Interesting statement. Taking the general diagnosis age defnining one as having Dementia (65 yrs) as opposed to Early onset dementia (< 65yrs) and considering the health, activity levels, interests of persons of any age over 65, definition and sterotypical classification of one as being "elderly" is incongurant with the spirit of life is for living at any age.

To define "Elderly" using the chronological age of 65, bing based on ??? the Western worlds defined age of retirement, seems out of touch with many areas of society working way past the age of 65.

With global interest in reviewing the age of retirement ie: Australia is moving to the retirement age of 67 for males and currently discussion the idal of raising it to 70yrs of age, will this mean we could see the "re-definition" of the tem "elderly" being tagged to those over the age of 70?

Isn't the term Elderly a little presumptious? The term "Elderly" is outdated and derogatory to spirit of what the elderly are, and that is "they are our Elders". A group, that society should look upto and respect moreso than currently occurs (my opinion).

Western societys, in my opinion, show differnt opinions and value to our elders, when compared to more Eastern and Indian cultures.

I am involved in a running club and I train and compete/enter running events, up to and including marathon and ultra-marathon distance with people way past 65yrs and to refer to them as "elderly" would be paramount to telling them they are to old to do anything.

Take care,

Karl...

Thank you Karl for your reply.

I agree with you. Being "elderly" is defined from a perspective of economics. As mentioned bu you, Australia is looking forward to increase the retirement age to 70 years. Why? I believe in the present era, people live longer compared to the era when 65 years was set as the retirement age. They can still benefit the society and can work to earn their livelihood (and of course maintain their self-esteem).

I believe, in health system, there is a need to update this definition. As many therapeutic recommendations put forward by clinical guidelines are age based, defining old age using a mere number will prove as an hindrance towards individual based treatment strategies. What we often neglect when addressing old aged patients in clinical setting, is the heterogeneity that exists in this potentially vulnerable population.

Regards

Shamsher

Shamsher,

I agree with you that using a chronological age of 65 y to define "older adults" is completely non-biological. It is simply based on the retirement age in the US and many western nations. I think everyone working in gerontology recognizes the arbitrariness of this definition, and they are also acutely aware of the issue of heterogeneity in the health status of older adults of the same chronologic age. If you plot the mortality rates as a function of chronological age, you will see that it has a bath-tub shape (or a hockey stick shape), where the mortality declines from its peak at birth, to an age of 11 (around puberty); then it remains relatively flat until about 30-35 y; and then starts going up steadily thereafter. Using mortality rate as a global indicator of age, we might say that we start to "age" in our thirties. In any case, how we quantify/define "aging" depends on the domain that we are most interested in such as, for example, biology, physical function, cognitive function, social dynamics, etc.

Ravi Varadhan

Thank you very much for your reply. I agree with you. Thank you for mentioning about the plot of mortality rates as a function of chronological age. I also agree with you as regards perspective based definition of aging. What is your opinion about constructing such a definition which fits most, if not all, areas of gerontology such as, physical function, cognitive function? Since all these factors may affect the therapeutic needs of an aged individual, all such factors need to be enclosed in a single sphere while defining ageing or being "elderly".

I believe frailty, an emerging concept, has the potential to help health professionals understand the needs of aged population. Various studies so far have revealed the relationship between frailty and age-associated alterations in pharmacokinetics and pharmacodynamics.

Looking forward to your valuable opinions.

Shamsher

Chronological age does not correlate perfectly with functional age, i.e. two people may be of the same age, but differ in their mental and physical capacities. Each nation, government and non-government organisation has different ways of classifying age.

This why when we use drugs we should individualize the dose in view of liver . kidney , cardiovascular function etc.

Thank you very much Ahmed Ali for your view on the matter. Certainly treatment strategies constructed around individual parameters, such as renal and hepatic functions, will prove more beneficial to calculate risk-to-benefit ratio.

Kind regards

Shamsher

The age of 65 was defined as a result of calculations asking the question: At what can society afford to fund retirement benefits?

It has no physiologic basis.

It has no relationship to anything related to cognition, decline in function nor increased risk for disease.

I think the new 65 would be 87 in Canada if we were to re-do the financial calculation of at what could we properly fund retirement benefits (the original calculation was done about 80 years ago and has never been reviewed).

In my work I have found it useful to describe the "elderly" as the young-old (65-75), the old (75-85) and the old-old (those over 85).

The young-old are, for the most part, not really elderly (i.e. cognitively well. mobile and without functional impairment).

Shamsher,

Your observation about "frailty" is a good one. Frailty is proposed as a concept that can partially explain the heterogeneity in the health status of older adults. Our group at Johns Hopkins, as well as Ken Rockwood's group in Canada, have done a lot of work to advance the concept of frailty in gerontology (science of aging) and geriatrics (clinical care of older adults). More recently, the European geriatricians have been actively involved in the translation of frailty. So, we will likely see a big role for frailty in our understanding of aging processes and in the healthcare of older adults. However, there remains much theoretical work to be done in clearly defining and operationalizing the construct of frailty.

Dear Ravi Varadhan

Thank you for your reply. As mentioned by you, the concept of frailty has the potential to disclose various opportunities of better serving the aged population. We all know that frailty describes better the physical status of a person as compared to the use of chronological age. Thus, frailty may help to bring much awaited step in geriatric therapy; the individualization.

From the demographic point of view it can be calculated but even before this

we may easily conclude that the treshold to old age is 70 or more. I am afraid that some factors may have some interest in maintaining the "Historical Age of 65 years as the treshhold although it is already about 150 years old.....

Elderly may be > 70 years, 65-70 years may be productive based on experiences and visions of a person

We are of course talking about the demographic treshold of being included in the

elderly group. This has nothing to do with creativity , productivity or any other individual qualities a person has.

The range of elderly persons' age can vary between 65-75; 75-85 and over 85. 65-75 are productive and without any functional impairment.

People can be productive, creative or whatever at any age,

There is an indirect association between age and function

Age itself is just a chronological or demographic term .

Just to muddy the waters, the increase in chronic diseases, obesity and alcohol and drug abuse is likely to see what is tantamount to frailty in people under 65. We also see higher rates of frailty in countries with lower GDP - compare Eastern Europe with Northern Europe. 'Sucessful ageing seems to be as much about demographics and access to health and community care as it is about biology. Suggests that the factors affecting our ageing and our ability to reduce the impacts of it are there from birth. Poor access to healthcare, education etc are likely to see people age earlier and this will be reflected in chronological age. I read somewere that health outcomes for women in the southern states of the US are worse than they were in the 1940s! Makes you wonder why our own fedeal government's idealogical policy bent seems hell bent on replicating this.  

Frailty is a measure of deficit accumulation but it is a guide that opens the discussion about the level of vulnerability that an individual has to medical treatments and need for a comprehensive geriatric assessment and mangement plan. Resilience is another concept needing more investigation. We all see the 'old old' active and functioning well despite high levels of frailty. So while higher frailty is a prognostic indictor for less resilience to stressors it isn't the entire picture.

Sorry no clear answer here. My own think is 75 is the new 65 but it is helpful to profile older peope into the yound old through to the very old. We are seeing the highest rates of hospital admissions in the 85+ and even in the number of 100+; I remember a time when such a patient was a rarity in hospital. It does raise the issue, however, as to how our specialist, single organ focussed acute medical care system manages such patients.

Cheers