The relativity of age or geriatric medicine at the crossroads

Excerpt

The age of the Universe is estimated at 13.8 bn years and our current belief is that the Earth is 4.5–4.6 bn years old [1, 2]. Modern humans evolved about 200,000 years ago and therefore our history represents only a minor part of the old Earth and Universe. According to the World Health Organization statistics (WHO 2016), the average life expectancy at birth in the world population for 2015 was 71.4 years, the lowest being in Sierra Leone (50.1 years) and the highest in Japan (83.7 years) [3]. It is worth emphasizing that the average life expectancy for those born in 1965 was 53.3 years while 100 years ago, it was only approximately 35 years. Furthermore, in the millennia from B.C. up to the nineteenth century, the life expectancy remained very stable with only minor fluctuations. Therefore, in the last 150 years we are facing rapid ageing of the population in both developed countries and in those undergoing transition. The life expectancy in Europe, e. g. increased in the past century by 35–50 years. Ageing of the population is not only the success of the modern way of life, well-being and progress of health sciences but at the same time causes many medical, psychological, sociological and financial problems [4, 5]. It is associated with typical geriatric syndromes (e.g. sleep problems, delirium, dementia, osteoporosis, heart failure, falls and weight loss) that reduce the health-related quality of life, activities of daily living and therefore increase their dependence and need for various forms of support [6‐8]. The elderly frequently suffer from age-related vulnerability due to reduced compensatory and defence mechanisms that leads to frailty with associated polymorbidity and polypharmacy, undernutrition, poor social status, loneliness and repetitive hospital admissions [9‐11]. Once hospitalized, the main goal unfortunately remains rapid management of acute medical conditions. Even though older patients have a prolonged hospital stay and are at higher risk for hospital-acquired infections and death, discharge from hospital is often premature and with little concerns about the transition to domestic or nursing long-term facilities. …