© Borgis - Postępy Nauk Medycznych 5/2011, s. 464-465
The current issue of “Postępy Nauk Medycznych” focuses on some of the diagnostic and therapeutic matters, which are often encountered by family doctors when dealing with health issues in the elderly.
The articles were written by faculty of the Department of Family Medicine, Internal and Metabolic Bone Diseases to honor the 40th aniversary of the Medical Center of Postgraduate Education (CMKP). For the last 5 years, the clinic has been providing, apart from his every-day educational and medical services, continous education programs for family doctors and other doctors providing basic medical care to a variety of patients.
In the first article, the authors discuss the function of the thyroid gland changes with ageing. They point out that thyroid dysfunction (especially subclinical) is more often seen in older than in younger populations and is difficult to diagnose because of lack of symptoms or scant clinical symptoms, which might be non specific or masked by medications taken by patients. Both hypothyreosis and hyperthyreosis are risk factors for cardiovascular diseases and cognitive function impairment. However, only hyperthyreosis (even subclinical) is a predictor of increased mortality, while higher TSH serum concentrations in the elderly are associated with lower mortality. The problem of screening tests for thyroid gland dysfunction in the elderly as well as treatment of subclinical hypothyreosis in this group of patients remains unsolved.
In the second article, the authors raise an important issue of diabetes in the elderly and point out that diabetes is often missed in this population because its presenting symptoms may be nonspecific. The principles of diabetes management in elderly patients are similar to those in younger patients, but with special considerations linked to the increased prevalence of comorbidities and relative inability to tolerate adverse effects of medication and hypoglycemia. The goals of glycemic control in elderly patients should be individualized and formulated after consideration of their clinical and functional status and life expectancy. Aggressive glycemic control is less important than avoiding hypoglycemia and achieving a good quality of life.
In the third article, the authors focus on hypertension which is the most common cause of mortality in global population. The frequency of hypertension is increasing with age as a consequence of many processes in the arteries, especially stiffness of the arteries. A special form of hypertension which is concerned with the elderly is isolated systolic hypertension. The authors conclude that hypertensive therapy in the elderly gives them benefits, but it has to be kept with preserving principles as individualisation of therapy and careful lowering the pressure.
In the fourth article, the authors write that life extension as a result of progress of civilization increases the number of the elderly. Aging of population is associated with the occurrence of a large group of patients with coronary artery disease. Taking into account the current state of medical knowledge, it is necessary to use optimal pharmacological treatment and the best method of revascularisation (percutaneous coronary intervention – PTCA or coronary artery bypass grafting – CABG). The old age is characterized by many differences in terms of clinical evaluation, diagnosis and treatment. However, management patterns based on guidelines set by cardiological societies are not much different from those recommended for younger patients.
In the fifth article, the issue of joint pains in the elderly is discussed. The main reasons for them are: osteoarthritis, systemic diseases of connective tissue (polymyalgia rheumatica, giant cell arteritis, chondrocalcinosis, Forestier disease, acute relapsing symmetric seronegative synovitis and peripheral edema- RS3 PE, elderly onset rheumatoid arthritis- EORA, gout), paraneoplastic syndromes, and soft tissue rheumatism (carpal tunnel syndrome, trochanteric syndrome, hip pains, shoudler pains, fibromyalgia, Baker’s cyst). The diagnosis of giant cell arteritis should be considered in any patient older than 50 years who has experienced loss of vision, diplopia, a new form of headache, polymyalgia rheumatica, fever and unexplained constitutional symptoms. Disorders of soft, peri-articular tissues are a common cause of musculoskeletal pain in the elderly. Nevertheless, most physicians underestimate the role of soft tissue rheumatism. They are often treated with non steroidal anti inflammatory drugs. In local pain syndromes better results can be obtained by local treatment. Local injections of glicocorticoids are usually very effective and safe.
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