N Diseases of Old

Of the many diseases that afflict the elderly, certain medical problems are clearly restricted to the older population, while some overlap with those found in younger adults. Diseases that are primarily limited to the elderly are listed in Table 11. Diseases associated with aging with known and unknown etiologies are also listed in Table 11.

A list of common diseases responsible for death, compiled from hospital records in the United States (Fig. 8) and other developed countries, shows cardiovascular diseases (including hypertension and myocardial and cerebral vascular accidents) and cancer to be the diseases most related to old age (Table 12). It should be noted that when the information is secured not

TABLE 10 General Characteristics of Disease in the Elderly

Symptoms Vague and subtle Atypical Unreported Chronic vs. acute Multisystem disease Altered response to treatment

Increased danger of iatrogenicity (medically induced morbidity and/or mortality)

from general hospitals but specifically from geriatric units, the distribution of diseases is somewhat different, with atherosclerosis (and its cardiovascular consequences) being the major cause of hospitalization and deaths, while cancer is a lesser cause, especially after 80 years of age (Table 12).

Together with the higher morbidity, after 60 years of age, hospitalization days per person per year increase dramatically from two days to two weeks (Fig. 8). Such an increase has a significant impact on the cost of medical care.

As the characteristics of disease are different in the elderly, likewise, the goal of treatment is modified compared to treatment at young and adult ages. Frequently, a cure is not the main objective; rather efforts are shifted toward prevention and relief (Chapter 22). Often, the priority is to maximize the ability of the elderly to function. When cure is not possible, rehabilitation can help in some cases; in other cases, the provision of proper care can assist in preventing the development of further complicating illnesses. Quality of life versus prolongation of life becomes a significant issue that creates medicolegal and ethical dilemmas that are hotly debated but remain largely unresolved (Box 2).

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