Preface

The publication of the fourth edition of Physiological Basis of Aging and Geriatrics comes at a particularly opportune time. The lengthening of life expectancy at birth and in old age, which began in the twentieth century, has reached both industrialized and, increasingly, developing countries. Currently, individuals aged 80 years and older appear to be the fastest growing segment of the human population, and centenarians, once rarely seen, are much more frequently encountered. Understandably, these demographic changes are being accompanied by a new way of thinking about aging.

In the early twentieth century, the study of aging focused primarily on biomedical models of pathology, that is, how to diagnose the diseases and chronic disabilities afflicting the elderly, and how best to treat them. It is safe to say that most scientists studying aging before the 1980s regarded aging as a rising wall of mortality. Since then, however, due to a multiplicity of factors, social as well as medical, we have witnessed a major effort among researchers to reinterpret aging as a normal, healthy, and even positive feature of the life span. Although aging may make older adults more susceptible to disease, most retain sufficient plasticity and regenerative capability to ensure functional competence, which may determine how successfully, if not how long, aging populations may live. As we now view them, aging and death, much like development and maturation, entail numerous, complex interactions that have encouraged researchers to turn their attention to the physiological basis of aging as well as the genetic and environmental factors that alternately enhance and impair functional competence at molecular, cellular, and organismic levels.

Chapters are grouped into three main parts: In Part I, General Perspectives, aging is viewed as an individual's "journey taking place in a community setting." It describes the demographic, epidemiologic, and comparative aspects of aging and discusses molecular and cellular aspects of aging in relation to several theories of aging, thus providing a comprehensive profile of aging in individuals and populations. Part II, Systemic and Organismic Aging, surveys the aging of body systems, focusing on maintenance of optimal functioning and adaptation to environmental demands. Part III, Prevention and Rehabilitation, presents a synopsis of pharmacologic, nutritional, regenerative, and assistive interventions that promote successful aging and longevity. Using physiology as its unifying concept, the fourth edition contains concise, explicit explanations and numerous comprehensive tables and graphs. Clinical correlations are included as a practical reference for the geriatrician and as a guide to normal aging for the gerontologist.

Comparable books on aging target a professional and/or academic readership; here, the goal is to offer information that will be useful to a broad spectrum of readers from different biological and educational backgrounds. We believe it will not only meet the needs of those preparing for a career in gerontology or geriatrics or interested in aging as a specific topic in biological sciences, but also of older persons themselves, along with their families and caretakers, who seek to better understand the aging-related changes and to gain new insights about this stage of life.

When the elderly are viewed through the eye of the clinician, the emphasis is on the need for assessing, managing, and reducing risk factors. Equally important, as we begin to see aging in a new light, is strengthening physiologic competence and devising appropriate interventions aimed at improving quality-of-life. The concept of "continuity through change" is fundamental to all biological processes. As individuals and society itself age, continuity of prior events may provide "a usable past" that can serve us well in shaping future functions. Indeed, in a 1972 book, Developmental Physiology and Aging, (Timiras) identity was shown to be as dynamic a process among the elderly as it is in the young. Slowing or otherwise mitigating the effects of old age by strengthening physiological competence throughout life does not deny the inevitability of death, but it does deny the inevitability of disability, disease, and despair. In this first quarter of a new century, we have every reason to rejoice in the vigorous declaration of the nineteenth century English poet, Robert Browning's, "Grow old along with me/The best is yet to be/The last of life for which the first was made/Grow old nor be afraid!"

Paola S. Timiras

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