Beyond atypicality: reframing the clinical presentation of acute illness in older people

Geriatricians are aware that the clinical presentation of older people is often with 'atypical' symptoms of commonly encountered conditions. In this Commentary, we explore the emergence of this description as geriatric medicine developed during the era that the disease-diagnosis paradigm dominated medical discourse. We suggest that this recognition of atypicality may have increased the sensibility of non-experts to the more subtle clinical complexity of unwell older adults and added legitimacy to the role of specialist geriatrics, and therefore contributed to improvements in the access and quality of care of older people. Then, noting the growing understanding of the multidimensional nature of illness causation, with age-related frailty now widely appreciated, and insights emerging from geroscience, we offer a critique of its conceptual limitations. Finally, we suggest that holding to the notion of atypicality might be an obstacle to a more assertive reorientation to equitable and age-attuned healthcare, and that the time may be right to offer atypicality a well-deserved retirement.