As our population expands, and as life expectancy increases, the number of people in the geriatric age group rises too. The ageing of our population is unprecedented, all pervasive, irreversible, and has profound medical as well as non-medical implications. The proportion of elderly people is at its highest in human history, and is increasing throughout the world. This trend is not going to change in the foreseeable future, and as it has major health consequences, it needs to be analyzed in detail.
All over the world elderly people, men and women aged more than 65 years, constitute a rapidly increasing proportion of the human population. In India, this percentage is 7.8% in females, and 7.1% in males, leading to an average of 7.5%. By 2050, one in five people, i.e., 2 billion people, are expected to be above the age of 60 years. Nearly four-fifths of these will be residents of less developed countries, including an estimated 324 million Indians in old age.
Elderly patients have a disproportionately higher prevalence of endocrine and metabolic dysfunction. Thus, it makes sense for endocrine academia to acknowledge and highlight these aspects of our specialty.
Elderly citizens have a physiology which is different from that of younger adults, and leads to unique patterns of morbidity in them. In no branch of medicine is this difference as prominent as it is in endocrinology and metabolism.
Adult hypopituitarism, hypothyroidism, osteoporosis, diabetes mellitus, adrenal insufficiency, various forms of hypogonadism, and endocrine malignancies are all more frequent in old age.
The elderly group of people also have different physiological standards/ranges, and consequently, results of their investigations may differ from younger adults. Examples include a lower cut off level for serum testosterone in the elderly, and varying values for Z scores in the diagnosis of osteoporosis.
Treatment of endocrine disease also varies markedly in the elderly. Doses of growth hormone, thyroxine and insulin are relatively lower in this age group. Psychosocial factors unique to the elderly play an an important role in management of endocrine and metabolic disorders, such as osteoporosis and diabetes, and should be taken into consideration in the search for optimal care of such patients.
Keeping these factors in mind, it is imperative to consider geriatric endocrinology as a separate sub specialty of Endocrinology and Metabolism. An enhanced focus on this aspect of endocrinology and metabolism will sensitize health care providers, including endocrinologists, to the importance of evaluating and treating elderly endocrine patients differently. Subtle nuances of geriatric care will be understood and implemented on a wider scale. This will help improve both the endocrine and metabolic treatment provided by geriatricians and gerontologists, as well as the geriatric care given by endocrinologists.
To make an appointment with our geriatric endocrinology specialist, call our Manhattan endocrinology practice at 646-759-9388 or click here to make an appointment.