PERCEPTIONS OF AGING ARE SHIFTING

June 3, 2007
Rebekah McCallister

Internal Medicine World Report, February 2006, Volume 0, Issue 0

WASHINGTON, DC?A new way of thinking about aging is emerging from the medical community, according to a report titled "The Science of Aging Gracefully: Scientists and the Public Talk About Aging Research," which was presented at the White House Conference on Aging late last year.

Scientists interviewed for the report identified 3 major factors that are driving change in the field of aging research:

? Research in genetics

? Development of new technology

? Integration of knowledge from different fields.

"The goal is extending the health span, not just the life span," according to the authors of the report. "What we are talking about is keeping older people productive longer."

Although many of the participating scientists remain interested in specific age-related illnesses, they noted that a better understanding of the aging process may offer cures for many of these diseases and improve the quality of life for older people.

The report is based on telephone interviews, conducted in June and July 2005, with a diverse group of researchers representing all major aspects of aging. Members of the public were also interviewed to determine their views on aging research.

"Understanding the aging process?the basic fundamental mechanisms of aging?will help us understand how major geriatric diseases like cancer, heart disease, Alzheimer's disease, and other neurodegenerative conditions develop and progress," said Stephanie Lederman, executive director of the American Federation for Aging Research in New York City. "An investment in aging research is ultimately an investment in specific disease research."

Participating researchers were asked about their perceptions of the public's understanding of aging research issues. In an effort to either validate or refute these perceptions, the survey included questions that paralleled the researchers' perceptions and explored the issue of life span versus health span, the relationship of diet and exercise to aging, the role of socioeconomics in health and aging, support for basic biomedical research funding, and expectations for quick research results.

The report suggests that many of the researchers' concerns about the public's understanding of these issues emanate from political arguments or media coverage rather than actual pubic opinion. For example, researchers said that they are generally pessimistic about the public's enthusiasm for basic aging research. However, data indicate that the public is far more supportive of basic aging research than the official political voices would suggest. The public's level of interest also suggests that informal communication networks in families and communities could provide opportunities to cultivate a more nuanced understanding of topics such as "health span" and the lifestyle choices that play a role in an individual's ability to have both a healthier and longer life.

"This study highlights the tremendous promise of aging research and the public's understanding of its importance," said Daniel Perry, executive director of the Alliance for Aging Research in Washington, DC.

The report is available at www.publicagenda.org/research/research_reports_details.cfm?list=95.

Clinical Pearls in Geriatric Medicine

1. Serum creatinine level often does not reflect true renal function; a decline in renal clearance and lean muscle mass may make creatinine level normal. Creatinine clearance is therefore the best measurement to assess renal function.

2. White coat hypertension is more ?common in the elderly than in the general pop?ulation, and emphasis should be placed on home blood pressure readings.

3. Elevated respiratory rate may be the earliest, and sometimes the only, presenting sign of pneumonia.

4. Always rule out fecal impaction in elderly people who are suffering from diarrhea or urinary retention.

5. In the elderly, fever and leukocytosis may be absent, even during significant ?infections (eg, pneumonia, pyelone?phritis)..

6. Hypothyroidism in the elderly may present with nonspecific symptoms and signs, such as anorexia, weakness, hearing loss, or anemia. In some elderly patients, delayed deep-tendon reflex relaxation is the only presenting sign of this condition.

7. Avoid prescribing these medications: Diabetes: metformin (Glu?co?phage) (risk of metabolic acidosis in patients with renal insufficiency), glyburide (DiaBeta) (prolonged half-life, risk of hypoglycemia) Anal?gesics: pro?poxy?phene (Dar?von) and meperidine (Demerol) (toxic meta??bolites, risk of delirium and seiz?ures) Sedative antihistamines: dip?h?en?hydramine (eg, Benadryl) and chlorpheniramine (eg, Aller-Chlor) (delirium, sedation, risk of falls, urinary retention, constipation).

8. Review the patient's medications and adherence at each visit, both prescription and over the counter, including herbal/vitamin supplementation. Inquire about adverse drug reactions drug?drug interactions, and drug?disease interactions.

9. Review/determine advance caredirectives (ie, Durable Power of Attorney for Health Care, Living Will, code status). Do this at a ?routine visit rather than during a health crisis.

10. Hyperthyroidism in older patients may present atypically and may mimic symptoms of hypothyroidism