At what age is a person considered elderly?

Definition of Elderly Age

The age of 65 is most often used when referring to "old," "elderly," or "geriatric" patients, with high-quality evidence supporting this definition. 1

Standard Definitions of Elderly

• The United Nations (UN) in World Population Ageing 2019 defines older people as those aged 60 or 65 years or more 1
• The World Health Organization (WHO) defines older people in developed world economies as those aged 65 years or more 1
• The WHO also offers an alternative definition where an older person is someone who has already passed the median life expectancy at birth 1
• The age of 65 is the most commonly used threshold in medical literature and healthcare systems 1

Age Thresholds in Different Medical Contexts

• In trauma management, mortality adjusted for injury severity increases at age 70, suggesting this as a cutoff for geriatric trauma patients 1
• Advanced Trauma Life Support (ATLS) recommends transportation to a trauma center for patients older than 55 years 1
• Eastern Association for the Surgery of Trauma (EAST) guidelines define patients older than 65 years as elderly 1
• Recent multicenter analysis showed significant increases in mortality at ages 55,77, and 82 years in trauma patients, suggesting these as important thresholds 1

Special Considerations for Different Medical Specialties

• In oncology, particularly for malignant lymphoma, the International Society of Geriatric Oncology (SIOG) and European Organisation for Research and Treatment of Cancer (EORTC) recommend using the term 'elderly' for patients 70 years and older 1
• In hypertension management, guidelines vary in their definition:
  • JNC 8 guidelines classify elderly as ≥60 years of age 1
  • Chinese guidelines define elderly as ≥65 years of age 1
  • ASH/ISH, French, NICE, CHEP, and ESH/ESC guidelines define elderly as people ≥80 years for specific blood pressure targets 1

Biological vs. Chronological Age

• Chronological age does not correspond to biological age 1
• Aging correlates with para-physiological changes in organ systems that alter response to trauma and other medical conditions 1
• The German Society of Geriatrics (DGG), German Society of Gerontology and Geriatrics (DGGG), and German Group of Geriatric Institutions (BAG) emphasize that factors beyond chronological age must be considered when defining elderly patients 2
• Frailty, comorbidities, and functional decline are important factors that may better define an "elderly" patient than age alone 1, 2

Practical Implications

• Patients aged ≥55 years may require dedicated trauma care due to higher mortality rates 1
• Early trauma protocol activation is suggested for patients aged ≥55 years 1
• Careful evaluation of injured patients aged ≥55 years is recommended to avoid under-triage 1
• Assessment of frailty is strongly recommended in all elderly trauma patients 1

In summary, while 65 years is the most widely accepted threshold for defining elderly status across medical literature and international organizations, the definition varies by medical specialty and context. The biological age, functional status, and presence of comorbidities should be considered alongside chronological age when making clinical decisions.