The grand tradition of the Merck manuals started in 1889, with the publication of the Merck Index. In 1899, The Merck manual of Diagnosis and Therapy was published. These manuals are intended to be good reference guides for the practicing physician. The manuals approach medicine from a diagnostic perspective, while other references, like the PDR give information from a product perspective. The contributors and editorial board for the various Merck manuals are highly regarded experts in their fields.
Some statistics: In 1995 13 percent of Americans were over the age of 65. They used 30 percent of all health care services. In 2030, it is predicted that 20 percent of people will be over 65 and will use 50 percent of all health care resources.
In 1988, geriatrics was formally recognized as a specialized field of medicine. One could get a certificate of special conpetence in the field in much the same way that one became a pediatrician or cardiologist. Drug pharmacokinetics are different for seniors. Certain organs lose their functionality over time. Very little was known, much less compiled into a single source. Merck saw the need for a manual of geriatrics and started work in early 1989. In 1990, the first edition of The Merck Manual of Geriatrics was published. In 1995, edition two came out. The editors are Doctors Williams B. Abrams, Mark H. Beers and Robert Berkow.
§1-A Problem Oriented Approach.
This section gives an introduction to various problems universally faced by geriatric patients. The list is long and thourough. Nutrition, water/electrolyte disorders, geriatric emergencies, hyper/hypothermia, syncope, falls, sleep disorders, pain, and urinary incontinence are just some of the topics covered.
A hostpital, doctor or clinic cannot give adequate service to its' older patients without some knowledge of how to approach their care. Specifically, Merck points out the need for an accurate medical history, pharmacology (drugs), nursing/longterm care and surgery. Older patients have more trouble recovering from surgery, as, to put it in a crass way, they are shrinking, not growing.
Hearts and lungs are always problematic. They run for 75 years straight without stopping. If there is damage, healing takes a long time. Merck also touches on neurologic, psychiatric, hematologic and gynecologic/genitourinary disorders. Appropriately, this is the largest section, and details age-related health issues for the entire body, from eye to bone.
Death sucks, and some people die sooner then others. demographic profiling is cruel, but it helps doctors know what to look for. Heart conditions are more prevelent in certain areas of the country. Profiling helps doctors treat patients. Health care, as an industry, has issues. There are legal boundaries for doctors, as well as ethical ones. Dr. kevorkian anyone? The section on funding treatment is long. It details many government programs meant to help aging seniors, such as Medicare, Medigap, Medicaid, HMOs, PACE and community groups.
Lab testing tables, more insurance stuff.
Source:The Merck manual of Geriatrics.