human aging

human aging

▪ physiology and sociology

      physiological changes that take place in the human body leading to senescence, the decline of biological functions and of the ability to adapt to metabolic stress. In humans the physiological developments are normally accompanied by psychological and behavioural changes, and other changes, involving social and economic factors, also occur.

      Aging begins as soon as adulthood is reached and is as much a part of human life as are infancy, childhood, and adolescence. Gerontology (gerontology and geriatrics) (the study of aging) is concerned primarily with the changes that occur between the attainment of maturity and the death of the individual. The goal of research in gerontology is to identify the factors that influence these changes. Application of this knowledge is expected to reduce the disabilities now associated with aging.

      The biological-physiological aspects of aging include both the basic biological factors that underlie aging and the general health status. Since the probability of death increases rapidly with advancing age, it is clear that changes must occur in the individual which make him more and more vulnerable to disease (human disease). For example, a young adult may rapidly recover from pneumonia, whereas an elderly person may die.

      Physiologists have found that the performance of many organs (organ) such as the heart, kidneys, brain, or lungs shows a gradual decline over the life span. Part of this decline is due to a loss of cells (cell) from these organs, with resultant reduction in the reserve capacities of the individual. Furthermore, the cells remaining in the elderly individual may not perform as well as those in the young. Certain cellular enzymes may be less active, and thus more time may be required to carry out chemical reactions. Ultimately the cell may die.

Effect of aging of the body systems

Cardiovascular system
      Diseases (cardiovascular disease) of the heart are the single largest cause of death after age 65. Thus, with increasing age the heart becomes more vulnerable to disease. Even in the absence of detectable disease, the heart undergoes deleterious changes with advancing age. Structural changes include a gradual loss of muscle fibres with an infiltration of fat and connective tissue. There is a gradual accumulation of insoluble granular material (lipofuscin, or “age pigment”) in cardiac muscle fibres. These granules, composed of protein and lipid (fat), make their first appearance by the age of 20 and increase gradually, so that by the age of 80 they may occupy as much as 5–10 percent of the volume of a muscle fibre.

      The heart also shows a gradual reduction in performance with advancing age. The amount of blood pumped by the heart diminishes by about 50 percent between the ages of 20 and 90 years. There are marked individual differences in the effects of age. For example, some 80-year-old individuals may have cardiac function that is as good as that of the average 40-year-old individual.

      Under resting conditions, the heart rate does not change significantly with age. During each beat, however, the muscle fibres of the heart do not contract as rapidly in the old as in the young. This reduction in power, or rate of work, is due to the age-associated reduction in the activities of certain cellular enzymes (enzyme) that produce the energy required for muscular contraction.

      In spite of these changes, the heart, in the absence of disease, is able to meet the demands placed upon it. In response to physical exercise it can increase its rate to double or triple the amount of blood pumped each minute, although the maximum possible output falls, and the reserve capacity of the heart diminishes with age.

       arteriosclerosis, or hardening of the arteries, increases markedly in incidence with age, and is often regarded as part of aging. This is not necessarily true. Arteriosclerosis may appear even in adolescents. It is a progressive disorder and is present to some extent in practically all individuals by middle life. It is, therefore, impossible to make a clear distinction between the effects of aging and the effects of disease in blood vessels (blood vessel) in human beings. In some animal species, as, for example, the rat, that do not develop arteriosclerosis, age changes in the heart and blood vessels can be identified.

      In general, blood vessels become less elastic with advancing age. There is a progressive thickening of the walls of larger blood vessels with an increase in connective tissue. The connective tissue itself becomes stiffer with increasing age. This occurs because of the formation of cross-links both within the molecules of collagen, a primary constituent of connective tissue, and between adjacent collagen fibres. These changes in blood vessels occur even in the absence of the deposits on the arterial wall characteristic of atherosclerosis, which interfere with blood flow through the arteries. The gradual loss of elasticity increases with resistance to the flow of blood so that blood pressure may increase. This in turn increases the work that the heart must do in order to maintain the flow of blood.

      While both systolic and diastolic blood pressures (blood pressures at contraction and dilation of the heart, respectively) increase with age, the rate of systolic increase exceeds that of diastolic so that the pulse pressure widens. The increase in pressure stops in the eighth decade of life, and there may even be a slight decline in pressure in extreme old age.

      On the average, obese people have higher blood pressures than those with normal body weights. Since the incidence of obesity increases with age at least up to the age of 55–60, this factor may contribute in part to the increase in blood pressure with age.

Digestive system (digestive system, human)
      Loss of teeth (tooth), which is often seen in elderly people, is more apt to be the result of long-term neglect than a result of aging itself. The loss of teeth and incidence of oral disease increase with age, but, as programs of water fluoridation are expanded and the incidence of tooth decay in children is reduced, subsequent generations of the elderly will undoubtedly have better teeth than the present generation.

      While it is true that the secretion by the stomach of hydrochloric acid, as well as other digestive enzymes, decreases with age, the overall process of digestion is not significantly impaired in the elderly. Sugar, proteins, vitamins, and minerals are absorbed from the stomach and intestine as well in the elderly as in the young. Some investigations indicate a slight impairment in fat absorption, but the reduction is probably of little practical significance.

      These findings have important implications for nutrition (nutrition, human) of the elderly. There is no evidence that the intake of any nutrient, such as vitamins and minerals, need be increased in the elderly because of impaired absorption. Nutritional deficiencies can be avoided as long as the diet is varied to assure adequate intake of all nutritional elements. Deficiencies are most likely to develop from poor eating habits, such as excessive intake of carbohydrate with a reduction in protein. In the elderly these deficiencies are most apt to be in the intake of protein, calcium, iron, vitamin A, and thiamine (also called vitamin B1).

Nervous system (nervous system, human)
      Changes in the structures of the brain due to normal aging are not striking. It is true that with advancing age there is a slight loss of neurons (neuron) (nerve cells) in the brain. This is because, in the adult, neurons have lost the capacity to form new neurons by division. The basic number of neurons in the brain appears to be fixed by about the age of 10. The total number of neurons is extremely large, however, so that any losses probably have only a minor effect on behaviour. Since the physiological basis of memory (memory abnormality) is still unknown, it cannot be assumed that the loss of memory observed in elderly people is caused by the loss of neurons in the brain.

      Neurons are extremely sensitive to oxygen deficiency. Consequently, it is probable that neuron loss, as well as other abnormalities observed in aging brains, results not from aging itself, but from disease, such as arteriosclerosis, that reduces the oxygen available to areas of the brain by reducing the blood supply.

      There are probably functional changes in the brain that account for the slowing of responses and for the memory defects that are often seen in the elderly; and even small changes in the connections between cells of the brain could serve as the basis for marked behavioral changes, but, until more is known about how the brain works, behavioral changes cannot be related to physiological or structural changes. It is known that, because of the slow course of aging, the nervous system can compensate and maintain adequate function even in centenarians.

      Human behaviour is highly dependent on the reception and integration of information derived from sensory organs, such as the eye and ear, as well as from nerve endings in skin, muscle, joints, and internal organs. There is, however, no direct relation between the sensitivity of receptors and the adequacy of behaviour, because the usual level of stimulation is considerably greater than the minimum required for stimulation of the sense organs. In addition, an individual adapts to gradual impairments in one sensory organ by using information available from other sense organs. Modern technology has also provided glasses and hearing aids to compensate for reduced acuity in the sense organs.

      The incidence of gross sensory impairments, of which many are the result of disease processes, increases with age. One survey conducted in the United States classified 25.9 per 1,000 persons aged 65–74 as blind, in contrast to 1.3 per 1,000 aged 20–44 years. In the age group 65–74, 54.7 per 1,000 persons were classified as functionally deaf, compared with 5.0 per 1,000 in the age range 25–34 years.

 Visual acuity (ability to discriminate fine detail) is relatively poor in young children and improves up to young adulthood. From about the middle 20s to the 50s there is a slight decline in visual acuity, and there is a somewhat accelerated decline thereafter. This decline is readily compensated for by the use of eyeglasses. There is also reduction in the size of the pupil with age. Consequently, vision in older people can be significantly improved by an increase in the level of illumination.

      Aging also brings about a reduction in the ability to change the focus of the eye for viewing near and far objects ( presbyopia), so that distant objects can ordinarily be seen more clearly than those close at hand. This change in vision is related to a gradual increase in rigidity of the lens of the eye that takes place primarily between the ages of 10 and 55 years. After age 55 there is little further change. Many people in their 50s adopt bifocal glasses to compensate for this physiological change.

      The sensitivity of the eye under conditions of low illumination is less in the old than in the young; that is, “night vision” is reduced. Sensitivity to glare is also greater in the old than in the young.

      The incidence of diseases of the eye, such as glaucoma and cataracts (cataract) (characterized, respectively, by increased intra-ocular pressure and opaque lenses), increases with age, but recent advances in surgery and the development of contact lenses have made it possible to remove cataracts and restore vision to many individuals.

      Hearing does not change much with age for tones of frequencies usually encountered in daily life. Above the age of 50, however, there is a gradual reduction in the ability to perceive tones at higher frequencies. Few persons over the age of 65 can hear tones with a frequency of 10,000 cycles per second. This loss of perception of high frequencies interferes with identifying individuals by their voices and with understanding conversation in a group, but does not ordinarily represent a serious limitation to the individual in daily life. Listening habits and intellectual level play an important role in determining the ability to understand speech, so that there is often a disparity between measurements of pure tone thresholds and ability to perceive speech.

Other sensory impairment
      After the age of 70 other sense organs may show a reduction in sensitivity. Reduced taste sensitivity is associated with atrophy and loss of taste buds from the tongue in the elderly. The effect of aging on the sense of smell has not been precisely determined because this sense is extremely difficult to assess quantitatively; in addition, smoking and exposure to occupational odours and noxious substances in the air influence sensitivity to smells.

      Sensitivity to pain is difficult to evaluate quantitatively under controlled laboratory conditions. There is some evidence that it diminishes slightly after the age of 70.

      There is a general slowing of responses in the elderly. Reflexes (reflex) become slightly more sluggish and the speed of conduction of impulses in nerves is slightly slowed. Old people require more time to respond to the appearance of a light than do young. The slowing with age is greater in situations where a decision must be made. For example, more time is required to initiate a response in experiments in which the instructions are “Press the button with your right hand when the green light comes on, but with your left hand when the red light comes on” than if the instructions are, “Push the button if either light comes on.” From these and other experiments it is concluded that the primary site of slowing of responses is within the brain rather than in the end organ (eye) itself.

      The primary age change in the skin is a gradual loss of elasticity. Although this basic change plays a role, other factors, such as exposure to the weather and familial traits, also contribute to the development of wrinkles and the pigmentation associated with senescence. The ability of the skin to take up slack and remain closely adherent to the underlying structures is due to the presence of fibres of the proteins elastin and collagen. Studies of the minute structures of the skin show a gradual reduction in elastin. In addition, the collagen fibres show an increase in cross-links, which greatly restricts the elastic properties of the collagen network.

      The effectiveness of facial massage in retarding the development of wrinkles has not been evaluated under carefully controlled conditions. The application of creams containing female sex hormone stimulates regeneration of skin and improves its elastic properties. Other effects, which may be undesirable or even hazardous, may follow repeated administration of these hormones (hormone).

Endocrine system (endocrine system, human)
      Because of the importance of hormones in the regulation of many physiological systems, impairments in endocrine (ductless) glands have traditionally been cited as important determinants in aging.

       thyroxine, the hormone secreted by the thyroid gland, regulates the level of activity of all the cells (cell) of the body. When thyroxine secretion is reduced, all metabolic processes proceed at a reduced rate and basal metabolism falls. (Metabolism consists of the chemical changes taking place within the cells of an organism during the processes of growth and restoration of tissues and the production of energy necessary for bodily processes; basal (basal metabolic rate) metabolism is the metabolism, as measured by the rate at which heat is given off, when an organism is in a resting and fasting state.) Since basal metabolism decreases with age, it seemed reasonable to ascribe aging to a loss of thyroid function, but this assumption has proved to be incorrect. Experimental studies have shown that the ability of the thyroid gland to produce thyroxine is not reduced in the elderly, and that there is a reduction in the utilization of thyroxine in various tissues of the body. Further studies of cellular metabolism are needed to find out why this is so.

      Since aging is associated with reduced ability to adjust to stresses, and since the adrenal cortex (the outer part of the adrenal gland) plays a role in many of these adjustments, numerous attempts have been made to assess senescent changes in the function of the adrenal cortex. Although after the age of 50 there is a reduction in blood levels of the hormones secreted by the adrenal cortex, the ability of the gland to produce hormones when stimulated by the experimental administration of adrenocorticotrophic hormone (ACTH), the pituitary hormone that regulates the activity of the adrenal cortex, has been shown to be as good in the old as in the young.

      The pituitary gland is often referred to as the master gland of the body, since it produces hormones that stimulate the activities of other endocrine glands, such as the adrenal, the thyroid, and the ovary. It was therefore once assumed that reduction in the function of these glands associated with aging is due to lack of proper stimulation from the pituitary gland. Methods for determination of the very small amounts of these regulating hormones present in the blood have been developed and as yet no systematic studies of age differences in blood levels of these hormones have been reported.

      The pancreas secretes insulin, the hormone that regulates the utilization of sugar and other nutrients in the body. When the pancreas fails to produce adequate amounts of insulin, diabetes (diabetes mellitus) occurs. One test for diabetes involves measuring the rate of removal of sugar from the blood, that is, the glucose-tolerance test. One characteristic of aging is a reduction in the rate of removal of excess sugar from the blood. At present it is not known whether this represents the early stages of diabetes or whether it is a normal age change. It does appear in aged individuals who do not show any of the other symptoms of diabetes. Furthermore, it has been shown that, unlike the diabetic, elderly subjects can, with additional stimulation, produce more insulin. In normal young persons the pancreas releases more insulin in response to even a slight rise in blood sugar levels. In the elderly, the sensitivity of the pancreas is reduced so that a higher level of blood sugar is required to stimulate it to action. With maximum stimulation the pancreas in the aged can produce as much insulin as the pancreas in the young.

      It has long been known that the excretion of both male and female sex hormones diminishes with age. In the female, the excretion of estrogens (estrogen) (female sex hormones) falls markedly at the menopause. In the male, the excretion of androgens (androgen) (male sex hormones and their degradation products) falls gradually over the age span 50–90, so that the existence of a male “climacteric” is highly improbable.

      Sexual (sexual intercourse) activity, as reported in interview studies, diminishes progressively between the ages of 20 and 60 in both males and females. In males the frequency of marital intercourse falls from an average of four per week in 20-year-olds to one per week in 60-year-olds. Practically all males aged 20–45 reported some level of sexual activity. Between the ages of 45 and 60 only about 5 percent of males reported loss of sexual activity.

      Few systematic studies have been made of sexual behaviour in individuals over the age of 60, but clinical reports indicate that at least some males remain sexually active at 90.

      There are wide individual differences in the level of sexual activity in both males and females. In human beings, sexual behaviour is influenced more by psychological and social factors than by the levels of sex hormones circulating in the blood. Nevertheless, the use of male sex hormones has had a long, and stormy, history as a rejuvenating agent for males. Attempts to rejuvenate elderly males by injecting crude extracts from testicles of animals, as well as various androgenic compounds, were made, but the effects, if any, were only transitory. In the early 1900s, sex glands from other animals were transplanted into human beings, but the results were questionable and the side effects were often disastrous. At about the same time, an operation was devised in which the spermatic ducts were tied off. It was assumed that preventing the loss of sperm would stimulate the sex glands to produce androgenic hormones which would rejuvenate the individual. None of these assumptions proved correct, so that the operation was soon abandoned as a rejuvenating procedure.

      Since tissue loss does occur with aging, the administration of anabolic (anabolic steroid) hormones (hormones that promote the buildup of tissues) may represent an important future development. The compounds that are currently available have a number of undesirable side effects and cannot be used routinely. Chemists and pharmacologists continue research to produce new steroids that will have anabolic effects without the undesirable side effects.

Skeletal system (skeletal system, human)
      With aging, the bones gradually lose calcium. As a result they become more fragile and are more likely to break, even with minor falls. Healing of fractures is also slower in the old than in the young. Recent advances in orthopedic surgery, with the replacement of parts of a broken bone or joint with new structures or the introduction of metallic pegs to hold broken parts together, have been of great value to elderly people.

      The incidence of osteoporosis, a disease characterized by a loss of calcium and minerals from bone, also increases with age. It occurs more frequently in women after menopause than in men and is especially evident in the spinal column. Back pain is a primary symptom of the disease. It can be treated by increasing calcium intake in association with the administration of anabolic hormones.

      The mobility of joints diminishes with age and the incidence of arthritis increases.

Respiratory system (respiration, human)
      Vital capacity, or the total amount of air that can be expelled from the lung after a maximum inspiration, diminishes with age, as does the total volume of air that can be contained in the lungs. In contrast, the amount of air that cannot be expelled from the lung increases. These changes in respiratory mechanisms are primarily a reflection of the increased stiffness of the bony cage of the chest and decreased strength of the muscles that move the chest during respiration.

      The lung also contains elastin and collagen to give it elastic properties. As indicated previously, the formation of cross-links in elastin and collagen that takes place with aging reduces the elastic properties of the lung.

      The transfer of oxygen and carbon dioxide from the air in the lungs to the blood is influenced by the amount of blood flowing through the lungs as well as by the amount of air moved in and out. The characteristics of the membranes that separate blood and air in the lungs are also important in maintaining an adequate supply of oxygen to the body. Although with age there is a slight reduction in the amount of oxygen that can be moved from the air to the blood in the lungs, the reduction becomes apparent only when large amounts of oxygen are required, as during strenuous exercise. It is believed that a primary factor in the impairment of oxygen transfer in the lungs of elderly subjects is the lack of appropriate adjustment of the blood flow to the air sacs in the lung.

       emphysema, abnormal distension of the lungs with air, is a lung disease reaching its highest incidence between the ages of 45 and 65. In the United States the death rate from emphysema increased by almost 400 percent between 1950 and 1960. Although the exact causes of the disease are still unknown, the presence of noxious or toxic agents in the air may be a contributing factor. Many studies have shown a relationship between the incidence of emphysema and bronchitis (inflammation of the bronchi) and smoking. Among British physicians death rates from bronchitis were six times higher in those smoking 25 cigarettes a day than in nonsmokers.

      Measurements of lung function are significantly lower in cigarette smokers than in nonsmokers of the same age. Values for cigarette smokers are, on the average, about equal to those of nonsmokers who are 10–15 years older. There is evidence, however, that when cigarette smokers quit smoking, measurements of pulmonary function closely approach those of nonsmokers within one to two years, even in the case of heavy smokers 50–60 years old.

      The kidney removes wastes from the body by separating them from the blood and forming urine. In this process many substances are accumulated in the urine at a higher concentration than in the blood. With advancing age the concentrating ability of the kidney falls, so that a greater volume of water is required to excrete the same amount of waste material. This loss in concentrating ability is probably partially offset by a decrease in the excretory load because of reduced activity, alterations in food intake, and the reduction in muscle mass of the elderly. These changes in kidney function may not be reflected in urine volume, since volumes fluctuate widely at all ages and are determined primarily by fluid intake.

      The reduction in renal (kidney) function is due in part to a gradual reduction in blood flow to the kidney. Since the kidney receives a great excess of blood (about 25 percent of the blood pumped by the heart each minute), the reduction with age does not normally result in an accumulation of waste products in the blood. Any such accumulation is the result of disease that damages the kidney. The reduced concentrating ability of the kidney results from a loss of some of the nephrons, the functional elements of the kidney, and the reduced activity of cellular enzymes.

Regulatory mechanisms
      Some physiological characteristics, such as the mechanisms that regulate the acidity of the blood or its sugar level, are adequate to maintain normal levels under resting conditions even in very old people; however, the aged require more time than the young to reestablish normal levels when changes from the normal occur.

      In order to test the effectiveness of control mechanisms of the body, physiologists produce changes experimentally and determine the rate of recovery. When the acidity of the blood is increased to the same extent in old and young subjects, it is returned to normal within 6–8 hours in the young; in the elderly 18–24 hours are required.

      Similarly, the rate of return to fasting levels after sugar has been administered intravenously or orally is slower in the old than in the young. The response to insulin, which accelerates the removal of sugar from the blood, is also diminished in the elderly.

      The body's physiological mechanisms for adjusting to changes in environmental temperature are less adequate in the old than in the young. Consequently older people may prefer more uniform and slightly higher temperatures than the young. High temperatures are also more hazardous to the elderly. The incidence of heat prostration in hot weather increases with age.

  exercise is one of the physiological stresses of daily living. In reasonable amounts it is a valuable stimulus to maintain physiological vigour. A number of studies have indicated a lower incidence of cardiovascular disease (human disease) among adults who indulge in physical activity than in those who do not.

      The capacity to perform muscular work diminishes progressively in the elderly. Muscle strength diminishes; however, the reduction in strength is less in muscles that continue to be used throughout adult life than in those that are not. Thus a part of the reduction in muscle strength may be an atrophy of disuse.

      Maximum work capacity is reduced in the elderly, largely because of the inability to deliver enough oxygen to the working muscles. In the young, the need for oxygen is met for the most part by increasing the heart rate. Under conditions of maximum work, young adults can increase their heart rate to over 200 beats per minute; the elderly to only about 150 per minute. In addition, the transfer of oxygen from the lungs to the blood is reduced in the elderly under conditions of strenuous exercise.

      With less than maximum exercise, there is a greater increase in blood pressure, heart (organ) rate, and respiration in the old than in the young; that is, a given work load induces a greater physiological stress in the old than in the young. Furthermore, recovery of blood pressure, heart rate, and respiration to resting values takes longer in the old.

Premature aging
       progeria is an extremely rare disease of early childhood characterized by many of the superficial aspects of aging, such as baldness, thinning of the skin, prominence of blood vessels of the scalp, and vascular disease. These children have the general appearance of “little old men.” They rarely live beyond the age of 15–18. Death is usually caused by cardiovascular disease.

      The disease is extremely rare. In fact, only about 50 cases have been identified for study. In spite of the appearance of premature aging, these patients fail to show an acceleration of other age changes, except for the early development of cardiovascular disease. Most tests of physiological and psychological functions give values which are normal for their chronological age. It is doubtful whether the child with progeria is suffering only from accelerated aging; rather, progeria should be regarded as a rare disease with a superficial resemblance to senescence.

Psychological aspects of aging
      The most outstanding psychological features of aging are the impairment in short-term memory and the lengthening of response time. Both of these factors contribute to lower scores of the elderly on standard tests of “intelligence.” When the aged are given all the time that they wish on tests that are not heavily dependent on school skills, their performance is only slightly poorer than that of young adults. Age decrements are negligible on tests that depend on vocabulary, general information, and well-practiced activities.

      Experimental studies on learning show that, although the elderly learn more slowly than the young, they can acquire new material and can remember it as well as the young. Age differences in learning increase with the difficulty of the material to be learned.

      Aged people tend to become more cautious and rigid in their behaviour and to withdraw from social contacts. These behaviour patterns may be the result of social institutions and expectancies rather than an intrinsic phenomenon of aging. Many persons who “age successfully” make conscious efforts to maintain mental alertness by continued learning and by expansion of social contacts with individuals in a younger age group.

Nathan Wetherill Shock

Additional Reading
George L. Maddox et al. (eds.), The Encyclopedia of Aging, 2nd ed. (1995), is an extensive general reference. General principles are addressed in Paola S. Timiras (ed.), Physiological Basis of Aging and Geriatrics, 2nd ed. (1994), addressing the aging process from a physiological viewpoint including all systems of the body; Imre Zs.-Nagy, The Membrane Hypothesis of Aging (1994), a comprehensive, multidisciplinary description of the cell maturation and aging process; Arthur K. Labin (ed.), Practical Handbook of Human Biologic Age Determination (1994), covering metabolic profiles, organ system approaches, biological measurements, and nonhuman model studies; Robert Arking, Biology of Aging: Observations and Principles (1991); and Alexander P. Spence, Biology of Human Aging (1989).The following provide advanced knowledge on various aspects of geriatrics and gerontology: Jean M. Lauder et al. (eds.), Molecular Aspects of Development and Aging of the Nervous System (1989); Claire Murphy, William S. Cain, and D. Mark Hegsted (eds.), Nutrition and the Chemical Senses in Aging: Recent Advances and Current Research Needs (1989); Allan L. Goldstein (ed.), Biomedical Advances in Aging (1990); and Steven R. Gambert (ed.), Handbook of Geriatrics (1987). The essentials of geriatric medicine are presented in William Reichel, Care of the Elderly: Clinical Aspects of Aging, 4th ed. (1995), a comprehensive clinical approach geared to the practicing physician; M.R.P. Hall, W.J. MacLennan, and M.D.W. Lye, Medical Care of the Elderly, 3rd ed. (1993); and Contemporary Geriatric Medicine (biennial).Alan J. Sinclair and Ken W. Woodhouse (eds.), Acute Medical Illness in Old Age (1995) , presents guidelines for effectively managing various conditions in the elderly. Richard L. Byyny and Leon Speroff, A Clinical Guide for the Care of Older Women: Primary and Preventive Care, 2nd ed. (1996), addresses issues of older female patients such as specific guidelines for screening, diagnosis, and management. Cornelius L.E. Katona, Depression in Old Age (1994), covers clinical features, measurement, etiology, and other aspects of aging. Margret M. Baltes and Paul B. Baltes (eds.), The Psychology of Control and Aging (1986), focuses on control-related beliefs and behaviours with regard to theory and practice in the psychology of aging. Gerald Felsenthal, Susan J. Garrison, and Franz U. Steinberg (ed.), Rehabilitation of the Aging and Elderly Patient (1994), focuses on practices to prevent or delay confinement of patients to custodial institutions and on the rehabilitation of both disabled and elderly patients who are losing functions.

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