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Numerous molecular concomitants of aging have been described. For instance, there is an increase in chromosome structural abnormalities, DNA cross-linking, and frequency of single-strand breaks; a decline in DNA methylation; and loss of DNA telomeric sequences. The primary structure of proteins is unaltered, but posttranslational changes, such as deamidation, oxidation, cross-linking, and nonenzymatic glycation, increase. Mitochondrial structure also deteriorates, albeit not universally.
Certain features of the examination should receive special attention, depending in part on clues from the history. Weight and postural blood pressure should be measured at most visits. Vision and hearing should be checked; if hearing is impaired, excess cerumen should be removed from the external auditory canals prior to audiologic referral. Denture fit should be assessed, and the oral cavity should be inspected with the dentures removed.
Although thyroid disease becomes more common with age, the sensitivity and specificity of related findings are substantially lower than in younger individuals; consequently, the physical examination can rarely corroborate or exclude thyroid dysfunction in older patients. The breasts should not be overlooked, since older women are more likely to have breast cancer and less likely to do breast self-examination.
The systolic murmur of aortic sclerosis is common and may be difficult to differentiate from aortic stenosis, especially since the presence of a fourth heart sound in an elderly person does not imply significant cardiac disease, and the carotid upstroke normally increases owing to age-related arterial stiffening.
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Prevention of ageing
Much can be done to prevent the progression and even the onset of disease in older people. Dietary inadequacies should be corrected. Daily calcium intake should approximate 1500 mg, and most elderly people should take 400 to 800 IU of vitamin D daily (contained in one to two multivitamin tablets). Tobacco and alcohol use should be minimized, since the benefits of discontinuing these accrue even to individuals over age 65. The importance of reviewing all of a patient's medications and discontinuing them whenever feasible cannot be overemphasized.
Exercise should be encouraged not only because of its beneficial effects on blood pressure, cardiovascular conditioning, glucose homeostasis, bone density, insomnia, functional status, and even longevity, but also because it may improve mood and social interaction, reduce constipation, and prevent falls. Resistance training should be encouraged as much as a walking program. Spinal flexion exercises should be avoided in patients with osteopenia; consultation with a physical therapist may be helpful.
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