field of study or have been identified as up‐and‐coming geriatricians and scientists who in the years to come will continue to lead the campaign for better high‐quality medical care for all older people globally.
This Sixth Edition has been positively facilitated by the addition of two new editors: Matteo Cesari from Italy and Medha Munshi from the United States. Both are international experts with significant university appointments and strong reputations for excellent clinical science. We have also been generously supported for this Sixth Edition by the tremendous backing of four new associate editors: Ahmed Hafiz (UK), Milta Little (US), Julien Delrieu (France), Beatrice Arosio (Italy), and Suzanne Salamon (US). They have tirelessly undertaken their roles and responsibilities with great professionalism and skill.
This international textbook has been particularly challenging not only because of the immense field it covers in two volumes with more than 130 chapters, but also because of the impact of the Covid‐19 pandemic. Whilst the textbook prides itself on ensuring that the majority of chapters are written by practising clinicians, this has created dilemmas on many occasions for those clinicians wishing to complete chapters when their whole day or week was taken up with Covid‐related duties. It is a real tribute that those authors affected by Covid‐19 managed to complete their writing tasks.
Modern geriatric medicine is a discipline that has now universally established itself as distinct and separate from general internal medicine. Although many of the clinical and scientific principles are similar, geriatric medicine requires a greater understanding of ageing and age‐related pathophysiology in order to understand the varied presentation of disease in old age and deliver targeted medical care. It also requires a remarkable commitment to examining how environmental and social factors influence care and prognosis. In the future, of course, there will be a need for a greater emphasis on preventative care. We hope this textbook will influence and inspire future geriatricians to strive for excellence as always.
Alan J. Sinclair
John E. Morley
Bruno Vellas
Matteo Cesari
Medha Munshi
Foreword
This Sixth Edition of Pathy’s Principles and Practice of Geriatric Medicine, first published in 1990, continues to be a valuable and authoritative resource for healthcare professionals involved in the care of older patients. Each subsequent edition has been revised and reorganized, always with the goal to provide an accessible, updated, practical source of consultation. Although particularly intended for geriatricians and gerontologists, this book is also a resource not easily obtained elsewhere for anyone whose work connects with the field of ageing and/or who cares for older people.
This edition of the textbook has been deeply revised; new chapters have been added to reflect the recent enormous increase in the knowledge base of gerontology, as well as in clinical medicine and healthcare systems. Although its main focus is geriatric medicine, the first part of the book deals with the biological, psychological and social aspects of aging, which are deeply relevant to the health of older people. The main part of the book deals with the clinical aspects of geriatric medicine, providing comprehensive coverage of the major diseases affecting the older population, without unnecessary duplication of topics presented in textbook of Internal Medicine. The third part deals with global healthcare systems; special attention is given to geriatric education and quality of care issues, which have changed with recent progress in medical research and clinical practice.
The ageing of the population represents societal challenges and their enormous and multifaced impact. This trend is impacting not only established countries but also emerging countries such as China. This book dedicates specific chapters to the healthcare systems and geriatric medicine practices in selected developed and developing countries. I interpret this as an attempt to raise awareness about the critical link between ageing and healthcare systems and as a stimulus to promote rigorous and coordinated international research in geriatric medicine. The health of the elderly population is of paramount importance in all countries of the world because it is one of the main determinants of social and economic well‐being. International collaborations will help us address the challenges and opportunities of global ageing and prepare for a better future.
Many outstanding authors of international repute have brought a wealth of clinical experience and scientific expertise in the field of gerontology and geriatric medicine to their chapters. I wish to congratulate each of them and the editors for courageously taking the lead on such an important initiative; I am confident that this textbook will continue to be an invaluable tool for geriatricians and gerontologists in the years to come.
Stefania Maggi
Research Director
CNR Aging Branch‐IN
Italy
Past President, EuGMS
Introduction: Historical perspectives
Michael J. Denham1 and John E. Morley2
1Wellcome Trust Centre for the History of Medicine at UCL, London, UK
2Saint Louis University Medical Center and St Louis Veterans’ Affairs Medical Center, St Louis, Missouri, USA
This original chapter from the 5th edition has been lightly edited by Alan Sinclair (Editor).
Introduction
The broad subject of old age has attracted the attention of writers and philosophers for many centuries. It contains the interrelated topics of the theories of ageing, how to increase longevity, and the medical management of sick elderly people. Initially, the first two themes attracted the most attention. It was not until the twentieth century that literature relating to medical care came to the fore.
The earlier writers on old age
Early writers such as Hippocrates, Cicero, Galen, Roger Bacon, and Francis Bacon discussed old age in general terms pointing to features such as skin changes, reduction in physical strength, and deteriorating memory, sight, and hearing. None were sure of the cause(s) of old age. Theories ranged from incorrect diet through loss of heat to loss of moisture. Although the basis of growing old was unclear, several philosophers thought that a healthy old age could be promoted by keeping active, eating sensibly, and exercising regularly.
Later, British writers of the eighteenth and nineteenth centuries, such as Sir John Floyer, Sir John Hill, Sir Anthony Carlisle, Professor George Day, and Sir John Sinclair, wrote about old age and how life might be prolonged, but devoted limited attention to medical management of disease in older people. They generally considered it impossible to turn an elderly man into a young person but agreed that much could be done to make later life healthy. Lifestyle was important. They recommended wise eating of easily digestible foods taken at regular intervals, exercising regularly, ensuring good sleep, keeping clean, wearing warm clothing, and avoiding constipation. In 1863, Dr Daniel Maclachlan, medical superintendent at the Royal Hospital Chelsea, criticised the lack of English literature relating to old age and pointed out that precise diagnosis could be difficult in older people because several diseases could exist simultaneously. In 1882,
