Arti Hurria: Chronological age does not equal functional age
Arti Hurria, M.D., director of the Cancer and Aging Research Program at City of Hope, feels strongly that too little attention has been paid to the needs of older people with cancer. She's working to change that.
She recently presented an overview of her work – and the context for it – at the annual meeting of the American Society of Clinical Oncology (ASCO), where she was honored as the 2013 recipient of the B.J. Kennedy Award for her contributions to the research, diagnosis and treatment of cancer in the elderly. Here, we offer the third in a five-part series on the most important aspects of her work – and what doctors and others need to know about treatment of the elderly.
Part 3: Understanding the aging process.
Aging begins the moment we are born. Understanding this process – and its dilemmas – is necessary if we’re to improve care for elderly adults diagnosed with cancer.
As Hurria explained, caring for older people is similar to caring for children in that both populations require the same skill set.
"If you look across the aging spectrum, we can learn a lot from pediatrics and how they have developed their fields," Hurria said. "Pediatric [doctors] have recognized that this is a population that has a unique skill set. They have age-related changes in physiology, dependent on daily activities and there’s concern regarding long-term effects of treatment in this incredibly vulnerable population. These are the same things that make the geriatric population potentially vulnerable."
Just as society has recognized a need for pediatric care, so too must it recognize a need for geriatric care, Hurria said.
However, differences in the populations do exist. Older patients tend to have more complications. For example, in pediatrics chronological milestones are set to help determine functional age and warn of potential problems.
In geriatrics, it’s not so simple. Chronological age doesn’t equal functional age. Aging is a more heterogeneous process.
Aging is also found to be associated with the decline of organ function, which is exacerbated by physical stress to the patient – such as that caused by chemotherapy.
Although declining strength, or physiological reserve, happens naturally as one ages, doctors can help slow their patients’ decline by recommending lifestyle changes and physical activity, Hurria said.
"This is a modifiable process. It’s not something that you can eliminate, but you can alter the trajectory," Hurria said. "This is a really important lesson for us to share with our patients."
Once the aging process is more fully understood, doctors can start to identify the adults at risk of rapid decline and prevent excessive changes, she added.