Articles: aged.
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Comparative Study
Cardiovascular response to spinal anaesthesia in elderly men: effects of head-up tilt and dihydroergotamine administration.
In nine elderly (mean age 60, rang 42-74 years) cardiovascular pressures and cardiac output have been measured by catheterization of the pulmonary and brachial artery during spinal anaesthesia without and with dihydroergotamine (DHE) and during an added slight head-up (10-15 degrees). Spinal anaesthesia lowered arterial pressure and also stroke volume. After DHE arterial pressures as well as stroke volume were normalized. ⋯ It is concluded that in elderly men, unlike the young men previously studied, spinal anaesthesia decreases arterial blood pressures by a combination of reduced peripheral resistance and decreased stroke volume. The decreases in stroke volume and cardiac output were most pronounced in those patients with a reduced blood volume. DHE also prevents arterial pressure fall with head-up tilt during spinal anaesthesia.
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Acta Anaesthesiol Scand · Jun 1981
Lumbar epidural anaesthesia with bupivacaine in old patients: effect of speed and direction of injection.
The spread of lumbar epidural analgesia was studied in 48 old urological patients (56-81 years). Bupivacaine 0.5% 20 ml was injected at either 1 ml/s with a Tuohy needle with the bevel directed cephalad (Group I) or caudad (II) and at 0.22 ml/s directed cephalad (III) or caudad (IV). Immediately after injection, the patients moved from a sitting to a horizontal position and analgesia was tested every 2 min by skin pin-prick. ⋯ The mean venous blood levels of bupivacaine were highest in Group III and lowest in Group I (n.s.). The highest individual bupivacaine blood level was 1.25 micrograms/ml 30 min after injection, while generally the highest concentrations appeared at 20 min after injection. The study indicated a lack of significant difference on varying the speed of injection or turning the Tuohy needle, but it has to be emphasized that this may apply only to bupivacaine, which has distinct physicochemical properties, and also to old patients with an age-dependently modified epidural space.
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Feelings of loneliness in relation to disease, handicaps, social network and social background were studied in a representative sample of 1,007 70-year-old people living in Göteborg, Sweden. The results showed that loneliness was a problem to 24% of the women and 12% of the men. ⋯ The lonely had a negative self-assessment of health and consumed more out-patient care, social welfare help and sedatives. The higher consumption of medical service and/or social care was, however, not associated with a higher prevalence of definable somatic disease or handicaps.
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Senior citizens, particularly those aged 75 or older, are the fastest growing group in the US today. 25 million strong, the elderly make up 11% of the total population, the proportion ranging from 18.1% in Florida to 2.6% in Alaska. 1/4 of the federal budget, $155 billion in 1980, now goes to their support yet many face difficulty in gaining access to the programs designed to benefit them. The elderly, especially those who rely solely on Social Security, comprise a disproportionate share of all poor households. The retirement system itself is facing financing challenges that promise to grow as the baby boom generation swells the number of senior citizens to 55 million in 2030. Plans to coordinate government programs and improve the method of financing the retirement system are receiving increasing attention. Financing Social Security from revenue funds, or with actuarial reserves, are 2 alternatives to the present pay-as-you-go system. Another area of concern to policymakers is America's health care system, which is now crisis oriented and heavily biased toward institutionalization. Health care must be made more responsive to the long-term needs of the oldest segment of the population, many of whom suffer from chronic illnesses. Impaired elderly receive most of their care from family or friends, and private organizations, but this natural support network largely has been ignored by government. New program initiatives might emphasize homemaker services, geriatric day care, compensation for families that provide for the needs of an elderly relative, and the strengthening of the informal partnership between the elderly themselves, their families and friends, community groups, private organizations, and government at the state and local as well as the federal level.