|Aging; Diseases; Favorable developments
|During the last century, there was delight with improving life
expectancy and relatively little concern for how to deal with the elderly.
In 1900, the average life expectancy at birth was 48.3 years, and by
the end of the century, it had increased to 76.9 years . Improved
sanitation, nutrition and medical care initiated this increase, and
improvements in both propelled it. Unlike the increased life expectancy
demonstrated from birth, life expectancy for people after retirement
age did not increase until the last third of the century so there was little
need for a substantial change in the management of the aged. Although
increased life expectancy was appreciated by individuals, the need for
new and revised medical and social planning has been substantially and
|The severe impairments in brain function occurring during aging
are the result of disease or injury (stroke and other cerebro-vascular
diseases, Alzheimer’s, neurosyphilis etc.) not the result of aging
developments themselves. Intellectual abilities continue to develop
during advancing age, particularly over a wide range of domain
knowledge, vocabulary, and verbal comprehension which Kanfer and
Ackerman call “crystallized or Gc” to distinguish it from Gf “Fluid”
current, abstract, adaptive intellectual abilities which is better measured
by general metal ability tests . Aging, in adult development, and
Work motivation, they indicate domain knowledge across the life
course and suggest that individuals may compensate for declines in Gf
by selecting jobs and goals and by using self-regulatory strategies that
optimize existing knowledge and skill.
|Asthma and Allergies
|Some studies suggest that elderly adults are somewhat less
likely to experience asthma and rhinitis than children or younger
adults. A National Health Interview Study (NHIS) of 54,485 noninstitutionalized
US adults over age 65 years reported an asthma
prevalence of 7.0%, with a decreasing prevalence with increasing age
. Asthma prevalence was only 45% as common among those aged
85 or more years (3.6%) as compared to those in the 65 to 69 age group
(8.0%)(95% CI of 0.36-0.55) . A Swiss study of 9,651 adults of 18+
years had self reported allergic rhinitis rates which were significantly
greater in the younger versus older age cohorts (women 24.5% at ≤ 60
years, 15.4% at 60+ years, p<0.001, and men 21.6% at ≤ 60 years and
13.0% at 60+ years p<0.001) .
|Although asthma is less common in advancing years, asthma
often goes undiagnosed or untreated in elderly adults . The exact
mechanism for lower asthma and allergy rates in the elderly is not well known, but may be related to lower rates of allergic sensitization in
older adults. A Swiss study of 9,651 adults reported that Phialatop®
measured atopy to common inhaled allergens (such as pollen, mold,
domestic animals and dust mites) was significantly more common
in young subjects versus older subjects (women 30.6% at ≤ 60 years,
18.1% at 60+ years, p<0.001, and men 36.4% at ≤ 60 years and 26.6% at
60+ years p<0.001) .
|Rates of upper respiratory diseases such as colds and influenza are
generally less frequent among older adults as compared to younger
adults and children. A Netherlands study analyzed 541 cases of upper
respiratory illness presenting to general practitioners . Compared to
a cohort of young adults (15-24 years), adults 60+ years had only a 30%
less risk of getting an upper respiratory infection such as rhinovirus,
coronavirus, or influenza A (95% CI 0.5-0.9), while children aged 1 to
4 years had a 220% greater risk of an acute upper respiratory infection
(95% CI of 3.0-3.4) . While upper respiratory infections are generally
less common in the elderly, influenza morbidity and mortality rates are
generally higher in the elderly .
|Older adults less frequently experience new onset of many
autoimmune diseases than younger people do. A review of 40
autoimmune diseases reported that only 6 of the autoimmune
diseases (giant cell arteritis, pernicious anemia, bullous pemphigoid,
rapidly progressing glomerulonephritis, myasthenia gravis, fibrosing
alevolitis) most commonly appear after age 50 years . Many common
autoimmune diseases like type 1 diabetes, rheumatoid arthritis,
rheumatic fever, multiple sclerosis, lupus, and sarcoidosis most
commonly begin during childhood or early adult life . On the other
hand, a number of animal and human studies have suggested that aging
related immune system changes may reduce self tolerance and increase
risk of autoimmunity and inflammatory responses . More research
in needed to elucidate the effects of aging on autoimmunity and self
tolerance and develop better prevention and treatment strategies.
|Rates of cancer seem to level off at about 80 to 85 years and then
fall significantly during greater age. A US SEER Cancer Registry study
reported that overall cancer incidence and death rates in both women
and men were only about 50% as great at the age of 100 years as at 85
years . Incidence rates from most of the 24 types of cancer examined
in this study peaked somewhere between 75 and 90 years . Many
worldwide studies have reported that cancer rates decline by at least a
factor of two to three by age 100 as compared to those or about 85 years
of age . Several autopsy studies have also reported that the presence
of cancer at death is significantly lower in individuals aged 90 or more
years at death [12,13]. Perhaps conditions are less favorable for cancer
growth in adults over aged 85 years than in those aged 65 to 85 years.
|Growth rates of many forms of cancer are significantly slower
in older adults as compared to younger adults. A Netherlands study
reported that median volume doubling times for primary female breast
cancer was 80 days in women under 50 years of age (95% CI 44-147
days), 157 days in women aged 50 to 70 years (95% CI 121 to 204 days)
and 188 days in women over aged 70 years (120 to 295 days) .
Autopsy studies have also reported significantly slower cancer primary
growth rates and metastatic growth rates in adults who died at 90 years
or older versus those who died younger . Studies with laboratory
mice have also reported slower growth rates of several types of cancers
in older animals versus younger animals . The slower growth rate
of cancer in older patients may make these cancers easier to treat.
|Natriuretic peptides are generally present in significantly higher
levels during aging . Natriuretic peptides have many potentially
beneficial properties for heart failure patients, including opposition
to vasoconstriction, sodium retention and antidiuretic effects [17,18].
A number of therapeutic approaches to increase atrial natriouretic
peptides (ANP) are currently being investigated, including the use
ANP analogues such as carpetide and the use of several inhibitors of
neutral peptidase inhibitors which block breakdown of ANP .
|Search for still more favorable developments during aging to share
with other gerontologists and to exploit your current practice. Most
of the favorable developments will require interdisciplinary studies:
biochemistry, cell and molecular biology, pharmacology, etc. Further
study of complex metabolic interactions is likely to make management
better, improve the quality of the later years of life, and increase
|Continuing with the last third of the 20th century, gerontology has
been responsible for managing an increasing part of the population
that now exceeds those of earlier generations surviving beyond the
“retirement” age. Infirmities of the aged have received extensive study,
but the favorable developments have almost completely escaped
|Search, exposition, and utilization of the favorable developments,
to supplement attention to damage, can improve the satisfaction
and productivity of the elderly who are swiftly mounting among our
population. Previous organization has become inadequate for changes
in the composition of the community.
|Study of such positive factors in aging can help scientists and
clinicians better understand disease processes and develop better
strategies to prolong health and productivity among the elderly.
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