Disease Description (Causes and Symptoms)
- Definition summary: Aging is a normal physiological process in which the structure and function of the body gradually deteriorate with age. It involves a reduced ability to maintain homeostasis in various organs and increased susceptibility to disease and stress.
- Main causes and pathophysiology (summary):
- At the cellular and molecular levels: reduced cell differentiation and proliferation, telomere shortening, and accumulation of cellular senescence
- Decline in mitochondrial function and increased oxidative stress
- Breakdown of protein homeostasis (proteostasis) and stem cell exhaustion
- Chronic low-grade inflammation (“inflammaging”) and impaired immune function
- Effects of genetic, environmental, and lifestyle factors (nutrition, smoking, exercise, etc.)
- Main symptoms (general):
- Skin wrinkles and reduced skin elasticity
- Decreased bone density (osteoporosis) and muscle strength
- Decline in exercise capacity, cognitive function, and senses (vision and hearing)
- Fatigue, weight changes, and reduced vitality
- Increased risk of developing diseases affecting each organ system (cardiovascular disease, diabetes, cancer, dementia, etc.)
- Differential diagnosis: Normal aging must be distinguished from frailty — frailty is a state in which physiological homeostasis declines rapidly, causing disability to occur easily even with minor stress; it may improve with active correction of its causes.
Treatment Methods and Precautions
- Basic principles: There is no medication that can completely reverse aging itself. The goals are to maintain function, improve quality of life, prevent coexisting diseases, and reduce the risk of complications.
- Lifestyle management (recommended as the priority)
- Regular aerobic and strength exercise (the recommended standard of 150 minutes of aerobic exercise per week and strength training at least twice a week should be adjusted to the patient’s condition)
- Balance training (fall prevention), smoking cessation, and limiting alcohol consumption
- Nutrition: Adequate protein intake, vitamin D and calcium supplementation (if needed), and a balanced diet
- Social activities and cognitive stimulation (reading, conversation, hobbies)
- Preventive medical care
- Regular health checkups (follow recommended screening items for cardiovascular risk factors, diabetes, and cancer)
- Vaccinations: Consider seasonal influenza, pneumococcal, and herpes zoster vaccines, among others
- Osteoporosis assessment (BMD) and fracture-risk management
- Medication and disease-specific treatment (depending on coexisting diseases)
- Osteoporosis: Bisphosphonates (e.g., alendronate), denosumab, calcium and vitamin D supplementation, etc.
- Cardiovascular risk management: Treatment of risk factors with antihypertensive medications, statins, etc.
- When cognitive decline is present: After evaluating the cause, consider dementia medications (such as cholinesterase inhibitors) if necessary
- Treatment of correctable causes such as dehydration, malnutrition, and anemia
- Multidisciplinary approach: Comprehensive geriatric assessment, with referrals to physical therapists, dietitians, and social workers recommended
- Precautions (complications and self-management considerations)
- Be aware of drug interactions and adverse effects caused by polypharmacy — organize a list of all medications and consult medical professionals
- Manage the risk of falls and fractures (maintain a safe indoor environment and consider using assistive devices)
- Acute orthostatic hypotension, infection, dehydration, and acute confusion (delirium) require immediate evaluation
- Active management of chronic diseases is important for maintaining overall function
Outpatient Visit Checkpoints (Including Preparation Items and Example Questions)
- Preparation items
- A list of all medications currently being taken (including prescription and nonprescription medications and supplements)
- Copies or summaries of recent test results (blood tests, bone density tests, electrocardiograms, etc.)
- A record of when symptoms began and how they have progressed (weight changes, fatigue, number of falls, etc.)
- A record of changes in activities of daily living (ADL/IADL) (e.g., dressing, bathing, cooking, etc.)
- Lifestyle information (diet, exercise, sleep, alcohol consumption and smoking status)
- Observations from a caregiver or family member (changes in cognition, behavior, etc.)
- Useful items to check during the consultation (information to provide to the doctor)
- Recent history of falls, fainting, or acute illness
- Changes in sleep, appetite, urination, or bowel movements
- Social support (cohabitants and whether caregiving is needed)
- Things to be sure to mention during the outpatient visit
- Medications being taken and history of allergies
- The impact of symptoms on daily life and any concerns
Examples of General Questions to Ask the Doctor
- What are the expected effects and side effects of this medication (or treatment)?
- Given my current physical condition (test results), what are my risk factors, and what should I improve first?
- What is my prognosis (likelihood of maintaining function)? What goals would be realistic to set?
- Which lifestyle factor (exercise, nutrition, or sleep) should I change first?
- I am taking many medications. Are there any that can be reduced or discontinued? Are there any drug interactions?
Examples of Disease-Specific Questions
- How much bone density do I have (or what is my fracture risk)? If osteoporosis treatment is needed, which medication do you recommend?
- How can we distinguish whether symptoms such as fatigue and weight loss are simply due to aging or are signs of frailty? If it is frailty, what additional tests should be performed?
(Examples of emergency symptoms: If you experience sudden severe chest pain, difficulty breathing, a high fever, collapse or loss of consciousness, or a sudden change in consciousness, it is recommended that you visit an emergency room immediately.)