Medical Differences Between the Young and the Aged*

A bstract Although the medical profession is slowly realizing that many disorders in the aged must be treated differently than in the young, there is still no proper appreciation of these age differences. Too often, when a patient reaches life‐expectancy age, the physician relaxes his medical attention. It is assumed that the patient will die soon, although the actuarial statistics may show that he has many more years of life. Accordingly, therapy should be more intensive in order to attain the maximal life span. Elderly people will tolerate many major operations (e.g., herniorrhaphy or thyroidectomy) as well as young people. However, when it comes to serious major operations (e.g., radical neck dissection or radical excision of the rectum for carcinoma), the mortality rate for the aged may be four to eight times higher than for young patients. Elderly patients tolerate emergency major operations and complications very poorly. The chronologic age is not the chief factor in the mortality rate; more important are the operative complications. Therefore, preoperatively, every effort should be made to identify and treat diseases that might cause complications postoperatively. After operation a close watch must be kept for complications so that they may be treated promptly and effectively. Operative technic must be meticulous, with no excessive trauma and with particular attention to hemostasis and wound closure. The operation should be completed in the shortest possible time consistent with safety. A summary of 6 reports in the medical literature shows an operative mortality rate for major operations of 2.6 per cent in patients under 60, compared to 7.2 per cent for patients over 60. The mortality rate for emergency operations is much higher than for elective operations—18.5 per cent versus 6.5 per cent, respectively. A summary of 4 reports shows that cardiac complications were the greatest single cause of postoperative mortality (21.6 per cent), with pneumonia and atelectasis a close second. Despite precautions such as bandaging the extremities and early ambulation, pulmonary embolism accounted for 9.4 per cent of the deaths. Though inoperable carcinoma caused more deaths (22.2 per cent of the entire group) than any of the other diseases, it is classified as a multiple cause. Since the mortality rate for major operations in both aged and young patients is still significant, there is great need for more accuracy in determining operability.