[Problems of therapy in very old age (author's transl)].

The care of the elderly covers a wide spectrum: 1, The prophylaxis of the relatively healthy olds. 2, The somatic, psychic and social care of the handicapped aged. 3, The treatment of special illnesses in old age. The gerotherapy must consider the characteristics of the biological age and the degree of the multimorbidity. I. General principles of therapy. The guide-lines of gerohygiene (diet, physical and mental activity, limitation of alcohol and sexuality, regular medical check-ups for registration of risk factors) have to be taken into consideration. The existing multimorbidities in high age should not be treated simultaneously in a polypragmatic way, but according to the prevailing illness with the least possible medicine. II. Special principles of therapy. In the early stage of heart insufficiency in long-lived persons low doses of Digoxin should be used. For aged with kidney insufficiency Digitoxin is preferable. Even in over 90 year old heart patients with the life threatening AV-block the implantation of the intracardial pacemaker is indicated. The myocardial infarction in very old patients developes mostly atypical and should not be treated with coumarin. The more severe hypertension in old age can be treated with low doses of beta-blocking substances in combination with a potassium saving diuretic and low doses of cardiac glycosides. Finally, the frequent sleep disturbances and their therapy in old age are mentioned. The brain function of elderly people depends on the quality of cardiac output and circulation.