The process of aging produces important physiologic changes in the central nervous system, including neuroanatomic, neurotransmitter, and neurophysiologic changes.
These processes result in age-related symptoms and manifestations for many older persons.
These physiologic changes develop at dramatically variable rates in different older persons, however, the decline being modified by factors such as diet, environment, lifestyle, genetic predisposition, disability, disease, and side effects of drugs.
These changes can result in the common age-related symptoms of benign senescence, slowed reaction time, postural hypotension, vertigo or giddiness, presbyopia, presbycusis, stiffened gait, and sleep difficulties.
[...] Neuropsychiatric disorders, the leading cause of disability in older persons, account for nearly 50% of functional incapacity. Severe neuropsychiatric conditions have been estimated to occur in 15 to 25% of older adults worldwide. These conditions are due to diseases that increase with age but are not part of the normal aging process. Alzheimer's disease and related dementias occur in approximately 10% of adults age 65 and older and 40% of adults older than 85. Delirium occurs in 5 to 10% of all persons age 65 and older, usually in the setting of acute illness and hospitalization. [...]
[...] The important relationship of functional status with health in older persons is reflected in the finding that functional measures are stronger predictors of mortality after hospitalization than are admitting diagnoses. Functional measures strongly predict other important hospital outcomes in the elderly, such as length of stay, functional status at discharge, future care needs, caregiver burden, risk for institutionalization, and long-term prognosis. The functional assessment should include an assessment of the patient's ability to perform basic self-care activities of daily living and instrumental activities of daily living, the higher level activities needed for independent living. [...]
[...] Similarly the risk of cognitive decline increases directly with the number of drugs prescribed, from a three-fold increased risk with two or three drugs to a 14-fold increased risk with six or more drugs. PRINCIPLES OF DRUG THERAPY IN THE ELDERLY Physicians always should consider whether nonpharmacologic approaches are appropriate alternatives to medications in older persons. Relaxation techniques, massage, and music are highly effective for the treatment of insomnia and anxiety; localized pain often can be managed effectively with local measures, such as injection, heat, ultrasound, and transcutaneous electrical stimulation. [...]
[...] MENTAL STATUS EXAMINATION In addition to a detailed neurologic examination, evaluation of neuropsychiatric disturbances in older persons requires a careful mental status examination, including an assessment of mood, affect, and cognition. Brief screening tests are available to evaluate these domains and to assist in the detection of potential problems requiring further evaluation and treatment. For depression screening, scores of 6 or more on the 15-item short-form Geriatric Depression Scale indicate substantial depressive symptoms requiring further evaluation. Alternative depression screening instruments include the General Health Questionnaire; for cognitively impaired patients, observer-rated depression scales, such as the Hamilton Depression Scale, are recommended. [...]
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