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      Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population

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          Abstract

          By 2050, the American 85 years old and over population will triple. Clinicians and the public health community need to develop a culture of sensitivity to the needs of this population and its subgroups. Sensory changes, cognitive changes, and weakness may be subtle or may be severe in the heterogeneous population of people over age 85. Falls, cardiovascular disease, and difficulty with activities of daily living are common but not universal. This paper reviews relevant changes of normal aging, diseases, and syndromes common in people over age 85, cognitive and psychological changes, social and environmental changes, and then reviews common discussions which clinicians routinely have with these patients and their families. Some hearing and vision loss are a part of normal aging as is decline in immune function. Cardiovascular disease and osteoporosis and dementia are common chronic conditions at age 85. Osteoarthritis, diabetes, and related mobility disability will increase in prevalence as the population ages and becomes more overweight. These population changes have considerable public health importance. Caregiver support, services in the home, assistive technologies, and promotion of home exercise programs as well as consideration of transportation and housing policies are recommended. For clinicians, judicious prescribing and ordering of tests includes a consideration of life expectancy, lag time to benefit, and patient goals. Furthermore, healthy behaviors starting in early childhood can optimize quality of life among the oldest-old.

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          Most cited references77

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          Frailty in Older Adults: Evidence for a Phenotype

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            A Randomized Trial of Intensive versus Standard Blood-Pressure Control

            New England Journal of Medicine, 373(22), 2103-2116
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              Social isolation, loneliness, and all-cause mortality in older men and women

              Both social isolation and loneliness are associated with increased mortality, but it is uncertain whether their effects are independent or whether loneliness represents the emotional pathway through which social isolation impairs health. We therefore assessed the extent to which the association between social isolation and mortality is mediated by loneliness. We assessed social isolation in terms of contact with family and friends and participation in civic organizations in 6,500 men and women aged 52 and older who took part in the English Longitudinal Study of Ageing in 2004-2005. A standard questionnaire measure of loneliness was administered also. We monitored all-cause mortality up to March 2012 (mean follow-up 7.25 y) and analyzed results using Cox proportional hazards regression. We found that mortality was higher among more socially isolated and more lonely participants. However, after adjusting statistically for demographic factors and baseline health, social isolation remained significantly associated with mortality (hazard ratio 1.26, 95% confidence interval, 1.08-1.48 for the top quintile of isolation), but loneliness did not (hazard ratio 0.92, 95% confidence interval, 0.78-1.09). The association of social isolation with mortality was unchanged when loneliness was included in the model. Both social isolation and loneliness were associated with increased mortality. However, the effect of loneliness was not independent of demographic characteristics or health problems and did not contribute to the risk associated with social isolation. Although both isolation and loneliness impair quality of life and well-being, efforts to reduce isolation are likely to be more relevant to mortality.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                11 December 2017
                2017
                : 5
                : 335
                Affiliations
                [1] 1Skilled Nursing Department, Herzog Hospital , Jerusalem, Israel
                [2] 2Hebrew University of Jerusalem , Jerusalem, Israel
                [3] 3Johns Hopkins University , Baltimore, MD, United States
                [4] 4Herzog Hospital , Jerusalem, Israel
                Author notes

                Edited by: Gerry Leisman, University of Haifa, Israel

                Reviewed by: Eli Carmeli, University of Haifa, Israel; Chris Fradkin, University of California, Merced, United States

                *Correspondence: Efraim Jaul, jaul@ 123456zahav.net.il

                Specialty section: This article was submitted to Child Health and Human Development, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2017.00335
                5732407
                29312916
                50d9212d-ab77-48ef-ad7c-edfe702d9021
                Copyright © 2017 Jaul and Barron.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 03 October 2017
                : 24 November 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 70, Pages: 7, Words: 5737
                Categories
                Public Health
                Mini Review

                oldest-old,medical decision-making,public policy,aging,longevity

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