Jaul Efraim, Barron Jeremy
Skilled Nursing Department, Herzog Hospital, Jerusalem, Israel.
Hebrew University of Jerusalem, Jerusalem, Israel.
Front Public Health. 2017 Dec 11;5:335. doi: 10.3389/fpubh.2017.00335. eCollection 2017.
By 2050, the American 85 years old and over population will triple. Clinicians and the public health community need to develop a culture of sensitivity to the needs of this population and its subgroups. Sensory changes, cognitive changes, and weakness may be subtle or may be severe in the heterogeneous population of people over age 85. Falls, cardiovascular disease, and difficulty with activities of daily living are common but not universal. This paper reviews relevant changes of normal aging, diseases, and syndromes common in people over age 85, cognitive and psychological changes, social and environmental changes, and then reviews common discussions which clinicians routinely have with these patients and their families. Some hearing and vision loss are a part of normal aging as is decline in immune function. Cardiovascular disease and osteoporosis and dementia are common chronic conditions at age 85. Osteoarthritis, diabetes, and related mobility disability will increase in prevalence as the population ages and becomes more overweight. These population changes have considerable public health importance. Caregiver support, services in the home, assistive technologies, and promotion of home exercise programs as well as consideration of transportation and housing policies are recommended. For clinicians, judicious prescribing and ordering of tests includes a consideration of life expectancy, lag time to benefit, and patient goals. Furthermore, healthy behaviors starting in early childhood can optimize quality of life among the oldest-old.
到2050年，美国85岁及以上的人口数量将增至三倍。临床医生和公共卫生界需要培养一种对该人群及其亚组需求保持敏感的文化氛围。在85岁以上的异质人群中，感官变化、认知变化和身体虚弱可能很轻微，也可能很严重。跌倒、心血管疾病和日常生活活动困难很常见，但并非普遍现象。本文回顾了正常衰老的相关变化、85岁以上人群常见的疾病和综合征、认知和心理变化、社会和环境变化，然后回顾了临床医生与这些患者及其家属经常进行的常见讨论。一些听力和视力丧失是正常衰老的一部分，免疫功能下降也是如此。心血管疾病、骨质疏松症和痴呆症是85岁人群常见的慢性疾病。随着人口老龄化和超重情况增多，骨关节炎、糖尿病及相关行动障碍的患病率将会上升。这些人口变化具有相当大的公共卫生重要性。建议提供照顾者支持、家庭服务、辅助技术、推广家庭锻炼计划以及考虑交通和住房政策。对于临床医生而言，明智地开具检查项目时需要考虑预期寿命、获益延迟时间和患者目标。此外，从幼儿期开始的健康行为可以优化最年长者的生活质量。
