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September 2, 1983

Elderly patient needs assessment, not neglect

JAMA. 1983;250(9):1132-1133. doi:10.1001/jama.1983.03340090008005

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New loss of function in the elderly is more likely the result of new illness than of "a sudden attack of old age," according to Richard W. Besdine, MD, of the Division on Aging, Harvard Medical School, and director, Geriatric Medical Education, Hebrew Rehabilitation Center for the Aged, Boston.

Speaking at a technology assessment conference on evaluating the elderly patient, Besdine explained that in the older patient functional loss, rather than a specific symptomatic complaint, may be the first sign of new disease or of the exacerbation of preexisting illness. And a given loss, such as difficulty with mobility, cognition, continence, or nutrition, may be caused by any of a number of diseases, sometimes with no obvious relationship to the loss induced.

Why does illness occur so nonspecifically in the elderly? Besdine believes aging is accompanied by progressive decline in the ability to maintain homeostasis—a deficit that has been dubbed