Specific pairs of diseases can increase synergistically the risk of disability. (synergistic 协同的)
特殊的成对疾病可以协同增加病残的风险。
Arthritis and heart disease coexist in 18% of older adults; although the odds of developing disability are increased by three-fold to four-fold with either disease alone, the risk of disability increases 14-fold if both are present. (arthritis 关节炎)
有18%的老年人同时患有关节炎和心脏病，虽然每个疾病可以增加3~4倍的病残率，但两个疾病同时存在，可使病残率提高14倍。
A second way in which older adults differ from younger adults is the greater likelihood that their diseases present with nonspecific symptoms and signs. (likelihood 可能性)
老年与青中年的第二个差异是更容易出现非典型的症状和体症。
Pneumonia and stroke may present with nonspecific changes in mentation as the primary symptom. 肺炎和中风时可出现非典型意识变化作为主要的症状。
(pneumonia 肺炎 mentation 精神作用、心理活动 primary 初始的、首要的、主要的)
Similarly, the frequency of silent myocardial infarction increases with increasing age, as does the proportion of patients who present with a change in mental status, dizziness, or weakness rather than typical chest pain. (silent 沉默的、静止的 proportion 成比例的、相称的)
同样地，隐匿性心肌梗塞发生频度随着年龄的增大而增加，这些病人相应地频发精神状态改变、眩晕、虚弱而不是典型的胸痛症状。
As a result, the diagnostic evaluation of geriatric patients must consider a wider spectrum of diseases than generally would be considered in middle-aged adults. (spectrum 谱、光谱)
因此，老年病人的诊断应考虑更广泛的疾病谱，要超过通常对中年病人所考虑的范围。
A third condition that is found primarily in older adults is frailty, frailty is thought to be a wasting syndrome that presents with multiple symptoms and signs, including reduced muscle mass, weight loss, weakness, poor exercise tolerance, slowed motor performance, and low physical activity.
(primarily 起初、首先 frailty 脆弱、意志薄弱tolerance 宽容、忍耐、耐受)
主要出现在老年人的第三个情况是衰弱，衰弱被认为属于衰竭综合症，它有许多症状和体征中，包括肌肉萎缩、体重下降、虚弱、运动耐受差、动作慢、身体活动少。
Some estimates indicate that the full syndrome is found in 7% of community-dwelling people age 65 and older, and in 25%of community-dwelling people age 85 and older.
(estimate 估计、评价、看法 indicate 指出、表时、象征、适应征)
一些人估计7%的65岁以上社区老人和25%的85岁以上社区老人上述症状全部出现。
Many institutionalized older adults also are frail. 许多老人院里的老人也是衰弱的。
(institutionalized 使成公共团体、将…收容 frail 身体虚弱的、易损坏的、意志薄弱的)
Frailty is a state of decreased reserve and increased vulnerability to all kinds of stress, from acute infection or injury to hospitalization, and may identify individuals who cannot tolerate invasive therapies. (reserve 保存、克制 vulnerability 易受伤、易受责难)
衰弱是对各种压力耐受下降、损害增加的一种状态，从急性感染、损伤到住院治疗，都可以发现一些人不能忍受侵入性诊疗措施。
The syndrome of frailty is associated with high risk of falls, needs for hospitalization, disability, and mortality. (fall 跌倒、下降)
衰弱的症状与易于病倒、需要住院治疗、病残、死亡的高风险是相关的。
There is early evidence that a core component of frailty is sarcopenia, or loss of muscle mass associated with aging, which occurs in 13 to 24% of persons age 65 to 70 and in 60% of persons age 80 and older.
component 成分、构成要素 sarcopenia 肌减少（症)、与年龄相关的骨骼肌质量下降
衰弱一个主要成分的早期表现是肌肉减少，或说随年龄增长的肌肉减少，它发生在13~24%的65~70岁的老人，60%的80岁以上的老人。
It is likely that dysregulation of multiple physiologic systems, including inflammation, hormonal status, and glucose metabolism, underlies the syndrome, with resulting decreased ability to maintain homeostasis in the face of stress.
dysregulation 失调 homeostasis 内环境稳定
多种生理系统易于失调 ，包括炎症、激素状态、糖的代谢，结果是在压力面前保持内环境的稳定的能力下降。
Subclinical disease (e.g., atherosclerosis), end-stage chronic disease (e.g., heart failure), or a combination of comorbid diseases may precipitate the syndrome.
atherosclerosis 动脉粥样硬化
亚临床疾病(如动脉粥样硬化), 晚期慢性疾病(如心力衰竭)，或多种疾病并存可共同形成症状。
Evidence from randomized, controlled trials shows that resistance exercise, with or without nutritional supplements, and home-based physical therapy can increase lean body mass and strength in even the frailest older adults.
随机对照试验的迹象显示无论有无营养支持和家庭身体疗法，即使是最虚弱的老年人，对抗运动能够增加瘦弱躯体的质量和力量。
This evidence suggests that earlier stages of frailty may be remediable, although end-stage frailty likely presages death. (remediable 可挽回的 presage 预兆、预示)
这个结果提示早期衰弱是可挽回的，尽管末期衰弱常提示死亡。
Fourth, cognitive impairment increases in prominence as people age.
(prominence 突出、显著 )第四，人们变老时认知损害显著增加。
Cognitive impairment is a risk factor for a wide range of adverse outcomes, including falls, immobilization, dependency, institutionalization, and mortality.
immobilization 活动能力减少 institutionalization 制度化、专门照料
认知损害是大量不利结果的风险因子，包括摔倒、活动能力下降、不能自理、需住老人院护理、死亡。
Cognitive impairment complicates diagnosis and requires additional care giving to ensure safety.
认知损害使诊断复杂，为保证安全需要更多的照料。
Finally, a serious and common outcome of chronic diseases of aging is physical disability, defined as having difficulty or being dependent on others for the conduct of essential or personally meaningful activities of life, from basic self-care (e.g., bathing or toileting) to tasks required to live independently (e.g., shopping, preparing meals, or paying bills) to a full range of activities considered to be productive and/or personally meaningful.
最后，老年人慢性病严重又常见的结果是身体能力不足，描述为个人最基本的或有意义的日常活动有困难或不得不依靠别人帮助指导，从基本的自理（如洗澡或如厕)到独立生活需要的各种任务（如购物、做饭、支付各种账单)，到具有集体和／或个人意义的所有活动。
Of older adults, 40% report difficulty with tasks requiring mobility, and difficulty with mobility predicts the future development of difficulty in instrumental activities of daily living (IADL; household management tasks) and activities of daily living (ADL; basic self-care tasks).
在老年人中， 40%对需要运动的任务有困难，运动困难提示将来开展日常工具锻炼（IADL；家庭护理项目)和目常锻炼（ADL；基本自理项目)的困难。
In persons age 65 and other, difficulty with IADL is reported by 20%, and difficulty with ADL is reported by 11%; for both, the prevalence increases with age. prevalence 流行
大于65岁的老人或其它人，IADL困难报导为20%，ADL困难报导为11%；随年龄增加两个都困难成为普遍现象。
People who have difficulty with tasks of IADL and ADL are at high risk of becoming dependent.
IADL和ADL困难的人处于不能自理演变的高风险中。
Of persons older than age 65, 5% reside in nursing homes, largely as a result of dependency in IADL and/or ADL secondary to severe disease. (reside 居住 nursing home 疗养院)
小于65岁的老人中，5%住在疗养院里，大多数是严重疾病后依赖IADL和ADL的结果。
Generally, woman live more years with disability, whereas men who become similarly disabled are more likely to die at a younger age.
一般来说，同样的能力不足，男性常死得更年轻，女性比男性能多活几年。
Although physical disability is primarily a result of chronic diseases and geriatric conditions, its onset and severity are modified by other factors, including treatments that control the underlying diseases, physical activity, nutrition, and smoking.
(Primarily 首先、起初、主要、、根本 onset 进攻、有力的开始、发作)
虽然身体能力不足是慢性疾病和年老状态的一个主要结果，它的发生和严重程度被其它因素影响着，包括基础疾病的治疗和控制、身体锻炼、营养和吸烟。
