Pre‐habilitation (ii): time for a patient‐doctor contract?
Pre‐habilitation (ii): time for a patient‐doctor contract?
复制标题
预康复训练 (ii)：签订医患合同的时间？
作者：
A. Ćorović;R. Griffiths
英国国家统计局最近的数据似乎进一步加重了人们对我们可能面临“人口定时炸弹”的担忧。现在英格兰和威尔士的90岁及以上人口不到50万，仅在过去十年中，这个数字就增加了三分之一。随着人口老龄化的不断增加，预计未来只会扩大[3]，可以预期更多的人将在老年时接受大手术和其他生理要求高的干预措施。事实上，英国国家关节登记处的最新报告再次证实了接受髋关节和膝关节置换术的患者数量持续逐年增加的趋势，其中大多数患者年龄超过60岁[4]。大手术，特别是全身麻醉下的大手术，对老年患者的生理学是一个重大挑战，这主要是因为作为正常人体衰老的一部分，所有主要身体系统的功能储备都会下降[5-9]。心血管功能的下降也许可以通过检查“精英”老年运动员在各种跑步项目中的最佳时间来说明。图1显示了不同年龄组的1500米世界纪录[10]。不足为奇的是，随着年龄的增长，时间会变长，也许在80岁之后更是如此，原因尚不清楚。
The nature of the problem Recent data from the UK’s Office for National Statistics would seem to add further weight to concerns that we may be facing a ‘demographic time bomb’ [1]. There are now just under half a million people aged ninety years and over in England and Wales, a number that has increased by a third in the last decade alone [2]. With an increasingly older population, which is predicted only to expand in the future [3], one can expect that many more individuals will be undergoing major surgery and other physiologically demanding interventions at an older age. Indeed, the latest report from the UK’s National Joint Registry has yet again confirmed the trend of sustained annual increases in the number of patients undergoing hip and knee joint replacement procedures, the majority of whom are over sixty years of age [4]. Major surgery, in particular that under general anaesthesia, represents a significant challenge to the physiology of the older patient, owing largely to a decline in functional reserves that is seen across all the major body systems as a part of normal human senescence [5–9]. The decline in cardiovascular performance can perhaps be illustrated by examining ‘elite’ older athletes’ best times for various running events. Figure 1 shows the world 1500 m record for different age categories [10]. Not surprisingly, as individuals age the times lengthen, perhaps more so after the age of eighty years for reasons that are not clear.
影响因子：
10.7
作者：
Strøm C;Rasmussen LS;Sieber FE
通讯作者：
Sieber FE