From Pediatrics to Geriatrics--Not that Great a Leap

A. Mark Clarfield, MD

Last Scene of all,
That ends this strange eventful history,
In second childishness, and mere oblivion,
Sans teeth, sans eye, sans taste, sans everything

William Shakespeare (As You Like It. II, vii, 157)
(1564-1616)

The Bard, a noted gerontologist, described those at the extremes of life as having much in common. Both are more fragile than their counterparts mired in middle age. Each exhibits an easy perturbation from the physiologic norms of maturity. As has been said about nostalgia: "It ain't what it used to be"; thus with respect to the homeostasis of both the very young and extremely old. Both can swing out from their narrow organ reserves into failure very quickly indeed.

Many analogies can be drawn between the two ends of the age spectrum--some quite credible, others a bit more fantastic. This month's column will touch on some of these in hope that perhaps a few pediatricians will decide to transfer their allegiance and bolster the still slim ranks of Canada's geriatricians.

More and more I am struck by the similarities exhibited by patients at the extremes of life. For one thing, the older person suffering from severe dementia can no more be maintained at home with the help of community services, as good as they might be, than the average two-year-old.