WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANtl
WHO EXPERT COMMITTEE ON PLANNING AND ORGANIZATION OF GERIATRIC SERVICES Geneva, 6-12 November 1973
SHS/RGR/73.4 ORIGINAL: RUSSIAN
INDEXED
STUDIES OF THE AGING PROCESS AND THEIR SIGNIFICANCE FOR THE PUBLIC HEALTH SYSTEM
by
Professor D. F. Chebotarev Director
Institute of Gerontology, AMS USSR
According to modern ideas gerontology is a complex sociobiological science which includes the biology of aging, geriatry and social gerontology, a main component of which is the hygiene of old age.
There is a close link between the biology of human aging - study of the processes of aging - and the different manifestations of human pathology and exposure to various environ- mental factors, including social ones. This is what unites all the various branches of gerontology, makes the problem important not only for biologists but also for representatives of all medical specialities, public health administrators and social insurance experts, and makes i t essential to treat the basic problems of gerontology on a multidisciplinary basis.
The development of the biology of aging and the elucidation of the physiological features of the aging or already old organism and its reactions to both pathogenic and healing factors in the environment are of great importance for gaining a correct understanding of the causa- tion of diseases peculiar to the second half of human life and for correctly planning their treatment. Age-related changes in the aging organism are often the background and sometimes the foundation for the development of a chronic pathological process. In this sense it must be emphasized first of all that such medicobiological disciplines as cardiology and oncology are inseparable from gerontology. Elucidation of the genesis of atherosclerosis, late arterial hypertension, the development of tumoral processes, late-onset diabetes mellitus, chronic cor pulmonale, many chronic diseases of the lung, etc. and their rational prevention and treatment are closely connected with the biology of aging.
Statistics indicate that the gradual building-up of the chronic illnesses typical of the older age-groups begins as early as the 35-40 year group. In modern studies on the biology of aging, which quite rightly look upon the processes of aging from the point of view of
ontogeny, there is a theory of periods of rise and fall in the development of man. The period of fall, which begins at the age of 30-35, is characterized not only by a gradual reduction in function and metabolic processes and a decrease in the adaptive powers of the organism but also in the appearance of numerous compensatory mechanisms, on the development of which the nature and rate of aging of the body largely depend. These mechanisms are most important in the body's system of neurohumoral regulation, which undergoes considerable changes as a result of the restructuring of the endocrine system that takes place. While i t pays
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SHSjRGR/73.4 page 2
due attention to people of pensionable age, i.e. above 60-65 years of age, modern gerontology is not undertaking sufficiently intensive studies of the processes of aging in the period 45-60 years, which under the working classification adopted at the WHO/EURO Seminar on the Health Protection of the Elderly and the Aged and on the Prevention of Premature Aging held in Kiev in 1963 is defined as middle age, preceding the elderly stage (60-75 years), and yet i t is precisely in middle age that considerable changes take place in the neurohumoral regulatory mechanisms which require the development of new adaptive reactions to ensure the body's functioning under the new conditions connected with the climacteric period and the thoroughgoing reconstruction of the nervous and endocrine systems. Middle age is the period of most intensive development of atherosclerosis and its complications, arterial hypertension, diabetes and other diseases which are essentially responsible for the process of premature aging of the human body.
Thus, the significance for the public health system of the results so far achieved in the study of aging processes is that they have shown that attention must be paid to this age-group and special recommendations made regarding the way of life of middle-aged people and the need for periodic follow-up examinations of such people.
Modern gerontology rejects the idea of age as a disease. Over 30% of people above 65 years of age at the present day remain fit for work. According to the results of a mass sample survey of long-lived persons (27 OOO persons of 80 years of age and over) carried out in the USSR, about 36% of them are to all intents and purposes healthy and not burdened by illness, The complaints of elderly and old persons are manifestations of disease and not of old age as a physiological stage in their existence. This position requires special attention when medical services are to be provided for persons in the older age-groups and calls for a change in the attitude of the doctor to the complaints of the elderly and old and for the acquisition of more thorough knowledge of clinical geriatry, which must take into account not only the physical condition of the patient but also his psychological
mood and mental health and must determine his place in the social environment - in the family and in society as a whole.
Study of the biology of human aging and the organization of medical and social services are closely interconnected also because in the overwhelming majority of persons calendar age and biological age do not coincide. This question is important from the medical point of view also - it means that a differentiated approach is needed to physiological changes and disease symptoms and signs of the chronic pathological processes which so often affect people in the older age-groups. It is important also from the point of view of sociology and econo- mics, since i t affects suitability for a particular occupation, the degree of residual working capacity and the possibility of using that capacity in actual practice.
Unfortunately modern gerontology is not yet able to give a sufficiently clear-cut idea of biological age and of age standards. Both in this respect and in a number of others the biology of hu.~an aging does not yet possess sufficient data to solve many practical questions and to determine the nature of social and medical services to be provided for people in the older age-groups.
In modern geriatry the subdivisions of geriatric pharmacology and geriatric drug therapy are becoming ever more clearly demarcated. Most drugs, and particularly cardiac glucosides, hormonal agents, analgesics, sedatives, etc., have their own pharmacodynamic features arxl face the pharmacologists with the new task of determining dosages suitable for different ages and finding out the special aspects of the effect of drugs not only on children but also on elderly and old persons, who very often show changed and sometimes paradoxical reactions to drug administration. Features of the effect of drugs in the aging organism are very often explicable on the basis of the data already available on the biology of human aging. This branch of experimental gerontology, which is closely connected with geriatric pharmacology and practical geriatry, still requires further development.
SHS/RGR/73.4 page 3
One task for studies on the biology of aging is to search for and determine the suitabi- lity of biologically active agents capable of exerting pharmacological control over aging and to provide practitioners with readily available agents for the prevention of premature senescence,
An important feature which links the biology of aging with the organization of geriatric care, the approach of the doctor to the prevention of premature aging and the treatment of elderly patients is study of the difference in the mean duration of life of men and women, i.e. the female "lead".which in a number of economically well-developed countries has reached eight and even nine years. Here, on the one hand, we have extensive problems of a biological nature and on the other the elucidation of social problems. In public health administration this should find an outcome in suitable attention to the early manifestations of premature aging and the development of pathological processes, particularly in men. Thus, problems of the organization and carrying out of preventive measures against premature aging, and of medical care and treatment for the elderly and the old cannot be separated from fundamental
research on the biology of aging and the clinicophysiological features of the biology of human senescence.
Dr M. G. Candau, Director-General of the World Health Organization, stated in his report on the work of WHO in 1971 that progress in the control of some diseases might be halted if scientific research were not carried out more intensively. This is confirmed by the whole development of practical medicine and is particularly important for its new branch, geriatry, and for problems of organizing geriatric services. One of the most promising tasks of the World Health Organization is the drawing-up and implementation of a long-term programme of research on gerontology and its main subdivisions.
