Why illness is more important than disease in old age : Age and Ageing journal 50th anniversary commentary series
SourceAge and Ageing, 51, 1, (2022), article afab267
Article / Letter to editor
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Age and Ageing
SubjectRadboudumc 18: Healthcare improvement science RIHS: Radboud Institute for Health Sciences; Radboudumc 1: Alzheimer`s disease DCMN: Donders Center for Medical Neuroscience
Clinical reasoning and research in modern geriatrics often prioritises the disease concept. This is understandable as it has brought impressive advances in medicine (e.g. antibiotics, vaccines, successful cancer treatment and many effective surgeries). However, so far the disease framework has not succeeded in getting us to root causes of many age-related chronic diseases (e.g. Alzheimer's disease, diabetes, osteoarthritis). Moreover, in aging and disease constructs alone fail to explain the variability in illness presentations. Therefore, we propose to apply the underused illness concept in a new way by reconsidering the importance of common symptoms in the form of a dynamic network of symptoms as a complementary framework. We show that concepts and methods of complex system thinking now enable to fruitfully monitor and analyse the multiple interactions between symptoms in such in networks, offering new routes for prognosis and treatment. Moreover, close attention to the symptoms that bother older persons may also improve weighing the therapeutic objectives of well-being and survival and aligning treatment targets with the patients' priorities.
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