倡導考慮環境對老年人的影響


  Dec. 9, 2002─嬰兒潮世代出生的人已經開始邁向老齡化,但是他們將靠X世代支撐。到了2035,美國超過65歲人口是現在的兩倍,這樣的趨勢促使環境保護機構(EPA)嚴肅考慮環境及污染物對老年人口的影響。
  
  EPA衰老研究計劃始於今年十月,美國決定優先進行這方面的研究。12月5 、6日兩天在華盛頓,研究者聚合展開一系列會議,討論已經知道的環境因素對老年人生活的影響以及未知的領域有哪些。
  
  已經知道的,首先最重要的是在逐漸衰老的過程中,人體對傳染性因素和化學毒性變淂越發敏感。傳染因素方面的證據,康乃狄克州的一位老婦人是上個秋天炭疽病毒攻擊的最後幾個受害者之一,專家估計健康成人吸入10,000個病毒孢子才會被傳染,而這位婦人僅吸入100個孢子。
  
  Floyd Frost博士(Lovelace呼吸研究所藥物經濟中心主任)表示,老年人對水源性傳染因素也相當敏感,例如寄生蟲Cryptosporidium,可引起腹瀉和其它腸道問題,而Giardia,可引起胃部發炎。諷刺的是,純淨水要負部分責任,這些相對無害的生物體在成人體內的數量很多,人體對其已有免疫力。現在,飲用純淨水,人們可能更容易被傳染,未來水系統出問題,我們可能發生大規模流行病。
  
  其它潛在的危害包括化學和顆粒狀污染物,上個世紀中葉,「倫敦大霧」 經常湧進城內,它的來源是泰唔士河沿岸非法工廠排放的顆粒。對激增的住院病人及死亡者的分析顯示,大多數是由於心臟病或心血管方面的問題─(原因不是很清楚,心臟的顆粒似乎比肺和呼吸道的堅硬。紐約大學醫學院環境醫學教授George Thurston指出,65歲以上老人在那段時間的死亡率是平時的三倍。
  
  老年人與環境之間的互動不只是單向的,1987的一項研究發現超過70%的老人每天至少服用一種藥物,這些藥物或代謝物用水送服進去。
  
  總之,結果有非常多的不確定性,但是美國老年人遭受的環境危害更大是無庸置疑的。一些人對於威脅老年人的傳染病持老一套的看法,Frost博士甚至與這些人爭論。許多人傾向於忽視這些將老年人推向死亡深淵的傳染病。Frost博士認為,一些老人將因此而壽命減短。如果是這樣,健康照顧體系需要仔細研究不同疾病對老年人的影響。Frost博士告訴Medscape說:「我認為我們做得不夠。」
  
  
  
  

Initiative Considers Impact of

By Jim Kling
Medscape Medical News

Jim Kling

Baby boomers may claim credit for starting the trend toward an aging population, but it will be bolstered by Generation X. By the year 2035, the number of people older than 65 years in the U.S. is expected to double. That trend has prompted the Environmental Protection Agency (EPA) to seriously consider the effects of the environment and pollutants on the aging population.

The result was the EPA's Aging Initiative, begun in October of this year, which is to be the foundation of a national agenda to prioritize research in this area.

On Dec. 5 and 6 in Washington, D.C., researchers gathered for the first of a series of meetings that will bring together experts to discuss what is known about how environmental factors affect the health of older people, as well as key areas of uncertainty.

What is known, first and foremost, is that as people age, they become more susceptible to both infectious agents and chemical toxins. For evidence of the effect of infectious agents, look no further than the elderly Connecticut woman who was one of the last victims of the anthrax attacks last fall. Experts estimate that it takes 10,000 spores to infect a healthy adult, but analysis suggested she inhaled only about 100.

Older adults are also more susceptible to water-borne infectious agents, such as the parasites Cryptosporidium, which can cause diarrhea and other intestinal problems, and Giardia, which can cause inflammation of the stomach. Ironically, cleaner water may be partially to blame. These relatively innocuous organisms used to be so plentiful that adults had built up immunity to them. Now, with cleaner water, people may be more vulnerable. "When water systems fail in the future — and they will fail — we are likely to have much larger epidemics," said Floyd Frost, PhD, director of the Center for Pharmacoeconomic and Outcomes Research at the Lovelace Respiratory Research Institute.

Other potential hazards include chemical and particulate pollutants. In the middle of the last century, the "London fog" frequently rolled into the city. Its source was particulates emitted by unregulated factories mostly along the Thames River. An analysis of hospital admissions and deaths during one London fog episode revealed a striking increase in hospital admissions and death, most due to heart or cardiovascular conditions (for reasons not yet understood, particulates seem to be harder on the heart than on the lungs and airways). People older than 65 years were almost three times as likely to die during that time, according to George Thurston, ScD, a professor of environmental medicine at the New York School of Medicine.

The interaction of an aging population and the environment isn't just a one-way street. A 1987 study found that more than 70% of the elderly take at least one prescription drug per day. Those drugs or their metabolites end up in the water supply.

Overall, the findings were characterized by a great deal of uncertainty, but there was no dispute that older Americans are at greater risk of environmental hazards than their younger counterparts. Frost even takes issue with some of the stereotypical attitudes toward infections that strike the elderly. Many people tend to dismiss such infections as occurring in people that were already knocking on death's door. Not so, Frost says. "There are elderly people whose lives are being cut short."

If so, the health system needs to take a more careful look at how different diseases affect an aging population. "I don't think we've looked carefully enough," Frost told Medscape.

Reviewed by Gary D. Vogin, MD

Jim Kling is a freelance writer for WebMD.

    
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