The specificity of aging in old age
Changes in the cells and tissues of an elderly person are a reduction in the number of active parenchymal cells, deviations in neurohormonal regulation and metabolism. They have their reflection not only in the morphology and physiology of the elderly organism, but also in the specificity of pathology. It means that old people are sick differently than young people. Young people are affected by acute diseases such as inflammation, infectious diseases, post-traumatic diseases and intoxication. In the old ones, we usually encounter chronic and degenerative diseases and their complications.
Due to aging, almost all diseases can be divided into:
Diseases of any age, e.g. pneumonia. However, their course is strongly modified in the old age and usually more dangerous. Complications are quite common and the course may even be fatal. Diseases that appear more often in older age, eg atherosclerosis, various forms of cancer. Diseases and ailments directly related to old age, eg emphysema, hip fracture. As the body ages, it becomes more easily diseased and, during their lifetime, breaks down more easily, even when the younger body cope with them.
The interaction of many factors in the formation and course of many diseases during the old age is obvious.
Typically, these are degenerative changes, atrophic and progressive atherosclerosis. And so for example; Decubitus ulcers in old people arise if there has been a capillary leakage, narrowing of fine arteries, poor blood supply to the tissues, weakening of fluid flow, vitamin deficiency and refraction of trophic nervous system effects.
Old age affects clearly the course of many diseases, modifying it and changing the incidence of these diseases. During this period of life, usually different chronic illnesses overlap and each of them may additionally have changed reactivity. This results in various, often unclear clinical images, which in turn give rise to numerous diagnostic difficulties.
However, it must be remembered that death, even in the most advanced old age, always has some underlying cause.
The atypical nature of the course of the disease. Gaps in the interview.
Thus, in the senile body, classic, textbook, disease images often blur and undergo various deviations, and this results in multiple abnormalities of clinical images. In 1969 Butler introduced the concept of ageism. It defines a discriminatory approach to man because of his age, which in many cases is a fixed stereotype. This often involves feeling that you have to work for someone who is no longer working. This approach often results from the loss of intergenerational bond in contemporary industrialized societies. However, the most unpleasant is if discriminatory behavior due to age is also visible among employees of medical services or social care workers. Many publications are alarming that old people are the most medically neglected group. It is reported that in the last decade, patients over 65 make up 40-50% of patients in internal, neurological and orthopedic departments for adults. They consume 25-30% of all prescribed drugs. Treatment of the pensioner is 3-4 times more expensive than people from the younger age group, and for example, treatment of a diabetic patient after the age of 70 is 7 times more expensive than young people without diabetes.
The fact is that the treatment of old people has its own specificity.
Increased sensitivity of senile tissues to particular preparations, hormones, centrally acting drugs, reduced detoxification capacity, reduced weight and amount of circulating blood; all of these factors mandate a reduction in drug doses. On the other hand, worse absorption in the gastrointestinal tract or reduced permeability of capillaries makes it difficult for drugs to enter the tissues. Thus, the treatment of old people has its own specificity and requires considerable experience in treating people of this age. Polypragia is especially dangerous here. As an example, let's use an article from Spigel titled The doctor died, the patient recovered, which echoed all over Germany and triggered a wave of heated discussions about the treatment of the elderly.
The elderly patient almost always felt bad. She suffered from hypertension, so she was given tablets for dissolving in water and heart tonemakers. It did not help her, though. The old woman was constantly distracted, she did not know where she was or what she actually did, and besides, she was almost always unwell. In the end, she even had to take antiemetic pills regularly. One day she suddenly felt great. - Has your doctor finally found the right measure? her grandson asked her. The old woman replied: "No, dear boy, he died.
Although older people make up the majority of patients, probably in no other area of treatment, as many failures as in the treatment of the elderly are not allowed.
- A large proportion of patients are treated too intensively (that is, they receive too much medication) or unhealthy because of too small doses - says the gerontologist from Mannheim. It is estimated that people over 60 years of age suffer from side effects of drugs almost three times more often than patients from the younger age group. New analyzes also show that in the case of older people up to 23 percent. referrals to the hospital is a consequence of unwanted body reactions to the administered drugs. Mistakes and side effects in the pharmacotherapy of old people are a serious, constantly growing problem of health and financial policy. He even knows the cases of already-written patients, who, after discontinuing the medicines, were losing their rooms for the ill patients, considered hopeless cases, by themselves. A person over 60 years old constantly takes an average of three drugs, that is three times more than a younger patient. The more drugs the more dramatically the risk of interaction with other preparations and side effects increases. In addition, seniors are often visually impaired, have memory problems and are unfit for mobility; it's easy for them to make mistakes when taking medicines.
Doctor of Medicine Janusz Krzyżowski
Psychiatrist
