Prediction of Death in Elderly Men: Endocrine Factors
There are numerous definitions of successful aging. Rowe and Kahn (1987, 1997) defined it as including three main components: low probability of disease and disease-related disability, high cognitive and physical functional capacity, and active engagement with life. This definition was taken as a starting point in a study among 403 independently living elderly men. Since low muscle strength and functional ability were highly predictive of four-year mortality in this population, muscle strength and functional ability might be considered as the key characteristics of the physical functional status of independently living elderly men. Growth hormone and testosterone seem to play a role in the physical decline that occurs during aging. In addition, both serum IGF-I and testosterone concentrations are related to the presence of atherosclerosis. However, serum concentrations of both hormones are not predictive of death. Further, the effect of growth hormone and testosterone replacement on quality of life has hardly been examined in the elderly population.
Aging can be approached in two different ways: one can direct attention to the ensuing deficits or to the factors that play a protective role in the decline in function. These different approaches, which are reflected in the concepts of “frailty” and “successful aging;” need to be explained. Frailty is defined as a syndrome of multi-system reduction in physiological capacity as a result of which an older person’s function may be severely compromised by minor environmental challenges, giving rise to the condition “unstable disability” (Campbell and Buchner 1997). The variable presence of co-morbidity makes research findings more difficult to generalize. Therefore, the alternative of focussing research on the least frail and “non-diseased;” which implies the successfully aged, might be easier. Older persons with minimal physiologic loss, or none at all, when compared to the average of their younger counterparts, can be regarded as having aged more broadly successful in physiologic terms (Rowe and Kahn 1987). The concept of frailty focuses mainly on the physical aspects of aging, whereas the concept of successful aging includes a broader range of aspects, such as physical, psychological and social aspects. Neither concept is easy to define in a single measure, and there are no generally accepted criteria to categorize a certain individual.
Although definitions of successful aging in gerontology are numerous, there is still no consensus on the definition of successful aging. Rowe and Kahn (1997) defined it as including three main components: low probability of disease and disease-related disability, high cognitive and physical functional capacity, and active engagement with life (Fig. 1). A definition proposed by Day et al. (2002) focused on psychological well-being, capacity for self care and social support. Fries (1988) defined successful aging as optimizing life expectancy while simultaneously minimizing physical, psychological and social morbidity. Vaillant and Vaillant (1990) argued that, in addition to physical health, there are three further dimensions, or outcomes, of successful aging: mental health, psychosocial efficiency and life satisfaction.
In our study population we focused on the least frail, which implies the successfully aged. To decrease the number of subjects with severe diseases to a minimum, we invited subjects who lived independently, had no severe mobility problems and did not have signs or symptoms of dementia. Finally, 403 men, aged between 73 and 94 years, participated in this study.
KeywordsSuccessful Aging Testosterone Replacement Testosterone Replacement Therapy Physical Functional Status Physical Functional Capacity
Unable to display preview. Download preview PDF.
- Ant W, Callies F, Koehler I, van Vlijmen JC, Fassnacht M, Strasburger CJ, Seibel MJ, Huebler D, Ernst M, Oettel M, Reincke M, Schulte HM, Allolio B (2001) Dehydroepiandrosterone supplementation in healthy men with an age-related decline of dehydroepiandrosterone secretion. J Clin Endocrinol Metab 86: 4686–4692CrossRefGoogle Scholar
- Baulieu EE, Thomas G, Legrain S, Lahlou N, Roger M, Debuire B, Faucounau V, Girard L, Hervy MP, Latour F, Leaud MC, Mokrane A, Pitti-Ferrandi H, Trivalle C, de Lacharriere O, Nouveau S, Rakoto-Arison B, Souberbielle JC, Raison J, Le Bouc Y, Raynaud A, Girerd X, Forette F (2000) Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci USA 97: 4279–4284PubMedCrossRefGoogle Scholar
- Boonen S, Lesaffre E, Dequeker J, Aerssens J, Nijs J, Pelemans W, Bouillon R (1996) Relationship between baseline insulin-like growth factor-I (IGF-I) and femoral bone density in women aged over 70 years: potential implications for the prevention of age-related bone loss. J Am Geriatr Soc 44: 1301–1306PubMedGoogle Scholar
- Day R, Salzet M (2002) The neuroendocrine phenotype, cellular plasticity, and the search for genetic switches: redefining the diffuse neuroendocrine system. Neur Lett 23: 447–451Google Scholar
- Erfurth EM, Hagmar LE, Saaf M, Hall K (1996) Serum levels of insulin-like growth factor I and insulin-like growth factor-binding protein 1 correlate with serum free testosterone and sex hormone binding globulin levels in healthy young and middle-aged men. Clin Endocrinol (Oxf) 44: 659–664CrossRefGoogle Scholar
- Goodman-Gruen D, Barrett-Connor E (1997) Epidemiology of insulin-like growth factor-I in elderly men and women. The Rancho Bernardo Study [published erratum appears in Am J Epidemiol 1997 Aug 15;146(4):357]. Am J Epidemiol 145: 970–976Google Scholar
- Guralnik JM, Seeman TE, Tinetti ME, Nevitt MC, Berkman LF (1994) Validation and use of performance measures of functioning in a non-disabled older population: MacArthur studies of successful aging. Aging (Milano) 6: 410–419Google Scholar
- Herschbach P, Heinrich G, Strasburger CJ, Feldmeier H, Marin F, Attanasio AM, Blum WF Development and psychometric properties of a disease-specific quality of life questionnaire for adult patients with growth hormone deficiency. Eur J Endocrinol 145: 255–265Google Scholar
- Ho KK, O’Sullivan AJ, Hoffman DM (1996) Metabolic actions of growth hormone in man. Endocr J 43 Suppl: S57–63Google Scholar
- Hsieh CY, Phillips RB (1990) Reliability of manual muscle testing with a computerized dynamometer. J Manip Physiol Ther 13: 72–82Google Scholar
- Morales AJ, Haubrich RH, Hwang JY,Asakura H, Yen SS (1998) The effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone ( DHEA) on circulating sex steroids, body composition and muscle strength in age-advanced men and women. Clin Endocrinol (Oxf) 49: 421–432Google Scholar
- Rowe JW, Kahn RL (1987) Human aging: usual and successful. Science 237: 143–149 Rowe JW, Kahn RL (1997) Successful aging [see comments]. Gerontologist 37: 433–440Google Scholar
- Yen SS, Morales AJ, Khorram 0 (1995) Replacement of DHEA in aging men and women. Potential remedial effects. Ann NY Acad Sci 774: 128–142Google Scholar