The elderly patient

Last scene of all,

That ends this strange eventful history, Is second childishness, and mere oblivion, Sans teeth, sans eyes, sans taste, sans everything (sans = without)

William Shakespeare (1564-1616) ^s You Like It

The ageing (over 65 years) are the fastest growing section of the Australian population. The number of 'old-old' (over 85 years) is increasing at an even faster rate. 1

The over 65s in 1988 made up 10.8% of the Australian population (12% in the United States). It is expected that this group will make up 13.4% in 2011 and 20% in the year 2031. A similar trend is expected in the United States with 13% by the year 2000 and 18% in 2040. 2

The over 65s use twice the number of health services per head of population. They account for 25% of all hospital costs and 75% of all nursing home costs. They represent 25% of all general practice consultations. 1 Many are affected by multisystem disease. All are affected to a greater or lesser extent by the normal physiological changes of organ ageing.

Ageing is characterised by the following: 1

• decrease in metabolic mass

• reduction in the functional capacity of organs

• reduced capacity to adapt to stress

• increased vulnerability to disease

• increased probability of death

Age-associated deterioration occurs with hearing, vision, glucose tolerance, systolic blood pressure, renal function, pulmonary function, immune function, bone density, cognitive function, mastication and bladder function. One of the main contributing factors is the problem of disuse. Encourage exercise, especially walking and water aerobics.

Ageing and disease

Degenerative cardiovascular disease emerges with ageing according to the following approximate guidelines:

55 — ischaemic heart disease

65 — myocardial infarction

70 — cardiac arrhythmias

75 — heart failure

80 — cerebrovascular accidents

Deterioration in health and the 'masquerades'

Unexpected illness including mental confusion (one of the major hallmarks of disease in the elderly) can be caused commonly by any of the so-called masquerades outlined in Chapter 15 :

• depression

• drugs, including alcohol

• diabetes mellitus

• thyroid disease

• urinary tract infection

• neurological dilemmas o Parkinson's disease o cerebrovascular accident

• infections, e.g. bronchopneumonia neoplasia

• giant cell arteritis/polymyalgia rheumatica

Common significant management disorders encountered in the elderly include:

• hypertension

• ischaemic heart disease and heart failure

• depression

• social and physical isolation

• osteoarthritis

• disorders of the prostate

• urinary incontinence

• locomotive (lower limb) disorders o neurological

■ peripheral neuropathy

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