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Important points:

1. The most; rapid increase in population m the US. (percentage-wise) is in people over 65. Within this group, the over-85 subgroup is increasing most rapidly.

2. At age 80 patients have half the lean body mass of a 30-year-old. Because basal metabolic rate depends on lean body mass, elderly patients need fewer calories. They also need more sodium, vitamin Bn, vitamin D (and/or calcium), folate, and nonheme iron.

3. Normal changes in elderly: slightly impaired immune response, visual (presbyopia) and hearing (presbycusis) impairment, decreased muscle mass, increased fat deposits, osteoporosis, brain changes (decreased weight, enlarged ventricles and sulci), and slightly decreased ability to learn new material.

4. Normal sexual function changes in men: elderly men take longer to get an erection and have an increased refractory period (after ejaculation it takes longer before the patient can have another erection). Delayed ejaculation is common, and the patient may ejaculate only 1. of every 3 times that he has sex. impotence and lack of sexual desire are not normal and should be investigated. Look for psychological (depression) as well as physical causes. Medications, especially antihypertensives, are notorious culprits.

5. Normal sexual function changes in women: for decreased lubrication, advise water-soluble lubricants. Atrophy of clitoris, labia, and vaginal tissues may cause dyspareunia; treat with estrogen cream. Delayed orgasm is common, but lack of sexual desire is not normal and should be investigated (psychological or physical causes).

6. The best prophylaxis for pressure ulcers in an immobilized patient is frequent turning.

7. Sleep changes: elderly people sleep less deeply, wake up more frequently during the nighv, and awaken earlier in the morning. They take longer to fall asleep (longer sleep latency) and have less stage 3 and 4 and rapid-eye-movement sleep.

8. Depression in the elderly may present as dementia (i.e., pseudodementia). Look for a history that would trigger depression (e.g., loss of a spouse, terminal or debilitating disease).

9. In 1993, 12% of the IIS. population was over age 65.

10, Fifteen percent of people over age 65 suffer from dementia. The most common causes of dementia, in order, are Alzheimer's disease (gradually progressive, neurofibrillary tangles) and multiinfarct (step-wise, risk factors for cerebrovascular accident). Other causes include HIV and Pick's disease.

11, Only 5% of people over the age of 65 live in nursing homes.

Epidemiology, and Biostatistics

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