青島英華外語培訓學校臨床醫(yī)學英語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亞臨床的同樣的疾病,年齡大的病人在許多方面與青中年病人是有區(qū)別的,其中之一是并存病多

2、和亞臨床疾病多。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同時發(fā)生作為高發(fā)疾病的結果,并存病(兩個或更多的疾病在同一個體同時發(fā)生也是多見的。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、給予additive附加的、附屬物65歲以上的老年中,50%患有兩種以上的慢性疾病,這些疾病能夠增加不利預后的風險,如死亡率。In some patients,cognitive impairment may mask the symptoms of important conditions. cognitive認知的、認識的impairment損害mask口罩、假面具、掩飾在一些病人中,認知損害可以掩蓋重要病情的癥狀。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中風peptic ulcer消化性潰瘍對一種疾病的治療可能加重另一種疾病,例如,對有消化性潰瘍病史的病人使用阿斯匹林預防中風。The risk for becoming disabled or dependent also increases with the number of diseases present.d

5、isabled殘廢的、有缺陷的dependent依靠的、依賴的病殘或生活不能自理發(fā)生的風險也隨著并存的疾病數(shù)而增高。Specific pairs of diseases can increase synergistically the risk of disability.synergistic協(xié)同的特殊的成對疾病可以協(xié)同增加病殘的風險。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關節(jié)炎有18%的老年人同時患有關節(jié)炎和心臟病,雖然每個疾病可以增加34倍的病殘率,但兩個疾病同時存在,可使病殘率提高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可能性老年與青中年的第二個差異是更容易出現(xiàn)非典型的癥狀和體癥。Pneumonia and stroke may present with nonspecific changes in mentation as the primary symptom.pneumonia肺炎mentation精神作用、心理活動primary初始的、首要的、主要的肺炎和中風時可出現(xiàn)非典型意識變化作為主要的癥狀。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、靜止的proportion成比例的、相稱的同樣地,隱匿性心肌梗塞發(fā)生頻度隨著年齡的增大而增加,這些病人相應地頻發(fā)精神狀態(tài)改變、眩暈、虛弱而不是典型的胸痛癥狀。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譜、光譜因此,老年病人的診斷應考慮更廣泛的疾病譜,要超過通常對中年病人所考慮的范圍。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、原來frailty脆弱、虛弱、意志薄弱tolerance寬容、忍耐、耐受主要出現(xiàn)在老年人的第三個情況是衰弱,衰弱被認為屬于衰竭綜合癥,它有許多癥狀和體征中,包括肌肉萎縮、體重下降、虛弱、運動耐受差、動作慢、身體活動少。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估計、評價、看法indicate指出、表時、象征、適應征一些人估計7%的65歲以上社區(qū)老人和25%的85歲以上社區(qū)老人上述癥狀全部出現(xiàn)。Many institutionalized older adults also are frail.institutionalized使成公共團體、將收容在公共設施里frail身體虛弱的、易損壞的、意志薄弱的許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易受傷、易受責難衰弱是對各種壓力耐受下降、損害增加的一種狀態(tài),從急性感染、損傷到住院治療,都可以發(fā)現(xiàn)一些人不能忍受侵入性診療

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身體虛弱的、易損壞的、意志薄弱的衰弱的癥狀與易于病倒、需要住院治療、病殘、死亡的高風險是相關的。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、構成要素sarcopenia肌減少(癥、與年齡相關的骨骼肌質量下降衰弱一個主要成分的早期表現(xiàn)是肌肉減少,或說隨年齡增長的肌肉減少,它發(fā)生在1324%的6570歲的老人,60%的80歲以上的老人。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失調homeostasis內環(huán)境穩(wěn)定多種生理系統(tǒng)易于失調,包括炎癥、激素狀態(tài)、糖的代謝,結果是在壓力面前保持內環(huán)境的穩(wěn)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動脈粥樣硬化亞臨床疾病(如動脈粥樣硬化,晚期慢性疾病(如心力衰竭,或多種疾病并存可共同形成癥狀。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.隨機對照試驗的跡象顯示無論有無營養(yǎng)支持和家庭身體療法,即使是最虛弱的老年人,對抗運動能夠增加瘦弱軀體的質量和力量。This evidence suggests that earlier stages of frailty may be remediable,although end-stage frailty likely presages death.remediable可挽回的presage預兆、預示這個結果提示早期衰弱是可挽回的,盡管末期衰弱常提示死亡。Fourth,cognitive impairment increases in p

18、rominence as people minence突出、顯著第四,人們變老時認知損害顯著增加。Cognitive impairment is a risk factor for a wide range of adverse outcomes,including falls, immobilization,dependency,institutionalization,and mortality.immobilization活動能力減少institutionalization制度化、專門照料認知損害是大量不利結果的風險因子,包括摔倒、活動能力下降、不能自理、需住老人院護理、死

19、亡。Cognitive impairment complicates diagnosis and requires additional care giving to ensure safety.認知損害使診斷復雜,為保證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,老年人慢性病嚴重又常見的結果是身體能力不足,描述為個人最基本的或有意義的日

21、?；顒佑欣щy或不得不依靠別人幫助指導,從基本的自理(如洗澡或如廁到獨立生活需要的各種任務(如購物、做飯、支付各種賬單,到具有集體和/或個人意義的所有活動。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%對需要運動的任務有困難,運動困難提示將來開展日常工具鍛煉(IADL;家庭護理項目和目常鍛煉(ADL;基本自理項目的困難。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歲的老人或其它人,IADL困

23、難報導為20%,ADL困難報導為11%;隨年齡增加兩個都困難成為普遍現(xiàn)象。People who have difficulty with tasks of IADL and ADL are at high risk of becoming dependent.IADL和ADL困難的人處于不能自理演變的高風險中。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療養(yǎng)院小于65歲的老人中,5%住在療養(yǎng)院里,大多數(shù)是嚴重疾病后依賴IADL和ADL的結果。Generally,woman live more years with disability