Accidental hypothermia in the elderly is a rather unknown clinical syndrome in Germany. Manifestations are those of a generalized disease without striking symptoms or signs. To assure the clinical diagnosis, a low graded thermometer is necessary. Treatment consists of slow and passive rewarming and of correction of the accompanying disturbances. As important as correct diagnosis and treatment are preventive efforts against exogenous and endogenous risk factors.
Isolated rat livers were perfused with a medium free of immune globulins, protein and hemoglobin to investigate age-dependent differences in the phagocytosis of erythrocyte membranes. Membranes of young erythrocytes were phagocyted significantly more than those of old ones. The control parameters of the liver function also were significantly higher during the increased phagocytosis of the young cells than for the old cells and the control group. In the aged animals the characteristic of the elimination curve is changing. The old livers eliminated less ghosts than the young ones. These results are significant.
During their rehabilitation treatment 61 inpatients with different cardiovascular diseases or disorders were investigated with structured interviews, questionnaires about anamnesis and psychological tests in order to determine the individual coping strategies. The mean results show that three of four pts with functional heart and circulatory disorders don't know anything or something wrong about the pathology of their symptoms. Pts with coronary heart disease without myocardial infarction don't have any or any right information in 45%, but coronary infarction-pts don't have any right pathogenetic knowledge in only 12% (differences: p less than .05). The pathogenetic knowledge is not statistically correlated with the age of the pts. In total 54% can't give any reasons for the incidence, 18% are accusing their own health behaviour, 15% say that it is fate and 13% are believing that primarily environmental factors are the best conception about the etiology of their disease. The subjective illness-related psycho-physical irritation show a moderate to average strength and does not depend on pts' age. The main actual cognitive and emotional reaction to illness is in 40% denial, 30% are trying to adept actively to the given situation, 22% show acute mourning and anxiety and 8% respond with rebellion, aggressiveness or anger (differences: p less than .01). There is a tendency growing with increasing life-age to accept the event of illness as a chance for an active change to a better style of life in future. Pts with cardiovascular diseases design an overall optimistic development for their own future: they expect an age of 66.2 years, male pts believe to grow older than female (p less than .01). The prospected satisfaction with life doesn't show any significant differences depending on diagnosis or age. All in all the results lead to the conclusion that the factor "age of life" does not play a dominant role in the process of managing with cardiovascular diseases compared with psychological factors of coping with the illness.
61 falls and accidents and one suicide needed medical attention in our nursing home during a five-year period. Most frequent sequelae were scalp lacerations, followed by fractures of the femoral neck. 73% of the patients who got hurt by falls suffered of dementia. 38% were being treated with neuroleptic, antihypertensive or diuretic drugs. It was not possible however to document a relationship between drug treatment and falls. Most falls occurred while patients were walking on the floor without obstacles and without external influences. 3 patients died as immediate consequence of their falls. We observed falls more often in the first period of the patient's stay in our institution and again shortly before the patient's death. Prophylactic measures against falls include bed-rails, little tables that can be fixed to the wheel-chairs in order to hinder unassisted standing up of patients, unable to walk alone and judicious treatment with sedative drugs. The most important measure however seems to be compassionate and attentive patient care that conveys trust and confidence between patients and the nursing personnel. Possibly the incidence of falls and accidents could be used as a measure of the quality of nursing care in geriatric institutions.
A study on wound failures after surgical operations performed at the Dep. of Surgery, Köln-Merheim, revealed an overall rate of 10,8%. 40,3% of all complications were observed in patients aged more than 60 years, which gives a rate of 19,1% for those people. To date this significant increase of wound failures in older individuals is preferently explained by the reduced resistance of the old organism to infections. Our trials with rats as well as numerous publications of other authors on the topic of age-related changes of metabolism prove that the wound healing process is delayed in older individuals. This fact does not consequently lead to complications but the prolonged healing in connection with the repeated change of wound dressing gives an enhanced risk for infections. If special precautions are observed the age of a patient is not a principal contraindication to a great surgical operation today.
trying to replace worn-out parts of the body by transplantation from one patient to another, or even from one generation to another, and in seeking for ways of preventing the body from destroying itself by immunological hara-kiri or from being overwhelmed by the undisciplined growth of some of its components, we are aiming high. As Professor A S Parkes has remarked in a somewhat different context, 'Experiments on immortality are apt to take rather a long time.'
The investigation of cellular aging has mainly been limited by experimental and descriptive work on two separate cell culture systems. On one hand studies were performed on in vitro aging, comparing fibroblasts in early and late passage. On the other hand, fibroblasts derived from donors of different age were compared (in vivo aging). Recently, results have been achieved, stating that some of the investigated parameters change similarly in both systems. Therefore it is of great importance to find criteria for cellular aging, not only to precise the results in both cell culture systems, but also to be able to draw conclusions concerning aging of the organism in vivo.
Elderly people rarely develop hepatitis A, because of their acquired immunity, but they are more exposed to hepatitis-B and -nonAnonB infections. The course of viral hepatitis is usually more severe and more prolonged, the mortality of fulminant hepatitis is higher, and the risk of developing chronic hepatitis B is increased. There exists an association between chronic hepatitis B virus infection, old age, and the incidence of hepatoma. Exposed elderly persons should be vaccinated against hepatitis B but it might be necessary to give them additional booster doses in order to achieve sufficient antibody production.
Clinical symptoms in elderly patients with hyperthyroidism are atypical and uncharacteristic. In 13 patients with overt hyperthyroidism a goiter was found in only half the patients, eye signs in just three of them. Tachycardias, sometimes even paroxysmal tachycardias, predominate. In old people the diagnosis of hyperthyroidism is frequently missed, in 11 of 13 patients the disease was diagnosed following transfer to the rehabilitation center. About 50% of patients were iodine contaminated and this may have contributed to the disease. Data are presented to demonstrate that hyperthyroidism in old age may be a life threatening disease.
Authors examined the peripheral lymphocytes of 366 healthy individuals electron microscopically. They described age related degenerative changes in the mitochondria. The lamellar structure, electron-dense and electron-opaque material shown in the mitochondria of the lymphocyte proved to be similar to lipofuscin. The relationship of mitochondrial damage in lymphocytes and age was analysed, too. They stated that the number of patients with mitochondrial changes in the lymphocytes increased from 50 years of age until 80 years, but after 80 years decreased.
The correlations between serum HDL, total cholesterol, triglycerides or free fatty acids levels and the percentage of human peripheral blood lymphocytes bearing receptors for SRBC, MRBC, Con A or sIgG were sought in the aged people. The persons examined showed a marked heterogeneity in their serum lipid levels as well as in the results of lymphocyte surface receptor analysis. However, the only correlation found was that between the percentage of MRBC-rosette forming cells and the level of serum free fatty acids. The total cholesterol level, known as the modulator of some physical parameters of lymphocyte membrane, had, in our examination, no correlation with the changes of surface properties of lymphocytes. The possible physiological role of the phenomena observed is discussed.
In the life of old people the birthday has a special importance because at this day the entire family comes together and celebrates the anniversary. By means of 2000 advertisements of a daily newspaper the problem was investigated wether the birthday has a life-lengthening consequence in the meaning of that the old man or woman wants to be alive till this day and then he will die in peace. The results show fluctuations about the average monthly death-rate without statistical significance. Such a psychosomatic influence on the time of death commonly does not exist, although it may occur in an individual case.
The need of institutional care is strongly correlated to age. In the population, that is between 70 and 79 years of age the proportion of patients in long-term medical care units increases twenty-fold. The present investigation is a part of the longitudinal population study of 70-year-olds who have been followed to 79 years of age in Göteborg. A representative sample of 79-year-old men and women has been investigated. At this age 8.7 per cent of the men and 8.3 per cent of the women were living in medical and social institutions. Institutionalization was defined as constant care outside the patient's home for at least three successive months at the time of the investigation. The percentage of men living in somatic long-term medical care facilities was 4.3, while for women it was 2.4. The corresponding figures for psychiatric long-term care were 1.9 per cent for men and 1.8 per cent for women. 1.9 per cent of the men and 3.7 per cent of the women had moved to old people's homes where the subjects are expected to manage their own daily activities. Among the institutionalized probands only 7 per cent of the women were married, while this was the case for 43 per cent of the men. The subjects in psychiatric long-term care had the longest nursing time, i.e. about 20 years, while in the other types of institutions this time was about 3 years. The longitudinal strategy makes it possible to describe age-related changes in the background factors behind institutionalization.
A labyrinth-learning experiment was conducted with 83 elderly subjects (median 53 years), which was validated against the architectural "reality" of the clinic in which the test was conducted. The orientation capability of psychologically normal subjects was compared with the performance of patients with a depressive syndrome and/or with an organic mental syndrome. Factor Analysis revealed the independent influence of component functions, the most important being spatial imaging, memory, goal-seeking orientation, labyrinth learning and right-left coordination. Orientation in reality is not accurately predicted by performance on the labyrinth test model. Contrary to our expectation, the presence of OMS alone did not decrease performance; however the presence of a depressive syndrome, both alone as well as in conjunction with OMS did. Diagnostic and therapeutic implications are discussed.
In a prospective study of 50 patients a good correlation was found between the central venous pressure and the sonographic appearance of the inferior caval vein (ICV) behind the liver in right paramedian scanning. Dependent on central venous pressure (CVP) there were typical variations in the configuration, width and respiratory movements. These changes allowed a reliable estimation of the CVP. Decrease of the width in anteroposterior diameter in connection with a reduction of respiration-dependent caval movement indicated a deficiency of circulating blood volume. These alterations were always positive in cases of dehydration. Elongation of the vessel together with a widening over 2 cm and the lack of the normal end-inspiratory collapse were signs of an increased CVP. This non-invasive method is without risks or inconvenience for the patient. It is easily and quickly applied and very reliable for analyzing ICV haemodynamics. ICV ultrasonography can be recommended as a diagnostic aid for dehydration and hyperhydration as well as right heart failure, especially unrecognized, that means cardiac insufficiency without peripheral edema, constrictive pericarditis, tricuspid valve disease and for the assessment of the course of right cardiac failure.
Diseases of the bone have always to be considered in geriatric patients, especially because of the therapeutic consequences in osteomalacia (3/100) and hyperparathyreodism (1/100). Therefore calcium, phosphate and alkaline phosphatase should be measured in geriatric patients. The high prevalence of pathologic vitamin D measurements (78/100) in spring points to the importance of outdoor activities.
Drug interactions are found in elderly patients to a higher degree than in younger persons, because of the multimorbidity in the advanced age. The reasons are pharmacokinetic and/or pharmacodynamic mechanisms. At the first glance the amount of interactions seems puzzling but after regarding details more thoroughly it turns out that most of those interactions may be attributed to just a few drugs.
Cardiovascular diseases show a significant increase with age. However, there are no lesions which especially or exclusively affect blood vessels of old people only. Nevertheless, old persons seem to be more exposed to events occurring in their environment or, for example, during vascular or bone surgery, which can result in such lesions. Hyperergic vascular diseases can also occur and are mostly induced by polypragmasy as a consequence of multimorbidity. Drug-elicited reactions depend on changes in pharmacokinetics or pharmacodynamics. In addition, defects in cardiovascular adaptability may enhance the effectivity of the risks.
