Geriatrics
Introduction
Introduction to geriatric diseases Geriatric disease refers to a disease that is related to aging and has its own characteristics in the elderly. After entering the old age, the human tissue structure is further aging, the functions of various organs gradually appear obstacles, the body's resistance is gradually weakened, the activity capacity is reduced, and the synergistic function is lost. There are five types of diseases in the elderly: one is the primary senile disease, which is a disease that is easy to occur during normal aging, such as cerebral arteriosclerosis; the other is secondary senile disease, that is, a disease secondary to aging, such as the brain. Stroke; Third, susceptibility to the elderly, such as gout, diabetes, cancer, osteoarthritis, etc.; Fourth, the elderly are generally milder diseases, that is, most diseases that can occur at any age; Fifth, rare in the elderly Diseases, such as various infectious diseases. basic knowledge The proportion of the disease: the incidence of geriatric diseases in the elderly over 60 years old is about 0.04%-0.05% Susceptible people: middle-aged Mode of infection: non-infectious Complications: senile pneumonia Alzheimer's disease senile deafness elderly hypoglycemia elderly hypotension elderly lung cancer elderly hypertensive crisis elderly acute left heart failure elderly neurosis elderly gastric cancer elderly heart failure senile epilepsy
Cause
Causes of geriatric diseases
Prevention and treatment of geriatric diseases is one of the important measures for elderly health care. As the structure and function of various cell organ tissues in the elderly age with age, the resilience declines, the resistance decreases, and the incidence increases. Because the elderly are the continuation of young adults, many geriatric diseases are obtained in young and middle-aged countries, and they are more obvious in old age. The diseases that are susceptible to the elderly in China are tumors, hypertension and coronary heart disease, chronic bronchitis and pneumonia, gallbladder disease, prostatic hypertrophy, femoral fracture and diabetes. The mortality rate is pneumonia, cerebral hemorrhage, lung cancer, stomach cancer, acute myocardial infarction and so on.
Prevention
Geriatric disease prevention
Diet control
Measures to prevent and treat geriatric diseases are multi-faceted. The main purpose is to carry out physical exercise suitable for the elderly to enhance physical fitness and pay attention to reasonable diet. First of all, in the diet, the food intake should be distributed as evenly as possible, so as to eat less and eat more. meal. At least three meals a day, if four meals a day, five meals better. Eat only eight or nine minutes per meal. Eat low animal fat, low cholesterol, low salt foods. Eat more vegetables and fruits rich in cellulose, vitamins and trace elements. And have enough quality protein. Seafood foods should not be eaten because they contain high cholesterol. Avoid eating irritating foods and drinking irritating drinks. This will not only prevent the occurrence of a variety of cancers and cardiovascular and cerebrovascular diseases, but also make you energetic. Get rid of bad hobbies such as smoking, avoid harmful stimuli; maintain personal hygiene, avoid prolonged bed rest and respiratory infections, constipation, overwork, falls and other unexpected stimuli; perform regular physical examinations to achieve early detection of geriatric diseases, early diagnosis and Early treatment.
Exercise prevention
Proper exercise can improve cardiopulmonary function, protect the cardiovascular system, prevent osteoporosis and reduce mental stress. For the elderly, aerobics is the most suitable exercise, such as walking, jogging, swimming, dancing, cycling. Exercise should follow the principle of low to high, starting from a small amount of exercise, step by step, persevere, and pay attention to the selection of appropriate sports according to the season and individual circumstances. Exercise time three to five times a week, each time or add up to more than 30 minutes, and exercise time as much as possible in the afternoon and evening. If you exercise in the morning, you should not do it on an empty stomach. A reasonable diet and moderate exercise can help maintain proper weight and prevent a variety of serious geriatric diseases. Older friends who are already ill can also effectively control and alleviate the disease with their own efforts and the help of doctors.
Chinese medicine health care
Nowadays, the elderly will eat a lot of western medicines. After eating western medicine, what effect does it have on the body? I dont dare to say that the pulse of the elderly who control the various physiological indicators such as aspirin tablets is different from the elderly who do not take medicine. In this case, the Chinese medicine practitioner cannot determine the actual condition of the patient's body through the pulse. It is better to diagnose if you stop taking the medicine for 3-5 days.
Medicinal porridge
Medicated porridge has the characteristics of decoction, fluid and semi-liquid. It is not only sweet and delicious, but also easy to absorb, and it can nourish the stomach and treat chronic diseases. Compared with Pills, it can be taken for a long time, without side effects, and can be added or subtracted as needed. However, the medicinal porridge must be selected according to the physical condition, living habits and the symptoms of the disease; at the same time, it must be flexibly controlled according to the change of the season. The porridge described below is available for the elderly.
Complication
Geriatric complications Complications elderly pneumonia senile dementia senile deafness elderly hypoglycemia elderly hypotension elderly lung cancer elderly hypertensive crisis elderly acute left heart failure elderly neurosis elderly gastric cancer elderly heart failure senile epilepsy
Chronic obstructive pulmonary disease: coronary heart disease, hypertension, diabetes, lower extremity arteriosclerosis obliterans, cerebral arteriosclerosis, dementia disease, cognitive dysfunction.
1, smoking is one of the main causes of chronic obstructive pulmonary disease, cough, cough and other symptoms will be relieved after smoking cessation, but also can delay the rate of FEV decline year by year.
2, acute exacerbation of patients with chronic obstructive pulmonary disease often appear acute aggravation in autumn and winter, manifested as cough, increased sputum, pus or increased difficulty in breathing. At this time, you must actively seek medical attention, use antibiotics, expectorants and bronchodilators as appropriate, and actively treat complications.
3, stable period of treatment should still adhere to treatment, such as reducing cough, cough or difficulty breathing, to prevent discomfort, reduce the frequency and severity of acute exacerbations, and maintain lung function. The drugs used include bronchodilators, 2 agonists, anticholinergics, and methylxanthine. When the doctor has developed a systemic treatment plan, the patient should actively cooperate with the doctor for treatment.
Symptom
Symptoms of geriatric symptoms Common symptoms Blood pressure, high blood lipids, abnormal blood sugar, dementia, repeated pneumonia, hand tremor, deafness, osteoporosis
Elderly hypertension
1. Simple systolic hypertension is common: in the elderly, due to arteriosclerosis, the elasticity and stretchability of the arterial wall are reduced, the elastic expansion of the systolic phase and the elastic retraction of the diastolic phase are weakened, and the buffering capacity is lowered, resulting in an increase in systolic blood pressure. The diastolic blood pressure is lowered and the pulse pressure difference is increased. Therefore, the elderly are often simple systolic hypertension.
2, high blood pressure fluctuations, abnormal rhythm of blood pressure fluctuations day and night, damage to target organs such as heart, brain and kidney; susceptible to environmental changes, stress response makes the blood pressure of the clinic much higher than self-test blood pressure; prone to morning peak blood pressure Increase, that is, the average value of systolic blood pressure within 2 hours after getting up - the lowest value of systolic blood pressure during nighttime sleep (including the average value of 1h including the lowest value), 35mmHg is the increase of morning blood pressure. It is recommended to measure 24-hour ambulatory blood pressure in order to clarify blood pressure fluctuations, adjust medication regimens, and promote home self-test blood pressure.
3, prone to orthostatic hypotension and postprandial hypotension.
4, the sensitivity of the elderly taste decreased, often eating very salty. The kidneys have a reduced ability to regulate water and salt, and blood pressure is more sensitive to salt. Excessive intake of salt will increase blood pressure, lowering the efficacy of antihypertensive drugs, and blood pressure is difficult to control.
5, often combined with other cardiovascular risk factors, more likely to occur target organ damage and cardiovascular disease; due to a variety of diseases coexisting with a large number of drugs, prone to drug interactions, prone to adverse drug reactions.
Elderly diabetes
1, high prevalence
The incidence rate of patients under 40 years old is only 0.04%, it is increased to 2.5% above 40 years old, and the prevalence rate of over 60 years old is 4.3%.
2, the symptoms are not typical
The onset is concealed and easy to miss, but overweight and obese are the majority. Although postprandial blood glucose has increased, there are only some non-specific symptoms such as exertion, blurred vision, genital itching, impotence, etc., often with complications as the first symptoms, such as hypertension, cerebrovascular disease, retinopathy and kidney disease Performance.
3, prone to hypoglycemia
It may be related to the low calorie control, which occurs when the patient is bedridden, the activity is insufficient, the glibenclamide or insulin is used too much.
4, often have serious complications
Cardiovascular and neuropathic, urinary tract infections, kidney disease, and eye diseases are common, while hyperosmolar non-ketotic diabetic coma is a serious acute complication. It occurs mostly in patients with mild diabetes or no diabetes. The mortality rate is often as high. About 50%. It is mainly caused by infection, gastrointestinal dysfunction, inactivation of insulin, or supplementation with excessive glucose and corticosteroids during symptomatic treatment.
5, poor compliance with treatment
Most treatments do not meet the standard, often making blood sugar difficult to be ideally controlled. It is necessary to strengthen the self-care awareness of the elderly, control diet, physical exercise, and more importantly, rational choice of hypoglycemic agents.
Elderly osteoporosis
Senile osteoporosis, mostly due to vertebral or femoral fracture or low back pain, the most common symptoms are low back pain, pain spread along the spine to the sides, pain relief in supine or sitting position, pain when standing upright Intensified, the pain in the day is alleviated, the pain is aggravated when you wake up at night and in the morning, and the pain of bending, muscles, coughing, and stool is also aggravated.
Elderly chronic bronchitis
Old people with chronic bronchitis onset, mostly onset in young and middle-aged, and a few in the elderly. More patients than in the cold season, coughing, coughing, especially in the morning, sputum is white mucus foam. As the disease progresses, coughing and coughing continue throughout the year, and winter and spring are aggravated. Some patients with episodes of acute respiratory infections as a precursor, there may be fever, upper respiratory tract catarrhal symptoms, and then cough, cough significantly increased, increased sputum, sputum viscous or yellow purulent, a few can also be seen in the sacral belt blood. Patients with wheezing chronic bronchitis often have asthma-like episodes after coughing and coughing. Older patients often have emphysema, often shortness of breath and shortness of breath.
Hyperlipidemia
The clinical manifestations of hyperlipidemia are mainly the arteriosclerosis caused by the deposition of lipids in the dermis and the deposition of yellow tumors and lipids in the vascular endothelium. Although hyperlipidemia can cause yellow tumors, its incidence is not high; and the occurrence and development of atherosclerosis is a slow and gradual process. Therefore, under normal circumstances, most patients have no obvious symptoms and abnormal signs. Many people found elevated levels of plasma lipoproteins when they were tested for blood biochemistry for other reasons.
Elderly pneumonia
The clinical manifestations are not typical, such as insidious onset, often no symptoms such as cough, cough, fever, chest pain. Older people have lower basal body temperature and poorer ability to respond to fever. Even pneumococcal pneumonia rarely has typical chills, high fever, rust stains, and large signs of lung consolidation. There are reports of geriatric pneumonia in the literature, only 28% of survivors, and only 13% of non-survivors have fever. The elderly have a weak cough, and most of them are white or yellow purulent, which is easily confused with chronic bronchitis and upper respiratory tract infection. More common is increased respiratory rate, shortness of breath or difficulty breathing. In contrast to mild or absent respiratory symptoms, systemic poisoning symptoms are more common and can occur early, manifested as listlessness, fatigue, loss of appetite, nausea and vomiting, increased heart rate, arrhythmia, paralysis, confusion, and severe blood pressure. coma. It is rare to check the typical lung consolidation signs. There are 576 cases of pneumonia in the elderly, and only 13.8% to 22.5% of those with pneumonia. Blood leukocytes were 38% or 7% normal or below normal. The wetness of the lungs is easily confused with coexisting chronic bronchitis and chronic heart failure.
Examine
Geriatric examination
As the structure and function of various cell organ tissues in the elderly age with age, the resilience declines, the resistance decreases, and the incidence increases. Therefore, the prevention and treatment of geriatric diseases is one of the important measures for geriatric health care.
1. Regularly measure blood pressure: The blood pressure in the lying position, sitting position, and standing position is an auxiliary examination method for checking whether the blood pressure is normal.
2. Measuring blood sugar: Most of the energy required for cell activity in various tissues in the body comes from glucose, so blood sugar must be kept at a certain level to maintain the needs of various organs and tissues in the body. Normal people have a fasting blood glucose concentration of 80-120 mg in the morning.
3. Electrocardiogram examination: During each cardiac cycle, the heart is excited by the pacemaker, atrium, and ventricle. With the change of bioelectricity, various forms of potential change patterns are extracted from the body surface by electrocardiograph (abbreviation) ECG).
4, blood routine examination: blood routine is the most general, the most basic blood test. Blood has three different functions of cells - red blood cells (commonly known as red blood cells), white blood cells (commonly known as white blood cells), and platelets. The disease is judged by observing the quantitative change and the morphological distribution.
5, urine routine examination: urine analyzer is also known as dry chemical urine analyzer. The instrument is easy and fast to operate (the detection of 11 urine components can be completed within 10 seconds).
6. Chest CT examination: CT examination of the chest is a method of examining the chest by X-ray computed tomography (CT).
7, Doppler ultrasound examination of the brain: through the sputum window, pillow window, sputum window exploration, can explore the cerebral artery, according to the intracranial blood vessel flow rate, bandwidth, abnormal flow or audio abnormalities, etc., applied to cerebrovascular diseases Diagnosis and classification of causes.
Try to find early early prevention and early treatment.
Diagnosis
Diagnosis and diagnosis of geriatric diseases
1. Diseases unique to the elderly: These diseases are only available to the elderly and are characterized by the elderly. In the process of aging of the elderly, functional decline and obstacles occur, such as senile dementia, senile psychosis, senile deafness, cerebral arteriosclerosis and consequent strokes. Such diseases associated with degenerative aging of the aging increase with age.
2. Common diseases in the elderly: These diseases can occur in the middle-aged (pre-sensual) or in the old age. But it is more common in old age or becomes more serious. It is related to the pathological aging of the elderly, the decline of immune function, long-term strain or the disease of young and middle-aged patients. Such as hypertension, coronary heart disease, diabetes, malignant tumor, gout, tremor palsy, senile degenerative osteoarthrosis, senile chronic bronchitis, emphysema, pulmonary heart disease, senile cataract, senile osteoporosis , senile pruritus, pneumonia, hyperlipidemia, cervical spondylosis, prostatic hypertrophy, etc.
3. Diseases that can occur in young and middle-aged people: but they have their own characteristics in the elderly. These diseases occur in all ages, but because of the decline in the function of the elderly, the same lesions have special effects in the elderly. Sex. For example, people of all ages may develop pneumonia, while in the elderly, they have the characteristics of atypical symptoms and serious illness. For example, peptic ulcer can occur in young, middle and old age, but the elderly are prone to complications or cancer.
