Increased longevity throughout the world is influencing medical care dramatically as more older individuals develop or survive with various medical conditions.
Although some elderly present typically with single-system disease, they often have presentations and responses to treatments that are different from their younger counterparts.
This variation in behavior of illnesses, which is due to the combined effect of aging and comorbid disease, must be understood if the elderly are to receive successful care.
[...] IMMUNE SYSTEM CLINICAL SYNDROMES OF AGING There are increased morbidity and mortality associated with influenza and pneumonia with advancing age and reactivation of infections such as tuberculosis and herpes zoster. The decline in immune function also may make it less likely that older adults will develop autoimmune diseases, such as systemic lupus erythematosus. HEMATOPOIETIC SYSTEM The pluripotent stem cell and the erythroid and myeloid progenitor cells show no age-related reduction, indicating that there is minimal or no change in basal hematopoiesis during aging. [...]
[...] Aging is associated with a progressive decline in the synthesis of neurotransmitters and a decline in their corresponding receptors. A major functional change is slower reaction times, which may be the result of a slower nerve conduction or transsynaptic speed. The farsightedness of aging is caused by the diminished ability of the lens to focus on nearby objects because of its thickening and stiffening. There is reduced ability to distinguish colors, particularly blue, owing to yellowing of the lens. NERVOUS SYSTEM Overall transmission of light through the lens may decline by 50 to 65% between ages 25 to 60 years; as a result, individuals require more ambient light. [...]
[...] Ultraviolet light exposure also predisposes to the development of skin cancer, the most common of which is basal cell cancer, but squamous cell cancer and melanoma are also age dependent. INTEGUMENTARY SYSTEM Approximately two thirds of aging individuals experience at least one skin problem, and about 40% have two underlying skin disorders. The most profound consequence of environmental exposure and age-related changes is that wound repair rates are significantly prolonged. In individuals older than age 65 years, healing takes about 50% longer compared with individuals in their 30s; complete skin healing can take 5.5 weeks instead of 3.5 weeks. [...]
[...] Aging is associated with a significant reduction in small intestinal surface area with the consequence of reduced absorption of some dietary components, such as calcium. Colonic function seems to decline with advancing age. Motility up to the rectosigmoid area, measured by passage of markers, does not seem to decline with advancing age. GASTROINTESTINAL SYSTEM Distal to this point, however, evacuation is characteristically slower with advancing age. Stool frequency tends to decline, and hardness of stools seems to increase with advancing age. [...]
[...] RESPIRATORY SYSTEM AGE-RELATED RESPIRATORY SYNDROMES The major clinical impact of normal physiologic aging in the lungs is an earlier appearance of shortness of breath as a warning signal of underlying disease. Myocardial infarction and heart failure can present primarily with shortness of breath, owing mainly to age-related mechanical changes, an inability to clear blood from the lungs, and a decline in resting pulmonary function to near the threshold for clinical hypoxia. GASTROINTESTINAL SYSTEM A broad series of changes occur in gastroenterologic tissues, but the redundancy of overall gastrointestinal function usually prevents clinical symptoms. [...]
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