Invited Commentary



Citations regarding the negative impact of old age on clinical outcomes can be found as far back as the beginning of the medical literature itself. The hieroglyphic sentence below from the Papyrus Prisse (1580 B.C.), quoted in the Edwin Smith Papyrus which is thought to be among the oldest surviving documents in the surgical literature, decries the vicissitudes of growing old by stating “To be an old man is evil for people in every respect [1]” (Invited Commentary Fig. 1.1). At the time of that writing, attaining a 25th year of life was an accomplishment achieved by only the heartiest of persons. Over the ensuing 3,500 years, mean life expectancy increased very slowly, on average 0.7 years per century, reaching 47 years in western countries by 1900 A.D. Then, thanks to the advent of public health measures, modern medicine, and lifestyle modification in the following one century alone, life expectancy increased an additional 30 years. “Old” now is very different in many ways from “old” back then. But while the time point at which one becomes “old” has changed, the fact that old age has negative consequences has not. In fact, recent advances have created a population living longer with diseases that would have proven fatal in the past. Over the next several decades, as the baby boom generation reaches “old age,” the medical profession will be faced with a huge number of octogenarians and nonagenarians, many with chronic diseases, expecting to not only live longer, but also to do so in an active and productive manner. Many of these older patients will find themselves needing the services of a surgeon; they will require cataract removal, total joint replacement, resection for cancer, and coronary and peripheral revascularization. The need to analyze when, how, by whom, and on whom these procedures should be performed, as well as how to pay for them, has only recently begun to attract the attention of healthcare providers and healthcare policymakers.


Total Joint Replacement Public Health Measure Baby Boom Generation Health Care Workforce Major Surgical Intervention 
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  1. 1.
    Gruman GJ, editor. Roots of modern gerontology and geriatrics. New York, NY: Ayers; 1979.Google Scholar
  2. 2.
    Committee on the Future Health Care Workforce for Older Americans, Institute of Medicine. Retooling for an Aging America: Building the Health Care Workforce. Washington, D.C.: The National Academies. 2008.
  3. 3.
    Sollano JA, Rose EA, Williams DL, et al. Coat-effectiveness of coronary artery bypass surgery in octogenarians. Ann Surg. 1998;228:297–306.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of SurgeryYale University School of Medicine, VA Connecticut Healthcare SystemWest HavenUSA

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