摘要:

Demography is of great importance for those involved in caring for the elderly or in planning services. In this paper, current and future variations in the proportions of elderly people around the world are reviewed. The determinants of age structure are considered, and aging and aged populations are defined and discussed. The consequences of population aging extend into every sphere of life; particular attention is paid to the health service and economic implications. Attitudes to population aging and some of the special characteristics of the elderly in the West today are also considered. The paper concludes with a discussion of probable future trends in both the developed and the less developed parts of the world.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1983.tb05741.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Considerable evidence suggests that glucose tolerance deteriorates with age, in spite of a generally normal insulin response to the oral glucose tolerance test (OGTT). However, several metabolic events besides pancreatic secretion are known to influence the peripheral insulin concentration. Thus, C‐peptide is considered a more reliable index of beta cell activity than insulin. Moreover, the simultaneous assay of C‐peptide and insulin in peripheral blood provides a noninvasive method to estimate the hepatic removal of insulin. In this study, insulin and C‐peptide responses to the OGTT were evaluated in a group of 12 nondiabetic, obese, aged subjects and in a group of 12 sex‐ and weight‐matched young controls. Compared with younger subjects, older subjects showed significantly higher glucose levels and incremental areas in spite of comparable concentrations of C‐peptide and insulin. Ratios of C‐peptide to insulin, both in the fasting state and after glucose load, did not differ in elderly and young subjects. The results suggest that the higher glucose levels in the aged are not due to decreased insulin secretion by the beta cell or to alterations in the hepatic catabolism of insulin. The discrepancy of normal insulin concentrations and elevated glucose levels may be interpreted as the result of an age‐related decrease in insulin sensitivity. However, the differences in glucose concentrations in old and young subjects also might be due to (1) an age‐related reduction in the size of those tissues that dispose of very large amounts of glucose or (2) an age‐related impairment in those gastrointestinal factors that promote the uptake of orally administered g

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1983.tb05742.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Physicians not only have a responsibility for the diagnosis and management of illness in the aged but also must address the patient's emotional needs, functional status, and psychosocial problems. The Institute of Medicine Report on Geriatric Medical Education has emphasized the need to train physicians to understand how the social components of care enhance the course and outcome of treatment. A physician's reference guide to social and community services should be developed to provide information that will enable clinicians to integrate medical and community health services into their practice.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1983.tb05743.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

General practice physicians and clinical specialists use various methods for assessing dementia, including the Mental State Questionnaire (MSQ), Face‐Hand Test (FHT), Dementia Rating Scale (DRS), tests for developmental reflexes and focal neurologic signs, and examination for evidence of clinical depression, stroke, or other physical health problems. In order to determine how these various methods concur, a sample of elderly persons living in the community were evaluated on eight indices. When MSQ scores were used as criteria, the DRS and FHT concurred with classification of impairment in 76 per cent and 45 per cent of cases, respectively. Positive focal signs and developmental reflexes were significantly related to cognitive impairment but were not common features in this sample. Physical health, drug use, and demographic variables did not appear to be related to cognitive function. Although dysphoric mood was related to cognitive impairment, pseudodementia was not identified. After one year the subjects were retested with the MSQ and the DRS; 14 per cent and 20 per cent, respectively, had improved, indicating a lack of predictive validity of these measures. Results are discussed in the context of the utility of clinical methods for screening and staging cognitive impairment, and recommendations are made regarding a standardized batter

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1983.tb05744.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Much attention is now focused on high users of health care. The literature indicates that elderly decedents are more often hospitalized than survivors, but little is known about the relationship of age, sex, and decedence to hospital usage. This paper uses the Manitoba Longitudinal Study on Aging to compare the hospital utilization patterns of elderly survivors and decedents. The results show that (1) the 5 per cent of the elderly who died accounted for 20 per cent of all the hospital days used by all the elderly; (2) impending death was associated with a substantial increase in the relative odds of being hospitalized and of using more than 18 hospital days; and (3) once hospitalized, the youngest decedents, who make up the largest proportion of the elderly population, spent more time in the hospital than those who were older. The findings underline the need for research into what hospitals are doing for decedents and into the quality of decedents' hospital stays.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1983.tb05745.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

The treatment of myasthenia gravis in the elderly is controversial. Thirty‐seven myasthenic patients with onset of the disease after the age of 60 were followed for a period of 14 years. All of the 37 patients received anticholinesterase drugs during this period, ten underwent thymectomy, and 24 were treated with corticosteroids. At present, one patient is in remission, 28 are improved, one is unchanged, and seven have died. Only one death was directly related to myasthenia. In the authors' experience thymectomy can be an effective treatment of myasthenia gravis in elderly patients; corticosteroid therapy can also be useful in addition to or as an alternative to surgery. Using a “personalized” schedule the authors obtained good results in 78 per cent of their pat

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1983.tb05746.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Active tuberculosis is highly prevalent in the geriatric population. The clinical syndromes and diagnostic indications of the different forms of tuberculosis are described. Reactivation pulmonary tuberculosis and miliary tuberculosis in the elderly are particularly difficult to diagnose. A high index of suspicion, a tuberculin skin test, and appropriate laboratory studies are essential for early diagnosis. Therapy for tuberculosis in the elderly must consider efficacy, patient compliance, and toxicity.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1983.tb05747.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

The specific sleep disorders of 97 patients 61–81 years old were compared with those of 264 middle‐aged (41–60 years old) and 202 young (20–40 years old) patients. Sleep disorder diagnoses were made according to the Diagnostic Classification of the Association of Sleep Disorders Centers based on evaluations consisting of mental and physical examinations and all‐night sleep recordings. Most young and middle‐aged patients complained of excessive daytime sleepiness; the elderly complained of insomnia as often as excessive daytime sleepiness. The evaluations revealed objective findings in 93 per cent of the elderly, but only 77 per cent of younger patients. Nocturnal myoclonus or restless leg syndrome was the diagnosed cause of 23 per cent of elderly patients' sleep—wake problems, but only 11 per cent of middle‐aged and 4 per cent of young patients had this problem. Respiratory disorders of sleep were found in 27 per cent of elderly, 35 per cent of middle‐aged, and 20 per cent of young patients. Elderly patients (6 per cent) had psychiatric disorders diagnosed as the causes for their problems less frequently than did younger patie

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1983.tb05748.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1983.tb05749.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1983.tb05750.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY