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.
Shoes and stockings should fit properly but still allow room for free movement of toes. If garters are tight enough to be effective they will interfere with the circulation in the legs and therefore had better not be worn. The aged should not be allowed to attend to their own toe nails, calloses corn or bunions since, with their failing sight, they often inflict wounds, which although insignificant, allow infections to become established.
They should be encouraged to rest for a half hour after meals and in late afternoon. They should sleep as long hours at night as they possibly can. You can gauge whether they are sleeping long enough by ascertaining whether they get up rested in the morning. As a rule six or seven hours will be sufficient. Beware of the fact that they are prone to complain of insomnia even though you have gone to their bed side and found them in profound sleep. It is notorious that they frequently sleep in their chair during the day and therefore are not sleepy at night.
Warm milk with crackers, more exercise during the day (if feasible), a placebo, or even a glass of wine taken at bed time may suffice to induce sleep, and frequently may be just as efficacious as either the oral or the hypodermic administration of morphia. Where one recognize constipation as a cause of irritability and sleeplessness a cathartic will satisfactorily solve the problems.
Their early morning temperature are notoriously subnormal and therefore the older person should allow from twenty to thirty minutes for arising, thus allowing the circulation to gradually return to normal. If further, they can have breakfast in bed, the stimulation to circulation is extremely beneficial.
Their bed clothes should be warm but as light as possible. In cold weather if a blanket is placed over the mattress they will need less weight of bed clothes on top of them. Many are most comfortable and happy when sleeping either directly under or between blankets.
Dont keep old people in bed unless the nature of an illness makes it absolutely mandatory because the bedridden patient often loses hope and is thereby handicapped. By the same token keep them at work in order that both their minds and their bodies shall be reasonably active.
Even in the face of an acute respiratory infection keep them out of bed and in a chair for at least short periods. Not only is this beneficial but the psychic stimulus it produces is tremendous. Of course there are exceptions notably severe heart failure with passive congestion; peripheral vascular disease and conditions where they have reached the limit of their energy and vital capacity. Under these later conditions, order gentle but thorough massage and passive movement of all four extremities daily.
Even let them dangle their legs over the side of the bed. Myocardial infarct, of necessity, calls for weeks of absolute rest for both body and mind. Where there is the slightest sign of impending cyanosis or the presence of physical signs suggesting the insidious onset of passive (hypostatic) congestion the prompt administration of oxygen by means of a tent is most sagacious and often life-saving.
As a matter of fact the abrupt and radical curtailment of habits such as the use of tobacco, liquor and coffee is fraught with danger. Any adjustment should be aimed at moderation and should be accomplished gradually.
They should bathe at least twice a week in warm or tepid water. This should be followed by brisk rubbing with a turkish towel for the stimulating effect, upon the skin and circulation. For the common ailment of dry skin use lanolin or a satisfactory skin oil.
The aged should have a sensible, well balanced, mixed diet high in vitamins and essential minerals totaling thirty to thirty-five calories per kilogram of body weight. Salt should be drastically restricted, but the food should be freely seasoned with spices, acid and sugar. The food should be such that it is easily masticated and assimilated. Partial and complete dentures should be used in order to secure adequate grinding surfaces. They often thrive better on frequent small feedings rather than the customary three meals a day.
Be cautious in taking their complaints of indigestion or dyspepsia at full face value for, whereas they are quite prone to mild functional disturbances of the gastrointestinal tract, symptoms are only too frequently the danger signs of cardiac failure with passive congestion which is too often unrecognized and ignored during the important period when it could be checked with comparative ease.
