| 书目名称 | Geriatrics | | 编辑 | A. N. Exton-Smith,P. W. Overstall | | 视频video | | | 丛书名称 | Guidelines in Medicine | | 图书封面 |  | | 出版日期 | Book 1979 | | 关键词 | geriatrics | | 版次 | 1 | | doi | https://doi.org/10.1007/978-94-011-7191-5 | | isbn_softcover | 978-94-011-7193-9 | | isbn_ebook | 978-94-011-7191-5 | | copyright | A. N. Exton-Smith and P. W. Overstall 1979 |
| 1 |
Front Matter |
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Abstract
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| 2 |
,Ageing, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
The more one thinks and talks about ‘the elderly’ the easier it is to forget that in clinical practice one is always dealing with an individual. Although some useful generalizations may be made about the ageing process and the differences in disease presentation and management of the older patient, it is a mistake to regard the elderly as a homogeneous group. Indeed, variations between individuals tend to increase with age.
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| 3 |
,Special features of disease in old age, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
Two opposing types of change take place concurrently in organs and bodily systems throughout life. In earlier years the changes produced by evolution or growth are the most readily apparent, whereas in later life the changes associated with involution or atrophy of the tissues predominate. Many of the special features of disease in old age are consequences of the structural and functional alterations which occur in the body in senescence.
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| 4 |
,Mental disorders, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
There is usually some atrophy of the brain, particularly the frontal lobes, with shrinkage of the gyri and widening of sulci. Microscopically there is an accumulation in neurones of ., a yellowbrown pigment that although probably not harmful in itself, indicates a reduction in efficiency of the nerve cell’s metabolism. It is increased in the presence of degenerative disease.
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| 5 |
,Central nervous system and special senses, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
The clinical presentation of neurological disorders in old age is frequently influenced by age-related changes in the central nervous system. These changes may be intrinsic and part of the process of ageing (see Chapter 3) or they may be the result of pathological conditions in other organs and tissues, especially in the cardiovascular system. Critchley (1931) has drawn attention to the effects of ageing on neurological signs. Many physical signs indicative of disease in the young may not be of significance in the diagnosis of clinical neurological disorders in old age. Thus loss of vibration sense and tendon jerks in the lower limbs do not necessarily mean peripheral neuropathy; irregular sluggish pupils are not pathognomonic of neurosyphilis and the frequent occurrence of a bodily attitude of flexion, disorders of gait, tremors and a positive glabellar tap sign leads to difficulties in establishing the diagnosis of Parkinsonism.
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| 6 |
,Autonomic nervous system, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
Disorder of autonomic function is often concerned in the causation of two common clinical conditions in old age — postural hypotension and hypothermia. It may also be a factor in the development of heat illness, disturbances of oesophageal and gastrointestinal motility and in some cases of urinary retention and incontinence (see Chapter 11).
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| 7 |
,Cardiovascular system, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
The effects of ageing on the aorta are: cystic medial fibrosis; elastin fragmentation, characterized by disruption of elastic lamellae; fibrosis, defined as an increase in collagen at the expense of smooth muscle; and medionecrosis. These are probably wear and tear changes secondary to haemodynamic events (Schlatmann and Becker, 1977), and are most marked in the ascending aorta, arch and the lower limb arteries. As a result of smooth muscle atrophy and the increase in collagen, larger arteries tend to elongate and dilate. The intima thickens due to the deposition of collagen between the endothelium and internal elastic lamina.
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| 8 |
,Respiratory system, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
On gross examination the lungs of older people are lighter, whilst microscopically the thickness of the alveolar wall is reduced and the number of capillaries is decreased. Although there is no loss in the total number of alveoli they are increased in size with a reduction in the thickness of the elastic fibres in the bundles surrounding the alveolar ducts. The normal function of the elastic tissue is to maintain the patency of the small airways and this is impaired in old age.
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| 9 |
,Alimentary system, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
Many of the age-changes which occur in the alimentary system are asymptomatic. They may, however, directly predispose towards the development of clinical disorders; for example, constipation and diverticular disease become increasingly common with age. The functional and structural changes associated with ageing include: impairment of the sense of taste; disorder of oesophageal motility; atrophic changes in the gastric mucous membrane and the development of achlorhydria; functional impairment of small intestinal absorption; increase in gastrointestinal transit time leading to constipation and faecal impaction; the development of diverticula at various sites, in the oesophagus, duodenum, jejunum and especially in the colon.
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| 10 |
,Nutrition, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
Changes in nutritional status of elderly people are brought about by alterations in their socio-economic circumstances, which often occur about the time of retirement, and by the increasing incidence of disease and disability which lead to changes in dietary intake, absorption and metabolism of nutrients. The effects of disease and disabilities become more marked during the second half of the eighth decade. Thus, although frank malnutrition has been largely eliminated from most sections of our population, it is still found amongst the elderly as a consequence of the operation of these factors.
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| 11 |
,Urogenital system, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
With increasing age the kidney atrophies, affecting the cortex more than the medulla. Interstitial fibrosis is most marked in the medulla with coarse scarring also seen in a small percentage of cases. There are, however, considerable variations in the appearance of the kidney in old age.
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| 12 |
,Endocrine disorders, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
Studies on the ageing of endocrine glands are few and tend to be contradictory, reflecting the difficulty in distinguishing between physiological changes and the effect of diseases.
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| 13 |
,Blood disorders, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
Ageing has remarkably little effect on blood constituents. The life span of erythrocytes is unaltered and there are only very minor changes in the leukocyte count. With increasing age albumen falls and globulins rise, which probably accounts, in part, for increased values of the erythrocyte sedimentation rate (ESR).
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| 14 |
,Skin diseases, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
Along with connective tissue changes elsewhere in the body there is degeneration of dermal collagen with subsequent thinning and loss of elasticity of the skin. Environmental factors such as sun and wind are as important as ageing itself in causing wrinkling and roughening of the exposed skin. The skin is drier due to atrophy of eccrine and apocrine sweat glands and reduced sebum excretion. Pigmentary changes are common and may be isolated or widespread, particularly over exposed areas. In addition to male pattern baldness there is, in both sexes, a loss of hair follicles with diffuse thinning of hair.
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| 15 |
,The musculoskeletal system, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
Ageing is accompanied by loss of bone from the skeleton; the atrophy of bone corresponds to atrophy of other tissues which occurs with increasing age.
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| 16 |
,Rehabilitation with special reference to stroke, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
Rehabilitation of the stroke patient is a neglected subject in most medical schools. All too often the patient is regarded as an embarrassment for whom the doctor can do nothing, and the field is left open to the various remedial therapists to do the best they can. This is a sad state of affairs, since even if hard scientific evidence showing an advantage to the patient treated by a team skilled in stroke rehabilitation is hard to come by, there is little doubt that the enthusiasm and morale of such teams tend to be high. Many stroke patients have benefited from the work of teams skilled in rehabilitation.
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| 17 |
,Principles of drug therapy, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
Early pioneers in geriatrics showed what could be achieved in the management of seemingly ‘hopeless’ cases. Principles of rehabilitation of hemiplegia and other locomotor disorders were evolved, and the illeffects of immobilization of the elderly in bed were recognized and avoided. More recently, a major contribution of the specialty to medicine as a whole has been a fuller understanding of the possibilities of treatment of elderly patients, and many old people have benefited from a more optimistic and active therapeutic endeavour. A more thorough investigation of patients reveals the silent existence of many conditions and that multiple pathology is the rule rather than the exception. Treatment of these multiple disorders has, however, led to new problems resulting from the administration to the individual patient of a number of powerful drugs which may produce a variety of ill effects.
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| 18 |
,Care of the dying patient, |
A. N. Exton-Smith MD, FRCP,P. W. Overstall MB, MRCP |
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Abstract
There has recently been a renewed interest shown by the medical and lay press in the manner in which a person dies. Much of this interest reflects an awareness that sociological changes have produced an atmosphere in which death is a taboo subject. These changes are many and complex: the decline of formalized religion, the unrealistic expectations encouraged by a consumer-orientated society, and the growth of a complex health care system in which, with each new ‘breakthrough’, there is the promise of eventual victory over death. One of the results is that more and more people are dying, not at home among relatives and friends, but in a hospital amid the paraphernalia of lastditch resuscitation attempts. Thus Ivan Illich (1975) can write: ‘The medicalisation of society has brought the epoch of natural death to an end. Western man has lost the right to preside at his act of dying’.
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| 19 |
Back Matter |
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Abstract
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发表于 2025-3-21 19:31:40
