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Physiological and Clinical Changes of Aging. Pio L. Oliverio, MD Fellow, Geriatrics SVCMC, Jamaica, NY. OBJECTIVES. To describe basic concepts of physiologic changes with aging To describe the effect of aging on body processes/ systems. DEFINITION of TERMS.

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physiological and clinical changes of aging

Physiological and Clinical Changes of Aging

Pio L. Oliverio, MD

Fellow, Geriatrics

SVCMC, Jamaica, NY

objectives
OBJECTIVES
  • To describe basic concepts of physiologic changes with aging
  • To describe the effect of aging on body processes/ systems
definition of terms
DEFINITION of TERMS
  • Aging – the process of growing old, specially by failure of replacement cells in sufficient number to maintain full functional capacity

(Stedman’s Med Dictionary 2000)

definition of terms4
DEFINITION of TERMS
  • Aging – the gradualdeterioration of a mature organism resulting from time-dependent, irreversible changes in structure that are intrinsic to the particular species, and that eventually lead to decreased ability to cope with the stresses of the environment thereby increasing the probability of death

(Stedman’s Med Dictionary 2000)

definition of terms5
DEFINITION of TERMS
  • Aging – is a process that converts healthy adults into frail ones with diminished reserves in most physiologic systems and exponentially increasing vulnerability to most diseases and to death

(W. Hazzard, Principles of Geriatric Medicine & Gerontology 2003)

definition of terms6
DEFINITION of TERMS
  • Gerontology – the scientific study of the process and problems of aging.
  • Geriatrics – the branch of medicine concerned with the medical problems and care of the aged
definitions of life span
DEFINITIONS of Life Span
  • A lifetime
  • The average or maximum length of time an organism or object can be expected to survive or last
  • The maximum number of years that a person has been known to live, currently around 115 years
  • Frequently confused with life expectancy
definition of life expectancy
DEFINITION of Life Expectancy
  • length of time that a person on the average is expected to live
  • average number of years of life remaining to a person at a particular age and is based on a given set of age-specific death rates
  • Also Average Life Span or Mean Life Span
  • Can change over life cycle
  • Based on statistical probabilities
average life expectancy
Average Life Expectancy

(In years)

61 – developing countries

74 – developed countries

variations
VARIATIONS

in life expectancy

WORLD WIDE

  • Causes: differences in public health medicine and nutrition from country to country

USA + other developed countries

  • Variation in ethnicity and gender
factors
Genetic disorder

Exercise

Smoking

Excessive drug and alcohol use

FACTORS

affecting life expectancy

  • Poverty
  • Air pollution
  • Occupation
  • Diet
  • Access to health care
fundamental considerations
Fundamental Considerations
  • Aging is developmental
  • Old age is a gift of 20th century technology and scientific advancement
  • The effects of normal aging vs. pathologic aging must be differentiated
  • There is no universally accepted theory of aging
theories of aging
Theories of Aging

Oxidative stress (free radical) Theory

  • Tissue damage is caused by free radicals (super oxide or hydroxyl radicals) through lipid peroxidation
  • Specific form of wear and tear theory
  • Accumulation of aging pigments (lipofuscin) in lysosomes
theories of aging14
Theories of Aging

Rate of Living Theory (Metabolic Rate Theory)

  • The higher the basal metabolic rate (the rate, at which the body at rest, uses energy), the shorter the life span
theories of aging15
Theories of Aging

Error Catastrophe Theory

  • DNA errors promote senescence, programmed cell death (apoptosis)
  • Aging results from gene interference with the ability of the cells to reproduce
theories of aging16
Theories of Aging

Error Catastrophe Theory

Redundant DNATheory

  • Biologic age changes are a result of errors accumulating in functioning genes
  • Lifespan may be a degree of repeated genetic sequences
  • Fails to explain other possible aging factors
theories of aging17
Theories of Aging

Hayflick Limit Theory

  • Functional changes within cells are responsible for aging
  • Cumulative effect of improper functioning of cells and eventual loss of cells in organs and tissues
cardiovascular system
Cardiovascular System

Morphology:

  • Elongation and tortuosity, stiffening of arteries including aorta
  • Increase intimal thickening of arteries
  • Increased fibrosis of media of arteries
  • Sclerosis of heart valves
cardiovascular system19
Cardiovascular System
  • Cardiac Hypertrophy with aging
  • Inotropic and chronotropic responses to catecholamines sympathetic nervous system are impaired
  • Both systolic and diastolic blood pressures increase with age
  • Blood pressure regulation: older patients are at high risk for orthostatic hypotension
cardiovascular system20
Decreased

Cardiac output

Heart rate response to stress

Compliance of peripheral blood vessels

Cardiovascular System
respiratory system
Decreased

Lung elasticity

Activity of cilia

Cough reflex

Respiratory drive

Respiratory System
respiratory system22
Lower…

Respiratory muscle strength & endurance

Diffusing capacity (oxygen uptake)

PO2, O2 saturation due to V/Q mismatch (but no change in PcO2 )

Respiratory System
respiratory system23
Lower

Maximal expiratory flows:

FEV1, FEV1/FVC

VC

Increased

FRC and RV

Respiratory System
  • Stable
    • TLC
renal system
Decreased

Number of nephrons

Kidney weight and volume

Lean body mass

Maximum urine osmolality

Renal System
renal system25
Decreased

Renal blood flow

Creatinine clearance

Renin response to volume depletion or salt restriction

Renal System
renal system26
Renal System

Impaired:

  • Hydroxylation of Vitamin D
  • Metabolism of PTH, calcitonin and glucagon

Unchanged:

  • Erythropoietin production
musculoskeletal system
Decrease in:

Muscle mass

strength of grip/ contractile force

stability of neuromuscular innervation

Bone substance (osteoporosis)

Height and Weight

Musculoskeletal System

Most common disability cause in > 65 years old

gastrointestinal system
Gastrointestinal System
  • Decreased:
    • Hydrochloric acid production
    • Taste buds
    • Intestinal motility
    • Swallowing coordination
    • Vitamin K-Dependent factor synthesis
gastrointestinal system29
Gastrointestinal System

Increased:

  • Lithogenic index of bile composition (cholesterol gallstones)

Functional Changes (Large Intestine):

  • Slowed transit
  • Altered coordination of contraction
  • Increased opioid receptors (drug induced constipation)
endocrine system
Endocrine System
  • Decreased:
    • Free testosterone
    • Triiodothyronine
    • Cortisol production
    • Hypothalamic-pituitary-adrenal axis sensitivity to glucocorticoid feedback
endocrine system31
Endocrine System
  • Increased:
    • Insulin
    • Norepinephrine
    • Parathoromone
    • Vasopressin
immune system
Immune System
  • Impaired thermal regulation
    • Afebrile infection common
  • Total lymphocyte counts do not change with age
  • TNF-alpha increased but not interleukin-1
immune system33
Immune System

Decreased:

  • Humoral antibody-mediated response
  • Antibody response to vaccines
  • Production of thymic hormones
  • Mass of thymus
    • Production of lymphocytes
  • T-cell activity
vision
Vision
  • Retina becomes thinner
  • Changes in lens and iris = presbyopia
  • Cataract formation:
    • Lens yellows and accumulation of insoluble protein in center…
vision35
Lacrimal gland function

Tear production

Goblet cell function

Acuity

Accomodation

Color sensitivity

Depth perception

Pupil size

Aqueous humor production

Vision
  • Decreased:
hearing
Hearing
  • External auditory canal atrophies
  • Cerumen becomes drier

Hearing Loss caused by:

  • Loss of hair cells in the organ of Corti
  • Loss of cochlear neurons
  • Stiffening of the basilar membrane
  • Calcification of auditory mechanism
  • Degeneration of spiral ligament
thermoregulation
Thermoregulation
  • Increased susceptibility to hypo/hyperthermia
  • Impaired vasoconstrictor response to cooling
  • Impaired ability to conserve heat
  • Impaired skin vasodilatation response
  • Decreased sweat production
sexual function
Sexual Function
  • Slower arousal phase
  • Increased ability to stay at plateau levels of arousal
  • Estrogen loss reduces acidity of vaginal secretions, causes atrophic vaginitis and hot flashes
sexual function39
Sexual Function
  • In men, a longer refractory period
  • In older men, erectile dysfunction impotence. There is no such thing as male menopause
slide40
THANK YOU!

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