Coronary artery disease in the aged

Postponement of the early manifestations of coronary artery disease are more appropriately functions of the pediatrician and of the internist dealing with patients in early and middle adult life, with assistance from the marriage counselor and the geneticist. Reduction of mortality from acute myocardial infarction in the prehospital phase, where 66% or more of deaths occur, demands the widespread use of specially equipped ambulances with trained staffs, whose effect in reducing mortality has been estimated as small. The use of monitoring devices by large numbers of ambulatory aged considered at special risk has been recommended. These patients would need to administer their own medicines as indicated; there is still no agreement as to the type and dosage of medications required. Effective modalities of proved value for preventing a second or third acute myocardial infarction after an initial attack are not available. The rehabilitation of survivors through diet, exercise, etc. demands a program of continuous medical supervision, meticulous evaluation of capabilities, and regulated exercise with strong remotivation in a population whose capabilities and responsiveness are limited by physical, mental, and economic factors. Coronary artery disease in the aged must be dealt with as part of a widely based, concerted effort to improve the overall physical and mental health of the aged, in an environment where they can be given meaningful, productive roles which preserve their self respect and dignity.