Physical Presentations, Medical And Clinical Relevance Of The Health Problems In Elderly Persons

As an individual gets old, lots of his/her physical features begin to change (mostly depreciating). Some of these manifestations are seen in body weight and nutrition, ability to fight infections, cardiovascular changes, changes in the respiratory system, neurological disorders, autonomic dysfunction and depreciation in special senses such as sight, hearing etc.

Nutrition: The body weight tends to come down above the age of 70. Social neglect, loss of earning capacity and intercurrent illnesses tend to precipitate malnutrition.

Infections: The general resistance against microbes is lowered by malnutrition and impairment of immune mechanisms. The local defence mechanisms of the respiratory, urinary and alimentary tracts, mouth, skin, genitalia and eyes are impaired and therefore, bacterial infections are common. A common symptom occurring in the elderly subject is alteration in the level of consciousness, delirium and coma and these must raise suspicion of generalized infection. Fever may not be a prominent symptom in the early stages. Dehydration and electrolyte disturbances are common because of chronic renal impairment and endocrine deficiencies.

Cardiovascular changes: Ischemic heart disease is common. Above the age of 80 years, presbycardia results in cardiac failure and arrhythmias. Recurrent thromboembolism leads to cerebrovascular occlusion, ischemia of limbs and infection of other vital organs. Varicosity of veins may develop. Dependent edema occurs as a result of exudation of fluid due to loss of elasticity of the skin and fall in tissue tension. Hypoproteinemia, cardiac failure, venous stasis and immobility tend to perpetuate edema.

Respiratory System: Atrophic emphysema, chronic respiratory infection and aspiration pneumonia are disabling problems of old age. Staphylococcal bronchopneumonia may follow influenza and it is a fetal complication. Acute respiratory infection is a common complication of severe illness and this causes death in many cases.

Neurological disorders: Atherosclerosis leads to gradual deterioration of higher functions ending up in dementia. Cerebrovascular accidents accelerate this process. Subdural hematomas may develop following minor trauma, or even spontaneously. Cervical spondylosis, lumbodorsal osteoarthritis and ischemia to the spinal cord contribute to pain and dysfunction of the extremities. Peripheral neuropathy occurs frequently. The sensory loss accounts for unsteadiness of gait and clumsiness of movement. Tremor occurring in them aggravates the disability and, therefore, feeding, writing and other activities become difficult or impossible. Parkinsonism is common. This impairs speech and movements further. Cerebella dysfunction may develop. Herpes zoster is more common in the elderly. It sequelae, post-herpetic neuralgia tends to be troublesome.

Autonomic dysfunction: Elderly individuals lose control over the bladder and bowel. There is incontinence of urine and feces. This gives rise to problems of nursing. Postural hypotension may contribute to syncope and falls are common in the elderly. The heat hypothermia and hyperthermia may occur due to exposure.

Special Senses: Loss of vision due to cataract, retinal degenerations or chronic iridocyclitis, and glaucoma is common. Diabetes and hypertension aggravate the disability, Loss of vision incapacitates them considerably and pastimes like reading, writing and watching television become problematic.

Loss of hearing is common after the age of 50 years and it is a serious handicap. The diminution in hearing may be universal affecting all tones, or the higher frequencies may be selectively affected. Deafness impairs their ability to communicate with others and thus makes them isoltated. Tinnitus and vertigo may be troublesome. Ageusia or parageusia may occur and these may aggravate their feeding problems.

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