Successful Aging Normative Aging and Frailty

From an epidemiologic and demographic, as well as an economic and humanitarian standpoint, the ideal contribution of life-long nutrition would be to a situation of 'compression of morbidity,' first enunciated by J. Fries. It strives to keep individuals free of chronic illness, functional, and independent until the final moments of their lives, and thus reduces the burden of disability and dependency suffered by individuals, their families, and the society that contributes to their maintenance to a minimum.

A disclaimer has traditionally been appended to the official pronouncements of recommended nutrient intakes; whether they are from national or international expert panels, the prescriptions are meant to apply to 'healthy' individuals. Nutrient needs in disease conditions are considered to be a clinical matter, and are related to the pathologies in question.

When it comes to older persons, the exigency of being 'healthy' becomes immediately problematic. Advanced age is associated with increased susceptibility to chronic and degenerative illnesses. Most persons over 60 years of age have two or three chronic illnesses diagnosed, and are receiving multiple medications. Maintaining a rigid definition of healthy for application of nutrient recommendations in later life would exclude almost everyone from coverage by nutrient-intake standards.

In fact, the older the cohort of individuals examined, the more heterogeneous are individuals of the same chronological age in their physical and cognitive functioning. Over the last two decades, general domains of classifications have come into usage to embrace the heterogeneity of aging populations: successful aging; usual aging; and frailty. Successful aging has been defined as multidimensional, ''encompassing the avoidance of disease and disability, the maintenance of high physical and cognitive function, and sustained engagement in social and productive activities.'' It may involve aspects of resilience and wisdom, as well. Usual aging involves an accumulation of ailments and loss of function that is typical of older persons surviving to later life. Frailty is the far extreme of disability and dependency associated with major physical and cognitive decline in which disease and senescent processes become irreversibly established.

A prominent and optimistic school of thought suggests that exposures to behavioral and environmental factors that modify risk of disease and dysfunction determine one's position in these alternative outcomes in the aging process. In this view, more optimal nutrient intake, food selection, and life-style choices could reduce the heterogeneity, retaining more individuals in the successfully aged category for most of their life span. Others consider that genetic constitution may be as important in determining the course of aging as any positive or negative influences during our lifetime.

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