Health maintenance issues of the elderly. Sleep

Our understanding of the effect of aging on normal sleep and specific sleep disorders in the elderly has increased significantly in the last decade. Sleep complaints and the use of sedative hypnotics in the elderly are now more frequent than in younger patients. It is important in the management of elderly patients to determine whether a formal laboratory evaluation of a patient needs to be undertaken to diagnose a specific sleep disorder prior to initiating drug therapy for nonspecific complaints of difficulty with sleep.     

Health maintenance issues of the elderly. Exercise

If ever there an antidote to the decline associated with aging, it might be physical exercise. Older people who exercise regularly tent to be those at whom we marvel: they live longer, more vigorous, independent lives. Exercise has provided them with keys to a better quality of life and cardiovascular fitness, strengthened muscles, a well-functioning nervous system, good mental health, and improved functional capacity.     

Health maintenance issues of the elderly. Incontinence

Urinary incontinence, a prevalent and costly health problem that can have adverse effects on a patient's physical health and psychosocial status, often influences decisions for institutionalization.     

Health maintenance issues of the elderly. Immunization

The elderly are frequently underimmunized against vaccine-preventable infectious diseases. Comprehensive immunization of patients for vaccine-preventable diseases represent a major challenge for physicians treating the elderly. The healthy elderly should be specifically targeted since they are most likely to mount an appropriate immune response to the vaccine. Programs to identify inadequately immunized patients should be widely implemented.     

Health maintenance issues of the elderly. Hearing

Estimates of the prevalence of hearing impairment individuals over 65 years old are on the order of 30 percent. Although the psychosocial consequences of hearing impairment may be profound, less than 20 percent of hearing-impaired adults use hearing aids to compensate for their hearing loss. Primary care physicians play a vital role in identifying hearing impairment in the elderly and in assisting the older adult in obtaining rehabilitative services, including hearing aids. Screening tools, which are inexpensive, simple to use, and valid, are available for use in the primary care setting.     

Health maintenance issues of the elderly. Oral health

The risk for the most serious oral disease, oral cancer, increases with age as does the prevalence of other oral soft tissue diseases. Tooth loss is not part of normal aging. As more elderly retain their natural dentition, they are at continued risk for tooth-related diseases such as caries and periodontal disease. Preventive dental programs, including an oral exam as part of the physical examination, will be indicated for adults.     

Health maintenance issues of the elderly. Vision: age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of irreversible severe visual loss in the United States among persons over 50 years old. The majority of patients who develop severe visual loss from AMD have exudative disease. Treatment for AMD has been shown to be effective for only a small portion of patients who have well-defined choroidal neovascular membranes (CNVM) outside the foveal center. Even when successfully treated, severe visual loss is postponed for only about 18 months because of the high rate of recurrent CNVMs extending through the fovea. Presently, low-vision aids are the only treatment available for the majority of patients with exudative disease.     

Health maintenance of the elderly. Sexuality

Empirical research, clinical experience, and greater sophistication about the interaction of social, psychological, and biological factors have produced marked changes in the appreciation of the importance of sexuality in older persons. An earlier view linking sex exclusively with reproductive function has given way to a holistic view of sex as vital to self-concept, the maintenance of healthy interpersonal relationships, and a sense of integrity. Older adults often have difficulty communicating sexual problems, concerns, and questions because of their conflicting attitudes and perceptions. Sexual problems often are presented covertly, expressed in vague terms, or masked by embarrassment. Physicians need to be aware of the possibility of covert sexual dysfunctions, clear about their own attitudes and expectations to avoid stereotyping the elderly, and knowledgeable about pharmacological, organic, and psychosocial bases of sexual problems in older patients.     

Nutrition of the elderly.

The progressively increasing number of elderly people in the Canadian population and the disproportionate expenditure on their health care has stimulated interest in prevention of common illnesses observed in this age group. It is now recognized that nutrition plays an important role in health status, and both undernutrition and overnutrition are associated with greater risk of morbidity and mortality. Nutritional problems in the elderly can be suspected if there are several high-risk factors present--for example, living alone, physical or mental disability, recent loss of spouse or friend, weight loss, use of multiple medications, poverty, and high consumption of alcohol. Physical examination, anthropometry, and measurements of serum albumin levels and hemoglobin and lymphocyte counts are simple but helpful tools in confirming the presence of nutritional disorders. The prevention and correction of nutritional problems is likely to prove beneficial in the management of common geriatric illnesses. In these efforts, it is desirable to have a team approach in which the physician, the dietitian and the nurse each have a defined interactive role. Home care support services are important adjuncts in continuing care. Nutrition should receive a greater emphasis in the training of physicians and other health professionals.     

老年人的营养与免疫问题

免疫功能下降和营养不均衡与老年病的密切关联不容忽视,在社区老年人保健工作中应该高度重视。 一、老年人的免疫衰老问题 老年人机体免疫功能减退在医学上称为“免疫衰老”,胸腺衰老是免疫衰老的最重要标志。     

Health issues at the US-Mexican border

With a rapidly growing population, increasing manufacturing activity, and increased interdependence, health issues on the US-Mexican border are demanding greater attention. It is unlikely that any other border in the world separates two nations having such variety in health status, entitlements, and utilization. Binational initiatives in the areas of environmental health and sanitation are clearly needed. Further cooperation between the United States and Mexico in provision of health services is warranted and will probably require enhanced federal funding or subsidies to be successful.