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Laboratory Diagnosis and Geriatrics : More Than Just Reference Intervals for Older Adults

Introduction Radical improvements in health care and general lifestyle have brought about longer life expectancy and, with it, a demographic phenomenon that has never been observed before. The steady growth of the proportion of older adults in the general population, especially in industrialized countries, has resulted in what is called an inverse demographic pyramid. Concurrently, the subject of geriatric medicine has also gained in popularity, both…

Multidimensional Geriatric Assessment

Geriatric assessment is a multidimensional, usually interdisciplinary, diagnostic process intended to determine a frail older person's medical, psychosocial, and functional capabilities and problems, with the objective of developing an overall plan for treatment and long-term follow-up. It differs from the standard medical evaluation in its concentration on frail older adults, with their complex problems, emphasis on functional status and quality of life, and frequent use of…

Presentation of Disease in Old Age

Although diseases occur more commonly as people get older, many become more challenging to diagnose accurately in older adults. Classic presenting symptoms may be absent, or nonspecific symptoms such as altered mental status, weight loss, fatigue, falls, dizziness, or functional decline may be the earliest or only manifestations in this age group. For example, common infections (e.g., pneumonia, urinary tract infection) may present with a change…

Productive Aging

Introduction Far from being years of leisure and inactivity, later life is increasingly recognized as being characterized by high levels of productivity. The concept of productive aging captures both paid and unpaid activities that have social value and are performed by adults during the later years of the life course. Late life engagement in activities such as paid work, volunteering, informal helping, caregiving, and taking on…

The Aging Personality and Self: Diversity and Health Issues

Personality may be defined as the pattern of thoughts, feelings, and behaviors that shape an individual's interface with the world, distinguish one person from another, and manifest across time and situation. Personality is impacted by biologic, cognitive, and environmental determinants, including the impact of culture and cohort. Theoretical approaches to personality are as varied as the breadth of the construct they attempt to describe and explain…

Social Vulnerability in Old Age

People's lives are embedded in rich social contexts; many social factors affect each of our lives every day. This is perhaps more noticeable for older adults because declines in health and functional status may increase reliance on social supports and diminish opportunities for social engagement, even in the face of social circles dwindling due to declining health and function among peers. This chapter will provide an…

Social Gerontology

Introduction Social gerontology , as the term suggests, is concerned with the study of the social aspects of aging and old age. These include a large range of topics, disciplines, and methods requiring a good understanding of the clinical and economic dimensions of aging. This chapter includes the following discussions: individual experiences of aging (e.g., age identities, social networks and supports, life events, coping, and resilience);…

Normal Cognitive Aging *

* Material in this chapter contains contributions from the previous edition, and we are grateful to the previous authors for the work done. This chapter provides an overview of the principal features of cognitive functioning in normal aging adults. The first part of this chapter considers intelligence and the importance of esti­mating premorbid intellectual ability to detect discrepancies in functioning, followed by the concept of cognitive…

Antiaging Medicine

Attempts to reverse the aging process stretch back to the time when Adam and Eve were expelled from the Garden of Eden. Since then, wise sages and charlatans have made numerous pronouncements on what the populace should do to extend their life span. In most cases, this has required that those who wish to benefit pay exorbitant sums of money to those who have developed the…

The Pharmacology of Aging

Each day, worldwide, older adults consume millions of doses of medications. This remarkable amount of medication use benefits many older people by preventing and treating disease, preserving functional status, prolonging life, and improving or maintaining good quality of life. However, this level of medication exposure may harm older people via adverse drug reactions and is associated with other problems, such as drug interactions. The responses of…

Aging and the Skin

Introduction The last 25 years has seen enormous growth in our knowledge of skin function, with new subspecialties of cutaneous biology emerging during that time, not least of which is cutaneous neuroendocrinology. The position of the skin, our largest organ by weight (≈12% of total body weight) and extent, and as a sensor of the periphery has prompted some researchers to describe skin as our “brain…

Aging and the Blood

Introduction Age-related changes to normal blood cell development and function remain poorly understood but measurably evident. In 1961, Hayflick and Moorhead described experiments that established the concept that normal somatic cells have a finite number of cell divisions. After completing this limiting number of cell divisions, a resting cellular phase, or senescence, is irreversibly entered. These postmitotic cells do not immediately die, however. They may survive…

Endocrinology of Aging

Historical Overview The concept that hormones play a role in the aging process originated in the nineteenth century. Based on monkey studies, Hanley stated that myxedema resembled old age (senility), and this included “imbecility.” Brown-Sequard's experiments found that testicular extracts rejuvenated rodents and, through experiments on himself, reported that these extracts allowed him “to approximate the strength of a younger person.” By the start of the…

Aging of the Urinary Tract

Introduction Although traditional classification considers the upper and lower urinary tracts as part of one system, each serves a distinct function. In this edition, upper and lower urinary tract components will be considered, emphasizing the known effects of aging on each system. Nevertheless, a number of potentially pertinent topics will not be discussed in this chapter. For example, age-related changes in the renal handling of water…

Aging and the Gastrointestinal System

More than 20% of our population is expected to exceed 65 years of age by 2030, with the most rapidly growing segment older than 85 years. In 2050, the population aged 65 years and older is projected to be over 83 million, almost double its estimated population of 43 million in 2012. The baby boomers are largely responsible for this increase in the older population because…

Bone and Joint Aging

The musculoskeletal system serves three primary functions: (1) it enables an efficient means of limb movement; (2) it acts as an endoskeleton, providing overall mechanical support and protection to soft tissues; and (3) it serves as a mineral reservoir for calcium homeostasis. In older adults, the first two of these functions frequently become compromised; musculoskeletal problems are a major cause of pain and physical disability in…

Connective Tissues and Aging

Aging is a continuous process that constitutes a cycle studded with events that affect all systems in the body, including the connective tissues. The interrelationship between the aging process and connective tissues is complex, involving a variety of factors and interactions acting in a reciprocal fashion. One could inquire into the effects of aging on connective tissues and, conversely, one may ask how the components of…

Neurologic Signs in Older Adults

Neurologic disorders are a common cause of morbidity, mortality, institutionalization, and increased health care costs in the older adult population. Not only does advancing age increase the frequency and severity of neurologic disease, but it may also play an important role in modifying disease presentation. Although physical difficulties can occur independently of cognitive decline, physical difficulties coexist with cognitive impairment in many seniors. Data from the…

Age-Related Changes in the Respiratory System

Respiratory Function Tests The commonly used respiratory function tests are presented in this chapter. In addition, patterns of lung function abnormality seen in some of the common types of condition are also presented. Breathing parameters include the following: Forced expiratory volume (L) in 1 second, FEV 1 . This is the volume of air expired during the first second of a forced expiratory maneuver from vital…

Effects of Aging on the Cardiovascular System

Advanced age is a major risk factor for the development of cardiovascular disease. Why age increases the risk of cardiovascular disease is debatable. The increased risk might arise simply because there is more time to be exposed to risk factors such as hypertension, smoking, and dyslipidemia. In other words, the aging process itself has little impact on the cardiovascular system. However, an emerging view is that…