ways in which older adults present with subtle signs and symptoms may actually avert complications. Additionally, the nurse equipped with knowledge about and implementation of proactive assessment and interventions may actually prevent these complications in the first place. As in the previous, second edition (honored as American Journal of Nursing, Geriatric Book of the Year, 2003), we will present assessment and interventions for common geriatric syndromes. Geriatric syndromes are increasingly recognized as being related to preventable iatrogenic complications, or those that occur as a direct result of medical and nursing care, causing serious adverse outcomes in older patients (See Iatrogenesis chapter). We are also very happy to present five new topics and several new expert contributors in this edition. Many of these topics have been updated from the protocols that appear on the website of the Hartford Institute for Geriatric Nursing at NYU (www.HartfordIGN.org). The new topics in this edition are: n Interventions to Prevent Functional Decline in the Acute Care Setting n Catheter-Associated Urinary Tract Infection Prevention n Mistreatment Detection n Acute Care Models n Transitional Care In this fourth edition of Evidence-Based Geriatric Nursing Protocols for Best Practice, we provide guidelines that are developed by experts on the topics of each chapter and are based on best available evidence. A systematic method, the AGREE appraisal process (AGREE Next Steps Consortium, 2009; Levin & Vetter, 2007; Singleton & Levin, 2008), was used to evaluate the protocols in the second edition and identify a process to help us improve validity of the book’s content. Thus, a systematic process, xvi Introduction described in Chapter 1, was developed to retrieve and evaluate the level of evidence of key references related to specific assessment and management strategies in each chapter. The purpose in determining the best available evidence was to answer the clinical questions posed. The chapter authors rated the levels of evidence based on the work of Stetler and colleagues (1998) and Melnyk and Fineout-Overholt (2011). The first chapter in this book, “Developing and Evaluating Clinical Practice Guidelines: A Systematic Approach,” details the process of how the clinical practice guidelines were developed and how they complied with the AGREE items for rigour of development (AGREE Next Steps Consortium, 2009). Chapter 1, written by leaders in the field of evidencebased practice in the United States, will most likely be the most important chapter reference for understanding the rating of the levels of evidence. Most of the protocols reflect assessment and intervention strategies for acute care recommended by expert authors who have reviewed the evidence using this process; the evidence provided may come from all levels of care and may not have been specifically tested in the hospital setting. How to Best Use This Book The standard nursing approach was used as a guideline for the outline of each topic as deemed appropriate by the chapter author(s) providing: overview and background information on the topic, evidence-based assessment and intervention strategies, and a topic-specific case study with discussion. The text of the chapter provides the context and detailed evidence for the protocol; the tabular protocol is not intended to be used in isolation of the text. We recommend the reader to take the following into consideration when reviewing the chapters: n Review the objectives to ascertain what is to be achieved by reviewing the chapter. n Review the text, noting the level of evidence presented in the reference section— Level I, being the highest (e.g., systematic review/meta-analysis) and Level VI, the lowest (e.g., expert opinion). Refer back to Chapter 1, Figure 1.2 for definitions of level of evidence to understand the quantitative evidence that supports each of the recommendations. Keep in mind that it is virtually impossible to have evidence for all assessments and interventions, which does not mean it is not going to be used as an intervention. Many interventions that have been successfully used for years have not been quantitatively researched but are well known to be effective to experts in the field of