Biomedical Engineering Reference
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and for socioeconomic development, consisting of an increase in the world's population
aged 65 and over (from 7% in 2008 to 14% by 2040, with Japan in first position in the rank-
ing countries with the oldest population followed by Italy and Germany), an increase in
life expectancy, and a rise in the number of the oldest old (population aged 80 and above).
A geriatrician is consulted when an older person is frail and/or disabled (Fried 1994;
Fried and Guralnik 1997; Fried et al. 2001, 2004, 2009), as Hazzard wrote,
How often have I been asked over the past 30 years, ”What is a geriatrician?” I cannot
count the times and the ways that I have tried to answer this question. But clearly, even
as the field has grown and matured, the public continues to have at best a vague idea of
what a geriatrician is and does and why. […] I am a geriatrician. I specialize in the medi-
cal, psychological, and social care of old people. […] Perhaps my most typical patient is
the old-fashioned picture of frailty, a man—or more often a woman—who lives on the
razor's edge between independence and triggering a tragic cascade of diseases, dis-
abilities, and complications that all too often prove irreversible. […] I am by definition
an expert in subtlety and complexity. (2004, p. 161)
13.2 Analysis of the Older Patient: Diseases, Disability, and Frailty
Hazzard's words become clearer when considering the aging process. Aging is defined as
an “accumulation of diverse deleterious changes in the cells and tissues with advancing
age that increase the risk of disease and death” (Harman 2001, p. 2). Disease, disability, and
frailty play an important role in the aging process.
13.2.1 Disease
Fried (2000) identified the 15 most prevalent conditions among people aged 65 years old or
above in the United States: arthritis, hypertension, heart disease, hearing loss, influenza,
injuries, orthopedic impairment, cataracts, chronic sinusitis, depression, malignant neo-
plasms, diabetes mellitus, visual impairment, urinary incontinence, and varicose veins.
Heron and colleagues (2009) found that heart disease, cancer, strokes, chronic lower respi-
ratory tract disease, accidents (unintentional injuries), diabetes mellitus, and Alzheimer's
disease were the seven leading causes of death in the United States in 2006.
Studies on comorbidity—the combination of additional diseases beyond an index dis-
order (Feinstein 1970)—and multimorbidity—the co-occurrence of diseases in the same
person (Batstra et al. 2002)—have been conducted using different methods with the aim
of identifying the relationship among disease clusters, health outcomes, and possible pre-
vention programs (Guralnik 1996; de Groot et al. 2003; Marengoni et al. 2009). A recent
study evaluated patterns of comorbidity and multimorbidity in an elderly population
and found that chronic diseases were more likely to occur with comorbid conditions than
alone (Marengoni et al. 2009). Hypertension and dementia were the most frequent diseases
occurring with and without a comorbid disorder, whereas a few cases of heart failure
and hip fracture occurred without any comorbidity. Heart failure and visual impairment
were associated with the highest number of comorbid diseases and dementia with the
lowest. Circulatory diseases were the most commonly co-occurring pairs of conditions.
Co-occurring diseases clustered together beyond that which would be expected by chance
and five major clusters were identified: Two of them were linked to vascular diseases, the
others to dementia, diabetes mellitus, and malignancy.
 
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