**4. Biology of ageing**

40 Pulmonary Embolism

bacteriuria, premature ventricular contractions, and slowed reaction time. In addition, many older patients with multiple comorbidities may have laboratory abnormalities that, while pathologic, may not be clinically important. A complete workup for a mild anemia of chronic disease in a person with multiple other issues might be burdensome to the patient

Ageing is associated with a decline in expectation of healthiness. Those over age 65 generally give more positive evaluations of their healthiness in the face of increasing burden of disease and disability (Kriegsman et al.., 1996; Tinetti et al., 2000). The older the person is, the more likely they are to report very good health status (Gross et al.., 1996). However, overestimating healthiness (also called normalization) often results in explaining away symptoms or problems as caused by minor illnesses or even by external events. In either case, late recognition and delayed intervention are the usual outcome. Previous neglecting of symptoms by health care professionals is also likely to teach older patients that frailty and loss of independence are normal and to be expected with ageing; again, late detection and intervention are likely, resulting in high cost and discouraging outcomes. Perhaps these attitudes explain the finding of greater pessimism in older persons compared with those middle-aged, even when health status was factored in. *Underreporting of symptoms* is a

The problems identified were common and usually treatable diseases; congestive heart failure, correctable hearing and vision deficits, tuberculosis, incontinence, anemia, bronchitis, claudication, cancers, malnutrition, diabetes, immobility, oral disease preventing eating, dementia, and depression were frequent. Considerable underreporting was also seen among people with chronic diseases. More than a half of chronically ill individuals, who were surveyed in one study, failed to report at least one disease. Older people tend to report

The riskiness of underreporting of symptoms by older patients is obvious; late identification of disease (inclusive of PE) leads to late initiation of treatment, usually after substantial morbidity associated with advanced pathology has already occurred and caused major functional losses. Rehabilitation to independence from these losses is difficult; permanent

Majority of all biological functions culminates before the age of 30 y. Some of them gradually continuously decrease afterwards (Masoro & Austad, 2006). This decay is practically of no significance in terms of current everyday activity but it can matter under

Seniors as such represent very heterogenous group and from the point of wiev of fitness, risk and need of help (or specific service) they can be divided to the 3 basic areas with

• **Fit seniors** – Seniors in good condition and physical efficiency. Medical attitude towards them should be the same as standards which are valid for adults in middle age.

• **Independent seniors** – do not need extraordinary care and services, they can live independently in standard condition, however in stress situations (severe diseases, surgery, injuries, viral infections in epidemies, extreme variation of the weather, sudden

• **Frail seniors** – are instable and in the risk even in standard condition. These frail seniors usually need help in common daily activities or they are limited in motion, moreover they are confined to bed (Fried et al.., 2005; Wawruch et al.., 2006). This group

However, there can be also risk of atypical symptoms of diseases in them.

change of social state – death of partner, loneliness, moving etc.) they fail.

with little chance of impacting quality of life or longevity.

common theme in discussions of illness behavior of older persons.

inaccurately cardiac disease, arthritis, and stroke (Kriegsman et al.., 1996).

dependence in spite of "successful" treatment may occur.

stress or extended load (Humes, 2000; Hunter et al., 2002).

different focus of health attention:

Ageing and advanced age is a terminal phase of ontogenetic development of every individual (Beers et al., 2006; Pathy et al., 2006). **Specific degenerative morphological** and **functional changes** occur in individual organs at all levels from the cells to whole organism (Heltweg, 2006). Important role in aging is **apoptosis.** In the cell, which may compromise the body (eg, activated leukocyt, as malignant cells), respectively a correction would be difficult to run programmed cell death.

Despite the biologic controversy, from a physiologic standpoint human ageing is characterized by progressive constriction of the homeostatic reserve of every organ system. This decline, often referred to as *homeostenosis*, is obvious by the third decade and is gradual and progressive, although the rate and extent of decline vary. The decline of each organ system appears to occur independently of changes in other organ systems and is influenced by diet, environment, and personal habits as well as by genetic factors.

Even beyond age 85, only 30% of people are impaired in any activity required for daily living and only 20% reside in a nursing home. Yet, as individuals age they are more likely to suffer from disease, disability, and the side effects of drugs, all of which, when combined with the decrease in physiologic reserve, make the older person more vulnerable to environmental, pathologic, and pharmacologic challenges.

This happens in different periods of times and in different speed. It affects any living substance from the moment of it's birth (conception). The life expectancy of an individual in nature is species specific and has important inter-individual variability. Ageing speed of an individual is genetically coded – it is presumed that this type of genetics is a multi-factorial one (Masoro & Austad, 2006). Maximum potential life expectancy of a human being attainable under ideal circumstances could be 110 - 120 y. The influence of genetic factor on the life expectancy is considered about 35 per cent. The resting 65 per cent represent an influence of a life style and external environment.

Common and **typical features of ageing** in general:

Pulmonary Embolism in the Elderly – Significance and Particularities 43

In 2020 aged 60+ - 70 per cent of them will live in the developing countries. The highest proportion of these elderly is envisaged in Japan (31 per cent), than in Greece and

The growth of population aged 65+ in Europe and Northern America during the next 30 years is estimated to reach 24 – 35 per cent. Growing number of the elderly brings also both absolute and relative increase of occurrence of affections which are typical for the advanced age and this becomes a serious worldwide social problem (Seitz, 2003). This covers not only typically somatic diseases such as atherosclerosis, cardio- and cerebrovascular events, heart failure, peripheral vasculopathies, parkinsonism, hypo-thyreoses, diabetes, osteoporosis and osteoarthrosis, diverticulosis, anemies, etc. but also mental diseases with all manifestations and consequences of dementia, especially the Alzheimer's type (Braunwald et al.., 2001;

Analogically to the population ageing in society also medical science has experienced a phenomenon of the so called "**geriatrisation of medicine**" which means a significant prevalence of the elderly among all the patients to be treated (Asplund et al.., 2000). This aspect penetrates practically all the branches of medicine to begin with the front line up to

The elderly are highly heterogeneous group, and individuals become more dissimilar as they age. Individuals over 65 years – with or without chronic diseases – vary widely in their

The **ageing** – *is an inevitable physiological process, which is the last ontogenetic period of the human life.* People mostly achieve their old age without any enormous problems. They live to their **"successful ageing"**. in quite comfortable physical, psychical and social balance (Duthie et al., 2007; Williams, 2008). The somatic (diseases), psychical (dementia, depression) and social (loneliness) problems begin to appear apparently after 75th year ( more in women) (Barba et

• life expectancy grows as a consequence of improving medical care

Fig. 1. Demographic prognosis of old age population in the USA

• ageing leads to enhanced poverty

Sinclair & Finucane, 2003).

**6. Characteristics of ageing**

al.., 2000)

the various special fields including ophtalmology.

physical, behavioral, and cognitive functions.

Switzerland (28 per cent), USA (23 per cent), etc.


Senile performance decline is a consequence (Beers et al.., 2006) of general weakness, impaired locomotion and balance, lower stamina. The life expectancy is significantly influenced by risk factors, contingent metabolic changes and level of resistance to stress. A choice of life style is also essential. Ageing in human population is often connected with increased occurrence of degenerative affections, tumours and Alzheimer's disease (Holmerova et al., 2007).

In fact it should be a period of life in which broad harmonic development of human personality goes on and on. Most people of advanced age should remain independent, selfsufficient and retaining their good psychic condition up to the terminal period of their life (Nemeth et al., 2007).
