Speech-language pathologists are professionals who specialize in understanding the science behind the process of human communication. As a member of the interdisciplinary team in a medical setting, speech-language pathologists diagnose and treat disorders of speech sound production, resonance, voice, fluency, language, cognition, feeding, and swallowing. At times, the therapists encourage development of untapped potential and skill. In working with those with chronic disabilities, the speech-language pathologist may focus on the appreciation and development of the patients’ preserved abilities. Older adults exhibit retrieval difficulties in spelling, suggestive of challenges with word phonology and orthography. In the acute hospital arena, the speech-language pathologist serves to identify cognitive communication or swallowing deficits, educates patients and families regarding areas of concern, and suggests appropriate discharge treatment options aimed to enhance self-sufficiency. The goal of intervention is not geared to “cure” a disability, but rather, to foster an optimal level of independence and function.
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Physical modalities are used as adjuncts in a comprehensive therapy program that includes exercise, medication, adaptive equipment, and patient education. This chapter discusses various physical modalities as well as the effects of extended bedrest and the evaluation of functional independence. The Functional Independence Measure score, one of the common measurement scales used for this type of assessment, is presented. The chapter also discusses the effects of acute hospitalization and deconditioning in the elderly and presents the summary of adaptations to exercise in the elderly.
The importance of physical activity and sports for health benefits has continually been shown for both able-bodied and disabled individuals; however, 56% of people with disabilities do not participate in sports. With the advent of the Paralympic Games, adaptive sports have become a platform for promoting health and wellness among those with disabilities. It has also led to studies on sports physiology, as well as injury and illness epidemiology, in athletes with disabilities to expand our understanding of how to keep them actively engaged. Adaptive sports provide a safe and effective means of competitive play for those who have functional impairments that would not allow them to play otherwise. This chapter provides information on the history, equipment needed and/or required, medical coverage logistics, emergencies, epidemiology, and a brief discussion of common injuries in adaptive sports. The main focus is to emphasize the participants' athletic achievements rather than their disabilities.
- Go to chapter: Issues in Recruiting Elderly, Underserved, Minority, and Rural Populations (and Solutions)
Clinical trials are often considered the gold standard of care for cancer treatment. The National Cancer Institute reports less than 3% of adult cancer patients participate in clinical trials and participation rates among certain vulnerable populations (elderly, racial and ethnic minority, rural, and low social economic status patients) are even lower. This chapter focuses on understanding the cancer burden in these identified populations and describing barriers to accrual, followed by effective solutions to addressing barriers in these populations. It uses two frameworks to describe clinical trial accrual in vulnerable populations. First, the Accrual to Clinical Trials framework, which posits that the majority of accrual barriers can be categorized as patient, system, and provider factors that influence or impact accrual to clinical trials. The second framework is Multilevel Model of Health Disparities, which states that disparities interact synergistically to promote reduced access and increased risk of developing and dying from disease.
The current gold standard for assessment of older adults with cancer is a comprehensive geriatric assessment (CGA). The primary purpose of a screening tool in geriatric oncology is to provide a busy clinician with a means to quickly identify patients in need of a CGA. This chapter outlines the G8, Vulnerable Elders Survey (VES-13), and other screening tools used for older adults with cancer. It discusses the evidence for the benefits and limitations of these screening tools. The chapter provides recommendations for how to implement geriatric screening tools into routine oncology practice. In addition to being used as a screening tool, the G8 has also been studied to predict treatment toxicity, functional decline and falls, and overall survival. Investigators have also assessed the predictive ability of the VES-13 in older patients with cancer for treatment-related toxicity and overall survival.
This book provides a concise and practical resource to assist in real-time, clinical decision making for managing lung cancer. The first two chapters deal with epidemiology and etiology of lung cancer, lung carcinogenesis, lung cancer genetics, epigenetics, and tumor microenvironment. Environmental Tobacco Smoke (ETS) is associated with a 20% to 40% increase in lung cancer risk. The third chapter provides an overview of several of the driver oncogenes that are important in the pathogenesis of non–small-cell lung carcinoma (NSCLC) and have emerged as targets for therapeutic approaches. The advent of molecular profiling and targeted therapy renewed interest in the distinguishing between the major subtypes of NSCLC: adenocarcinoma (ADC), squamous cell carcinoma (SqCC) and large cell lung carcinoma (LCLC). The fourth and fifth chapters deal with screening and diagonosis of lung cancer. This is followed by four chapters which describe the management of early stage, locally advanced stage, advanced stage, and recurrent NSCLC, and their respective treatment therapies such as video-assisted thoracic surgery, robotic-assisted thoracic surgery, sequential induction chemotherapy, necitumumab, maintenance therapy, and sequential single-agent therapy. Chapters 10 and 11 discuss the management of limited-stage and extensive-stage small-cell lung carcinoma (SCLC) and the treatment therapies. Lung cancer is a disease of the elderly, and accordingly chapter 13 covers the management of elderly and high-risk patients suffering from this disease. This is followed by a focus on the management of neuroendocrine tumors (NET), pleural mesothelioma, and thymic tumors. The book ends with a discussion on palliative care in thoracic oncology.
This chapter presents a discussion of special considerations in the management of stroke recovery and rehabilitation for older adults. It describes the incidence, prevalence, and economic impact of stroke in the aging population. The chapter discusses the management of common risk factors for recurrent stroke. It addresses challenges to successful rehabilitation in older adults with stroke, and suggests strategies to overcome barriers and optimize outcomes. Factors, such as onset stroke severity, preexisting disability, and atrial fibrillation (AF), are significant age-related independent predictors of prognosis after stroke. Poststroke guidelines recommend transfer to a stroke-specific rehabilitation unit as soon as possible to ensure early mobilization; availability of speech, physical, and occupational therapy; rehabilitation psychology; and the social support derived from interaction with other stroke survivors. A recent literature review indicated that most studies on economic impact of stroke emphasize the short-term costs associated with hospital and intensive care unit (ICU) care.
- Go to chapter: Survivorship Care for Older Adults With Cancer: The Role of Primary Care Physicians and Utility of Care Plans as a Communication Tool
Survivorship Care for Older Adults With Cancer: The Role of Primary Care Physicians and Utility of Care Plans as a Communication Tool
The four pillars of survivorship care: surveillance for recurrence and secondary cancers, encouragement of beneficial lifestyle choice, management of long-term systemic therapy sequelae, and addressing of psychosocial burdens associated with a cancer diagnosis, must be integrated with care for preexisting comorbid medical conditions typically present among older patients. This chapter summarizes how to best leverage the survivorship care plan (SCP) to ameliorate problems in and enhance geriatric survivorship care, both by addressing specific elements of the SCP itself and by considering how SCPs optimize transitioning patients to nononcologist-driven survivorship care. It underscores the importance of adapting SCPs to not only meet the unique issues of an older population, but also to act as a potentially critical communication tool to be disseminated among all medical specialists, including primary care providers, who are providing care to an older adult with a history of cancer.
This book provides a comprehensive and concise visual reference on acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) seen in children and adults. It addresses all aspects of AML and ALL including their risk factors, cytogenetics and mutational characteristics, diagnoses, clinical management and prognoses which are imperative and challenging for medical students, residents, hematology and medical oncology fellows, and even community oncologists and hematologists. The book focuses on issues surrounding the epidemiology, diagnosis, treatment, and overall management in both pediatric and elderly patients; psychosexual issues that arise as a consequence of both the disease and treatment; and the complex field involving the development, approval and regulatory aspects of new treatment strategies. It stimulates readers to develop new and refreshing concepts that, in turn, could lead to cures and enhanced quality of life for children and adults suffering from acute leukemias. The book contains over 40 tables and over 220 illustrations, histologic photomicrographs, flow diagrams, graphs, and schemata with detailed figure legends. The result is a visually engaging book that is easy to read, review, and remember. The book also provides helpful and evidence-based treatment recommendations when providing induction therapy, consolidation therapy, and bone marrow transplantation.
Treatment of older colorectal cancer patients presents different challenges than treatment of younger patients. This chapter discusses the concept of frailty as it impacts chemotherapy decision making, and reviews some of the most common challenges that may be faced by medical oncologists taking care of older colorectal cancer patients. Patients with more deficits based on geriatric assessment (GA) are considered to be frail. Cancer treatment decision making is based on GA and organ function of older colorectal cancer patients. The chapter describes treatment decision making for older cancer patients with localized colorectal cancer and metastatic colorectal cancer. Be cautious about the use of oxaliplatin in adjuvant setting and metastatic disease, especially if the patient suffers from neuropathy. It recommends chemotherapy toxicity calculators when deciding on number and dose of agents. Administering more than two lines of chemotherapy to metastatic colorectal cancer patients older than age 75 has extremely limited benefit.