THERE IS considerable variation in the effect of aging on healthy individuals, with some people exhibiting extensive alteration in physiological functions with age and others little or none. It has been suggested that it might be useful to distinguish between usual and successful patterns of aging.1 Genetic factors, lifestyle, and societal investments in a safe and healthy environment are important aspects of successful aging. Traditionally, the aging process, including the development of physical frailty and a gradual loss in cognitive function toward the end of life, has been considered to be physiological and unavoidable. In recent years, however, it has become evident that it might not be necessary to accept the grim stereotype of aging as an unalterable process of decline and loss.1 As life expectancy increases further in the coming decades, the overarching goal for the coming years should be an increase in years of healthy life with a full range of functional and mental capacity at the last stage of life. Such a compression of morbidity can in principle be achieved in part by healthy lifestyle measures, and these already seem to result in a decline in the prevalence of long-term disability in the elderly population.2
During aging a decline in the activities of several hormonal systems occur. A, A decrease in growth hormone (GH) release by the pituitary gland causes a decrease in the production of insulin-like growth factor-I (IGF-I) by the liver and other organs. B, An increase in the release of gonadotropins (luteinizing hormone [LH] and follicle-stimulating hormone [FSH]) follows a decreased secretion at the gonadal level (from the ovaries, decreased estradiol [E2]; from the testicle, decreased testosterone [T]). C, The adrenocortical cells responsible for the production of dehydroepiandrosterone (DHEA) decrease in activity (adrenopause) without clinically evident changes in corticotropin (ACTH) and often a slight increase in cortisol secretion. These changes in hormone levels might be related to changes in physical and cognitive function in elderly individuals. PRL indicates prolactin; TSH, thyroid-stimulating hormone; equal sign, no change; and T4, thyroxine.
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