Geriatrics

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By Frederick F. Holmes M.D. (auth.)

The lifetime of a individual is finite, and all people age (see Fries 1980). it really is tough to split the consequences of sickness on organs and tissues from these anticipated of getting older. this can be quite real for vascular and degenerative strategies, for which there are not any transparent obstacles among getting older and illness. Morbidity and mortality from middle sickness and stroke are most likely due either to ailment and to alterations of getting older. For melanoma, the second one prime reason for demise in the USA, the location is kind of assorted; melanoma is obviously a sickness and isn't a transformation anticipated with getting older. melanoma prevalence raises virtually logarithmically after age forty. within the usa approximately one-half of all circumstances of melanoma are clinically determined after age sixty five, even if these over sixty five contain under one-eighth of the inhabitants. hence, melanoma is especially a lot a disorder of the aged. There are no less than purposes for this: first, the lengthy publicity to cancer-inducing brokers, and moment, the waning strength of immune defenses opposed to cancer.

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In contrast to the local stage of this disease and to many other regional cancers, there is no mitigation of mortality with advancing age. Virtually all patients in the 85-94 age-group died with or of bladder cancer. Though survival apparently improved in the 1970s, this is apparent and not significant. Radiotherapy is the mainstay of treatment at this stage and there is obviously considerable room for improvement in survival rates. One can certainly hope that the trend of fewer patients in this stage will continue.

In the past 30 years the treatment of acute leukemia has been, on the one hand, one of the great victories of chemotherapy and, on the other hand, one of the great disappointments. Aggressive multidrug therapy has lengthened mean survival in acute lymphoblastic leukemia of children from 5 months in 1950 to more than 5 years in the 1970s (PinkeI1971). Indeed, it is believed that some children have been cured of this awful illness. By contrast, the response of the elderly has been very disappointing.

3), the other half are probably cured by surgery. Neither radiotherapy nor chemotherapy is of particular use in this stage. Death from the disease after 5 years is a factor, and late recurrence is not unusual. Obviously there is a great need to develop means of systemic therapy, particularly as adjuvant to potentially curative surgery, in this stage of the disease. I :) 30 20 Fig. 3. I :) 30 20 Fig. 4. Years survival by age and time groups for distantly spread colorectal cancer 10 , \ \ \ \ \ \ '\ '\ '\ '\ '\ '\ '\ 0 '\ 3 65-74 3 75-64 3 85-94 5 26 Colon and Rectum Distant Just about 15% of all cases of colorectal cancer are diagnosed at this stage, with little variation among the three age groups and between the two time periods.

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