青岛英华外语培训学校临床医学英语第八章老年病人的特殊性

1、Chapter8Why Geriatric Patients Are Different第八章老年病人的特殊性Older patients differ from young or middle-aged adults with the same disease in many ways, one of which is the frequent occurrence of comorbidities and of subclinical disease. comorbidities并存病subclinical亚临床的同样的疾病,年龄大的病人在许多方面与青中年病人是有区别的,其中之一是并存病多

2、和亚临床疾病多。As a function of the high prevalence of disease,comorbidity(or the co-occurrence of two or more diseases in the same individualis also common.prevalence流行、普遍co-occurrence同时发生作为高发疾病的结果,并存病(两个或更多的疾病在同一个体同时发生也是多见的。Of people age65and older,50%have two or more chronic disease,and these diseases c

3、an confer additive risk of adverse outcomes,such as mortality.confer授予、给予additive附加的、附属物65岁以上的老年中,50%患有两种以上的慢性疾病,这些疾病能够增加不利预后的风险,如死亡率。In some patients,cognitive impairment may mask the symptoms of important conditions. cognitive认知的、认识的impairment损害mask口罩、假面具、掩饰在一些病人中,认知损害可以掩盖重要病情的症状。Treatment for one

4、 disease may affect another adversely,as in the use of aspirin to prevent stroke in individuals with a history of peptic ulcer disease.stroke中风peptic ulcer消化性溃疡对一种疾病的治疗可能加重另一种疾病,例如,对有消化性溃疡病史的病人使用阿斯匹林预防中风。The risk for becoming disabled or dependent also increases with the number of diseases present.d

5、isabled残废的、有缺陷的dependent依靠的、依赖的病残或生活不能自理发生的风险也随着并存的疾病数而增高。Specific pairs of diseases can increase synergistically the risk of disability.synergistic协同的特殊的成对疾病可以协同增加病残的风险。Arthritis and heart disease coexist in18%of older adults;although the odds of developing disability are increased by three-fold to

6、 four-fold with either disease alone,the risk of disability increases14-fold if both are present.arthritis关节炎有18%的老年人同时患有关节炎和心脏病,虽然每个疾病可以增加34倍的病残率,但两个疾病同时存在,可使病残率提高14倍。A second way in which older adults differ from younger adults is the greater likelihood that their diseases present with nonspecific

7、 symptoms and signs.likelihood可能性老年与青中年的第二个差异是更容易出现非典型的症状和体症。Pneumonia and stroke may present with nonspecific changes in mentation as the primary symptom.pneumonia肺炎mentation精神作用、心理活动primary初始的、首要的、主要的肺炎和中风时可出现非典型意识变化作为主要的症状。Similarly,the frequency of silent myocardial infarction increases with inc

8、reasing age,as does the proportion of patients who present with a change in mental status,dizziness,or weakness rather than typical chest pain.silent沉默的、静止的proportion成比例的、相称的同样地,隐匿性心肌梗塞发生频度随着年龄的增大而增加,这些病人相应地频发精神状态改变、眩晕、虚弱而不是典型的胸痛症状。As a result,the diagnostic evaluation of geriatric patients must con

9、sider a wider spectrum of diseases than generally would be considered in middle-aged adults.spectrum谱、光谱因此,老年病人的诊断应考虑更广泛的疾病谱,要超过通常对中年病人所考虑的范围。A third condition that is found primarily in older adults is frailty,frailty is thought to be a wasting syndrome that presents with multiple symptoms and sign

10、s,including reduced muscle mass,weight loss,weakness,poor exercise tolerance,slowed motor performance,and low physical activity.primarily起初、首先、原来frailty脆弱、虚弱、意志薄弱tolerance宽容、忍耐、耐受主要出现在老年人的第三个情况是衰弱,衰弱被认为属于衰竭综合症,它有许多症状和体征中,包括肌肉萎缩、体重下降、虚弱、运动耐受差、动作慢、身体活动少。Some estimates indicate that the full syndrome i

11、s found in7%of community-dwelling people age65and older,and in25%of community-dwelling people age85and older.estimate估计、评价、看法indicate指出、表时、象征、适应征一些人估计7%的65岁以上社区老人和25%的85岁以上社区老人上述症状全部出现。Many institutionalized older adults also are frail.institutionalized使成公共团体、将收容在公共设施里frail身体虚弱的、易损坏的、意志薄弱的许多老人院里的老人也

12、是衰弱的。Frailty is a state of decreased reserve and increased vulnerability to all kinds of stress,from acute infection or injury to hospitalization,and may identify individuals who cannot tolerateinvasive therapies.reserve保存、克制vulnerability易受伤、易受责难衰弱是对各种压力耐受下降、损害增加的一种状态,从急性感染、损伤到住院治疗,都可以发现一些人不能忍受侵入性诊疗

13、措施。The syndrome of frailty is associated with high risk of falls,needs for hospitalization, disability,and mortality.fall跌倒、下降frail身体虚弱的、易损坏的、意志薄弱的衰弱的症状与易于病倒、需要住院治疗、病残、死亡的高风险是相关的。There is early evidence that a core component of frailty is sarcopenia,or loss of muscle mass associated with aging,which

14、 occurs in13to24%of persons age65to70and in60%of persons age80and ponent成分、构成要素sarcopenia肌减少(症、与年龄相关的骨骼肌质量下降衰弱一个主要成分的早期表现是肌肉减少,或说随年龄增长的肌肉减少,它发生在1324%的6570岁的老人,60%的80岁以上的老人。It is likely that dysregulation of multiple physiologic systems,including inflammation, hormonal status,and glucose met

15、abolism,underlies the syndrome,with resulting decreased ability to maintain homeostasis in the face of stress.dysregulation失调homeostasis内环境稳定多种生理系统易于失调,包括炎症、激素状态、糖的代谢,结果是在压力面前保持内环境的稳定的能力下降。Subclinical disease(e.g.,atherosclerosis,end-stage chronic disease(e.g.,heart failure,or a combination of comor

16、bid diseases may precipitate the syndrome.atherosclerosis动脉粥样硬化亚临床疾病(如动脉粥样硬化,晚期慢性疾病(如心力衰竭,或多种疾病并存可共同形成症状。Evidence from randomized,controlled trials shows that resistance exercise,with or without nutritional supplements,and home-based physical therapy can increase lean body mass and strength in even

17、the frailest older adults.随机对照试验的迹象显示无论有无营养支持和家庭身体疗法,即使是最虚弱的老年人,对抗运动能够增加瘦弱躯体的质量和力量。This evidence suggests that earlier stages of frailty may be remediable,although end-stage frailty likely presages death.remediable可挽回的presage预兆、预示这个结果提示早期衰弱是可挽回的,尽管末期衰弱常提示死亡。Fourth,cognitive impairment increases in p

18、rominence as people minence突出、显著第四,人们变老时认知损害显著增加。Cognitive impairment is a risk factor for a wide range of adverse outcomes,including falls, immobilization,dependency,institutionalization,and mortality.immobilization活动能力减少institutionalization制度化、专门照料认知损害是大量不利结果的风险因子,包括摔倒、活动能力下降、不能自理、需住老人院护理、死

19、亡。Cognitive impairment complicates diagnosis and requires additional care giving to ensure safety.认知损害使诊断复杂,为保证安全需要更多的照料。Finally,a serious and common outcome of chronic diseases of aging is physical disability, defined as having difficulty or being dependent on others for the conduct of essential or

20、 personally meaningful activities of life,from basic self-care(e.g.,bathing or toiletingto tasks required to live independently(e.g.,shopping,preparing meals,or paying billsto a full range of activities considered to be productive and/or personally meaningful.最后,老年人慢性病严重又常见的结果是身体能力不足,描述为个人最基本的或有意义的日

21、常活动有困难或不得不依靠别人帮助指导,从基本的自理(如洗澡或如厕到独立生活需要的各种任务(如购物、做饭、支付各种账单,到具有集体和/或个人意义的所有活动。Of older adults,40%report difficulty with tasks requiring mobility,and difficulty with mobility predicts the future development of difficulty in instrumental activities of daily living (IADL;household management tasksand ac

22、tivities of daily living(ADL;basic self-care tasks.在老年人中,40%对需要运动的任务有困难,运动困难提示将来开展日常工具锻炼(IADL;家庭护理项目和目常锻炼(ADL;基本自理项目的困难。In persons age65and other,difficulty with IADL is reported by20%,and difficulty with ADL is reported by11%;for both,the prevalence increases with age.prevalence流行大于65岁的老人或其它人,IADL困

23、难报导为20%,ADL困难报导为11%;随年龄增加两个都困难成为普遍现象。People who have difficulty with tasks of IADL and ADL are at high risk of becoming dependent.IADL和ADL困难的人处于不能自理演变的高风险中。Of persons older than age65,5%reside in nursing homes,largely as a result of dependency in IADL and/or ADL secondary to severe disease.reside居住nursing home疗养院小于65岁的老人中,5%住在疗养院里,大多数是严重疾病后依赖IADL和ADL的结果。Generally,woman live more years with disability