Terminology helps differentiate life stages of patients

Patient and doctor

Dear Doctors: When I was in the waiting room at my doctor’s office, I overheard the nurses referring to two of the patients as a “young old” and an “oldest old.” Is this office shorthand, or are these actual medical categories? It sounded disrespectful.

Dear Reader: Sadly, there is no shortage of stereotypes, prejudice, jokes and even outright cruelty directed at people who have reached older age. It has come to be known as “ageism,” a term that was coined in the late 1960s. However, we’re happy to say that the language you overheard does not fall into that category. As you suggested, it is part of medical terminology. Rather than signaling disrespect, its use by the nurses at your doctor’s office suggests a nuanced awareness of the differing needs of older patients.

One of the factors involved in medical care is the stage of life of the patient. The needs of an infant, a toddler, a young child and an adolescent are obviously all quite different. The same holds true for a young adult in their 20s or 30s and someone who has reached middle age. But as the physical effects of advancing age begin to become evident, such as graying hair, balding, loss of skin elasticity and decrease in muscle mass, older adults can appear to blend into a single, homogenous group. Yet in terms of physical health, disease risk, mental acuity and emotional and social engagement, the distinct stages of life continue. And that’s where the language you are asking about comes into play.

The most commonly used terms at this time are “young old,” “middle old” and “oldest old.” Specific age ranges of these categories haven’t been codified, so they tend to vary a bit. In general, the term “young old” refers to the decade after retirement. That is, people between the ages of 65 and 74. People between the ages of 75 and 84 are often known as “middle old.” At age 85 and above, they fall into the category of “oldest old.” And interestingly, due to the ageist connotations of the word “old,” there is now some pushback against its use to describe these life stages.

The differences in these groups lie in the risk and prevalence of disease or illness, the frequency and length of the resulting hospital stays and the likelihood of either cognitive decline or impairment or neurodegenerative disease. Each is likely to increase with advancing age.

For the oldest old, frailty becomes a real risk. This is a clinical diagnosis in which chronic and metabolic diseases such as hypertension, arthritis, heart disease, cancer or diabetes -- coupled with age-related changes to the body, including decreases in strength, stamina, muscle mass and stability -- put the person at increased risk of frequent or prolonged hospitalization and of death.

Awareness of the stages of older age can be useful in setting health care goals and evaluating treatment options. The hip replacement that makes sense at age 65 might not be wise at age 85. But because we each age differently and at different rates, these categories serve as guidelines and not directives.

(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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