Diagnosis and treatment of older population has its own challenges. as a result of physiological changes associated with aging, elderly patients with polygenic disorders may not present with classic symptoms. With age, there is an increased prevalence of incapacity useful associations and comorbidities that contribute to the quality management of polygenic disorders. Treatment of older patients with polygenic disorders should consider not merely thinking microvascular quality and macrovascular complications, but additional conditions such as disorders of psychological features, falls and impaired operation.
physiology of Aging
Many age-related changes will alter the clinical presentation and creates a polygenic disorders identification problematic. Typical symptoms of symptoms such as nephropathy, thirst and polyphagia also disguise(Meneilly and Tessier, 2001). Threshold for aldohexose urinary organs will increase with advancing age, and glycosuria may not be visible(Meneilly, 2000). no thirst, and therefore the initial presentation among patients aged also dehydrated by thirst perception changed and delayed liquid supplements. More often, changes such as dry eyes, dry mouth, confusion, incontinence or complications regarding ar polygenic disorder symptoms.
Hypoglycemia can be a polygenic disorder treatment risks. Studies have shown healthy patients aged aldohexose counterregulation that involves hormones, catecholamines and response to symptoms ar somatotropic hormone is reduced. This may contribute to the reduction of forced warning symptoms(Meneilly et al., 1994). Symptoms may not appear until severe symptoms at levels < 50 >
diagnosis
The Association yank current polygenic disorder(ADA) criteria for the identification of polygenic disorders or applicable to all populations and : on 2 separate occasions, both aldohexose rapid plasma levels = 126 mg / dL, random plasma aldohexose = 200 mg / dL with symptoms or a check aldohexose two hours of oral tolerance(OGTT) = 200 mg / dL. Because the enzyme recommend that anyone over forty- five plays, all parents should be screened annually for polygenic disorders.
Recent literature of Epidemiology polygenic disorders : a cooperative analysis Of Diagnostic criteria in Europe(DECODE) experiment, including subject age, found that the association ? OGTT of 200 mg / dL will increase the danger of all-cause mortality, even in the presence of fast aldohexose standards(European polygenic disorder clusters medical specialties, 1999). despite the rapid measurement of plasma levels aldohexose will improve the detection of polygenic disorders in younger patients, it should really lose thirty cases in older patients(DECODE Study of clusters, 1999). Two -hour OGTT is most helpful in the identification of polygenic disorders in age.
All complications polygenic disorders, together with microvascular and macrovascular, will occur in older patients with polygenic disorders. Older patients usually present with these complications at the time of identification. Some under-recognized complication seen in these patients are listed in Table ar.
cognitive complications
Often, the patient has a psychological disorder aged features, limitations in their daily activities, depression is unknown and problematic social issues that will contribute in the event of complications. synchronal health problems, such as dementedness or cure the disease, it can take a simplified approach for treatment of polygenic disorders.
Diabetes is associated with lower levels of psychological functions and features features a greater reduction in psychological age(Gregg et al., 2000). Prospective trial showed no consistent improvement in the management of psychological features aldohexose tight, although empirical studies noted an increase in psychological functioning features a low hemoglobin A1c(HbA1c) levels(Tun et al., 1990). Mechanisms that polygenic disorder associated with psychological disorders remain unclear features.
The risk of symptoms is higher in patients ar ar WHO cognitive impairment. These patients usually have impaired awareness of the warning symptoms of involuntary symptoms even after they are educated about them. they even will delay the response content to intervene in the correction of symptoms(Thomson et al., 1991). Therefore, the risk of each patient for symptoms should be considered - about, and medical care should be personalized as a result each patient.
microvascular complications
Common microvascular complications of diabetes retinopathy realize, nephrosis and pathology. Because patients could have some sort of a polygenic disorder for years before the identification was made, ar microvascular complications are usually already present.
The dominant values ??of blood sugar that can reduce microvascular disease in a kind pair of polygenic disorders has been well established for a younger population. knowledge of whether or not strict management aldohexose increase mortality or improve operating between weak or less institutionalized ar old.
Diabetic retinopathy could be the reason behind the common visual defects among all patients with polygenic disorders. As in young, smart management of diabetes among older patients would slow the onset of retinopathy(Morisaki et al., 1994). Cataracts are a common ar additional related occurred at an earlier age among those with polygenic disorders. Thus, the patient should be referred for a comprehensive eye exam yearly.
Nephrosis diabetes can be a common reason behind nephrosis in the geriatric population. important tool in the management of nephrosis made ??freelance blood sugar. Protein angiotensin -converting(ACE) inhibitors and management pressure to < 130/80 >
Neuropathy deserves special attention as a result of these complications will increase the prevalence of patients with age polygenic disorders. it is very common and occurs in 500 patients with a sort of a polygenic disorder more than sixty years old(Young et al., 1993). pathology ends in gait imbalance and could be a problem for the risk of falling.
macrovascular disease
Cardiovascular, peripheral vessels and tubes ar additional common disease among all patients with polygenic disorders and causes of excess mortality ar(Croxson et al., 1994). Macrovascular complications semipermanent cause a significant reduction useful in patients aged(Sinclair, 1999).
medical therapy
Management of a kind pair of old patients with polygenic disorders have the same goals and objectives that will be completely different from younger patients. Lifetime of the patient, medical disorders or medical synchronal, and because the disposition of the patient and the talent to go with the issues that are projected treatment is required ar(Halter, 1998). Medical medical care will contribute to the event of complications in older patients. The next agent may require modification once used in ages.
Biguanides(such as Glucophage [Glucophage]) does not cause symptoms never used rotation. However, they should be used with caution in older patients as a result of them will lead to eating disorders and weight loss(Lee and chemists, 1998).
Metformin will put patients at risk for pathology dairy products if they need a kidney disorder. old patient had endured muscle mass, and creatinine humor they may not mimic creatinine actuality. so the 24-hour urinary samples should be ordered for patients over seventy.
The first generation of antidiabetic agents(eg chlorpropamide [Diabinese]) should be avoided in age because of their long half-life and increases the tendency for the symptoms of age.
The thiazolidinediones(eg, rosiglitazone [Avandia], pioglitazone [Actos]) is not indicated in patients with evidence of heart disease aged or disease. In patients aged WHO does not have those contraindications, these medications are very helpful because they do not cause symptoms as monotherapy.
The risk of severe symptoms related to the hormone will increase with age(Stepka et al., 1993). Initiation of hormone in patients with a sort of age should have completed a pair of polygenic disorders multidisciplinary team involvement. entire geriatric assessment should be done first to ensure that the patient will go to their regimen and to find potential complicating factors. If there ar caregivers, provision for adequate respite program should be created and offered to avoid caregiver burnout.
conclusion
Ideal geriatric care requires a multidisciplinary approach. the triple -crown polygenic disorder treatment in an aging population requires an understanding of the physiology of aging association and recognition of the particular problems faced by the elderly. such as patients with polygenic disorders, the overall goal should be aimed at reducing complications. In older patients, medical treatment must be personalized and embodies helpful vote. The goal of treatment should be aimed toward optimizing operations and minimize the complications that would lead to a loss of independence or early institutionalization.
Dr. Chau is a professor of medicine at the University of the Silver State faculty treatment and therefore the U.S. Department of Veterans Affairs Sierra attention system.
Dr. Shumaker is professor of medicine at the University of the Silver State faculty of medicine and chief of gerontology and extended care at the VA Sierra attention system.
Dr. Plodkowski is a professor of medicine at the University of the Silver State faculty of medicine and chief medical specialties attention VA Sierra Systems.
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