1: Rehabilitation and older people

Older people make up the majority of participants in general rehabilitation programs. Stroke and hip fracture are the major diagnostic groups. Most older people with significant disability of recent onset have the potential to benefit from rehabilitation. Assessing an older person's premorbid functional and cognitive status, which are strong determinants of rehabilitation outcome, is an important component of management. The major goals of rehabilitation for older people are mobility and self-care without the assistance of another person. Evidence suggests that rehabilitation for older people involving a coordinated multidisciplinary team of health professionals (including nurses and doctors) is effective. Contemporary rehabilitation practice is not confined to traditional inpatient rehabilitation units; it also occurs in the community and other non-hospital settings, and involves general practitioners.     

老年人的功能评价

急性和慢性疾病共同导致的功能受损是老年人前往医疗机构就诊的主要原因。功能下降继而丧失生活自理能力以致需要专门护理机构帮助,是老年人功能损害的必由之路。然而这一进程并非不可避免或逆转。及时认识到功能下降,并进行早期干预,可预防和阻止功能进一步下降。本文为全科医师介绍老年人功能评估的方法（框图1是这一大领域常使用的术语）。     

Nocturnal leg cramps in older people

Nocturnal leg cramps are common in older people. Such cramps are associated with many common diseases and medications. Physiological methods may be useful for preventing cramps in some people, but there have been no controlled trials of these approaches. Quinine is moderately effective in preventing nocturnal leg cramps. However, there are concerns about the risk/benefit ratio with this drug. In patients with severe symptoms, a trial of 4-6 weeks' treatment with quinine is probably still justified, but the efficacy of treatment should be monitored, for example using a sleep and cramp diary.     

高尿酸血症与老年患者颈动脉硬化斑块发生的临床研究

目的 探讨高尿酸血症对老年患者颈动脉硬化斑块发生的作用.方法 随机抽取2005年10月至2008年2月住院老年患者1 719例,其中高尿酸血症827例,无高尿酸血症892例.记录患者一般资料,测定血糖、血尿酸、血脂,并进行螺旋CT脑血管成像或数字减影CT全脑血管造影检查.结果 性别(χ2 ＝12.87,P＝0.005 6)、原发性高血压(χ2＝14.52,P＝0.002 3)与颈动脉硬化斑块发生显著相关.血糖升高(χ2＝9.16,P＝0.012)、高胆固醇血症(χ2＝7.46,P＝0.036)、低密度脂蛋白偏高(χ2＝6.92,P＝0.038)、高尿酸血症(χ2 ＝9.02,P＝0.017)与颈动脉硬化斑块发生有关.高尿酸血症患者中男性(OR=1.02,95%CI=1.12～1.66)、原发性高血压(OR=3.46,95%CI=1.19～6.01)、血糖升高(OR=2.23,95%CI=1.15～3.54)和尿酸偏高(OR=2.21,95%CI=1.13～3.46) 发生颈动脉硬化斑块的危险性增加.结论 高尿酸血症加快老年患者颈动脉硬化斑块的发生.     

Care for suicidal older people: current clinical-ethical considerations

This article opens by reviewing the state of the knowledge on the most current worldwide facts about suicide in older people. Next, a number of values that have a role in this problem are considered. Having a clear and current understanding of suicide and of the related self-held and social values forms the framework for a number of clinical-ethical recommendations for care practice. An important aspect of caring for older people with suicidal tendencies is to determine whether their primary care fosters self-esteem and affirms their dignity. In addition to providing a timely and appropriate diagnosis and treatment of suicidality, the caregiver is responsible for helping the patient to cope with stressful conditions, and for treating the patient with respect and consideration, thereby supporting the patient's dignity and giving the patient a reason to live. Paying attention to these central points will foster caring contact with suicidal older people.     

Depression in older people: a point to remember in all specialties

Depression is a common disorder in older people. It is usually undiagnosed in elder patients due to atypical symptoms, masked depressive state, mixed with agitation, psychotic delusions and worsening of physical symptoms already present or multiple pains in extremities. It is a very common associated comorbidity with patients of all disciplines--as in post CVA state or postmyocardial infarction, postoperative state, posthysterectomy or in recovery state of various medical disorders, even in a viral influenza, or in a metabolic medical disorder like diabetes mellitus. Author has studied and analysed 120 patients in different wards of Midnapore Medical College & Hospital and some others usually referred by other physicians at OPD and have found high incidence of depression and a marked improvement of symptoms after a short period of treatment.     

老年性颈椎病的外科治疗

目的　探讨老年性颈椎病的治疗。方法　采用颈前入路脊髓减压椎体融合 ,颈后入路椎板切除减压及双开门自体棘突植骨椎管扩大减压 ,对 1 6例患者进行治疗。结果　术后观察 6个月以上 ,优良 4例 ,良好 7例 ,改善 3例 ,无改善 2例。结论　三椎体间以上多椎体性病变 ,以及病变范围不能肯定而神经症状呈现多样性者 ,选择颈后入路双开门自体棘突植骨椎管扩大减压术。目的　探讨老年性颈椎病的治疗。方法　采用颈前入路脊髓减压椎体融合 ,颈后入路椎板切除减压及双开门自体棘突植骨椎管扩大减压 ,对 1 6例患者进行治疗。结果　术后观察 6个月以上 ,优良 4例 ,良好 7例 ,改善 3例 ,无改善 2例。结论　三椎体间以上多椎体性病变 ,以及病变范围不能肯定而神经症状呈现多样性者 ,选择颈后入路双开门自体棘突植骨椎管扩大减压术。     

Effectiveness of treatments for depression in older people

OBJECTIVE: To conduct a systematic review of the evidence for the effectiveness of a range of possible treatments for depression in older people. DATA SOURCES: Literature search using the PubMed, PsycInfo and Cochrane Library databases. DATA SYNTHESIS: Treatments that have been suggested to be effective for depression were grouped under three categories: medical treatments, psychological treatments, and lifestyle changes/alternative treatments. We describe each treatment, review the studies of its effectiveness in people aged > or = 60 years, and give a rating of the level of evidence. CONCLUSIONS: The treatments with the best evidence of effectiveness are antidepressants, electroconvulsive therapy, cognitive behaviour therapy, psychodynamic psychotherapy, reminiscence therapy, problem-solving therapy, bibliotherapy (for mild to moderate depression) and exercise. There is limited evidence to support the effectiveness of transcranial magnetic stimulation, dialectical behaviour therapy, interpersonal therapy, light therapy (for people in nursing homes or hospitals), St John's wort and folate in reducing depressive symptoms.