Successful or Healthy Aging Functional Plasticity Persists in Old

Chronologic age (age in number of years) and physiologic age (age in terms of functional capacity) do not always coincide, and physical appearance and health status often do not always correspond to what is typical at a particular chronological age. Although specialized knowledge is not required to estimate age, in many cases, people may look younger or older than their chronologic age. Early attempts were made to standardize functional profiles of old persons, similar to the well-established diagnostic charts of growing children. Yet, these attempts have failed given the characteristic and substantive heterogeneity of aging processes in human populations. Indeed, some individuals show signs of old age at a much slower or faster rate than others and the variability among individuals of the same age in response to a variety of physiologic or psychologic tests increases with old age (Fig. 4).

As already mentioned (Chapter 1), in humans, the physiologic "norm" is represented by the sum of all functions in a 25-year-old man free of any disease, with a weight of 70 kg and a height of 170 cm. Comparison of old individuals with this "ideal health" inevitably discloses a range of functional decrements with advancing age. Early studies were conducted in selected samples of "representative" elderly (28). Because the prevalence of chronic disease increases in old age, a large part of the data relating to functional loss with aging in early studies may have been due to the effects of disease rather than to aging. In those earlier studies, comparison of several functions from young to old age revealed a gradation of decrements with old age. More recent approaches have challenged the inevitability

FIGURE 4 The heterogeneity of the elderly population as illustrated by scores on a hypothetical test. Results from a large number of tests show that the mean of two scores (as represented by the barograms) is the same for both young and old individuals. However, the much greater standard error of the mean (bracketed lines) in older than in younger individuals indicates a greater variability among individuals from the old population.

FIGURE 4 The heterogeneity of the elderly population as illustrated by scores on a hypothetical test. Results from a large number of tests show that the mean of two scores (as represented by the barograms) is the same for both young and old individuals. However, the much greater standard error of the mean (bracketed lines) in older than in younger individuals indicates a greater variability among individuals from the old population.

of functional impairment and of disease in the elderly by grouping aging processes into three possible trajectories (29):

1. Aging, with disease and disability

2. Usual aging, with the absence of overt pathology, but with the presence of some declines in function

3. Successful (or healthy) aging, with little or no pathology and little or no functional loss

Such a grouping of aging processes:

■ De-emphasizes the view that aging is exclusively characterized by declines in functional competence and health

■ Re-focuses on the substantial heterogeneity among old persons

■ Underscores the existence of positive trajectories (i.e., without disability, disease, and major physiological decline)

■ Highlights the possible avoidance of many, if not all, the diseases and disabilities usually associated with old age

Conditions for successful old age include interactions among several factors, such as higher level of formal education and financial income, strong social support, consistent participation in educational and intellectual activities and adherence to moderate exercise, good diet, and hygienic habits (e.g., no drugs, no smoking, avoidance of excessive alcohol intake) (Fig. 5).

Functional plasticity, that is, the capacity of the individual to adapt to environmental demands without loss of physiologic competence, is most effective at young developmental ages. However, as discussed throughout this book, functional plasticity persists into old age, albeit at less intensity. As we consider the many cross-cultural differences that greatly influence aging, factors such as diet, exercise, drugs, and psychosocial environment should not be underestimated as potential moderators of the aging process. Taking these elements into account, the prospects for avoidance, or eventual reversal, of functional loss with age are vastly improved, and the risks of disability and disease are reduced. Successful or healthy aging in certain functions is a demonstration that aging may occur with little loss of function.

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