The fact that there are special problems in the care of the elderly in
the community is ample justification for writing a separate volume on
the subject. The knowledge that there are increasing numbers of older
people in virtually every country in the world makes it all the more
important that the family physician should have sympathy with and
understanding of the problems of them, since they are lilcely to make up
a significant part of his worlcload and, increasingly, will take up more
of his time and energy. There is a progressive amount of disability with
advancing years, and this is particularly true of those aged 75 years
and over. Increasing age is associated with serious impairment of
hearing and vision, senses which younger people take for granted. Old
age sees the arrival of major diseases of middle age with much greater
frequency, such as ischaemic heart and cerebrovascular disease, diabetes
mellitus and osteoarthritis. There are other disorders that are
virtually confined to the elderly, such as fractures of the femoral
neck, Paget's disease and myeloma. We now know that the disintegration
of the con- ducting tissue of the heart is largely an age-related
phenomenon. Ageing processes affect every major organ system in the body
and the impairment of physiological perfor- mance resulting from these
affects the elderly individual's response to infections, disease and
environmental changes in complex ways that are not seen in younger
people.