[Successful aging: what can neurology and geriatrics contribute?]

The relative proportion of elderly persons in Western societies is rapidly growing, leading to an increasing frequency of age-related neurological diseases (e.g. dementia) and functional impairments (e.g. immobility). This article argues that this development should prompt a new focus in medical care. The key questions should not only be how can we improve treatment of age-related disorders but also how can we prevent age-related disorders in the first place or at least substantially delay their onset? These questions touch on an even more profound question: how can successful aging be accomplished? That is, which factors and processes characterize successful aging both on a system and on a molecular level? Thus, the crucial societal, scientific and medical challenges for Western societies are to develop and implement measures of primary prevention of dysfunctional aging. The disease-centered framework which currently determines most clinical thinking, scientific research and third party funding has to be supplemented by a novel framework of successful aging. This article defines dysfunctional aging as a convergent downstream result of multiple interacting system processes. Each of these detrimental system processes must be targeted by specific measures of geriatric primary prevention. This, in turn, implies that geriatrics does not start in the elderly or with the onset of particular geriatric disorders. Instead, it starts in the daily practice of neurology and other medical disciplines taking care of persons aged 20-40 years who are largely healthy and in the middle of their professional and personal career. Or, in a nutshell, geriatrics starts right in the middle of medical care.