Common diseases among the elderly
Because the organizational structure and physiological functions of the organs of the elderly have certain degenerative changes, and the body's immune function and disease resistance have also weakened, there are many chronic diseases. Geriatric diseases refer to diseases related to aging. Common diseases in the elderly are introduced as follows:
Circulatory system diseases:
1. Hypertension: It is a common disease in the elderly. Its prevalence increases with age. On the other hand, hypertension is the main cause of coronary heart disease, cerebral thrombosis, heart failure, and stroke in the elderly. At the same time, the diagnosis and treatment of hypertension plays a positive role in improving health and prolonging life.
2. Ischemic heart disease: Also known as coronary heart disease, it is an age-related disease with a high incidence rate in the elderly. It is caused by coronary artery and atherosclerosis causing cardiac ischemia. The heart is an oxygen-demanding organ and needs sufficient oxygen to supply the energy required for cardiac contraction. When the heart's oxygen consumption exceeds the blood oxygen provided by the coronary blood flow, ischemia occurs, causing angina pectoris. The electrocardiogram shows T wave flow and ST segment depression, which is a typical ischemic heart disease. In addition to age-related factors, arteriosclerosis can also be accelerated and aggravated by high blood pressure, cholesterol, diabetes, smoking, lack of physical activity, and obesity.
3. Cor pulmonale: It is a heart disease secondary to lung disease that increases the burden on the right heart. 80-90% of chronic cor pulmonale is further developed from chronic bronchitis combined with emphysema, so active treatment of chronic bronchitis can prevent the occurrence of cor pulmonale.
4. Arrhythmia and conduction block: The heart can beat rhythmically because it has highly special myocardial cells that can send out rhythmic sinoatrial nodes and atrioventricular nodes, and a conduction system that can conduct bioelectricity. With the increase of age, various geriatric diseases such as coronary heart disease, hypertensive heart disease, cor pulmonale, etc. can cause changes in the structure and function of the heart, which can cause arrhythmia and conduction block.
5. Heart failure: Under normal circumstances, the heart's contraction and relaxation balance keeps the heart's discharge and recovery of blood in a dynamic balance. Once the balance is disturbed, heart failure occurs. Age changes the basic functions of the heart in the elderly, including decreased cardiac systolic and diastolic function, decreased blood output, decreased coronary blood supply, decreased cardiac reserve function, and the elderly are more susceptible to coronary heart disease, hypertensive heart disease, and cor pulmonale. Therefore, the elderly heart can still capture enough blood under normal circumstances, but cannot adapt to various stress states.
The most common triggering factors of heart failure in the elderly are various infectious diseases, especially respiratory infections. In addition, myocardial infarction, arrhythmia, too fast infusion, physical labor, and emotional excitement are all triggering factors of heart failure in the elderly. The impact of triggering factors on heart failure in the elderly is greater than the original heart disease, so preventing and controlling triggering factors is the main link to prevent heart failure in the elderly.
Respiratory system diseases:
With age, the lungs gradually age, the chest deforms, the anterior-posterior diameter increases to a barrel shape, and the intercostal muscles, diaphragm, and respiratory muscles atrophy, which weakens the chest breathing of the elderly. The respiratory mucosa atrophies, the number of mucus-secreting cells and sputum-discharging ciliated epithelial cells decreases, and the mucosa secretes less local antibodies, which reduces the respiratory clearance function and is conducive to the growth and reproduction of bacteria and viruses. Therefore, the elderly should not suffer from respiratory infections. Such as pneumonia and chronic bronchitis. Geriatric diseases, coupled with a variety of lung and chest diseases that have not been cured for a long time, reduce the number of ventilated alveoli, reduce elasticity, and increase the overall number of respiratory remnants, forming emphysema. Therefore, the elderly are prone to hypoxemia and respiratory failure when they suffer from lung diseases.
Endocrine metabolic system diseases:
1. Diabetes: Diabetes is a complex disease caused by many reasons. The common point is that insulin is insufficient or relatively insufficient. It is divided into insulin-dependent and non-insulin-dependent types. Both have a genetic tendency, and the latter has a stronger genetic factor. Most elderly diabetes patients are non-insulin-dependent, and their incidence rate increases with age. Although the genetic factors of diabetes cannot be ruled out, active prevention of inducing factors such as obesity, mental stimulation, long-term overeating, surgery, and physical activity is required. Reducing stress can make adults with a genetic history of diabetes latent for a long time without developing the disease.
2. Hyperlipidemia: It is one of the common diseases in the elderly. Blood lipids are related to atherosclerosis, fatty liver, and blood viscosity. Fats in the blood include cholesterol, triglycerides, etc. Since these fats must be combined with certain proteins to form lipoproteins to be transported throughout the body in the blood, elevated blood lipids are often manifested as elevated plasma lipoproteins. Plasma lipoproteins can be divided into chylomicrons, very low-density lipoproteins, low-density lipoproteins (also known as β-lipoproteins), and high-density lipoproteins (also known as α-lipoproteins) according to the size of the lipoproteins. The main component of low-density lipoproteins is cholesterol. If the plasma concentration increases, it can cause cholesterol to deposit in the blood vessel wall cells, causing arteriosclerosis. When high-density lipoproteins increase, it is beneficial to prevent the occurrence of arteriosclerosis. Elevated cholesterol or elevated β-lipoproteins can cause coronary heart disease, and foods with high cholesterol, such as egg yolks and animal offal, must be strictly restricted. Increased plasma triglycerides or very low-density lipoproteins are often caused by diabetes and high-sugar diets. Sugar intake must be controlled to prevent diabetes. Drug lipid-lowering treatment is only an auxiliary measure for diet and exercise.
3. Hyperuricemia: Serum uric acid is the final product of purine catabolism. The normal blood uric acid concentration is relatively stable. The elderly have various kidney diseases, reduced uric acid excretion, the use of certain diuretics to control uric acid excretion, acidified urine after taking a large amount of vitamin C, and some common diseases in the elderly such as hypertension, coronary heart disease, hyperlipidemia, and obesity, which are all prone to cause increased blood uric acid. Increased blood uric acid eventually leads to the formation of uric acid stones, which are deposited in the renal tubules and renal interstitium, causing renal artery damage. When deposited in joint tissues, it causes gouty arthritis.
Digestive system diseases:
With age, the time of kidney urination is prolonged, which may lead to indigestion. The height of the villi of the small intestinal mucosa of the elderly is lower than that of the young, while the density of the villi is slightly increased, resulting in a significant reduction in the mucosal surface, which affects the absorption function and may cause malabsorption. The elderly have low fat absorption, especially calcium absorption, so they are prone to osteoporosis. Since the synthesis function of the liver is reduced in the elderly, serum protein can also be reduced. The elderly are more constipated, often due to reduced physical activity, slow intestinal peristalsis, multiple diseases, malnutrition, and general weakness that weakens the diaphragm, which can cause constipation. Because of tooth loss, they can only eat soft food, and there is too little fiber in the food. The feces formed are not enough to mechanically stimulate the rectal mucosa, and there is no defecation reflex, resulting in constipation.
Common diseases of the nervous system in the elderly:
1. Stroke: Stroke refers to all acute cerebrovascular diseases, which have three common characteristics: acute onset, hemiplegia, aphasia symptoms, and lesions in blood vessels. Stroke is divided into ischemic cerebrovascular disease and hemorrhagic cerebrovascular disease. Common hypertensive cerebral hemorrhage is caused by the rupture of small arteries in the brain, blood flows into the brain tissue, directly or indirectly destroys the brain tissue, and causes a series of clinical symptoms. Another example is subarachnoid hemorrhage, which is caused by the rupture of aneurysms at the base of the brain or abnormal blood vessels inside and outside the brain, and blood flows into the subarachnoid space. Ischemic cerebrovascular disease is divided into cerebral embolism. Cerebral thrombosis is the thickening, necrosis, and stenosis of the blood vessel wall itself. On this basis, blood flow stagnates and coagulates, forming an occlusion. The blood vessels of cerebral embolism themselves have no lesions, but the emboli that fall off from other parts flow here with the blood circulation and block the blood vessels. Whether it is cerebral thrombosis or cerebral embolism, the final result may cause the brain tissue controlled by the occluded blood vessels to soften and necrotize. This softening lesion is called cerebral embolism.
2. Senile dementia: This disease is seen in the elderly. The older the age, the more likely it is to occur. The incidence of men and women is similar, and the onset is very hidden. In the early stage, memory loss is the primary symptom, followed by mental retardation, incomplete calculation, inability to return home, and childish behavior. Since the cause is unknown, there is no effective treatment.
3. Vascular dementia: refers to dementia caused by cerebrovascular disease. The most common one is multi-infarct dementia, which is caused by hypertension and arteriosclerosis, resulting in multiple lacunar-like small infarcts in the brain. When the small infarcts add up to a certain extent, dementia may appear clinically. Mild multi-infarct dementia has a good prognosis with drug treatment and can be regarded as "reversible dementia". However, it is difficult to treat severe cases that are bedridden and rely on feeding.
Changes in physiological functions of the elderly Changes in digestive function of the elderly:
Due to periodontal disease, caries, and atrophic changes in teeth, the elderly experience tooth loss or obvious wear, which affects the chewing and digestion of food. The number of taste buds on the tongue papilla decreases, which reduces the sense of taste and smell, thus affecting appetite. The average number of taste buds on each tongue papilla is 248 for children, and is reduced to 30-40 for people over 75 years old, most of whom also have abnormal taste and smell. Mucosal atrophy and decreased motility. 50% of people over 60 years old may experience atrophic changes in the gastric mucosa, thinning of the gastric mucosa, atrophy of muscle fibers, prolonged gastric emptying time, reduced digestive tract motility, especially weakened intestinal motility, which can easily lead to indigestion and constipation. Digestive glands atrophy, reduced secretion of digestive juices, and decreased digestive ability. Oral gland atrophy reduces saliva secretion, making saliva thinner and amylase content lower; gastric juice volume and gastric acidity decrease, and pepsin is insufficient, which not only affects food digestion, but is also one of the causes of iron deficiency anemia in the elderly; trypsin, lipase, and amylase secretion and activity decrease, and the ability to digest food is significantly reduced. Insulin secretion decreases, and glucose tolerance decreases. The number of liver cells decreases and the fibrous tissue increases, so the detoxification ability and protein synthesis ability decrease, resulting in a decrease in plasma albumin and a relative increase in globulin, which in turn affects the plasma colloidal osmotic pressure, leading to the formation and reflux of tissue fluid, and edema is prone to occur.
Changes in the function of neural tissue:
The number of nerve cells gradually decreases, and the brain weight decreases. It is estimated that brain cells have been decreasing since the age of 30, and the decrease is particularly significant after the age of 60. By the age of 75, it can drop to about 60% of the youth. Cerebral vascular sclerosis, increased cerebral blood flow resistance, decreased utilization of oxygen and nutrients, resulting in a gradual decline in brain function and the appearance of certain neurological symptoms, such as memory loss, forgetfulness, insomnia, and even mood changes and certain mental symptoms.
Changes in cardiovascular function:
Physiological aging of the heart is mainly manifested in myocardial atrophy, fibrous changes, myocardial sclerosis and endocardial sclerosis, resulting in a decrease in the efficiency of the heart pump and a decrease in the effective circulating blood volume per minute. Physiological and pathological hardening of the coronary arteries of the heart reduces the blood flow of the myocardium itself, reduces oxygen consumption, further affects cardiac function, and even causes clinical symptoms of myocardial insufficiency such as angina pectoris. Blood vessels also undergo a series of changes with age. After the age of 50, the physiological hardening of the blood vessel wall becomes increasingly obvious, the elasticity of the vessel wall decreases, and many elderly people are accompanied by lipid deposition in the blood vessel wall, which further reduces the elasticity of the blood vessel wall and increases its fragility. As a result, the blood vessels of the elderly have a reduced regulatory effect on blood pressure, and the peripheral resistance of the blood vessels increases, which often causes high blood pressure in the elderly; the effective number of capillaries in organ tissues decreases and the resistance increases, which reduces the blood flow of tissues and makes it easy to have nutritional disorders of tissues and organs; the fragility of blood vessels increases, and the blood flow rate slows down, which significantly increases the chances of cardiovascular accidents in the elderly, such as cerebral hemorrhage and cerebral thrombosis, which are significantly higher than those of young people.
Changes in respiratory function:
Due to the atrophy of respiratory muscles, thoracic bones and ligaments, the elasticity of alveoli, trachea and bronchial elasticity decreases, and the elderly are prone to frequent alveolar enlargement and emphysema, which significantly reduces vital capacity and ventilation, reduces the number of alveoli, reduces the effective gas exchange area, and reduces the efficiency of venous blood in the lungs to update oxygen and discharge carbon dioxide. The blood flow rate slows down, the number of capillaries decreases, the function of tissue cells decreases, and the membrane permeability changes, which reduces cellular respiration and oxygen utilization.
Other changes:
Changes in skin and hair. Due to malnutrition changes in subcutaneous blood vessels, the hair medulla and keratin degeneration may cause hair thinning and hair loss; melanin synthesis disorders may cause hair and beard to turn white; skin elasticity decreases, subcutaneous fat decreases, and intracellular water decreases, which may lead to sagging skin and wrinkles. Changes in bones: With age, the content of inorganic salts in bones increases, while the calcium content decreases; the elasticity and toughness of bones decrease, and the brittleness increases. Therefore, the elderly are prone to osteoporosis and fractures.
Changes in the urinary system:
The kidneys shrink and become smaller, the renal blood flow decreases, the glomerular filtration rate and the renal tubular reabsorption capacity decrease, leading to renal dysfunction. In addition, the bladder detrusor atrophy and the sphincter relaxation make the elderly often have polyuria. Changes in the reproductive system. The secretion of sex hormones gradually decreases after the age of 40, and sexual function decreases. The prostate of elderly men often has proliferative changes, and prostate hypertrophy can cause urination difficulties. Women aged 45-55 may experience menopause and the ovaries stop ovulating. Endocrine function declines, the body's metabolic activity weakens, the biotransformation process slows down, and the detoxification ability decreases. The body's immune function decreases, and it is easy to suffer from infectious diseases. Changes in facial features: The elasticity of the lens decreases, the adjustment ability of the ciliary muscle decreases, and presbyopia often occurs, and the vision at close range is blurred. At the same time, hearing decreases, and the sense of smell and taste function decreases. In metabolism, catabolism is often greater than anabolism. If you do not pay attention to nutrition and arrange your meals properly, a negative metabolic balance is likely to occur.
Personality and mental changes:
Elderly people gradually slow down their movements, react slowly, have poor adaptability, repeat their words, change their temperament, or become irritable and angry, or withdrawn and taciturn. If they are widowed or have family discord, it will have a negative impact on their emotions. Physiological characteristics of the elderly Changes in metabolism and energy consumption: According to measurements, tissue oxygen consumption and basal metabolism have been declining since birth. Compared with middle-aged people, the elderly are about 10-20% lower; at the same time, the amount of physical activity of the elderly is relatively reduced, which significantly changes the total energy metabolism. The reduction in metabolic rate often requires an adaptation period of regulation and control to maintain metabolic balance. This imbalance in regulation will increase the proportion of body fat content, or even if you reduce your food intake, you cannot control the increase in weight.
Decreased cell function:
With age, the metabolic type in the body gradually changes from being dominated by anabolism to being dominated by catabolism, resulting in a loss of balance between anabolism and catabolism, causing a decline in cell function, changes in body composition, a gradual increase in body fat, a gradual decrease in lean (de-fat) tissue, muscle atrophy, and a decrease in body water. Cell changes (aging) inevitably affect other metabolic changes. The ability of the elderly to synthesize, degrade, and excrete glucose and lipid metabolism changes. Cholesterol rises significantly after a full meal, indicating that the tissue's utilization of cholesterol decreases, thereby causing lipids to accumulate in the body's tissues and blood. Bone composition changes, bone density decreases, especially in postmenopausal women. It is known that there are many factors that affect it, among which dietary nutrition is also very important. For example, high protein, low phosphorus, and low vitamin D all affect calcium metabolism.
Changes in organ function:
The function of internal organs decreases to varying degrees with age. Dental diseases are common among the elderly, and many of them are missing teeth, which seriously affects their chewing function. Taste bud atrophy often affects the taste of sweet and salty, and sometimes is accompanied by changes in smell, which changes appetite and limits the types of food. The secretion of gastrointestinal digestive juices decreases, and the activity of digestive enzymes decreases, resulting in poor absorption of nutrients.
Decreased function; slowed intestinal motility, constipation is very likely to occur, and also indirectly affects appetite and digestive function. The number of liver parenchymal cells decreases. Changes in liver function reduce liver gluten, ascorbic acid and ribonucleic acid, protein synthesis, enzyme activity, hippuric acid synthesis, bile acid secretion, and thinning of the gallbladder wall, which affects the excretion of bile. Changes in liver function and reduction of glycogen storage in the liver can easily cause hypoglycemia and hypoproteinemia in the elderly when they are under long-term load. Changes in kidney tissue structure, such as atrophy of renal units and decreased enzyme activity, often cause a decrease in renal function, and high protein can easily cause uremia; excessive water will increase the load on the heart; electrolyte balance will also be disturbed; the ability of the kidney to hydroxylate 25-(OH)D3 is reduced, which increases the need for vitamin D.
Changes in endocrine function:
Although there are different opinions on the hormone metabolism of the elderly, hormone changes can still be seen from the analysis and determination of hormone levels in plasma and the sensitivity of receptors in the body. The most obvious change in pituitary function in the elderly is the effect on basal metabolism, which is reduced. The thyroid gland of the elderly may also atrophy, which is also one of the factors that reduce the metabolic rate. In addition, diabetes, obesity, etc. are all related to hormonal changes. The weakening of pituitary function in the elderly not only affects basal metabolism, but also often affects the entire metabolism. For example, when the body is overloaded, it is difficult to mobilize body fat to support energy metabolism, and more glucose and glycogen are required, which leads to the enhancement of protein catabolism. The reduction of estrogen is one of the important causes of osteoporosis in elderly women.