Læknablaðið - 01.12.1973, Síða 65

LÆKNABLAÐIÐ
263
complete rest in bed and then very gradual
ambulation. On the first day the patient sits
up in a chair for thirty minutes and behaves
as if recovering from a severe illness with
gradual increase in exertion over the period
of a week.
MULTIPLE PATHOLOGY
The classical teaching of a single path-
ology to explain all symptons does not ap-
ply where elderly people are concerned,
where multiple pathology is the rule rather
than the exception. The observation by an
informed relative that the older person has
aged suddenly is well worth noting and
this is often explained by some remedial
illness. A very sensible lady of 87 years
was able to stand beside her bed without
being able to walk. She noticed all was
not well with her when she could no longer
carry her history textbooks home from the
library. On physical examination no ab-
normality was discovered apart from
muscle weakness and it was thougt that she
had some metabolic disorder. When investi-
gated in hospital she was found to have a
profound potassium deficiency from inade-
quate nutritional intake and when this was
remedied she was able to walk about in
her usual manner and continue the activities
of daily iiving. In the West of Scotland
potassium deficiency while not common is
occasionally found. The diet chosen by old
people is often poor in potassium containing
foods and either illness such as depression,
diarrhoea, or medication by a diuretic, or
simply heart failure may result in depletion
of the body’s stores of potassium and this
may manifest itself by continuing depres-
sion, by mental confusion and apathy, and
muscle weakness may be noted; the hand-
grip is usually diminished. These symtoms
demand investigation re the potassium
status of the individual and are completely
curable by a potassium supplementation
and then advice about the addition or, for
example, orange juice to the daily diet. A
pint of milk per day would abolish the risk
of potassium deficiency and, incidentally,
the danger of any lack of vitamin D, espe-
cially in a country like Scotland where sun-
shine is not very common. Illness such as
potassium deficiency may make the task
of the doctor very difficult indeed as the
older person may only complain of a desire
to remain in bed and not get up which is
surely quite natural or so it seems in ex-
treme old age.
TEMPERATURE
Temperature regulation becomes im-
paired in old age and the value of tempera-
ture elevation as a pointer to infection is
unreliable. Recording of the patients tem-
perature is still important and hypo-
thermia is not too uncommon in the
Winter time. Any illness when the older
person remains immobile and exposed to
a drop in temperature may, because of
faulty temperature control, result in hypo-
thermia. The possibility of undiagnosed
myxoedema should always be considered in
patients with hypothermia.
HYPERPYREXIA OF
PARKINSONISM
Hyperpyrexia may be found when a pa-
tient with long-standing Parkinsonism is
transferred from his home to hospital. The
exacerbation in the symptomatology of the
illness is frequently associated with a high
temperature. This condition is so serious
that if a patient with Parkinsonism is be-
ing cared for at home and the relative de-
sires correctly to have a holiday and the
request is made for admission to a geriatric
unit, the relative is always warned of the
danger of transfer to hospital. This seems
another example of the impairment of con-
trol of temperature regulation in ill old
people.
TíIIRST
The sensation of thirst appears diminish-
ed in elderly people as many come into hos-
pital with a dry tongue and will take fluid
immediately it is offered to them but will
seldom of their own accord ask for a drink.
Such people are often suffering from faecal
impaction and may have disturbance also
of potassium balance. The need to restore
correct and appropriate water and electro-
lytes to the elderly ill person must be
stressed.