Geriatric medicine encompasses the diagnosis, treatment and prevention of diseases associated with elderly patients, and also their related problems in the society. It is also a science incorporating anti-aging principles such as monitoring of the aging process in order to achieve longevity and better health. In Europe and America, old age is defined as a person of 65 and above, whereas in China, old age is 60 and above.
Categorisation of Geriatric diseases
Category 1: This is chiefly associated with conditions directly assocuiated with the general aging process such as cataracts, prostatic hypertrophy,senile vaginitis, osteoporosis, dementia, and senile depression, or senile melancholia.
Category 2: This is associated with diseases contracted prior to reaching old age, where old age has brought further deterioration, such as chronic bronchitis, hypertension, joint disorders, coronary disease with atherosclerosis, diabetes, Parkinsons disease and cancer.
Category 3: Diseases affecting both young and elderly patients: Acute infection, trauma and injury, etc.
Special characteristics of age-related disease
- Signs and symptoms are not typical: The nervous system and its reaction is substantially reduced in older patients and so they are less sensitive to pain rendering the disease less noticeable because symptoms are less obvious or atypical.
- Multi-organ disorders: In elderly patients dysfunction of essential organs such as the heart, brain and kidney reflects pathological changes which may be anything from marginal to critical. Any pathological changes in a vital organ may affect the functions of other organs, and complications of this kind can be life threatening. Research indicates that the 60-69 years age group suffers from an aggregate of 7.5 independent diseases; the 70-79 years age group suffers from 7.8 independent diseases; the 80-89 years age group suffers 9.7 independent diseases; the 90 and over age group suffers from 11.1 different types of independent diseases.
- The disease course is protracted, the condition tends to be severe, recovery is slow , and complications are common, exacerbating all of the above factors.
Classification of age-related disease
Kidney disease: Chinese Medicine states that the kidneys are the root of pre-heaven. They govern reproduction, growth, strength and ageing. The lower back is the abode of the kidneys; kidneys store essence and engender marrow and bone. With age, the kidney qi gradually is gradually depleted and so there are symptoms of lower back ache and fatigue, pain and weakness of the knees, tinnitus, deafness etc. The kidney also governs the two yins or lower orifices and so if the kidney qi is insufficient with non-transformation of the bladder qi, this may cause frequent urination or dysuria.
Spleen and stomach disease: The spleen and stomach are the root of post-heaven; elderly patients undergo a gradual decline in middle qi, and impaired function affects the spleen’s function of transformation and transportation and the stomach’s function of reception and decomposition, resulting in a poor appetite, epigastric discomfort, abdominal pain and distension, or diarrhoea or constipation.
Cerebro-vascular disease: In addition to spleen and kidney deficiency, there can also be deficiency of the heart qi and and heart blood, giving rise to cardiovascular disorders. Deficiency of the chest yang, phlegm turbidity, or exuberant interior yin patterns, may manifest as chest bi with blood stasis and chest pain. For insufficiency of qi and blood combined with deficiency in the sea of marrow, there will be deficiecnt heart shen manifestations such as forgetfulness, confusion or dementia. Insufficiency of kidney yin characterised by deficient water failing to nourish wood, there may be an ensuing pattern of hyperactive liver yang manifesting as vertigo and headache. If the hyperactive yang transforms into endogenous wind, and is further accompanied by phlegm and stasis harassing the cerebral network vessels, stroke may eventuate.
Disease associated with qi and fluid insufficiency: As people age, there is exhaustion of qi and fluid; yang weakness and deficiency, unstable moods, irregular water metabolism leading to stagnation, blood stasis, water oedema and Xiao Ke (Insatiable thirst).
Aetiology and pathogenesis
Irregularity of yin and yang:Su Wen: Chapter 3 Sheng Qi Tong Tian Lun states “If the yin and yang energy of a man are kept in a state of equilibrium, his body will be strong and his spirit sound; if yin and yang fail to communicate, his vital energy will decline with ensuing exhaustion.” Good health is defined as the perfect balance of yin and yang. Aging is associated with the decline of kidney qi resulting in an imbalance of yin and yang qi which can be exploited by exterior pathogen.
Disharmony of zang and fu:Ling Shu: Chapter 54 states: At the age of 50, liver qi begins to decline; at the age of 60, the heart qi begins to decline; at the age of 70, the spleen qi is weak; at the age of 80, lung qi is declining; at the age of 90, the kidney qi is withered and exhausted; and at the age of 100, all the viscera are emptied.” This describes how the qi of the zangfu and physiological functions decline, affecting the zheng qi and subsequent resistance to disease.
Insufficiency of qi and blood with stasis stagnation: Aging also results in the progressive exhaustion and damage to qi and blood; aging is generally associated with impaired function of the spleen and stomach leading to the depletion of the post-natal source of qi and blood. Once the spleen’s function of transportation and transformation are diminished, there will be water retention, phlegm damp stagnation, and cough with wheezing and oedema. Dysfunction of the zangfu has an impact on both the vital energy and the spirit of a person. This may result in emotional disturbance, liver qi stagnation, disruption of the qi dynamic, blood stasis, etc. This is why phlegm turbidity, qi stagnation and blood stasis are prevalent in elderly patients.
Professor Zhang Tie Zhong of Beijing University of Chinese Medicine is the head of the Geriatric Department at the Sino Japanese Friendship Hospital in Beijing. He was nominated in the fourth selection of Chinese Nationally renowned Chinese medicine pr… Read more »