cmdt geriatrics practice in general medicine, Thesis of Medicine

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CURRENT

Diagnosis & Treatment

Geriatrics

a LANGE medical book

CURRENT

Diagnosis & Treatment

Geriatrics

Second Edition

Editors

New York Chicago San Francisco Athens London Madrid Mexico City Milan New Delhi Singapore Sydney Toronto

Cyrus Ahalt, MPP Clinical Research Coordinator Division of Geriatrics University of California, San Francisco San Francisco, California

Helen Chen, MD Chief Medical Officer Hebrew SeniorLife Health Care Services and Hebrew Rehabilitation Center Boston, Massachusetts Clinical Professor of Medicine Division of Geriatrics University of California, San Francisco San Francisco, California

Rebecca Conant, MD UCSF Housecalls Physician Medical Director, UCSF Home Health Associate Clinical Professor of Medicine Division of Geriatrics University of California, San Francisco San Francisco, California

C. Seth Landefeld, MD Spencer Chair of Medical Science Leadership Chair, Department of Internal Medicine University of Alabama at Birmingham Birmingham, Alabama

Christine Ritchie, MD, MSPH Professor of Medicine Harris Fishbon Distinguished Professor University of California, San Francisco The Jewish Home of San Francisco The San Francisco VA Medical Center San Francisco, California

Michi Yukawa, MD, MPH Medical Director of the Community Living Center San Francisco VA Medical Center Associate Clinical Professor of Medicine Division of Geriatrics University of California, San Francisco San Francisco, California

Brie A. Williams, MD, MS Associate Professor of Medicine Associate Director, Program for the Aging Century Division of Geriatrics University of California, San Francisco Medical Director, Geriatrics Clinic San Francisco VA Medical Center San Francisco, California

Anna Chang, MD Associate Professor of Medicine Associate Director, Program for the Aging Century Division of Geriatrics Department of Medicine Director, Foundations of Patient Care University of California, San Francisco San Francisco, California

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Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.

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vi CONTENTS

8. Prevention & Health Promotion 35

Dandan Liu, MD & Louise C. Walter, MD Screening Issues for the Geriatric Population 35 Geriatric Syndromes 35 Health-Related Behaviors 39 Immunizations 40 Endocrine Disorders 41 Cardiovascular Disease 42 Cancer 43

9. Principles of Prescribing for Older Adults 46 Michael A. Steinman, MD & Holly M. Holmes, MD Geriatric Principles 46 Drug Metabolism and Physiologic Effects in Older Adults 46 Geriatric Therapeutics 47 Prescribing for Older Adults 53 Adherence 55 Managing Complexity 56 Prescribing Across the Care Continuum 57 10. Addressing Multimorbidity in Older Adults 59

Cynthia M. Boyd, MD, MPH & Christine Ritchie, MD, MSPH Background and Definitions 59 Multimorbidity and Health Outcomes 59 Clinician Challenges in the Care of Older Adults with Multimorbidity 59 General Considerations in the Care of Multimorbid Older Adults 60

11. Geriatrics & Palliative Care 63

John G. Cagle, PhD, MSW & Eric W. Widera, MD Overview of Palliative Care 63 Psychological, Spiritual, and Social Issues 63 Communication, Decision Making, and Advance Care Planning 63 Challenges to Providing Palliative Care in Long-Term Care Settings 64 Caring for Family Members: Grief and Bereavement 67

12. Ethics & Informed Decision Making 69

Alexander K. Smith, MD, MS, MPH & Bernard Lo, MD Ethical Issues in the Care of Older Adults 69 Decision-Making Capacity and Informed Decision Making 69 Advance Care Planning and Advance Directives 71 Surrogate Decision Making 71 Balancing Promotion of Independence and Patient Safety 72

Section II. Care Settings

13. Transitions and Continuity of Care 75 Lynn A. Flint, MD General Principles in Older Adults 75 Defi nitions 75 Background 75 Adverse Events During Transitions 76 Barriers to Successful Care Transitions 76 Overcoming the Barriers: Best Practices 77 Evidence-Based Interventions 77 Innovations 78 Conclusion 78 14. Ambulatory Care & the Patient-Centered Medical Home 80

Helen Kao, MD General Principles in Older Adults 80 Personal Physician 80 Physician Directed Medical Practice 81 Whole-Person Orientation 81 Care Coordination and Integration 81 Quality and Safety 81 Enhanced Access 82

15. Providing Quality Care to Older Adults in the Emergency Department 83 Gallane D. Abraham, MD & Corita R. Grudzen, MD, MSHS, FACEP General Principles 83 Models of Emergency Care 83 Structural Enhancements 84 Financing 84 Clinical Care 84 Future of Emergency Care 85

CONTENTS vii

16. Hospital Care 87

Kathryn J. Eubank, MD, Edgar Pierluissi, MD, & C. Seth Landefeld, MD General Principles in Older Adults: Hazards of Hospitalization 87 Successful Models of Care 88 Approach to the Hospitalized Older Adult 89 Therapy 91 Prevention 92 Transitioning from Hospital to Home 93

17. Perioperative Care in Older Surgical Patients 95

Lawrence Oresanya, MD & Emily Finlayson, MD, MS General Principles in Older Adults 95 Surgical Risk in the Older Adult 95 Clinical Care 96 Models of Surgical Care 98

18. Long-Term Care, Nursing Home, & Rehabilitation 99 Theresa A. Allison, MD, PhD General Principles in Older Adults 99 Long-Term Care in the Community 99 Institutional Long-Term Care 100 Hospice and End-of-Life Care 102 19. Home-Based Care 104

Jessica L. Colburn, MD, Jennifer L. Hayashi, MD, & Bruce Leff, MD Preventive Home Care/ Geriatric Assessment 104 Medical House Calls 104 Posthospitalization Case Management & Transitional Care Models 104 Home Rehabilitation 104 Hospital at Home 104 Eligibility Requirements 105 Payment Denials 106 Innovations in Care Delivery 106 Medicaid 107 Area Agencies on Aging 107 Postacute Hospitalization & Home Rehabilitation Care 107 Home Care & Assessments 107 House Calls & Home-Based Primary Care 107

20. The Aging Traveler 109

Gerald Charles, MD General Principles in Older Adults 109 Overview of Travel Problems 109 Risk of Venous Thromboembolism Due to Travel 109 Resources About Travel Risks 110 Ship Travel 110 Air Travel 111

Section III. Common Conditions

in Geriatrics

21. Delirium 115 Tammy Ting Hshieh, MD & Sharon K. Inouye, MD, MPH 22. Cognitive Impairment & Dementia 123

Kaycee M. Sink, MD, MAS & Kristine Yaffe, MD

23. Cerebrovascular Disease 135

Daniel Antoniello, MD

24. Parkinson Disease & Essential Tremor 141

Nicholas B. Galifianakis, MD, MPH & A. Ghazinouri, MD Parkinson Disease 141 Essential Tremor 148

25. Falls & Mobility Disorders 150 Deborah M. Kado, MD, MS & Daniel Slater, MD, FAAFP 26. Osteoarthritis 159

C. Kent Kwoh, MD & Yong Gil Hwang, MD

27. Osteoporosis & Hip Fractures 169

Rubina A. Malik, MD, MSc

28. Coronary Disease 178

Sanket Dhruva, MD & Melvin Cheitlin, MD Acute Coronary Syndrome 180 Chronic Coronary Heart Disease 185

CONTENTS ix

42. Diabetes 305

Josette A. Rivera, MD, Jessamyn Conell-Price, MS, & Sei Lee, MD, MAS

43. Anemia 314

Gary J. Vanasse, MD

44. Common Cancers 321

Joanne E. Mortimer, MD, FACP & Janet E. McElhaney, MD Breast Cancer 321 Lung Cancer 323 Colorectal Cancer 324 Pancreatic Cancer 324 Ovarian Cancer 325 Leukemia 325 Lymphoma 325

45. Depression & Other Mental Health Issues 328

David Liu, MD, MS, Mary A. Norman, MD, Bobby Singh, MD, & Kewchang Lee, MD Depression 328 Suicide 333 Bipolar Disorder 333 Anxiety & Stress Disorders 334 Schizophrenia & Psychotic Disorders 337

46. Sexual Health & Dysfunction 340

Angela Gentili, MD & Michael Godschalk, MD

47. Common Infections 347

Lona Mody, MD, MSc, James Riddell IV, MD, Keith S. Kaye, MD, MPH, & Teena Chopra, MD, MPH Urinary Tract Infections 348 Respiratory Tract Infections 352 Gastrointestinal Infections 353 Skin and Soft-Tissue Infections 354 Prosthetic Joint Infections and Osteomyelitis 355 HIV/AIDS 356

48. Pressure Ulcers 359

David R. Thomas, MD, FACP, AGSF, GSAF

49. Common Skin Disorders 367 Christine O. Urman, MD & Daniel S. Loo, MD Seborrheic Keratosis 367 Epidermal Inclusion Cyst 367 Warts (Verruca Vulgaris & Verruca Plantaris) 368 Onychomycosis 369 Dry Skin, Pruritus, & Asteatotic Dermatitis 370 Seborrheic Dermatitis 372 Stasis Dermatitis 372 Psoriasis 373 Rosacea 374 Contact Dermatitis 375 Drug Eruption (Morbilliform) 376 Herpes Zoster 376 Scabies 378 Bullous Pemphigoid 379 Actinic Keratosis 380 Basal Cell Carcinoma 381 Squamous Cell Carcinoma 382 Melanoma 382 50. Sleep Disorders 384 Diana V. Jao, MD & Cathy A. Alessi, MD Insomnia 384 Sleep Apnea 388 Periodic Limb Movement During Sleep & Restless Legs Syndrome 388 Narcolepsy 389 Circadian Rhythm Sleep Disorders 390 REM Behavior Disorder 390 Sleep Problems in Special Populations 390 51. Oral Diseases & Disorders 392

Dick Gregory, DDS, FASGD, Bonnie Lederman, DDS, BSDH, & Susan Hyde, DDS, MPH, PhD, FACD

Section IV. Common Clinical

Scenarios in Geriatrics

52. Evaluating Confusion in Older Adults 399

Caroline Stephens, PhD, MSN

x CONTENTS

53. Addressing Polypharmacy & Improving Medication Adherence in Older Adults 404

David Sengstock, MD, MS & Jonathan Zimmerman, MD, MBA, FACP Problems Caused by Polypharmacy 404 Unprescribing: Intervening to Reduce Polypharmacy 405 Adherence 407

54. Managing Persistent Pain in Older Adults 410 Vyjeyanthi S. Periyakoil, MD 55. Considering Anticoagulation in Older Adults 417 Anita Rajasekhar, MD, MS & Rebecca J. Beyth, MD, MSc Available Classes of Anticoagulant Therapy 417 Management of Bleeding in Older Patients on Anticoagulants 423 56. Assessing Antiaging Therapies for Older Adults 425

Milta O. Little, DO & John E. Morley, MB, BCh Antiaging Therapies 425 Ethical and Legal Issues with Antiaging Therapies 425

57. Considering Complementary & Alternative Medicines for Older Adults 430 Milta O. Little, DO & John E. Morley, MB, BCh Massage and Chiropractic Therapy 430 Herbs & Supplements 431 Other Forms of Alternative or Complementary Medicine 434 58. Managing Misuse of Alcohol & Psychoactive Prescription Medications in Older Adults 436 Frederic C. Blow, PhD & Kristen L. Barry, PhD Health Risks Associated with Hazardous and Harmful Use in Older Adults 436 Psychoactive Medications 437 Defi nitions to Guide Screening and Interventions 437 Brief Interventions 441 59. Assessing Older Adults for Syncope Following a Fall 443

Natalie A. Sanders, DO, FACP & Mark A. Supiano, MD General Approach to the Patient with Falls or Syncope 443 How Falls and Syncope Overlap 444 When to Consider Syncope as a Cause of Falls 444 Common Diagnostic Categories to Consider 445

60. Treating Headaches in Older Adults 447

Katherine Anderson, MD & Jana Wold, MD

61. Managing Vision Impairment in Older Adults 451

Meredith Whiteside, OD Normal Changes in the Aging Eye 451 Cataracts 452 Age-Related Macular Degeneration 453 Diabetic Retinopathy 454 Glaucoma 455 Systemic Medications and Glaucoma 458 Visual Symptoms Indicating Need for Urgent Referral to an Eye-Care Specialist 458

62. Managing Hearing Impairment in Older Adults 460 Dane J. Genther, MD & Frank R. Lin, MD, PhD 63. Addressing Chest Pain in Older Adults 468 Christina Paruthi, MD & Miguel Paniagua, MD, FACP 64. Addressing Dyspnea in Older Adults 472

Leslie Kernisan, MD, MPH

65. Managing Joint Pain in Older Adults 478

Lisa Strano-Paul, MD Gout 478 Calcium Pyrophosphate Crystal Disease 479 Polymyalgia Rheumatica 480

66. Managing Back Pain in Older Adults 482 Una E. Makris, MD & Leo M. Cooney Jr, MD

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xiii

Authors

Gallane D. Abraham, MD Assistant Professor Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York, New York Providing Quality Care to Older Adults in the Emergency Department

Gunnar Akner, MD, PhD Professor in Geriatric Medicine Senior Physician Specialized in Geriatric Medicine Internal Medicine and Clinical Nutrition School of Health and Medical Sciences Örebro University Örebro, Sweden International Perspectives in Geriatric Care (Sweden)

Cathy A. Alessi, MD Professor of Medicine Director, Geriatric Research, Education and Clinical Center (GRECC) Chief, Division of Geriatrics VA Greater Los Angeles Healthcare System Department of Medicine VA Greater Los Angeles Healthcare System David Geffen School of Medicine at University of California, Los Angeles Los Angeles, California

Sleep Disorders

Gretchen E. Alkema, PhD Vice President, Policy and Communications The SCAN Foundation Long Beach, California

Public Policy Intersecting with an Aging Society

Theresa A. Allison, MD, PhD Associate Professor of Medicine and Family & Community Medicine Division of Geriatrics University of California, San Francisco San Francisco, California

Long-Term Care, Nursing Home, & Rehabilitation

Katherine Anderson, MD Assistant Professor Division of Geriatrics Department of Internal Medicine University of Utah Salt Lake City, Utah Treating Headaches in Older Adults

Sik Kim Ang, MB, BCh, BAO Consultant in Geriatric and Palliative Medicine Department of Internal Medicine RIPAS Hospital Bandar Seri Begawan, Brunei Darussalam Peripheral Arterial Disease & Venous Thromboembolism; Chronic Venous Insufficiency & Lymphedema

Daniel Antoniello, MD Assistant Professor of Neurology Department of Neurology Montefiore Hospital/Albert Einstein College of Medicine Bronx, New York Cerebrovascular Disease

Louise Aronson, MD, MFA Associate Professor of Medicine Division of Geriatrics Department of Medicine University of California, San Francisco San Francisco, California The Interprofessional Team

Kristen L. Barry, PhD Research Professor Department of Psychiatry University of Michigan Ann Arbor, Michigan Managing Misuse of Alcohol & Psychoactive Prescription Medications in Older Adults

Lisa C. Barry, PhD, MPH Assistant Professor Department of Psychiatry UCONN Center on Aging at the University of Connecticut Health Center Farmington, Connecticut Understanding the Effects of Criminal Justice Involvement on Older Adults

AUTHORS xv

Gerald Charles, MD Professor of Medicine, Emeritus Department of Medicine University of California, San Francisco San Francisco, California

The Aging Traveler

Melvin Cheitlin, MD Emeritus Professor of Medicine Department of Medicine, Cardiology Division San Francisco General Hospital San Francisco, California Coronary Disease

Helen Chen, MD Chief Medical Officer Hebrew SeniorLife Health Care Services and Hebrew Rehabilitation Center Boston, Massachusetts Clinical Professor of Medicine Division of Geriatrics University of California, San Francisco San Francisco, California

The Social Context of Older Adults

Jane Chen, MD Associate Professor of Medicine Department of Internal Medicine Cardiovascular Division Washington University School of Medicine St. Louis, Missouri

Heart Failure & Heart Rhythm Disorders

Bruce Allen Chernof, MD, FACP President and CEO The SCAN Foundation Long Beach, California

Public Policy Intersecting with an Aging Society

Ryan Chippendale, MD Assistant Professor Section of Geriatrics, Department of Medicine Boston University School of Medicine Boston, Massachusetts Benign Prostatic Hyperplasia & Prostate Cancer

Anna H. Chodos, MD, MPH Research Fellow Division of Geriatrics Department of Medicine University of California, San Francisco San Francisco, California Helping Older Adults with Low Health Literacy

Teena Chopra, MD, MPH Assistant Professor Division of Infectious Diseases Wayne State University Physician Detroit Medical Center Detroit, Michigan Common Infections

Jessica L. Colburn, MD Assistant Professor of Medicine Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine Baltimore, Maryland Home-Based Care

Jessamyn Conell-Price, MS Medical Student School of Medicine The UCSF-UC Berkeley Joint Medical Program San Francisco, California Diabetes

Leo M. Cooney Jr, MD Humana Foundation Professor of Geriatric Medicine Department of Internal Medicine, Section of Geriatrics Yale University School of Medicine New Haven, Connecticut Managing Back Pain in Older Adults

Kenneth E. Covinsky, MD, MPH Professor of Medicine Department of Medicine University of California, San Francisco San Francisco, California Applying Evidence-Based Medicine to Older Patients

Sanket Dhruva, MD Cardiology Fellow Division of Cardiovascular Medicine Department of Internal Medicine University of California Davis Medical Center Sacramento, California Coronary Disease

Manuel Eskildsen, MD, MPH Associate Professor of Medicine Division of General Medicine and Geriatrics Department of Medicine Emory University School of Medicine Atlanta, Georgia Meeting the Unique Needs of LGBT Older Adults

xvi AUTHORS

Steven R. Gambert, MD Professor of Medicine Associate Chair for Clinical Program Development Director of Medical Student Programs Co-Director, Division of Gerontology and Geriatric Medicine Director of Geriatric Medicine Department of Medicine University of Maryland School of Medicine University of Maryland Medical Center and R. Adams Cowley Shock Trauma Center Baltimore, Maryland Thyroid, Parathyroid, & Adrenal Gland Disorders

Julie K. Gammack, MD Associate Professor of Medicine Program Director, Geriatric Medicine Fellowship Program Division of Geriatrics Saint Louis University School of Medicine Saint Louis, Missouri Urinary Incontinence

Dane J. Genther, MD Resident Department of Otolaryngology–Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore, Maryland Managing Hearing Impairment in Older Adults

Angela Gentili, MD Professor of Internal Medicine Director, Geriatrics Fellowship Program Internal Medicine, Division of Geriatric Medicine McGuire VAMC & Virginia Commonwealth University Health System Richmond, Virginia Sexual Health & Dysfunction

A. Ghazinouri, MD Staff Physician Geriatrics, Palliative and Extended Care San Francisco VA Medical Center San Francisco, California Parkinson Disease & Essential Tremor

Michael Godschalk, MD Professor of Internal Medicine Director, Geriatric Health Care Center Internal Medicine, Division of Geriatric Medicine McGuire VAMC & Virginia Commonwealth University Health System Richmond, Virginia Sexual Health & Dysfunction

Kathryn J. Eubank, MD Associate Clinical Professor of Medicine Medical Director Division of Geriatrics Department of Medicine Acute Care for Elders (ACE) Unit University of California, San Francisco San Francisco VA Medical Center San Francisco, California

Hospital Care

Emily Finlayson, MD, MS Assistant Professor of Surgery Department of Surgery Institute of Health Policy Studies University of California, San Francisco San Francisco, California

Perioperative Care in Older Surgical Patients

Joseph H. Flaherty, MD Department of Internal Medicine Division of Geriatrics Saint Louis University School of Medicine St. Louis, Missouri International Perspectives in Geriatric Care (China)

Lynn A. Flint, MD Assistant Clinical Professor Staff Physician Division of Geriatrics University of California, San Francisco San Francisco VA Medical Center San Francisco, California

Transitions and Continuity of Care

Sara J. Francois, PT, DPT, MS Research Physical Therapist Program in Physical Therapy Washington University in St. Louis School of Medicine St. Louis, Missouri Determining the Appropriate Use of Exercise for Older Adults

Nicholas B. Galifianakis, MD, MPH Assistant Professor of Neurology San Francisco VA Parkinson’s Disease Research, Education, & Clinical Center (PADRECC) University of California, San Francisco San Francisco, California Parkinson Disease & Essential Tremor

xviii AUTHORS

Ravi Kant, MD Fellow Division of Endocrinology University of Maryland School of Medicine Baltimore, Maryland Thyroid, Parathyroid, & Adrenal Gland Disorders

Helen Kao, MD Associate Professor of Medicine Medical Director, Geriatrics Clinical Programs Division of Geriatrics Department of Medicine University of California, San Francisco San Francisco, California Ambulatory Care & the Patient-Centered Medical Home

Keith S. Kaye, MD, MPH Professor of Internal Medicine and Infectious Diseases Division of Infectious Diseases Detroit Medical Center Wayne State University Detroit, Michigan Common Infections

Leslie Kernisan, MD, MPH Clinical Instructor Division of Geriatrics Department of Medicine University of California, San Francisco San Francisco, California Addressing Dyspnea in Older Adults

Margot Kushel, MD Professor of Medicine Division of General Internal Medicine University of California, San Francisco/San Francisco General Hospital and Trauma Center San Francisco, California Understanding the Effects of Homelessness and Housing Instability on Older Adults

C. Kent Kwoh, MD Professor of Medicine and Medical Imaging Division of Rheumatology and University of Arizona Arthritis Center University of Arizona College of Medicine Tucson, Arizona Osteoarthritis

Sharon K. Inouye, MD, MPH Professor of Medicine Milton & Shirley F. Levy Family Chair Director, Aging Brain Center Department of Medicine/Institute for Aging Research Harvard Medical School Beth Israel Deaconess Medical Center Hebrew Senior Life Boston, Massachusetts

Delirium

Jeremy M. Jacobs, MBBS Senior Lecturer Department of Geriatrics and Rehabilitation Hadassah University Hospital Mt. Scopus, and Hebrew University Hadassah Medical School Jerusalem, Israel

International Perspectives in Geriatric Care (Israel)

Diana V. Jao, MD Staff Physician Department of Primary Care: Ron Robinson Senior Care San Mateo Medical Center San Mateo, California Sleep Disorders

Bree Johnston, MD, MPH Director, Clinical Professor of Medicine Palliative and Supportive Care Division of Geriatrics PeaceHealth St. Joseph Medical Center University of California, San Francisco Bellingham, Washington San Francisco, California Geriatric Assessment

Susan M. Joseph, MD Assistant Professor of Medicine Division of Cardiology, Heart Failure and Transplant Section Department of Internal Medicine Washington University School of Medicine Saint Louis, Missouri

Heart Failure & Heart Rhythm Disorders

Deborah M. Kado, MD, MS Associate Professor Departments of Family & Preventive Medicine and Internal Medicine University of California, San Diego San Diego, California

Falls & Mobility Disorders

AUTHORS xix

Bruce Leff, MD Professor of Medicine Associate Director, Elder House Call Program Johns Hopkins University School of Medicine and the Johns Hopkins University Bloomberg School of Public Health Johns Hopkins Bayview Medical Center Baltimore, Maryland Home-Based Care

Frank R. Lin, MD, PhD Assistant Professor Core Faculty Departments of Otolaryngology–Head and Neck Surgery, Geriatric Medicine, Mental Health, and Epidemiology Johns Hopkins Center on Aging and Health Johns Hopkins University School of Medicine Bloomberg School of Public Health Baltimore, Maryland Managing Hearing Impairment in Older Adults

Milta O. Little, DO Assistant Professor of Geriatric Medicine Internal Medicine-Division of Gerontology and Geriatric Medicine Saint Louis University School of Medicine Saint Louis, Missouri Assessing Antiaging Therapies for Older Adults; Considering Complementary & Alternative Medicines for Older Adults

Dandan Liu, MD Volunteer Assistant Clinical Professor; Staff Physician Division of Geriatrics University of California, San Francisco; On Lok Lifeways San Francisco, California Prevention & Health Promotion

David Liu, MD, MS Assistant Clinical Professor Department of Psychiatry and Behavioral Sciences University of California Davis Sacramento, California Depression & Other Mental Health Issues

Bernard Lo, MD President The Greenwall Foundation New York, New York Ethics & Informed Decision Making

Mark S. Lachs, MD, MPH Co-Chief Professor of Medicine Director, Center for Aging Research and Clinical Care Division of Geriatrics and Gerontology Weill Cornell Medical College Director, Geriatrics New York-Presbyterian Health System Detecting, Assessing, & Responding to Elder Mistreatment

C. Seth Landefeld, MD Spencer Chair of Medical Science Leadership Chair, Department of Internal Medicine University of Alabama at Birmingham Birmingham, Alabama

Hospital Care

Bonnie Lederman, DDS, BSDH Postdoctoral Scholar-Fellow Multidisciplinary Fellowship in Dentistry, Medicine, and Mental/Behavioral Health The Department of Preventive and Restorative Dental Sciences University of California, San Francisco San Francisco, California

Oral Diseases & Disorders

Kewchang Lee, MD Associate Clinical Professor Department of Psychiatry University of California, San Francisco Site Director, Psychiatry Medical Student Education Director, UCSF Psychosomatic Medicine Fellowship Program San Francisco VA Medical Center San Francisco, California Depression & Other Mental Health Issues

Sei Lee, MD, MAS Associate Professor of Medicine Senior Scholar, VA National Quality Scholars Fellowship Program Staff Physician Division of Geriatrics University of California, San Francisco San Francisco VA Medical Center San Francisco, California

Diabetes