When doctors consider how to treat elderly patients, they are likely to think, 'is this patient ill, or just old? Can their complaints be explained by the 'normal ageing process' or does the patient have an undiagnosed disease?'

Gerbrand Izaks and Rudi Westendorp believe that doctors don't need to make these distinctions. They argue that the symptoms of normal ageing could just as easily be symptoms of an as yet unrecognised disease.

They say: "Most new diseases have gone undiagnosed because their signs and symptoms escaped recognition or were interpreted otherwise. Many physical changes in the elderly that are not yet recognised as a disease are thus ascribed to normal ageing. For example, in the past this happened with osteoporosis. Therefore the distinction between normal ageing and disease late in life seems to a large extent arbitrary."

In the debate article, the authors present a model in which diseases are caused by several factors acting cumulatively. People get ill when, in effect, they have completed the set of risk factors that cause a particular disease. As we accumulate more of these causes over time, we end up suffering from more diseases when we are old.

Thinking in this way means that every change associated with ageing can be thought of as being a symptom of an illness. It should encourage doctors to rethink how they assess the body functions of older patients.

Rather than comparing the values obtained from assessing elderly patients to the values they would expect from people of the same age, doctors should compare the results to the 'normal values' from healthy young adults. This will highlight the fact that the
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BioMed Central
22-Dec-2003