Age and Date of Birth

Clinical (archive)
1

Hi All,

Date-of-Birth is a clear, concise, unequivocal event and can be represented as a simple
variable in a database. On the plus side, bypassing those cultures that use years instead
of days, most people will accept the DOB at face value.

The 'true' age of a Patient is impacted by many different factors too numerous to mention
here. 'Aging' is a process that is not only hard to define but affects individuals and groups
non-uniformly. The appearance of 'age' is based upon perception.

Age based upon DOB is a convenient way to measure other variables. However, measuring
individual and group rates of physical growth versus age produces results that often lead to
nonlinear functions (can be 'fixed' via statistics). Measuring mental accomplishments, even
those involving medical conditions, can prove to be very complicated.

I have a Grandson with a significant physical growth problem with above average mental
accomplishments (Engineers remember Steinmetz). Enormous amounts of efforts were
involved to get approval for a growth hormone to put a little height on. The common
perception of age is often very wrong. The 'side effects' to this medical problem are
significant.

The down side is that the future is uncertain but will definitely involve the close
relationship between growth, drugs and mental state. DOB is a baseline for us all.
When we do look at other variables, e.g., growth, we find nonlinear functions
everywhere. This should suggest that age itself is nonlinear and that DOB is a
convenient measurement.

It appears that we 'age' at different rates over our lifespan, at least my Practitioners
remind me of that. They still have my DOB in the records and they are sensitive to
my current rate of aging.

I have no problems with a age-related data structure that includes the DOB. However,
there are too many other significant age-related factors that require inclusion. How would
one handle these in a 'standard' fashion if age was set to the DOB only?

Regards!

-Thomas Clark

2

---end quoted text---

The issue here is one of interpretation. Unfortunately, in
English, the word 'age' is used variously in reference to
context to annotate conceptually different things. The way I
would approach this problem is to narrow down to definitives:

o Objective age: Define 'age' as a fixed chronicity related
  phenomenon. This would cover two things:

  - Chronological age (defined by DOB)
  - Gestational age (defined by actual/ estimated LMP)

  These are objective, precise and amanable to mathematical and
  statistical processes.
  
o Subjective age:

- 'Aging' as a process, is dependent upon certain physical, bio-
  logical and biochemical changes which occur with time over a
  known standard reference. Unfortunately, precise definitions
  of the markers nor normative data are available as of now.

- 'Age Related Factors': Most of these are undefined. Except for
  IQ which is defined as mental age over chronological age where
  objective parameters exist for estimation of mental age, most
  other areas are still grey. In paediatrics, the age related
  'growth measures' are also relatively well defined for most
  populations ... so things are a matter of a look-up table only
  (non-linear, yes, but very much there and fairly accurate).But
  for most other things, it is still very much subjective and
  non-precise mombo-jumbo.
  
- Perception of age .. Just imagine the vagueness in terms like
  'he looks young for his age', 'small for date', 'sub-normal
  growth' ... and even a term in official use 'apparant age'
  fall in this group.

- And the list goes on ...

Whereas, the idea is not to ignore these non-chronicity deriva-
tives of age (or subjective age), it would be prudent to leave
such things out of the prime definition of 'age' and deal with
these as discrete entities on individual merit. These would
need a consensus on the yardsticks for each situation. These
can not, and should not be considered for any standard as of
now.

Just my 2p

Dr USM Bish
Bangalore

3

Hi Dr USM Bish,

Thanks for the response. Looking at the various responses as well as other sources,
'age' is not a simple monotonically increasing function with a defined initial value.
Certainly 'age in being' can be calculated from the DOB at any time.

Presuming a 'reasonable, statistically average Patient' with known 'inheritance' (e.g., we
have the Parents), we should be able to make reasonably precise forecasts of the Patient's
future since we know, or have access to, their environment, barring interruptions due
to life in a complex society, e.g. auto accidents while commuting. Isolating the Patient
from these interruptions should allow us to precisely predict the Patient's life and
death.

Presuming that one has the Patient's genetic profile, certainty rules.

I know of no study that was able to accomplish such a goal. However, with a background
in Fault Tolerant Computing I can also state that computing systems (concentrate on the
hardware because the software has too many human errors in it), have as yet not come close
to achieving a similar goal. 'Aging' can be put done to physical process well beyond our
direct control.

In other words the best approach in this field to translate events into random events.

We do stir the pot with the Mean-Time-To-Failure (MTTF), lots of redundancy and
good recovery procedures. This sort of 'intervention' in Healthcare is in its infancy and
hopefully will succeed soon.

The point is that physical processes are responsible for change and what could be
termed 'aging'. As an example, many products contained a 'Best Used By' label to
avoid having the customer experience the 'ageing' of the product that has never been used.
No guarantees but easy replacement with a new model.

Change has been with us for some time and it will confound us in the future because the
rate of change is itself changing. Which reminds me of all the wonderful times we
had responding to massive system failures because someone in another area make changes
to the hardware (mostly) because the new model was much, much better.

Patients are currently assuming more control over their own Healthcare. They realize
that their Parents lived in a different world, a different environment. Social age has
changed along with many other components, e.g., the intelligence, knowledge and
capabilities of the populations. The Patient inherits from the Parents but undergoes
various changes influenced more by their Peers. Even the Greeks and the Romans
complained.

Research, as identicated in a prior email, shows that there will be opportunities for
Patients to effect changes that can bypass certain age-related 'triggers' and thereby
succeed where their Parents did not have the opportunity to. Research is moving us to
a Patient-centric world where the focus is on the individual not the 'average'.

Patients know the DOB given to them by the authorities occurs but given a choice regarding
age-related events my presumtion is that they will respond affirmatively to new procedures.
We are not aging like our Parents and our children are not likely to be mirror images.

My problem now is addressing some of the age-related impacts that Patients
experience or are concerned about. It appears as though a combination of
structured and unstructured data will be needed to resolve future issues.

Recall that searching a database for information that is related to a specific key is difficult
enough. If the relationship does not exist but the content of various entries contains hints,
whatever that would allow an application to infer that the relationship exists, someone
soon enough will suggest changes.

Must be my reluctance to make changes to relational database applications and my
preference for object-oriented databases where change is inevitable.

Again, thanks for the response!

Regards!

-Thomas Clark

USM Bish wrote: