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General Principles in Older Adults

Most older Americans expect to live longer and more independently than previous generations, and many seek to be involved in their own health through diet, exercise, and participation in health care decision-making. The combination of the desire to be involved in health care, a recent surge in the ready access to information, the wish to promote health and avoid aging, and interest in new ways to approach problems have created tremendous interest in therapies designed to prevent or retard aging.

Antiaging Therapies

Knowledge about the biologic mechanisms involved in aging and the physiologic changes associated with aging provides a rational basis for the quest for antiaging therapies. An antiaging therapy could act by 1 or more of the following 3 mechanisms:

  1. Modifying the biochemical and molecular events that cause aging.

  2. Correcting physiologic changes that cause signs or symptoms associated with aging.

  3. Lessening the susceptibility of an individual to diseases associated with aging.

Practices that act through the third mechanism (eg, colonoscopy, blood pressure reduction, cholesterol reduction, and other practices that aim to prevent age-associated diseases) are common in medical practice and are dealt with elsewhere in this book.

Ethical and Legal Issues with Antiaging Therapies

The pursuit of antiaging therapeutics is not without controversy and debate. There are several reasons for this. Most importantly, it has been difficult to come to an agreement on the definition of antiaging, with definitions running the gamut from a simple cosmetic procedure to reduce visible signs of aging to a quest for complete reversal of the body’s aging process. Because there are many ways to define antiaging therapeutics, patients and practitioners may have different expectations of therapeutic results. Discussions on definitions and expectations needs to take place before any therapeutic alliance can be successfully built. For our purposes, we exclude aesthetic procedures and focus mainly on treatments aimed at reversing or slowing pathologic aging.

With this in mind, it brings up the second area of controversy. When discussing aging, many cannot agree on what is “normal” aging and what is “pathologic” aging, nor on whether it is ethical to intervene in the aging process at all. Furthermore, extending life may not be a noble goal if the quality of that life is poor. It has been considered “a true failure” of antiaging medicine to significantly prolong a life that is full of functional disability.

Historically, there has been a lack of standardization of therapeutics, no established standard of care, little clinical research, and lack of training or certification of antiaging practitioners. To help with these issues the World Society of Interdisciplinary of Anti-Aging Medicine (WOSIAM) offers international education events and funds research projects to improve the scientific rigor of the antiaging field. In the United States, the American Academy of Anti-Aging Medicine (A4M) ...

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