chapter  1
6 Pages


ByLodovico Balducci, Martine Extermann

The practice of medicine evolves with societal changes. During the last 50 years, healthier lifestyles, medical advances, reduction in birth rate, and absence of a major world conflict have resulted in a progressive aging of the Western and, to a lesser extent, the world population (1). The medical implications of a more prolonged life expectancy include a higher prevalence of chronic diseases and disabilities, the emergence of new diseases and clinical pictures, and a closer interaction of health and social scientists to optimize function and quality of life of older individuals. For example, multiple comorbidities may delay the diagnosis of serious diseases, such as cancer, because early symptoms of cancer may be ascribed to a pre-existing condition, may prevent adequate cancer treatment due to increased risk of therapeutic complications, and may change the goals of treatment from life prolongation to symptom management and function preservation in view of the shortened life expectancy (2). Likewise, the dissolution of the extended family has reduced the pool of family caregivers, so that disabled or ill older individuals depend more and more on the formal support network.