The current issue of “Postępy Nauk Medycznych” focuses on some of the diagnostic and therapeutic matters, which are often encountered by family doctors when dealing with health issues in the elderly.

The articles were written by faculty of the Department of Family Medicine, Internal and Metabolic Bone Diseases to honor the 40th aniversary of the Medical Center of Postgraduate Education (CMKP). For the last 5 years, the clinic has been providing, apart from his every-day educational and medical services, continous education programs for family doctors and other doctors providing basic medical care to a variety of patients.

In the first article, the authors discuss the function of the thyroid gland changes with ageing. They point out that thyroid dysfunction (especially subclinical) is more often seen in older than in younger populations and is difficult to diagnose because of lack of symptoms or scant clinical symptoms, which might be non specific or masked by medications taken by patients. Both hypothyreosis and hyperthyreosis are risk factors for cardiovascular diseases and cognitive function impairment. However, only hyperthyreosis (even subclinical) is a predictor of increased mortality, while higher TSH serum concentrations in the elderly are associated with lower mortality. The problem of screening tests for thyroid gland dysfunction in the elderly as well as treatment of subclinical hypothyreosis in this group of patients remains unsolved.

In the second article, the authors raise an important issue of diabetes in the elderly and point out that diabetes is often missed in this population because its presenting symptoms may be nonspecific. The principles of diabetes management in elderly patients are similar to those in younger patients, but with special considerations linked to the increased prevalence of comorbidities and relative inability to tolerate adverse effects of medication and hypoglycemia. The goals of glycemic control in elderly patients should be individualized and formulated after consideration of their clinical and functional status and life expectancy. Aggressive glycemic control is less important than avoiding hypoglycemia and achieving a good quality of life.

In the third article, the authors focus on hypertension which is the most common cause of mortality in global population. The frequency of hypertension is increasing with age as a consequence of many processes in the arteries, especially stiffness of the arteries. A special form of hypertension which is concerned with the elderly is isolated systolic hypertension. The authors conclude that hypertensive therapy in the elderly gives them benefits, but it has to be kept with preserving principles as individualisation of therapy and careful lowering the pressure.

In the fourth article, the authors write that life extension as a result of progress of civilization increases the number of the elderly. Aging of population is associated with the occurrence of a large group of patients with coronary artery disease. Taking into account the current state of medical knowledge, it is necessary to use optimal pharmacological treatment and the best method of revascularisation (percutaneous coronary intervention – PTCA or coronary artery bypass grafting – CABG). The old age is characterized by many differences in terms of clinical evaluation, diagnosis and treatment. However, management patterns based on guidelines set by cardiological societies are not much different from those recommended for younger patients.

In the fifth article, the issue of joint pains in the elderly is discussed. The main reasons for them are: osteoarthritis, systemic diseases of connective tissue (polymyalgia rheumatica, giant cell arteritis, chondrocalcinosis, Forestier disease, acute relapsing symmetric seronegative synovitis and peripheral edema- RS₃ PE, elderly onset rheumatoid arthritis- EORA, gout), paraneoplastic syndromes, and soft tissue rheumatism (carpal tunnel syndrome, trochanteric syndrome, hip pains, shoudler pains, fibromyalgia, Baker’s cyst). The diagnosis of giant cell arteritis should be considered in any patient older than 50 years who has experienced loss of vision, diplopia, a new form of headache, polymyalgia rheumatica, fever and unexplained constitutional symptoms. Disorders of soft, peri-articular tissues are a common cause of musculoskeletal pain in the elderly. Nevertheless, most physicians underestimate the role of soft tissue rheumatism. They are often treated with non steroidal anti inflammatory drugs. In local pain syndromes better results can be obtained by local treatment. Local injections of glicocorticoids are usually very effective and safe.

In the sixth article, the authors focus on the current state of diagnosis and treatment of osteoporosis. Fractures are a clinical issue in osteoporosis, thus the aim of the diagnostic process is to identify properly patients who are at risk of fractures. Diagnosing osteoporosis according to the densytometric categories presented by WHO in 1994 does not meet this goal because about 70% of fractures concerns patients with a T-score above -2.5. In current medical practice the most importants issue in making therapeutic decisions is to conduct fracture risk assessment for an individual patient. Fast increases in the population of the elderly create the need for actions whose priority is to lower the risk for osteoporotic fractures. Such actions should include lowering influences of risk factors, preventing falls, improving bone resistance with the use of famacology especially antiresorptic and anabolic drugs. In the elderly, the treatment should include, apart from prescribing appropriate medications, taking into consideration contraindications and way of supplying, also attepting to motivate the patient to follow the guidelines for treatment of chronic diseases.

In the seventh article, the issue of constipation in the elderly is discussed. Constipation perceivable as a stool frequency lower than typical for a given population and/or disordered strained defecation occurs in any age, but its prevalence in older persons (> 65 years) is five times greater than in younger people. Ageing alone, although related to physiological bowel changes, is not really responsible for an increased prevalence of constipation in the elderly. Some factors predisposing to constipation, more frequent in older people, coexistent diseases and taken medications are more important. The authors discuss diagnostics of constipation and the rules for treatment. Management of constipation in older people depends on a diet modification and change in a mode of defecation, treatment with stool softeners, osmotic and stimulant laxatives, separately or in combination, treatment with 5HT₄ receptor agonist, sometimes on making enemas. In chosen cases of primary constipation with a slow transit or disordered defecation a surgical approach (subtotal colectomy or anorectal surgery) may be used. The authors present complications of constipation in older persons, of those fecal impaction in the rectum and/or colon needs a fiber restriction diet and the use of a laxative.

In the eighth article, the authors focus on COPD. The prevalence of COPD in individuals 65 years of age and older was recently estimated to be 50% compared with 20% in those 40 years. Symptoms of COPD in the elderly are nonspecific and recognition and diagnosis are often delayed. The diagnosis of COPD in the elderly, like as in other patients, should be based on history and demonstration of airway obstruction on spirometric testing. In elderly, development of these tests is very difficult, because there are contraindications and difficulties in cooperation during examination, resulting from physical impairments and/or poor cognitive abilities. In the elderly population COPD is frequently present with several comorbidites. The elderly patients are at increased risk for adverse effects associated with COPD medications. Because the elderly tend to use multiple drugs for numerous diseases, such polypharmacy may complicate disease management and increase the likelihood of drug interactions.

In the ninth article, the authors raise the issue of obstructive sleep apnea which is usually described as a middle-age male problem. However the prevalence of obstructive sleep apnea in elderly patients is very common. In the present publication the authors try to show the data on epidemiology, pathophysiology, morbidity, mortality, clinical significance and treatment of obstructive sleep apnea in the elderly. They focus on clinical problems related to obstructive sleep apnea, such as hypertension, coronary heart disease, heart failure, arrhythmias, diabetes to show differences between middle and old age patients.

In the tenth article, the treatment adherence is discussed. Poor adherence is a common cause of non-response to medication and it decreases effectiveness of therapy. It is the most significant reason for failed pharmacotherapy. It also leads to medical complications, increases mortality and has a major impact on healthcare systems and resources. 10% of hospital admissions and almost a quarter of nursing home admissions are due to non-compliance with medication. Consequences of non-adherence can range from inconsequential to disastrous, depending on drug characteristics, disease state and severity (i.e. drug-resistant strains in human immunodeficiency virus). Barriers to adherence include patients’ health beliefs, inadequate education, and age.

In the last article, the author reports on the increased prevalence of a group of disorders called autism spectrum disorders (ASDs). According to data from more than a dozen epidemiological studies conducted in the last two decades, ASD is diagnosed in 60-70 children/10 000. In popular press and the media, this phenomenon is often described and an “autism epidemic”, which may suggest that there has been a real increase in the incidence of autism, not just in the prevalence of the disorder. However, the latest publications clearly indicate that there are other variables (e.g., change in the diagnostic criteria, availability of services, awareness of the disorder) responsible for the rise of ASDs.