There are many differences between old and young people. In only some cases are these changes due to true aging, due to changes in the characteristics compared with when the person was young. One of the paradoxes of medical care of the older person is that the frequency of some presentations and of some diagnoses encourages the belief that medical management is straightforward and that investigation and treatment may satisfactorily be inexpensive and low skill. However the objective reality is the reverse. Diagnosis is frequently more challenging and the therapeutic pathway less clear and more littered with obstacles. However choose the right path and the results are substantial.

How can success be defined towards what aim should public health and clinical medicine be striving? The following definitions would acknowledge individual preferences. Successful aging without overt diseases, with good physical and cognitive function a high level of independence and active engagement with broader society. Usually ended by a peaceful death without a prolonged dying phase. Unsuccessful aging accelerated by overt disease, leading to frailty, poor functional status, a high level of dependence, social and societal withdrawal and more prolonged dying phase where life quality may be judged unacceptable.

There are many differences between old and young people. In only some cases are these changes due to true aging, due to changes in the characteristics compared with when the person was young. Changes not due to aging are due to selective survival is possible by genetic, psychological, lifestyle and environmental factors influence survival, and certain characteristics will therefore be over represented in older people.

Differential challenge systems and services like health, finance, transport, and retail are often designed and managed in ways that make them more accessible to young people. The greater the challenge presented to older people has manifold effects. Cohort effects like societies change during the twentieth century change have been rapid in most of the cases. Young and old have therefore been exposed to very different physical, social and cultural environments.

Regards
John George
Journal of Aging Science