Introduction
The latter half of the 20th century was characterized by a significant
increase in the number of elderly. This worldwide biological and demographic
phenomenon has many implications for a large number of different disciplines,
including health, politics, economics, social services, and others.
This introductory chapter will deal with the demography of the aged, will
present the concept of frailty in the elderly, and will provide a comprehensive
approach to the clinical evaluation of older people. We will emphasize the
effect of some of the physiological changes of aging on the clinical evaluation;
describe factors that make the assessment of the older patient more complex,
especially the nonspecific presentation of disease and the frequent presence
of multiple pathology in advanced age; describe the impact of social and
economic factors on the health status of the elderly; and, in particular, detail
the functional and clinical manifestations resulting from the combination of
these phenomena. Finally, the chapter will discuss the provision of home care
services designed to meet the needs of the elderly.