With the social progress, economic growth, medical and health development, people’s health level is generally improved, life expectancy is lengthening, the proportion of elderly population is increasing significantly, and population aging has become a common problem faced by the whole world.
China is the most populous country in the world, and also the country with the largest elderly population, accounting for 1/5 of the world’s elderly population, according to statistics, China’s elderly population grows at an average annual rate of 3.32 ％, China has entered the aging society since 1999, as of the end of 2004, China’s population over 60 years old has reached 140 million, accounting for 11% of the total population, marking that China has entered the ageing country, and will rise to 20% in 2025, becoming a super-elderly country.
With the proliferation of the elderly population, the medical, nursing and psychological problems of the elderly have become common social problems, which have attracted the great attention of the Party and the State. It has become the consensus of the whole society to pay attention to the elderly population, to provide care for the elderly, to provide medical care for the elderly, to provide education for the elderly, to provide fun for the elderly, and to make the elderly live a long and healthy life.
Characteristics of geriatric diseases
The basis of geriatric diseases is the aging changes in the morphology and physiological functions of the organs and tissues of the elderly, and there are many unstable factors in the psychosocial aspect. Therefore, geriatric diseases differ greatly from other age groups in terms of clinical manifestations, diagnosis and treatment and prevention. Some experts point out that “you cannot look at children with adult eyes, and likewise you cannot look at the elderly with adult eyes.” This fully emphasizes the special nature of the elderly. The characteristics of geriatric diseases are.
1, the coexistence of multiple diseases: the elderly often have a variety of diseases at the same time, the general elderly are suffering from 2 or 3 noteworthy diseases, there are reports in the hospitalized elderly patients with 2 major diseases at the same time accounted for 85%, while 3 or 4 major diseases accounted for about 50%; even some hospital data show that each elderly people suffer from an average of 6 diseases; 60-69 years old group This suggests that the number of diseases in the elderly increases with age. This often makes the symptoms atypical, causing difficulties in diagnosis and differential diagnosis, and needs to be alerted.
2, insidious and slow onset: most of the geriatric diseases are chronic degenerative diseases with insidious onset and slow development, which can be asymptomatic for a long period of time and cannot be determined; sometimes it is difficult to distinguish physiological changes from pathological changes, and generally the early changes are slow, which can be easily mistaken for physiological changes in old age. For example, some elderly people have diminished mental capacity, poor movement and stiffness of the limbs, which are thought to be the changes of old age, but later found to be early Parkinson’s disease.
3, rapid changes in multi-organ function: due to the elderly organ reserve function is low, although the disease of old age is insidious, slow development, the course of the disease, but when the development of the disease to a certain stage, organ function is on the verge of failure, once the occurrence of stress, can make the original barely maintain the compensatory state of organ failure, resulting in the disease malignant, life-threatening.
4, the onset of the unique way: the onset of the trigger is sometimes different from young people, such as myocardial infarction in the elderly is not necessarily excessive exercise, in emotional excitement or improper diet can also be triggered; the elderly with the ageing changes, organ aging, the onset of the more unique way, often with falls, do not want to move, mental symptoms, urinary and fecal incontinence and loss of ability to live and other geriatric disease one or several signs manifested. The most vulnerable parts of the brain, lower urinary tract, cardiovascular system, respiratory tract and motor system are the most vulnerable parts of the elderly over 75 years old.
5. Atypical manifestations: Some of the symptoms of geriatric diseases are as typical as those of adults, while a significant number of clinical symptoms and signs are atypical. Older people are less tolerant and often have a variety of co-morbidities, thus making the symptoms and signs atypical and easy to miss or misdiagnose. Therefore, it is important to pay attention to objective examination, especially the observation of body temperature, pulse, blood pressure and consciousness.
① Symptoms that should be present in the disease do not appear but are non-specific. For example, pneumonia only shows poor appetite, general weakness, dehydration; or sudden impairment of consciousness, but lack of respiratory symptoms, temperature rise is not obvious. Heart failure may first manifest as psychiatric symptoms and abdominal distension. Reduced nociception is not accurately localized, and diseases that can cause severe pain may have only mild discomfort.
② Asymptomatic (subclinical type) is more. Myocardial infarction 20%-80% no pain, diabetes mellitus 52.8% no three more or less symptoms, 80% lacunar infarction no symptoms.
(iii) Easy to have impaired consciousness. This is related to cerebral vascular sclerosis, blood pressure changes, infection, toxemia and dielectric disorders in the elderly.
④Easy to cause water-electrolysis disorder. The brain of the elderly is atrophied, the sensitivity of the thirst center is reduced, and they do not drink much water, so the slightest cause can cause disorders of water-electrolytic balance.
6, prone to complications or organ failure: the elderly due to organ function aging; brain function decline, immune function is reduced, after the disease complications increased significantly such as: infection, water-electrolyte disorders, multi-organ failure, reduced movement diseases (such as disuse muscle atrophy, limb contracture, bedsores, osteoporosis, thrombosis, crushing pneumonia), urinary tract infection, postural hypotension, etc..
7, more adverse drug reactions. As the elderly liver and kidney function decreases, resulting in drug metabolism and excretion is reduced, the sensitivity to drugs changes and multi-drug combination, etc., more prone to adverse drug reactions, generally three times higher than adults, and once it occurs, its degree is also more serious than adults. Therefore, the dose of drugs for the elderly should be reduced appropriately, and it is best not to use the drugs that are available or not. Some drugs such as barbiturates are prone to hypothermia in elderly patients, digitalis are prone to toxic reactions, and drugs that have a significant impact on liver and kidney function should be used with caution.
Prevention and treatment of geriatric diseases
Since elderly patients are different from other patients in that they suffer from multiple diseases at the same time, have limited mobility, intellectual impairment and high social concern, geriatric diseases often involve multiple clinical specialties, and the prevention and treatment of geriatric diseases especially emphasizes active collaboration and communication among physicians of various clinical specialties, and should cover intensive interventions and health treatment from multiple disciplines including medical, nursing, psychological, rehabilitation, nutrition and pharmacology. The prevention and treatment of geriatric diseases emphasizes active collaboration and communication among clinicians from various specialties, and should cover intensive interventions and health guidance (including health counseling and health promotion activities) from multiple disciplines, including medical, nursing, psychological, rehabilitation, nutrition and pharmacology. This is the strength of biopsychosocial medicine. This requires us to change the biomedical model into a biopsychosocial medical model, that is, to implement comprehensive human-oriented services according to the characteristics of the elderly and the modern “biopsychosocial” medical model and the characteristics of the geriatric disease management model. We are actively exploring a new concept and a model with geriatric characteristics.
The characteristics of geriatric diseases determine the requirements for the prevention and treatment of geriatric diseases.
1.Provide comprehensive and holistic medical diagnosis, rather than being limited to isolated diagnosis of a particular specialty.
2.Provide corresponding comprehensive treatment plan. Highlight the characteristics of geriatric treatment, consider the relationship between geriatric disease and natural decline of the body; strengthen the new concept of comprehensive geriatric treatment; treatment means should be symptomatic and comprehensive.
3.Provide advanced comprehensive physical therapy means (should include physical therapy, exercise therapy).
4.Establish the concept of regulation of the whole process of treatment. With the goal of improving the overall quality of life of patients, use the international advanced geriatric treatment model, scientifically assess the treatment effect; pay attention to the long-term nature of geriatric diseases, highlight the comprehensive nature of geriatric diseases, and establish new norms of three-dimensional whole process treatment.
5. Carry out health education on the prevention and treatment of geriatric diseases, and establish a close relationship between hospitals and social geriatric sources through health education, hotline consultation, community rounds of family beds, etc.
The health of the elderly is not only related to the quality of personal life and family harmony, but also to economic development, social stability, and the speed and prospects of modernization! “Life is dependent on health” is the sacred duty of all the medical and nursing staff of our cadre department and we have to persistently strive for it.