perspec-tives. The version that you hold in your hands today has reached its current state after careful andinspired reviews and critique by a host of talented individuals.

All authors, eminent experts in their field, have been identified with the guidance of sectioneditors. A typical chapter begins with a historical background followed by the main text discussingimportant issues on the subject and ends with future perspectives and key messages. Focus has beenon basic principles and how it differs in elderly compared to young and adults. Each author has pro-vided his viewpoint and writing style will differ from chapter to chapter while conforming to this overallstructure and theme. While each patient is unique and requires an individualized treatment, we haveattempted to give a more holistic approach and view. Those readers who want to learn more have beenprovided with suggested reading at the end of chapter.

May this book provide all elderly hope, healing and a healthy life. I also pray that all personnelconnected with care of elderly will have new and innovative ways of treatment and this book is able tohelp in a small way towards achieving that vision. I look forward to seek your patronage, suggestionsand critique.

Pratap Sanchetee

ACKNOWLEDGEMENTS

Quest for a good textbook on geriatric medicine which is directed towards problems in developing andunderdeveloped countries is a long pending dream for academician across the globe. Perhaps keepingthis in mind, Dr AB Dey proposed, at a general body meeting of Indian Academy of Geriatrics (IAG)at Jodhpur in October 2012, that the association must take the lead and bring out a textbook on thesubject. He also proposed my name as the editor. Before I could react and put my concerns, everyonepresent in the meeting approved it with an assurance of extending all the help I would need. I mustadmit that they not only kept their words but went beyond it in giving direction and shape to this book.I am grateful to office bearers and members of IAG including Dr AB Dey for giving me this opportu-nity.

I am thankful to Dr M Natrajan for writing the foreword and blessing this venture. I must alsomention here the constant support and encouragement provided by Drs Alka Ganesh, G Shanthi, TapasDas, IS Gambhir, Suresh Sanchetee and B Krishnaswamy throughout the creative process. Dr ArvindMathur deserves a special mention as he has been instrumental in pushing me into field of geriatricsand constantly monitoring progress of the book.

This book would not have been in the shape that it is today without Dr Manish Chaturvedy, whonot only reviewed each chapter in detail but has also offered clear and candid critique, and made surethat I meet all deadlines. I am deeply grateful to him for his undivided attention and passion towardsthis book.

I take this opportunity to express my gratitude and regards to all the section editors for theirguidance, monitoring and constant involvement throughout the preparation of this book. They wereinstrumental in identifying all great authors to write different chapters of the book. All authors withoutexception have contributed their best and provided a perfect blend of academic and clinical geriatrics.I thank all the authors for devoting their time and effort towards this book which I am sure will be agreat asset for all those who are in the field of geriatrics.

I also take this opportunity to thank the team at Paras Medical Publishers, Hyderabad under theleadership of Mr Divyesh Kothari for their cordial support and valuable inputs throughout the variousstages of this book.

It may not seem substantial to many, but the support given by my two granddaughters Navya andAanya has been quite helpful too. At the very young age of 7 and 5, they could grasp the importance ofthis task and did not harass me during my work and did not fight over the laptop which I used for hoursat stretch!

Last and certainly not the least, I would like to express my heartfelt thanks to my wife, Pramila,for standing beside me during this herculean task and being the pillar of strength and motivation fromthe start till the very end.

CONTRIBUTORS

AB Dey, MDProfessor & Head, Department of GeriatricMedicine, All India Institute of MedicalSciences, New Delhi

Abhisek Bagchi, MDResident, Department of MedicineMaulana Azad Medical College, New Delhi

Abhishek Pathak, MDSenior Resident, Department of PsychiatryInstitute of Medical Sciences, Varanasi

Abhra Chandra Chaudhury, MDSenior Resident, Department of ClinicalImmunology, Sanjay Gandhi Post GraduateInstitute of Medical Sciences, Lucknow

Aby Abraham, MD, DMAssociate ProfessorDepartment of HaematologyChristian Medical College, VelloreTamil Nadu

AC Anand, MD, DM, FICP, FSGEI, FACP, FACG, FAMS

Senior Consultant Hepatology &Gastroenterology, Indraprastha ApolloHospital, Sarita Vihar, New Delhi

Agnes Tiwari, PhD, MSc, DN, RN RCNT, RNT, FCMI, FAAN

School of Nursing, Li Ka ShingFaculty of Medicine, The University of HongKong Chinese Health, Aging and PolicyProgram, Rush Institute for Healthy AgingRush University Medical Center, Hong Kong

Ajay Duseja, MD, DM, MNAMS, FACGDepartment of HepatologyPostgraduate Institute of Medical Educationand Research, Chandigarh

Ajay Gogia, MD, DMDepartment of Medical OncologyDr BR Ambedkar Institute RotaryCancer HospitalAll India Institute of Medical SciencesNew Delhi

Akhil Kapoor, MDSenior Resident, Department of OncologyAcharya Tulsi Regional Cancer Treatment andResearch Institute and SP Medical College,Bikaner, Rajasthan

AK Mazumder, MDRtd. Professor & Head of MedicineKolkata Medical College & IPGMERSSKM Hospital Kolkata, West Bengal

Alakendu Ghosh, MDProfessor and Head, Department ofRheumatology, Institute of Post GraduateMedical Education and Research & SSKMHospital, Kolkata

Alka Ganesh, MDProfessor of Medicine (Retd), ChristianMedical College, Vellore, Tamil Nadu

Alka Goyal, MDDr BR Ambedekar Institute Rotary CancerHospital, All India Institute of MedicalSciences, New Delhi

Alladi Mohan, MD, FAMS, FRCP (Edin) FCCP (USA), FICP

Professor and Head, Department of MedicineChief, Division of Pulmonary and Critical CareMedicine, Sri Venkateswara Institute ofMedical Sciences, Tirupati, Andhra Pradesh

Amita Bhargava, MD, DMProfessor & HeadDepartment of NeurologyDr S N Medical College, Jodhpur, Rajasthan

Amitabh Sagar, MDAssociate Professor, Department of InternalMedicine, Armed Forces Medical CollegePune, Maharashtra

Amita Sanchetee, MSConsultant Gynaecologist, Sanchetee Hospitaland Cancer Institute, Jodhpur, Rajasthan

Amitava Goswami, MDSenior Resident, Department ofGastroenterology, Dr SN Medical CollegeJodhpur, Rajasthan

Amit Kumar, MD, DNBConsultant in Cardiology, Fortis Escorts HeartInstitute, New Delhi

AM Khan, PhDProfessor and Head, Department of SocialSciences, National Institute of Health andFamily Welfare, Munirka, New Delhi

Anand Banka, MD, DMConsultant Nephrologist, GorakhpurUttar Pradesh

Anil Bhansali, DM, FRCPProfessor & HeadDepartment of EndocrinologyPostgraduate Institute of Medical Education& Research, Chandigarh

Anju Kuruvilla, MDProfessor, Department of PsychiatryChristian Medical College, VelloreTamil Nadu

Ankit Shrivastav, MD, DMConsultant EndocrinologistOrchid Medical CentreRanchi, Jharkhand

Anne George, MDAssistant Professor, Obstetrics & GynecologyCommunity Hospital and DevelopmentHospital, Christian Medical College HospitalVellore, Tamil Nadu

Anoop SarayaProfessor, Department of Gastroenterologyand Human Nutrition UnitAll India Institute of Medical SciencesNew Delhi

Anthony LesserHonorary Research Fellow in PhilosophyUniversity of Manchester, UK

AP Jain, MD, PhDProfessor and Head, Department of MedicineMGIMS Sevagram, Wardha, Maharashtra

Apoorva Pauranik, MD, DMProfessor of NeurologyMGM Medical College & M Y Hospital, Indore

Arpita Konar, MScBiochemistry and Molecular BiologyLaboratory, Brain Research Centre,Department of Zoology, Banaras HinduUniversity, Varanasi, Uttar Pradesh

Aruna Kekre, MDProfessor Obstetrics & GynecologyHead Urogynaecology Unit, Christian MedicalCollege Hospital, Vellore, Tamil Nadu

Arvind Jain, MDProfessor, Department of MedicineDr SN Medical College, Jodhpur, Rajasthan

Arvind Mathur, MDPrincipal & Controller & Prof of MedicineDr SN Medical College, JodhpurRajasthan

Ashish Aggarwal, MChAssistant ProfessorDepartment of NeurosurgeryPostgraduate Institute of Medical Education& Research, Chandigarh

Ashish Goel, MDAssistant Professor, Department of MedicineUniversity College of Medical SciencesNew Delhi

Ashok D B Vaidya, MD, PhD, FAIMResearch Director, Medical Research CenterKasturba Health Society, Vile Parle, WestMumbai, Maharashtra

Ashok Kalwar, DNB, DRMAssistant Professor, Department of OncologyDr SN Medical College, Jodhpur, Rajasthan

Ashu Rastogi, MD, DMAssistant ProfessorDepartment of EndocrinologyPostgraduate Institute of Medical Education& Research, Chandigarh

Asia Mubashir, MDSuper Specialist, Rheumatology (USA)Specialist, Internal Medicine (USA)President and Consultant RheumatologistCentre for Arthritis and Rheumatism, J&K

Atul Mathur, MD, DMDirector Interventional CardiologyFortis Escorts Heart Institute, New Delhi

Auro Viswabandya, MD, DMProfessorDepartment of Clinical HaematologyChristian Medical CollegeVellore, Tamil Nadu

B Krishnaswamy, MDProfessor and Head (Retd)Department of Geriatric MedicineMadras Medical College, Chennai

Benny Paul Wilson, MD, MRCPAssistant Professor, Department of GeriatricMedicine, Christian Medical College, VelloreTamil Nadu

Bharat Bhushan, MDSenior Resident, Department of NeurologyDr S N Medical College, Jodhpur, Rajasthan

Bhom Raj Thanvi, MD, FRCP (Edinburgh) PGA (Medical Education)

Honorary Associate, Clinical ProfessorWarwick Medical School & ConsultantPhysician, Stroke and Elderly CareSouth Warwickshire Foundation HospitalsNHS Trust, Warwick, UK

Biju George, MD, DMProfessor, Department of HaematologyChristian Medical College, VelloreTamil Nadu

Celia ChowAssistant Professor (Nursing Practice)School of Nursing, Li Ka Shing Facultyof Medicine, Li Ka ShingThe University of Hong Kong

C Shanthi Johnson, PhD, RD, FDC, FACSMProfessor and Associate Dean (Research andGraduate Studies), Faculty of Kinesiology andHealth Studies, University of Regina, Canada

Chanchal Goyal, MBBS, MA, PhDSenior Research FellowDepartment of NeurologyAll India Institute of Medical SciencesNew Delhi

Chandra Mohan Verma, MD, DMProfessor & Head, Department of CardiologyLPS Institute of Cardiology, GSVM MedicalCollege, Kanpur, Uttar Pradesh

Chepsy C Philip, MDDepartment of Clinical HaematologyChristian Medical College, VelloreTamil Nadu

Debashish Danda, MBBS, MD, DM, FRCPProfessor & Head, Clinical Immunology &Rheumatology, Christian Medical College& Hospital, Vellore, Tamil Nadu

Deepak Amarapurkar, MD, DNB, FACG, FICP, AGAFGastroenterologist and HepatologistBombay Hospital & Medical Research CentreMumbai, Maharashtra

Deepak K Bhasin, MD, DM, FAMS, FASGEProfessor, Department of GastroenterologyPost Graduate Institute of Medical Educationand Research, Chandigarh

Deepak TripathiDepartment of Clinical ImmunologySanjay Gandhi Postgraduate Institute ofMedical Sciences, Lucknow, Uttar Pradesh

Dhananjay Chavan, MDHon Consultant, Deenanath MangeshkarHospital & Aditya Birla Hospital, PuneMaharashtra

Dharmendra Singh Bhadauria, MD, DMAssistant Professor, Department ofNephrology, Sanjay Gandhi PostgraduateInstitute of Medical Sciences, LucknowUttar Pradesh

Dharmesh Patel, MD, DNBConsultant Respiratory PhysicianCity Clinic and Bhailal Amin General HospitalLaxmi Bhavan, Pradhan Marg, Vadodara,Gujarat

Dipanjan Bandyopadhyay, MD, FICPMedical Superintendent-cum Vice Principal& Professor of Medicine, Institute of PostGraduate Medical Education & Research andSSKM Hospital, Kolkata

D Prabath Kumar, MDAssociate Professor, Department of MedicineSri Venkateswara Institute of MedicalSciences, Tirupati, Andhra Pradesh

Eesh Bhatia, MD, DNBProfessor and HeadDepartment of EndocrinologySanjay Gandhi Postgraduate Institute ofMedical Sciences, Lucknow, Uttar Pradesh

Gita Sinha, MD, MPHAssistant ProfessorInternal Medicine/Infectious DiseasesJohns Hopkins University School of MedicineBaltimore, USA

G Shanthi, MDAssociate ProfessorDepartment of Geriatric MedicineMadras Medical College, Chennai

Ghulam Saydain, MD, FCCPAssistant Professor of MedicineDirector Pulmonary Hypertension ProgramPulmonary Critical Care and Sleep DivisionWayne State University, School of MedicineDetroit Medical Center, Detroit, MI, USA

G Usha, MDAssociate ProfessorDepartment of Geriatric MedicineMadras Medical College, Chennai

Hardeep Singh Malhotra, MD, DMAssociate ProfessorDepartment of NeurologyKing George's Medical University (KGMU)Lucknow, Uttar Pradesh

Harish Agarwal, MDAssistant ProfessorDepartment of Geriatric MedicineDr SN Medical College, Jodhpur, Rajasthan

Hilde M BuitingComprehensive Cancer CentreNetherlands (IKNL)

Inderjeet Singh GambhirProfessor of MedicineHead, Division of Geriatric MedicineInstitute of Medical SciencesBanaras Hindu University, Varanasi

Inderpaul Singh SehgalSenior ResidentDepartment of Pulmonary MedicinePostgraduate Institute of Medical Educationand Research, Chandigarh

Indira Jai Prakash, MA, DM & SP, PhDFormer Professor and ChairpersonPG Department of Psychology, BangaloreUniversity, Bangalore, Karnataka

Indira Sharma, PhD, MD, MAMS, MIBRO, Dip YogaProfessor, Dept of Psychiatry, Institute ofMedical Sciences, Varanasi, Uttar Pradesh

Jaiprakash Sharma, MDDepartment of AnaesthesiologyAll India Institute of Medical Sciences, Bhopal

Jai Singh Yadav, MDAssistant ProfessorDepartment of Psychiatry and NDDTCAll India Institute of Medical Sciences, Delhi

J Harikrishna, MDAssistant ProfessorDept of Medicine, Sri Venkateswara Instituteof Medical Sciences, Tirupati

Jitendra K Chaudhary, PhDMolecular Biology LaboratorySchool of Life Sciences, Jawaharlal NehruUniversity, New Delhi

Joseph Troisi, PhD (Soc), PhD (Gerontology, Honoris Causa), MA (Soc), MTh MPhil, BA Hons (Phil)

Professor, Sociology, Social GerontologyDirector, International Institute on AgeingUnited Nations-Malta INIA), DirectorEuropean Centre for GerontologyUniversity of Malta

Jyotirmoy PalAssociate Professor MedicineIncharge Geriatrics ClinicIPGME&R and SSKM Hospital, Kolkata

Kapil Sharma, MD, DMAssistant Professor (Hepatology)Institute of Liver and Biliary Science, Delhi

Kaushik Chatterjee, MDProfessor and HeadDepartment of PsychiatryCommand Hospital (Eastern Command)Kolkata

Kayal Vizhi NSt Philomena's Hospital, BangaloreKarnataka

Kiran Preet Malhotra, MD, DNB, PDCCAssistant Professor, Department of PathologyDr RML Institute of Medical Sciences(RMLIMS), Lucknow, Uttar Pradesh

Kirti Rana, MD, DNB, MNAMSAssociate ProfessorDepartment of RadiodiagnosisDr SN Medical College, Jodhpur, Rajasthan

Komalkirti Apte, MBBS, PGDRSenior Research Fellow, Chest ResearchFoundation, Marigold Complex, KalyaninagarPune, Maharashtra

K Ravishankar, MDConsultant In-chargeThe Headache and Migraine ClinicsJaslok Hospital and Research Centre, Mumbai

K Umakalyani, MDAssistant ProfessorDepartment of Geriatric MedicineMadras Medical College, Chennai

Kuruvilla Prasad Mathews, MD, FRACPProfessor and HeadDepartment of GeriatricsChristian Medical College, Vellore, Tamilnadu

Lalit Kumar, MD, DM, FAMS, FAScProfessor & HeadDepartment of Medical OncologyInstitute Rotary Cancer HospitalAll India Institute of Medical SciencesNew Delhi

Lesser AHHonorary Research Fellow in Philosophy,University of Manchester, UK

Liza Rajasekhar, MDProfessor and HeadDepartment of RheumatologyNizam's Institute of Medical SciencesHyderabad, Andhra Pradesh

Mallikarjun Sakpal, MDDepartment of HepatologyPostgraduate Institute of Medical Educationand Research, Chandigarh

Manash P Baruah, MD, DMDepartment of EndocrinologyExcel Hospitals, Guwahati, Assam

Manish Chaturvedy, MD, DMAssociate Professor NephrologyDr SN Medical College, Jodhpur, Rajasthan

Maria Crotty, MPH, PhD, FAFRM, FRACGP, FAFPHMProfessor, RehabilitationAged and Extended Care Flinders UniversityAdelaide, Australia

Mathew Cherian, BE (Hons)Chief Executive, Help Age India, New Delhi

Maneesh Kumar Singh, MD, DMProfessor, Department of NeurologyKing George's Medical University (KGMU)Lucknow

Meghana Bhatnagar, MBBSResearch AssistantThe Headache and Migraine ClinicsJaslok Hospital and Research Centre, MumbaiMaharashtra

Melissa Simon, MD, MPHVice Chair of Clinical Research &Associate ProfessorDepartments of Obstetrics and GynecologyPreventive Medicine and Medical SocialSciences, Northwestern UniversityFeinberg School of MedicineChicago Illinois, USA

MI Tamayo-Velazquez, BSc, PhDAndalusian School of Public HealthGranada, Spain

MK Garg, MD, DM, FICP, FUDACommandant, Consultant Medicine &Endocrinology, Military Hospital, Shillong,Meghalaya

MK Thakur, PhD, FNAScBiochemistry and Molecular BiologyLaboratory, Brain Research CentreDepartment of Zoology, Banaras HinduUniversity, Varanasi, Uttar Pradesh

Mohd Jamil, MDSenior Resident, Department of GeneralMedicine, North Eastern Indira GandhiRegional Institute of Health and MedicalSciences, Shillong, Meghalaya

Molly Thabah, MD, DMAssistant ProfessorDepartment of MedicineJawaharlal Institute of Postgraduate MedicalEducation and Research, Pondicherry

Mona Liza Lyngdoh, MDAssistant Professor, Dept of General MedicineNorth Eastern Indira Gandhi Regional Instituteof Health and Medical Sciences, Shillong,Meghalaya

Mohana Maddula, MRCPSenior Registrar, Dept of Health Care of OlderPerson, Nottingham University Hospitals, NHSTrust, Nottingham, UK

Mohankumar Thekkinkattil, MD, DSc, DPPRHead & Senior Consultant PulmonologistInstitute of Pulmonary Medicine & ResearchSri Ramakrishna Hospital, CoimbatoreTamil Nadu

MP Sharma, MD, DM, FAMSHead, Department GastroenterologyRockland Hospital, Qutab Institutional AreaNew Delhi

M Senthilkumar, MDAssistant ProfessorDepartment of Geriatric MedicineMadras Medical College, Chennai

Narayan Prasad, MD, DMAdditional ProfessorDepartment of Nephrology, Sanjay GandhiPostgraduate Institute of Medical SciencesLucknow

Narendra Bhargava, MD, DM, DNBProfessor & Head, Dept of GastroenterologyDr SN Medical College, Jodhpur, Rajasthan

Naresh BhatSt Philomena's Hospital, Bangalore, Karnataka

Naveen Kishoria, MDAssociate Professor, Dept of MedicineDr SN Medical College, Jodhpur, Rajasthan

Navneet Singla, MChAssistant ProfessorDepartment Of NeurosurgeryPostgraduate Institute of Medical Education& Research, Chandigarh- 160 012

N Blanco-Pinero, PhD, MsCUniversity of Seville, Spain

Neelakshi Mahanta, MDAssociate Professor MedicineGauhati Medical College, Guwahati

Nitin Kumar Joshi, BDS, MPHAssistant Professor, Jodhpur School of PublicHealth, Jodhpur National University, Jodhpur,Rajasthan

N Loganathan, MD, DMFellow, Department of Pulmonary Medicineand Sleep Disorders, All India Institute ofMedical Sciences, New Delhi

Nirmalendu Sarkar, DIP-CARD, MDProfessorDepartment of Medicine & InChargeGeriatric Clinic, Calcutta National MedicalCollege, Kolkata

Noeline Whitehead, PhD, MN (Hons)Clinical Nurse DirectorAged Related Residential CareHealth Services for Older peopleCounties Manukau District Health BoardAuckland, New Zealand

Pablo Simon-Lorda, MSc (Bioethics), PhDAndalusian School of Public HealthGranada, Spain

Parthasarathi Bhattacharya, MD, DNBE, DMConsultant Pulmonologist, Institute ofPulmocare & Research, Kolkata

Parvaiz A Koul, MD, FCCP (USA), FRCP (London)Professor & Head, Department of Internal &Pulmonary Medicine, Sheri-i-KashmirInstitute of Medical Sciences, SouraSrinagar, J&K

Pawan Kumar, MDResident, National Institute of Health andFamily Welfare, Munirka, New Delhi

PC Das, MDAssistant ProfessorDepartment of Geriatric MedicineAll India Institute of Medical SciencesNew Delhi

Prasun Chatterjee, MD (Geriatrics)Senior Research AssociateDepartment of Geriatric MedicineAll India Institute of Medical SciencesNew Delhi

Pooja Dhaon, MDSenior Research AssociateDepartment of RheumatologyKing George's Medical University, Lucknow

Poonam Agrawal, MD, DNBAssistant ProfessorDepartment of DermatologyVenereology & Leprosy, Christian MedicalCollege, Vellore, Tamil Nadu

P Puri, MD, DNB, DMDepartment of GastroenterologyArmy Hospital (Research & Referral)New Delhi

Pradeep Bhatia, MDProfessor & HeadDepartment of AnaesthesiologyCritical Care & Pain ManagementAll India Institute of Medical Sciences,Jodhpur, Rajasthan

Pradeep Eswarappa HaranahalliSenior Registrar, LPS Institute of CardiologyGSVM Medical College, Kanpur, Uttar Pradesh

Pradeep KRSt Philomena's Hospital, Bangalore, Karnataka

Pradeep Kumar Siddappa, MD, DMSenior Research AssociateDepartment of GastroenterologyPostgraduate Institute of Medical Education& Research, Chandigarh

Prakash Sanchetee, MBBS, DMCW, DPH PGDHH, PGDHA

Lake Gardens, Kolkata

Pramod C Rath, PhDProfessor, Molecular Biology, School of LifeSciences, Jawaharlal Nehru UniversityNew Delhi

Pratap Sanchetee, MD, DMConsultant Neurologist, Sanchetee NeurologyResearch Institute, Jodhpur, Rajasthan

Preeticia Dkhar, MSc, PhDDepartment of BiochemistryNorth-Eastern Hill University, ShillongMeghalaya

Premashis Kar, MD, DM, PhD, FAMS, FNADirector, Professor and GastroenterologistDepartment of Medicine, Maulana AzadMedical College, New Delhi

Priya Tiwari, MDDepartment of Medical OncologyDr BR Ambedkar Institute RotaryCancer Hospital, All India Institute ofMedical Sciences, New Delhi

PS Karmakar, MDProfessor of MedicineRG Kar Medical College, KolkataWest Bengal

Punit Jain, MDDepartment of Clinical HaematologyChristian Medical College, VelloreTamil Nadu

Rabin Bhandari, A Mus A, B Med, FAFRM (RACP)Department of Rehabilitation MedicineRepatriation General Hospital, AdelaideAustralia

Rachna Kucheria, MD, MD, MPHClinical HeadHome HealthcareMax Healthcare, New Delhi

Rahul Mehrotra, MD, DNBSenior Consultant, Medanta Heart InstituteMedanta the Medicity, Gurgaon

Rajagopalan RamanProfessor, Department of OtolaryngologyFaculty of Medicine, University MalayaUMMC, Kualalumpur, Malaysia

Rajat Saha, MD, DNBConsultant, Department of Medical OncologyBLK Superspeciality Hospital, Delhi

Rajeev Chawla, MD, FRCPSenior Consultant DiabetologistDirector, North Delhi Diabetes CentreNew Delhi

Rajesh GopalakrishnanProfessor, Department of PsychiatryChristian Medical College, VelloreTamil Nadu

Rajnish Joshi, MD, MPH, PhDDepartment of MedicineAll India Institute of Medical SciencesBhopal, Madhya Pradesh

Rakesh Kochhar, MD, DMProfessor, Department of GastroenterologyPostgraduate Institute of Medical Education &Research, Chandigarh

Rama Vaidya, MD, PhD, DGO, DFPDirector, Unit of Endocrine and MetabolicDisorders, Medical Research Center,Kasturba Health Society, Vile Parle, WestMumbai, Maharashtra

Ramesh Thakur, MD, DMLPS Institute of Cardiology, GSVM MedicalCollege, Kanpur, Uttar Pradesh

Ramesh Sharma, MSc, PhD, FNAScDepartment of BiochemistryNorth-Eastern Hill UniversityShillong, Meghalaya

Ramnath Misra, MD, FRCPDean, Professor and Head ClinicalImmunology, Sanjay Gandhi Post GraduateInstitute of Medical Sciences, LucknowUttar Pradesh

Randeep Guleria, MD, DMProfessor and HeadDepartment of Pulmonary Medicine andSleep DisordersAll India Institute of Medical SciencesNew Delhi

Ranjit Unnikrishnan, MD, Dip. Diab (UK)Madras Diabetes Research Foundation &Dr Mohan's Diabetes Specialities CentreWHO Collaborating Centre forNon-communicable Diseases Prevention andControl, IDF Centre for EducationGopalapuram, Chennai

Ravinder Goswami, MD, DM, FASc, FNASc, FAMSProfessor, Department of Endocrinologyand MetabolismAll India Institute of Medical SciencesNew Delhi

Reenu Jain, MDDepartment of Medical OncologyDr BR Ambedkar Institute RotaryCancer HospitalAll India Institute of Medical SciencesNew Delhi

Rensa, MDInternal Medicine SpecialistDepartment of Internal MedicineSchool of Medicine, Atma Jaya CatholicUniversity, Jakarta, Indonesia

Renu George, MDProfessor and HeadDepartment of DermatologyVenereology & LeprosyChristian Medical College, VelloreTamil Nadu

Renuka Visvanathan, PhD, FRACP, MBBSDirector, Aged & Extended Care ServicesCentral Adelaide Local Health Network andAdelaide Geriatrics Training and Researchwith Aged Care CentreUniversity of Adelaide, South Australia

Ritesh Agarwal, MD, DM, FACP, FCCP, FAPSR, FRCPAssociate ProfessorDepartment of Pulmonary MedicinePostgraduate Institute of Medical Educationand Research, Chandigarh

RK Sharma, MD, DNBProfessor & HeadDepartment of Nephrology & DirectorSanjay Gandhi Post Graduate Institute ofMedical Sciences, Raebareli Road, LucknowUttar Pradesh

Rohini Handa, MD, DNB, FAMS, FICP FACR, FRCP (Glasgow)

Senior Consultant RheumatologistApollo Indraprastha Hospitals, New Delhi

Rohit Mathur, MD, DMAssistant ProfessorDepartment of CardiologyDr SN Medical College, Jodhpur, Rajasthan

R Ranga Rao, MD, DM (Medical Oncology)Director & Senior ConsultantDepartment of Medical OncologyBLK Superspeciality Hospital, Delhi

Ruchika Goel, MDDepartment of Clinical Immunology andRheumatology, Christian Medical College,Vellore, Tamil Nadu

R V Jayakumar, MD, DM, MNAMS, FRCPProfessor of EndocrinologyAmrita Institute of Medical SciencesCochin, Kerala

Shweta Agarwal, MDSenior Research AssociateDepartment of RheumatologyKing George's Medical University, LucknowUttar Pradesh

Sadik Mohammed, MDAssistant ProfessorDepartment of AnaesthesiologyDr SN Medical College, JodhpurRajasthan

Sagar Modi, MD, DMSenior ResidentDepartment of Endocrinology andMetabolism, All India Institute of MedicalSciences, New Delhi

Salil Gupta, MD, DNB, DMProfessor of Internal Medicine & NeurologistArmed Forces Medical CollegePune, Maharashtra

Sandeep Kharb, MD, DNBConsultant Endocrinology, Aditya BirlaMemorial Hospital, PuneMaharashtra

Sandip Pal, MD, DMAssociate ProfessorDepartment of NeurologyBurdwan Medical CollegeBurdwan

Sanjay Kalra, MD, DMDepartment of EndocrinologyBharti Hospital & BRIDE, KarnalHaryana

Sanjeev Misra, MS, M Ch, FRCS (Eng)FRCS (Glasgow), FICS, FACS (USA), FAMS

Professor of Surgical OncologyDirector and CEOAll India Institute of Medical SciencesJodhpur, Rajasthan

Sanjeev Sanghvi, MD, DMProfessor and HeadDepartment of CardiologyDr SN Medical College, Jodhpur, Rajasthan

Sanjib Kumar KarDepartment of GastroenterologySCB Medical College, Cuttack, Odisha

Sanjiv Sharma, MD, DMConsultant CardiologistBatra Hospital, New Delhi

Santosh Kumar MandalDepartment of Clinical Immunology andRheumatology, Christian Medical CollegeVellore, Tamil Nadu

Santosh Kumar Sinha, MD, DMLecturer, LPS Institute of CardiologyGSVM Medical College, Kanpur, UP

Santosh Patil, MDSDepartment of Oral RadiologyJodhpur Dental CollegeJodhpur National University, JodhpurRajasthan

Saptarshi Bishnu, MDPost Doctoral TraineeDepartment of HepatologySchool of Digestive and Liver DiseasesIPGMER, Kolkata

Sarvada C Tiwari, MD, FAMS, FIPS, FAPA, MIPAProfessor & HeadDepartment of Geriatric Mental HealthKing George's Medical University, LucknowUttar Pradesh

Satya Gupta, MD, DM, FESC, FACCDirector and Interventional CardiologistCIMS Hospital, Ahmedabad

Saurabh Saigal, MD, PDCC, EDICDept of Trauma and Emergency MedicineAll India Institute of Medical SciencesBhopal

S DeepaAssistant ProfessorDepartment of Geriatric MedicineMadras Medical College, Chennai

Shankar K Sankaran, MBBS, FRACPClinical Head and Consultant GeriatricianCommunity Geriatric ServicesAdult Rehabilitation & Health of OlderPeople, Middlemore Hospital, OtahuhuAuckland, New Zealand

Shankar Prasad Gorthi, MD, DMProfessor & HeadDepartment of NeurologyArmy Hospital (Research & Referral)New Delhi

Shanmuganandan Krishnan, MD, DMDepartment of RheumatologyArmy Hospital (Research & Referral)New Delhi

Shivaram Prasad SinghHead, Department of GastroenterologySCB Medical College, Cuttack, Odisha

Shymal Kumar Das, MD, DMProfessor and HeadDepartment of NeurologyBurdwan Medical College, Burdwan

Siddarth Kumar Das, MD, FICPProfessor and HeadDepartment of RheumatologyKG Medical University, Lucknow

S Irudaya Rajan, PhDProfessor, Centre for Development StudiesPrasaanth Nagar, Medical College,Thiruvananthapuram, Kerala

S Kaur, MA, PhD (Psychology)Department of Psychiatry, SRLN HospitalVaranasi, Uttar Pradesh

SN Mathuria, MS, MChProfessor and HeadDepartment of NeurosurgeryPostgraduate Institute of Medical Education& Research, Chandigarh

SP Misra, MD, DM, FRCP, FRCPE, FICPFACG, FNASc, FAMS

Professor and HeadDepartment of Gastroenterology andHepatology, Moti Lal Nehru Medical CollegeAllahabad, Uttar Pradesh

Sobia Nisar, MDAssistant ProfessorDepartment of Geriatric MedicineAll India Institute of Medical SciencesNew Delhi

S Rukmangatharajan, MD, DM, FMMCProfessor & HeadDepartment of RheumatologySri Ramachandra Medical College & ResearchInstitute, Porur, Chennai, Tamil Nadu

S Shankar, MD, DNB, MNAMS, FICP, FRCPProfessor (Internal Medicine)Rheumatologist & Clinical ImmunologistDepartment of Internal MedicineArmed Forces Medical College, PuneMaharashtra

S Sunitha, PhDResearch AssociateCentre for Development StudiesPrasanth Nagar, Medical CollegeThiruvananthapuram, Kerala

Subhash Balara, MS, MChAssistant ProfessorDepartment of Cardiothoracic and VascularSurgery, Dr SN Medical College, Jodhpur,Rajasthan

Subhash Varma, MDProfessor and HeadDepartment of Internal MedicinePostgraduate Institute of Medical Education& Research, Chandigarh

Subhash Yadav, MD, DNBAdditional ProfessorDepartment of EndocrinologySanjay Gandhi Postgraduate Institute ofMedical Sciences, Lucknow, Uttar Pradesh

Suganthi Ramchandran, MDResident, Department of PharmacologyAll India Institute of Medical SciencesNew Delhi

Sundeep Salvi, MD, DNB, PhD, FCCPDirector, Chest Research FoundationMarigold Complex Kalyaninagar, Pune

Sunil K Munshi, MD, Dip NBE, FRCP (London) FRCP (Edin)

Consultant PhysicianNottingham City Hospital; Honorary ClinicalLecturer, School of Medicine, NottinghamUniversity Hospitals NHS Trust, Hucknall RoadNottingham, UK

Sunil K Narayan, MD DM DNB FRCP (UK)Professor and HeadDepartment of NeurologyJawaharlal Institute of Postgraduate MedicalEducation and Research, Dhanvanthri NagarPondicherry

Sunita PaulOrthogeriatrician, Middlemore HospitalCounties Manukau, South Auckland, NZ

Suresh Kanchinadham, DNBAssistant ProfessorDepartment of RheumatologyNizam's Institute of Medical SciencesHyderabad, Andhra Pradesh

Suresh Sanchetee, MDChief Medical OncologistSanchetee Hospital and Cancer InstituteJodhpur, Rajasthan

Surinder S Rana, MD, DM, MAMS, FASGEAssistant ProfessorDepartment of GastroenterologyPost Graduate Institute of Medical Educationand Research, Chandigarh

Sushma Bhatnagar, MDProfessor and HeadAnaesthesiology, Pain and Palliative CareDr BR Ambedekar Institute Rotary CancerHospital, All India Institute of MedicalSciences, New Delhi

Sushma Sharma, MD, DM, DNBConsultant, Department of NeurologyAsian Institute of Medical SciencesNational Capital Region, Faridabad, Haryana

Tajamul H Shah, MDSenior Resident, Department of Internal andPulmonary Medicine, Sher-i-Kashmir Instituteof Medical Sciences, Soura, Srinagar, J&K

Tapas Das, MDProfessorDepartment of General Medicine andGeriatric Clinic, KPC Medical College &Hospital, Jadavpur, Kolkata

Thomas Kuriakose, DO, FRCS, DNBProfessor, Department of OphthalmologyChristian Medical College, VelloreTamil Nadu

Tony EteResidentDepartment of MedicineIPGME&R and SSKM Hospital, Kolkata

Uday C Ghoshal, MD, DNB, DM, FACG, RFFProfessor, Department of GastroenterologySanjay Gandhi Postgraduate Institute ofMedical Sciences, Lucknow, Uttar Pradesh

Ujjwal SonikaSenior ResidentDepartment of GastroenterologyAll India Institute of Medical SciencesNew Delhi

Umar Hafiz Khan, MDAssistant ProfessorRegional Geriatric CentreSher-i-Kashmir Institute of Medical SciencesSoura, Srinagar, Kashmir, J&K

Urmila Dhakad, MDAssistant ProfessorDepartment of RheumatologyKG Medical University, LucknowUttar Pradesh

Vaibhav Gupta, MDConsultant Medicine, Rockland HospitalQutab Institutional Area, New Delhi

Varun Chandra Alur, MDSenior Resident in EndocrinologyAmrita Institute of Medical Sciences, CochinKerala

Ved Chaturvedi, MD, DMProfessor and Senior ConsultantArmy Hospital (Research & Referral)New Delhi

Venugopal Kochiyil, DNB (PM&R) FAFRM (RACP), FFPMANZCA

Northern Adelaide Rehabilitation ServiceModbury Hospital Adelaide, Australia

Vibha Joshi, BDS, MPHAssistant ProfessorDepartment of Public HealthLachoo Memorial College, Jodhpur, Rajasthan

Vijay Kumar, MS, MChAssistant ProfessorDepartment of Surgical OncologyKing George Medical University, LucknowUttar Pradesh

Vikas Agarwal, MD, DMDepartment of Clinical ImmunologySanjay Gandhi Postgraduate Institute ofMedical Sciences, Lucknow, Uttar Pradesh

Vikas Suri, MD, DNBAssistant ProfessorDepartment of Internal MedicinePostgraduate Institute of Medical Education& Research, Chandigarh

Vikram Mathews, MD, DMProfessorDepartment of Clinical HaematologyChristian Medical College, VelloreTamil Nadu

Vinay Goyal, MD, DMProfessor of NeurologyDepartment of NeurologyAll India Institute of Medical SciencesNew Delhi

Vinay Joshi, MDVice Principal & HeadDepartment of Anaesthesiology and CriticalCare, Jodhpur Medical College & HospitalJodhpur, Rajasthan

Vinod Kumar, MDEmeritus ProfessorDepartment of MedicineSt Stephens Hospital, Delhi

Vishal Sharma, MD, DMPool Officer, Postgraduate Institute ofMedical Education & Research, Chandigarh

Vivek Mathew, MD, DM, DNBProfessor, Department of NeurologyChristian Medical College, VelloreTamil Nadu

Viswanathan Mohan, MD, PhD, DSc, FRCP, FNAMadras Diabetes Research Foundation &Dr Mohan's Diabetes Specialities CentreWHO Collaborating Centre forNon-communicable Diseases Preventionand Control, IDF Centre for EducationGopalapuram, Chennai

V Kurusu, PhDAssistant ProfessorDepartment of Business EconomicsKelkar Education Trust's VG Vaze Collegeof Arts, Science and Commerce, MumbaiMaharashtra

VP Sharma, MS (Orthopaedics), DNB (PMR) FACS, FIMSA

Director, ProfessorDepartment of Physical Medicine andRehabilitation, KG Medical UniversityLucknow, Uttar Pradesh

V Surekha, MDProfessor, Department of Geriatric MedicineChristian Medical College, VelloreTamil Nadu

XinQi Dong, MD, MPHChinese Health, Aging and Policy ProgramRush Institute for Healthy Aging, Hong KongRush University Medical Center, ChicagoIllinois, USA

YK GuptaProfessor and HeadDepartment of PharmacologyAll India Institute of Medical SciencesNew Delhi

Y Sathyanarayana RajuProfessor and HeadDivision of GeriatricsDepartment of MedicineNizam's Institute of Medical SciencesHyderabad, Andhra Pradesh

CONTENTS

PART I : GERONTOLOGY

SECTION 1: INTRODUCTION

Section Editor : AB Dey

1. Development of Geriatric Medicine in Indiaand Other Parts of World 2

– AB Dey, Prasun Chatterjee2. Demography of Aging in India 6

– S Irudaya Rajan, V Kurusu, S Sunitha3. Epidemiological Transition & Multi-morbidity 19

– AB Dey, Sobia Nisar4. Biological Basis of Aging: Theories and

Explanations 24– Ramesh Sharma, Preeticia Dkhar

5. Brain Aging and Associated Diseases 32– MK Thakur, Arpita Konar

6. Normative Structural and FunctionalChanges of Aging in Organ Systems 37

– PC Das7. Immunology of Aging 45

– Prasun Chatterjee8. Pharmacology of Aging 51

– YK Gupta, Suganthi Ramachandran

SECTION 2: SOCIAL GERONTOLOGY

Section Editor : Alka Ganesh

9. Impact of Globalization and ChangingFamilies on Older People in India 58

– Indira Jai Prakash10. Healthcare in Old Age and Role of Family 63

– AB Dey11. Care of Elderly: Problems and

National Initiatives 66– AM Khan, Pawan Kumar, Alka Ganesh

12. Physical Activity and Fitness inAging and Health 71

– C Shanthi Johnson13. Driving and Transportation in Elderly 76

– Alka Ganesh

14. Terminal Illness in Elderly 78– Alka Ganesh

SECTION 3: ETHICAL ISSUES

Section Editor : Ashish Goel

15. Caregiver Stress and Elder Abuse 82– Celia Chow, XinQi Dong,

Melissa Simon, Agnes Tiwari16. Ethical Issues in Geriatric Medicine 86

– Lesser AH17. Advance Directives 89

– MI Tamayo-Velazquez,N Blanco-Pinero, P Simon-Lorda

18. Immobility and Physical Restraints in Elderly 93– Rensa

19. Medical End of Life Decisions:Acts of Omission and Commission 98

– Hilde M Buiting

Part II : GERTIATRIC MEDICINE

SECTION 4: CLINICAL GERIATRICS

Section Editor : B Krishnaswamy

20. Principles and Practice of Geriatric Medicine 104– B Krishnaswamy, S Deepa

21. Clinical Evaluation of Older Patients 107– G Usha, K Umakalyani

22. Comprehensive Geriatric Assessment 112– B Krishnaswamy, M Senthilkumar

SECTION 5: SYNDROMIC MANAGEMENT

Section Editor : IS Gambhir

23. Dizziness in Elderly 115– IS Gambhir

24. Delirium in Elderly 119– IS Gambhir

25. Urinary Incontinence in Elderly 122– Dipanjan Bandyopadhyay,

Saptarshi Bishnu26. Immobility and Pressure Ulcer 127

– Jyotirmoy Pal, Ankit Srivastav,Tony Ete

27. Balance, Gait and Falls 131– IS Gambhir

SECTION 6: MANAGEMENT OF OLDER PATIENT

Section Editor : Tapas Das

28. Overview and History of GeriatricCare Management 136

– Tapas Das29. Principles of Geriatric Care Planning 138

– Nirmalendu Sarkar30. Models of Geriatric Care 141

– Arun Kumar Majumder, PS Karmakar31. Nursing Homes in Western Countries 149

– Noeline Whitehead, Shankar Sankaran32. Functional Assessment and Multidisciplinary

Management 153– Neelakshi Mahanta

33. Principles of Geriatric Critical Care 161– Rajnish Joshi, Saurabh Saigal,

Jaiprakash Sharma, AP Jain

SECTION 7: ISSUES IN GERIATRIC CARE

Section Editor : GS Shanthi

34. Quality and Planning of Care for Elderly 171– GS Shanthi, Uma Kalyani

35. Undernutrition and Older People 178– Renuka Visvanathan, Rachna Kucheria

PART III : SYSTEMIC DISORDERS

SECTION 8: INFECTIONS

Section Editor : Gita Sinha

36. Alterations in Host Defense among Elderly 186– Gita Sinha

37. Infectious Diseases: Diagnosis andManagement in Elderly 188

– Gita Sinha38. Tuberculosis in Geriatric Patients 192

– J Harikrishna, A Mohan

39. Human Immunodeficiency VirusInfection in Elderly 196

– D Prabath Kumar, A Mohan40. Antimicrobial Usage Among Elderly 203

– Gita Sinha41. Fever of Unknown Origin 206

– Arvind Jain

SECTION 9: CARDIOVASCULAR SYSTEM

Section Editor : Arvind Mathur

42. Effects of Aging on CardiovascularStructure and Functions 213

– Arvind Mathur, Harish Agarwal43. Coronary Artery Disease in Elderly 216

– Satya Gupta44. Valvular Heart Diseases in Elderly 220

– Sanjeev Sanghvi45. Heart Failure in Elderly 224

– Sanjiv Sharma46. Cardiac Arrhythmias 227

– Ramesh Thakur, Santosh Kumar Sinha47. Hypertension in Elderly 230

– Rahul Mehrotra48. Infective Endocarditis and Pericarditis

in Elderly 235– Chandra Mohan Varma,

Pradeep Eswarappa Haranahalli49. Peripheral Arterial Diseases 238

– Amit Kumar, Atul Mathur50. Venous Thrombo-Embolic Diseases 241

– Rohit Mathur51. Overview of Management of

Cardiovascular Diseases in Elderly 244– Ramesh Thakur, Santosh Kumar Sinha

52. Nonpharmacological Managementof Cardiac Diseases 248

– Naveen Kishoria53. Cardiac Surgery in Old Age 252

– Subhash Balara

SECTION 10: RESPIRATORY SYSTEM

Section Editor : Parvaiz A Koul

54. Investigations and Diagnosis ofRespiratory Diseases 254

– Umar Hafiz Khan

55. Respiratory Failure in Elderly 257– Parvaiz A Koul, Tajamul H Shah,

Pradeep Bhatia56. Infectious Diseases of the Respiratory

System 265– Randeep Guleria, N Loganathan

57. Diffuse Parenchymal Lung Disease 270– Parthasarathi Bhattacharya

58. Bronchial Asthma in Elderly 275– Komalkirti Apte, Sundeep Salvi

59. Chronic Obstructive PulmonaryDisease in Elderly 282

– Parvaiz A Koul, Umar Hafiz Khan60. Pulmonary Hypertension 287

– Ghulam Saydain61. Oxygen Therapy in Elderly 291

– Inderpaul Singh Sehgal, Ritesh Agarwal62. Diseases of Pleura 296

– Dharmesh Patel63. Sleep Disorders in Elderly 301

– Mohankumar Thekkinkattil

SECTION 11: ENDOCRINOLOGY AND METABOLISM

Section Editor : Vinod Kumar

64. Endocrinology of Aging – An Introduction 305– Vinod Kumar

65. Hormones and Aging: Physiologyand Evaluation 307

– Sanjay Kalra, Manash P Baruah66. Alterations in Pituitary and Adrenal

Function in Elderly 311– Eesh Bhatia, Subhash Yadav

67. Andropause and HormonalManagement of Aging 316

– RV Jayakumar, Varun Chandra Alur68. Sarcopenic Obesity in Postmenopausal

Women: A Silent Forerunner of Frailty 320– Rama Vaidya, Ashok DB Vaidya

69. Sexuality and Sexual Functions in Elderly 324– MK Garg, Sandeep Kharb

70. Thyroid Disorders in Elderly 329– Ashu Rastogi, Anil Bhansali

71. Management of Diabetes in Elderly 333– Rajeev Chawla

72. Obesity and Metabolic Syndrome in Elderly 337– Ranjit Unnikrishnan, Viswanathan Mohan

73. Metabolic Bone Disorders in Elderly 342– Sagar Modi, Ravinder Goswami

SECTION 12: GASTROENTEROLOGY

Section Editor : Premashis Kar

74. Investigations and Diagnosis ofGastrointestinal, Pancreatic andHepatobiliary Diseases 349

– Premashis Kar, Avishek Bagchi75. Syndromic Approach to Gastrointestinal

Symptoms 352– AC Anand, P Puri

76. Gastritis and Peptic Ulcer Disease 362– Ujjwal Sonika, Anoop Saraya

77. Gastrointestinal Bleeding in Elderly 368– Pradeep KR, Kayal Vizhi N, Naresh Bhat

78. Malabsorption Syndrome in Elderly 372– Uday C Ghoshal

79. Acute Viral Hepatitis in Elderly 377– Mallikarjun Sakpal, Ajay Duseja

80. Liver Abscess 382– MP Sharma, Vaibhav Gupta

81. Chronic Hepatitis 384– Narendra Bhargava, Amitava Goswami

82. Management of Cirrhosis in Elderly 387– Shivaram Prasad Singh, Sanjib K Kar

83. Disorders of Gall Bladder and Bile Duct 392– Deepak Amarapurkar

84. Acute and Chronic Pancreatitis in Elderly 395– Vishal Sharma, Surinder S Rana,

Deepak K Bhasin

SECTION 13: RENAL SYSTEM

Section Editor : Manish Chaturvedy

85. Renal Diseases in Geriatric Patients 399– Anand Banka, RK Sharma

86. Glomerular and TubulointerstitialDiseases in Elderly 404

– Narayan Prasad,Dharmendra Singh Bhadauria

87. Renovascular Disease in Elderly 410– Narayan Prasad,

Dharmendra Singh Bhadauria88. Urinary Tract Infections in Elderly 415

– Manish Chaturvedy

89. Fluid and Electrolyte Disorders in Elderly 418– Manish Chaturvedy

90. Drugs and Kidney 428– Manish Chaturvedy

SECTION 14: NEUROLOGY

Section Editor : Pratap Sanchetee

91. Investigations of NeurologicalDisorders in Elderly 431

– Amita Bhargava, Bharat Bhushan92. Stroke in Elderly 439

– Sunil K Munshi, Mohana Maddula93. Aging and Cognition 449

– Vivek Mathew,Kuruvilla Prasad Mathews

94. Parkinson’s Disease in Elderly 459– Bhom Raj R Thanvi

95. Central Nervous System Infections in Elderly 467– Sushma Sharma, Sunil Narayan

96. Disorders of Metabolism, Nutrition andAutonomic Nervous System 479

– Shyamal Kumar Das, Sandip Pal97. Epilepsy in Elderly 485

– Salil Gupta, Pratap Sanchetee98. Headache in Elderly 490

– K Ravishankar, Meghana Bhatnagar99. Cranial Nerves, Spinal Cord and

Peripheral Nerves 496– Shankar Prasad Gorthi

100. Motor Neuron Diseases in Elderly 506– Vinay Goyal, Chanchal Goyal,

Pratap Sanchetee101. Disorders of Speech in Elderly 512

– Apoorva Pauranik102. ICSOL in Elderly 521

– Ashish Aggarwal, Navneet Singla,SN Mathuriya

103. Normal Pressure Hydrocephalus 524– Navneet Singla, Ashish Aggarwal,

SN Mathuriya104. Traumatic Brain Injury in Old Age 526

– Navneet Singla, Ashish Aggarwal,SN Mathuriya

SECTION 15: PSYCHIATRY

Section Editor : Pratap Sanchetee

105. Epidemiology and Classification ofMental Disorders in Elderly 529

– Jai Sigh Yadav, S Kaur106. Psychoses in Old Age 533

– SC Tiwari, Dhananjay Chavan107. Management of Geriatric Depression 540

– Indira Sharma, Avishek Pathak108. Personality and Behavioural Disorders in

Older People 548– Anju Kuruvilla

109. Alcohol and Substance Use Among Elderly 553– Kaushik Chatterjee

110. Management of Psychiatric Disorders 559– Rajesh Gopalakrishnan

SECTION 16: MUSCULOSKELETAL DISORDERS

Section Editor : Siddarth Kumar Das

111. Clinical Evaluation of MusculoskeletalDisorders in Elderly 568

– Siddarth Kumar Das, Urmila Dhakad112. Osteoarthritis 573

– Siddarth Kumar Das,Shweta Agarwal

113. Gout in Elderly 578– Rohini Handa

114. Late Onset Rheumatoid Arthritis 581– Abhra Chandra Chaudhury

Ramnath Misra115. Systemic Lupus Erythematosus and

Systemic Sclerosis 586– Pooja Dhaon, Liza Rajasekhar

116. Spondyloarthropathies in Elderly 589– Ved Chaturvedi, Molly Thabah

117. Polymyalgia Rheumatica and GiantCell Arteritis 594

– S Rukmagtharajan118. Infectious Arthritis 597

– Monaliza Lyngdoh, Mohd Jamil119. Generalized Pain Syndromes 600

– Alakendu Ghosh120. Regional Pain Syndromes 604

– S Shankar, Amitabh Sagar

121. Low Back Pain 608– Urmila Dhakad, Siddharth K Das

122. Miscellaneous Systemic RheumaticDisorders in the Elderly 612

– Shanmuganandan Krishnan123. Inflammatory Myopathies in Elderly 615

– Hardeep Singh Malhotra,Maneesh Kumar Singh,Kiran Preet Malhotra

124. Neoplasms of Joint and RheumatologicalManifestations of Malignancies 619

– Suresh Kanchinadham125. Musculoskeletal Problems of

Endocrine and Renal Diseases 624– Asia Mubashir

126. Rehabilitation of Elderly withJoint Diseases 627

– VP Sharma127. Mechanisms of Inflammation:

A Geriatric Perspective 629– Santosh Kumar Mandal,

Ruchika Goel, Debashish Danda128. Autoimmunity 637

– Deepak Tripathi, Vikas Agarwal

SECTION 17: HAEMATOLOGY

Section Editor : Kuruvilla Prasad Mathews

129. Anaemia in Elderly 639– Subhash Varma, Vikas Suri

130. Management of Acute Leukemiain Elderly 644

– Punit Jain, Chepsy C PhilipVikram Mathews

131. Lymphoid Neoplasms in Elderly 651– Auro Viswabandya

132. Paraproteinemias and Multiple Myeloma 655– Aby Abraham

133. Myelodysplastic Syndromes in Elderly 659– Biju George

134. Anticoagulation in Elderly 665– Surekha V, Benny Paul Wilson

SECTION 18: GERIATRIC ONCOLOGY

Section Editor : Suresh Sanchetee

135. Cancer in Old Age: Biology & Epidemiology 670– Suresh Sanchetee, Ashok Kalwar

136. Geriatric Oncology: Evaluationand Management 673

– Rajat Saha, R Ranga Rao137. Hormone-dependant Malignancies

in Elderly: Endometrium, Breast andProstate 676

– Lalit Kumar, Ajay GogiaReenu Jain, Priya Tiwari

138. Carcinoma Gallbladder and Pancreas 682– SP Misra, Kapil Sharma

139. Colon and Gastric Cancer in Elderly 687– Rakesh Kochhar

Pradeep Kumar Siddappa140. Neoplasm of Lung 691

– Suresh Sanchetee, Amita Sanchetee141. Surgery in Geriatric Malignancy 695

– Vijay Kumar, Sanjeev Misra142. Pain in Elderly 698

– Suresh Sanchetee, Akhil Kapoor143. Palliative Care for Terminal Cancer 703

– Alka Goyal, Sushma Bhatnagar

SECTION 19: MISCELLANEOUS DISORDERS

Section Editor : Harish Agarwal

144. Diseases of Skin 706– Renu George, Poonam Agrawal

145. Diseases of Eye in Elderly 715– Thomas Kuriakose

146. Diseases of Ear, Nose and Throat in Elderly 719– Rajagopalan Raman

147. Disorders in Elderly Women 723– Aruna Kekre, Anne George

148. Oral Changes in Geriatric Population 728– Nitin Joshi, Vibha Joshi, Santosh Patil

149. Orthogeriatrics 731– Sunita Paul

150. Perioperative Considerations in Elderly 735– Vinay Joshi, Sadik Mohammed

151. Role of Imaging in Geriatric Care 740– Kirti Rana

152. Role of Complementary and AlternativeMedicine in Elder Care 747

– Prakash Sanchetee

SECTION 20: REHABILITATION

Section Editor : Maria Crotty

153. Rehabilitation and Older People 751– Rabin Bhandari

Venugopal Kochiyil, Maria Crotty

SECTION 21: PREVENTIVE GERIATRICS

Section Editor : Y Sathyanarayana Raju

154. Successful Aging and Health Belief Model 775– Y Sathyanarayana Raju

155. Geriatrics and Stem Cell Research 778– Pramod C Rath, Jitendra K Chaudhary

156. Policy for Older Person 786– Mathew Cherian

157. The United Nations and Approachesto Aging 800

– Joseph Troisi158. Interventions for Healthy Aging 812

– Ramesh Sharma, Preeticia Dkhar159. Art and Science of Successful Aging 816

– Pratap Sanchetee

Index 821