Disease-a-Month 61 (2015) 467–474

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Disease-a-Month

journal homepage: www.elsevier.com/locate/disamonth

Clinical implications of aging

Mitch King, MD, Martin S. Lipsky, MD

Introduction

Determining what constitutes normal aging and whether a decline in functional ability is
attributable to disease or pathology is not always clear cut. While a series of changes occur with
“normal” aging, a hallmark of aging is the range of individual variability in aging and the rate of
functional decline.
Aging results from the interaction of processes that occur over time and genetics interacting
with various disease states and the individual’s lifestyle.1 Simply stated, aging occurs at the
crossroads of time, genetics, disease, and environmental or behavioral factors. However, the role
of genetics on aging is often overstated and most gerontologists believe environmental factors
influence aging more than genetics. For example, a healthy 70-year old who remains physically
fit and does not use tobacco may appear and function quite differently than a sedentary 70-year
old overweight smoker with diabetes.. The complex nature of aging makes individual variation
in physical changes and rates of aging a hallmark of aging.2
The human body maintains significant reserve capacity. For example, an individual’s resting
heart rate will markedly increase to cope with the demands of strenuous activity or the stress of
an acute hemorrhage. This excess capacity allows individuals to endure and overcome a great
deal of stress. Aging lowers the ceiling for an organ’s or individual’s reserve and older adults
have a lowered maximal capability when compared to younger individuals. The 1% rule
estimates the rate of functional organ system reserve capacity loss at about 1% per year after age
of 30 years. When an individual ages, their reduced reserve capacity makes them more
vulnerable to stresses and places an older individual at greater risk of succumbing to stresses
that a younger patient might overcome. While even under ideal conditions, an individual loses
some of their functional reserve, disease and environmental factors significantly affect the rate
of decline.

Body composition/musculoskeletal system

With advancing age, body composition changes and the body loses muscle and experiences
increase in the percentage of body fat.3 There is also a loss of bone mass, a narrowing of joint
spaces (including intervertebral), and a decrease in total body water. Muscle mass may decrease
by as much as 50% and body fat may increase to comprise up to 30% of body weight.

http://dx.doi.org/10.1016/j.disamonth.2015.09.006
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