Modern Geriatrics Series – serie

Public health and antiseptic measures, vaccination and antibiotics, have all contributed to the reduction in the incidence and impact of diseases due to infections in younger age groups. Unfortunately, however, infections remain a very important cause of both morbidity and mortality in the elderly. The reasons for the continued effect of infection on the older person are multifactorial. Firstly, the immune response alters with age and may result in opportunistic infections. Secondly, while the diagnosis and management of some infections in the elderly can present little problem, altered signs and symptoms in other older patients, especially the old elderly, can cause considerable diagnostic difficulties with resulting delays in definitive treat­ ment. Thirdly, a degree of complacency can develop because some infec­ tions are seldom seen and, consequently, may not be considered in the differential diagnosis. The presence of other, more common, diseases serve only to distract attention and confuse the diagnosis. Since the number of elderly people is increasing, the need for continued high standard of skill in diagnosis and management is emphasized. These factors are considered in this book by contributors who are experi­ enced in their fields. The altered immune response with age, the appropriate use of antibiotics in older people and the latest developments of therapy are reviewed. Infections in various body systems are considered, with emphasis on differing presentations and diagnostic difficulties, ways of improving diagnostic skills as well as management and treatment.

Most patients in developed nations with medical problems requiring hospital care are elderly. Increasingly the dividing line between general internal medi­ cine and acute geriatric medicine is becoming more blurred. It is, nevertheless, apparent that some elderly patients on medical or sub-specialty hospital wards become 'bed blockers'. Why? Also, why are 'bed blockers' less of a problem on an acute geriatric ward? Many clinicians believe this is related to a faster access to the long-stay beds of the geriatric unit. Even a brief study of hospital operating statistics will show this is not and cannot be the case. When geria­ tricians are asked to see elderly 'bed blockers' on colleagues' wards they approach with anxiety because these patients often have to be placed on a long waiting list for these scarce and very expensive continuing care beds. Do geria­ tricians see different acute medical problems compared with their colleagues? The answer is not immediately obvious, though geriatricians are likely to receive more potential 'bed blockers' than their general medical colleagues. How is it then, that geriatricians seem to cope better than their colleagues? All geriatricians have experience of general internal medicine but the opposite unfortunately does not hold. This book is written in the hope of redressing the imbalance.