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As indicated in the preceding chapter, standards of growth, development, and maturation provide a frame of reference against which every pathologic process in early life must be viewed. It has been less appreciated, however, that at the other end of the life cycle, neurologic deficits must be judged in a similar way against a background of normal aging changes. The earliest of these changes begins long before the acknowledged period of senescence and continues throughout the remainder of life. Most authors use the terms aging and senescence interchangeably, but some draw a fine semantic distinction between the purely passive and chronologic process of aging and the composite of bodily changes that characterize this process (senescence).

Biologists have measured many of these changes. Table 28-1 gives estimates of the structural and functional decline that accompanies aging between ages 30 and 80 years. It appears that all structures and functions share in the aging process. Some persons withstand the onslaught of aging far better than others, and this constitutional resistance to the effects of aging seems to be familial. It can also be said that such changes are unrelated to Alzheimer disease and other degenerative diseases but that, in general, the changes of aging reduce the capacity to recover from virtually any illness or trauma. An entity of “frailty” has been conceived to encompass the sum of breakdown in multiple organ systems that result from the later stages of aging. With respect to the nervous system, it entails the loss of muscle mass, strength and endurance, decreased appetite, unintentional weight loss, and reduced mobility and balance, to which may be added the deteriorations in vision and hearing and other special sensory functions that occur to varying degrees in the aged. A working definition of frailty is summarized in Table 28-2 (see Fried). In the past, this was referred to as “failure to thrive,” a term adopted from pediatrics. A simplified approach has been given by the British Geriatrics Society. They have identified slowed walking speed, meaning the inability to cover 4 m in less than 5 s, the inability to stand from a chair and walk 3 m and return to sit down again in under 10 s, a score of 3 or more on a questionnaire called PRISMA 7, which focuses on age over 85, health problems that require the individual to stay at home, and the need for a cane, walker, or wheelchair. The British Geriatrics Society paper and the review by Clegg and colleagues are recommended on this subject.


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