EXCERPTS FROM SYMPOSIUM ON GERIATRICS


Especially is this true since it is well recognized that constant or repeated pain, like constant fears, has as profound effect on the body as on the mind. Many severe infections attack the aged with only mild or even with no temperature elevation. Dont ever lose sight of the fact that aged patients are commonly afflicted with more than one disease, e.g., heart failure, hypertension, nephritis and diabetes.


The term Geriatrics is derived from the Greek (geron-old man; iatrikas medical treatment). Thus in our own era we see being established a branch of medicine devoted to understanding, intelligent and proper care of old people throughout the civilized world and more especially in our own land. In his day Hippocrates mentioned some of the peculiarities of old age. As time went on Stromer, John Smith Floyer, Charcot, Loomis and others wrote of their observations on the subject.

Only within our own day did the first text written in English appear, compiled and written by Nascher in 1914, following which Thewlis presented the first edition of his book on “The Care of the Aged” in 1919. His third edition appeared as late as 1941. The tardy recognition and the acceptance of this new branch are analogous to that accorded to Pediatrics when Abraham Jacobi was inspired to champion it as a separate branch of medicine. His first articles did not appear in the Archives of Pediatrics until 1883 and his first text book on the subject was published as late as 1896.

The number of persons of advanced years who present themselves in the office or clinic for diagnosis and treatment make up an ever increasing and important proportion of the total practice of medicine. A keen and common sense knowledge of human nature as well as an accurate evaluation of the physiologic and psychologic status of every human organism is essential to the giving of accurate and sane advice regarding therapeutic procedures to be applied in every individual case.

Allow me to call your attention to “A Handbook of Elementary Psychobiology and Psychiatry”. Dr. Billings wrote this compendium in order to give the average physician a working understanding of the physiology, pathology and therapy “of the person as a whole”. I am finding its contents a great help to me as I strive to be of more service to my older patients.

Self preservation is the first law of nature and almost every normal individual wants to live on. Occasionally we see an individual who fears old age more than death. Longevity is dependent upon two great factors, first heredity and secondly environment. Mans age should be reckoned physiologically rather than chronologically and yet for practical purposes geriatrics applies in greater or less extent to all from 55 or 60 years of age upwards.

Wise clinicians have always recognized that there are some family strains that are uniformly old in their younger years while others are young in their old years. I glory in the person of eighty spare, tough, with clear voice, bright eyes, good stomach and strong will power; one who has continued his avocation and avocation within the limits of his diminishing strength and vitality. If he wishes to become a centenarian he is far more likely to do so than a person of sixty who has lost all ambition and is convinced that he has lived long enough.

It is important, as Pepper points out, not to confuse senescence and senility. The first is synonymous with old age and is a normal physiological process which is not curable, whereas the second signifies abnormal old age with its various infirmities.

When examining older people the physician would be fortunate were he endowed with the wisdom of Solomon. I say this because, although there are some who are hopeful, optimistic and frank, there are many who either evade examination or else grudgingly give scanty and untrustworthy answers for fear of receiving an unfavourable report. Still another group offer a multitude of symptoms and greatly magnify them in order to gain the sympathy and attention of both the doctor and the family.

One must realize that oldsters steadily become less flexible and their habits of thought become fixed. Often by creating discords and scenes within the family or social circle they seek to occupy the centre of the stage and thus gain the attention that their egos crave.

Let us consider for a moment a few of the commonplace, yet very important, factors, in the everyday life of these people. Since home is a most sacred possession, do not disrupt it and have them plan to spend their latter days in its happy and comfortable environment if at all possible. Encourage them to maintain sensible and regular habits of living.

They require more warmth than younger subjects generally let them decide the amount themselves. Note, however, that they are perfectly comfortable with a room temperature of 70 to 75 if the humidity is maintained between 50 and 70. They are very susceptible to cold and draft. Fresh air does not have to be cold to be wholesome. Their general clothing should be varied according to the season. It should always be warm but not heavy, since heavy clothing becomes too much of a burden for their strength.

Donald R. Ferguson