The levels of serum total cholesterol, LDL- and HDL-cholesterol, triglycerides and apolipoprotein B were determined in urban and rural persons of Ethiopia in dependency on age. Regarding total and LDL cholesterol a comparable age-dependency as in the population of other countries is observed. On the other hand higher values of these parameters were found in the serum of urban persons in comparison with rural subjects which may be a reflection of the different life style.
The situation of the elderly population in France is described. A section is included on demographic aspects. (SUMMARY IN ENG) (ANNOTATION)
The increase of older and oldest people explain the growing accident-frequency in household and traffic. From this it follows the priority of craniocerebral trauma. Pathological and normal aging beyond the seventy years show anomalies in symptomatology and clinical course as against young people. This research paper represent important aspects of epidemiology, anamnesis, clinic and examination-algorithm after craniocerebral trauma by senile patients.
The age structure of the population shows an increase in older people. In particular cardiovascular diseases become manifest prevailingly beyond the 65th year of life. So, the percentage of care for this age group with cardiovascular diseases will continue to rise in the years to come. Herein measures of rehabilitation with older patients have to be thought over again and put into practice. The comprehensive rehabilitation in this group of patients with a higher percentage of more severely sick patients aims at the maintenance and stabilisation of the physical and psychic capability and at support with social problems. The physician should remain in connection with the older patient in the process of mastering his/her disease and thus contribute to reaching his/her mental balance.
In a prospective study of 150 patients with definite myocardial infarction (WHO) risk group assignment in the acute phase was done based on lactate dehydrogenase isoenzyme monitoring. 28% of the patients were older than 60 years. The informative functional exercise test was performed by the end of the hospital phase according to three risk groups at different times. Low risk on the 14th day, medium risk on the 21st day, and patients at highest risk on the 28th day after the infarction at the earliest. In connection there this test lactate was determined. In older patients, upper age limit 75 years, any severe complications did not occur during exercise. High-risk patients were objectified by the lactate dynamism, and the decision was made on the further individual outpatient design of physical conditioning by means of low level exercise training.
Results on fitness and exercise tolerance of patients undergoing rehabilitation after myocardial infarction are shown in dependence on age. The fitness data of the patients recovering from myocardial infarction can be classified with the lower reference region of untrained normal populations and are subject to the same regularities in the ageing process. For sports therapy a versatile endurance training with average blood lactate concentrations of 2.5-3.5 mmol/l is recommended. The greater strain on the aerobic-anaerobic metabolism in older infarction patients during sports therapy emphasizes the necessity of the age-specific design of exercises.
The extent of the acute damage to the myocardium essentially determines the prognosis for patients after acute myocardial infarction. The definition of the risk in the early hospital phase by a semiquantitative evaluation of the infarction size is of great important to the layout of active early mobilisation and is done by iso-enzyme monitoring of lactate dehydrogenase. Beginning, intensity, and duration of the mobilisation programme are fixed individually according to risk groups under consideration of previous myocardial damages and of age. With older patients the stay in hospital is longer, and their performance in the informative exercise test is lower. In the course of the outpatient post-infarction conditioning the peculiarities of the older myocardial infarction patient should be taken into account.
The indication of surgical valva replacement also at older age (greater than 60 years) with chronically rheumatic valvular diseases requires both the assessment of the pre-operative constellation of findings and perioperative complications. From this combined point of view statements concerning the strategy of valve replacement at older age seem to be concludable. In the frame of a prospective study perioperative parameters were monitored in n = 90 patients with preoperative high-risk constellation out of a total of n = 300 patients for the quick recording of additional complications (such as perioperative myocardial damage, cardiac low output syndrome, and cases of death at the ICU). The average age of the whole group of patients was 52 years (25-68 years), that of the patients greater than 60 years was 63.6 years (61-68 years). In 72% of the older patients the preoperative high-risk constellation was confirmed by 50% deceased; 16% cLOS; 6% perioperative myocardial damage (PMD). On a total of 41% of the patients a combined operation was performed (valve replacement and bypass operation), there of 2/3 with aortic valve replacement and 1/3 with mitral valve replacement. The ejection fraction restricted heavily already before the operation (less than or equal to 30%) was the essential cause of perioperative complications (cases of death, cLOS) together with the combined operation. The immedicable pulmonary hypertension complicated the already preoperatively impaired left-ventricular function in a high percentage of patients with mitral valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)
Eighty patients were physically conditioned after definite myocardial infarction (WHO definition). The percentage of patients older than 60 years was 28%. Physical conditioning as part of the non-drug therapy of acute myocardial infarction is of great importance also to older patients. The older patient impaired in his/her performance becomes physically more capable by an individually adapted conditioning and can socially better be re-integrated. A suitable parameter for the demonstration of the efficiency of physical conditioning in older patients is the lactate dynamics.
In a prospective study n = 80 patients after acute myocardial infarction, upper age limit 75 years, were conditioned by a 6-week outpatient training programme. 78% of the patients older than 60 years could be conditioned successfully. In particular patients at high risk went through a low level exercise training. Any serious, life-threatening complications have not occurred in the older patients during the training programme. The results provide evidence of the efficiency of the outpatient physical conditioning of older patients in regard to the improvement of the quality of life and the support in social re-integration.
The percentage of older patients with AMI in the total of patients is predominating and is still increasing differentiatedly. The essential cause of there is an increase in complications and in mortality until the 28th day. In a prospective study over 48 months with n = 390 patients we analyzed the age groups less than 65 years (A) and greater than or equal to 65 years (B) regarding their different rates of complications. For the semiquantitative determination of myocardial infarction sizes we used: -Monitoring of ECG, creatinine kinase (CK), and ejection fraction global (EFg). In group A 81% survived, whereas in group B only 60% survived. The average age of the surviving patients was 56.2 years, that of the deceased 64.4 years. The percentage of surviving patients with transmural AMI was 96% in A and 57% in B. In both A and B. CKmax with p less than 0.01 was to be differentiated between non-transmural and transmural AMI. In the deceased CKmax was 89.7 (A) to 59.3 mumol/lxs (B) (p less than 0.05). The percentage with AMI extension was 4% in A and 43% in B, p less than 0.005. Patients of group B showed a significant difference (p less than 0.001) of EFg for non-transmural AMI 59.1 (36-70)%, transmural AMI 31.5%, and deceased 17.3%. In patients with Re-AMI EFg was generally measured to be less than 45%. Re-AMI could be diagnosed in 13% of A and in 29% of B (p less than 0.001). The ICU stay of the surviving patients of the total number of patients could be reduced by 1.1 days in the period from 1984 through 1987. With group B it could be reduced by 0.8 days. The overall stay in hospital (1984-1987) was 19.6 days (A = 18.3; B = 22.4). AMI extension and the Re-AMI result are the decivise factors to the essential increase in complications and cases of death with AMI at older age. The semiquantitative determination of the myocardial infarction size by monitoring makes up an efficient basis for the early assessment of the residual function of the myocardium and of the risk classification.
On the extended diagnosis for an aorto-coronary venous bypass operation, with a greater involvement of patients with instable angina pectoris symptomatik (inApS), left main artery disease (LAD), aneurysmal resection, and "bad" ventricle (ejection fraction global less than or equal to 30%), the preoperative risk was evaluated in n = 600 patients. In a total of n = 150 patients with preoperative high-risk constellation perioperative parameters were monitored to find complications (perioperative myocardial damage [PMD], cardiac low output syndrome [LOS]). Among them were n = 40 patients aged greater than 60 years (60-72), their average age being 62.9 years. In 30% of these older patients the preoperative high-risk constellation was confirmed: 15% PMD, 10% LOS, and 5% deceased. The further postoperative course (up to the 6th month) is objectified by the ejection fraction global (EFg) by multiple checks. As a whole, patients greater than 60 years with extended diagnosis for ACVB operation do not show any significant increase in hospital mortality, but an increase in PMD and LOS (p less than 0.001) compared to the age group less than 60 years. With corresponding individual intensive-therapeutic measures, however, both complications can be controlled in the majority of patients. Despite the demonstrated higher perioperative risk, the urgent ACVB operation proved to be strategically right (considering the results of EFg) for increasing the quality of life and improving the expectation of life also for patientes greater than 60 years, in particular with the operation indications of inApS and LAD.(ABSTRACT TRUNCATED AT 250 WORDS)
The influence of orally administrated procaine hydrochloride and of its metabolites diethylaminoethanol, monoethylaminoethanol and ethanolamine on specific intermediary processes in rats was tested. While the animals got procaine hydrochloride in a single dose or via food the incorporation rate of amino acids in protein was measured in homogenisates of liver tissue by the incorporation of a mixture of 14C-amino acids. Procaine hydrochloride, the commercial product K. H. 3, as well as diethylaminoethanol, monoethylaminoethanol and ethanolamine increased the amino acid incorporation rate in a dose and time dependent mode, while p-aminobenzoic acid remained without any effect. The dose of procaine hydrochloride inducing a maximal reaction was in the range of 50 to 100 mg/kg b. w. (250 to 500 mg/kg food). The minimal active dose was nearly at 10 mg/kg b. w. Paying regard to a metabolic factor of 10 the effective dose-range is nearly the dose used in experience with human beings to influence geriatric complaints. In the study described here haematoporphyrine (a component of the commercial product K. H. 3, not absorbed) shows no specific intermediary effect. May be it promotes the intestinal absorption of procaine hydrochloride by protection against intestinal hydrolysis. The intermediary effect of procaine hydrochloride is to measure on cellular or subcellular level without compatibility to the activity as a local anaesthetic. With regard to other intermediary effects mentioned in the literature like growth promotion or inhibition of monoamine oxidase activity, it is discussed whether the increase of the hepatic amino acid incorporation rate is corresponding to geriatric experiences made with procaine hydrochloride.
Entering the age of retirement means a threshold situation affecting various relations in the living-conditions, medical provision not excluded. Based upon the WHO-authorizised concept of classification of impairments, disabilities and handicaps (ICIDH), disability status was checked up in 62 male and 113 female at the age of 65 respectively 60 years, the trial forming the respondents rate out of a population total of 179 persons reaching the age of retirement within a one year's space at a district town in the north part of GDR. Medical provision in this context was analysed.
In rats treated with procaine hydrochloride, diethylaminoethanol, monoethylaminoethanol, ethanolamine, as well as a combination of procaine hydrochloride and haematoporphyrine the ratio of acetyl coenzyme A and coenzyme A clearly was enhanced in the liver and to a minor extent in the cerebellum. In the tissue of cerebral cortex, heart, muscle and duodenum no corresponding effects were demonstrated. These findings, showing a further intermediary effect of orally administered procaine, can be interpreted as an influence in intermediary energy utilisation.
In 3 and 14 years old mini pigs age dependent changes as well as the opportunity to modify them with a combination of procaine and haemotoporphyrine, administered daily over 6 weeks in doses of 150 mg procaine hydrochloride per animal (3-5 mg/kg b.w.), were tested. In serum a small age dependent increase in catecholamine concentration was recognized, while the concentration of cortisol was distinctly increased in the older pigs. The monoamine oxidase activity was increased in the liver of the 14 years old pigs while no differences were found in cerebral cortex. Under procaine the old animals showed a clear decrease in monoamine oxidase activity as well as in cholinesterase activity. Furthermore an age dependent decrease of the thymidine triphosphate incorporation rate as well as the amino acid incorporation rate was found in liver, cerebral cortex, small intestine and spleen. Jejunal enzyme activities also were decreased age dependently. Otherwise procaine hydrochloride induced an increase in intestinal enzyme activities of both animal groups. These findings demonstrate that different intermediary processes change age dependently. Also it is shown, that procaine hydrochloride develops intermediary effects.
Taking care for older people in homes for the aged and nursing homes should be improved and broadened concerning a higher activity of these people. A very good method seems to be group work. In this investigation group sessions with people in a nursing home have been made during the time of half a year.
The use of low power laser therapy in 30 in-patients aged from 72 to 86 years suffering from diseases of the movement apparatus resistant to treatment and from chronic peripheral and cerebral circulation disorders based on arteriosclerosis is proofed as efficient, riskless physicaltherapy method to improve the complaints and to economize with medicamentation.
104 chronically ill patients of an average age of 82.7 years were accommodated on geriatric wards of hospitals totaling 152 times during vacation, stay at a health resort, or illness of their attending relatives. On average, they stayed in hospital for 3 to 4 weeks. Main diagnoses were cerebrovascular circulatory disturbances or condition after insultus, chronic ischaemic heart disease, and tumor diseases. The morbidity rate during that stay was 9.2%, the mortality rate 6.8%. In 8 out of 10 cases the immediate cause of death was directly causally associated with the primary disease. Any severe nosocomial infections did not occur. The authors consider the risk of the temporary hospitalization of people in need of care for the temporary relief of their relatives, with regard to the patient's age and primary diseases, as justifiable.
