Dr. ISNANIAH, Sp. S

EFFECT OF AGING ON EFFECT OF AGING ON FUNCTION OF ORGANS FUNCTION OF ORGANS

Can be defined as a progressive, generalized impairment of function resulting in a loss of adaptative response to a stress and in a growing risk of age-associated disease (Kirkwood, 1996).

Definition of Ageing

Significance of Human Aging• People live longer now than ever before• By 2030, 20% of the US population will be 65 and older• Significant challenge to medicine - ethical, financial, etc.

Significance of Human Aging• What is “normal” in the aging process - primary aging • More susceptibility to disease - secondary aging• More heterogeneity in the elderly population• Onset indeterminable and progression varied• Genetic and environmental factors

Significance of Human Aging• Gender is a significant factor• Lifestyle a primary factor• Various theories of aging attempt to explain the process -

bottom line, there is disruption of homeostasis

Successful Aging

• Chronologic age and physiologic age not the same• Due to complex interactions of genetics and environment• Individuals “age” at different rates and there is significant

variability

Successful Aging

• Prevalence of disease increases with age• Proposed pathways of aging:

– Aging with disease and disability– Usual aging; absence of pathology but presence of

decline in function– Healthy aging; no pathology or functional loss

• Pathway goals:– De-emphasize aging characterized by decline– Emphasize heterogeneity among elderly– Underscore positive pathway of aging– Highlights possible avoidance of disease associated

with aging

Successful Aging - homeostasis less efficient, but still present

Successful Aging

• Heterogeneity of various values and functions• Many associated with physical inactivity

Theories on Aging

• Biological theories– Wear-and-tear– Cellular– Autoimmune– Genetic mutation

• Psychosocial theories of aging

• Aging1. Physiological process2. Individual changes3. Organ changes

PROBLEM

Skin: Exhibits most obvious sign of aging Loss of underlying connective tissue, fat and oil glands →

wrinkles, sagging skin Aging skin appears thinner, paler, and translucent Increased sensitivity to heat/cold, bruising, and bedsores Develops "age spots" due to deposits of melanin

pigment Ability to perspire is decreased Contributing factors: nutrition; exposure to sun,

chemicals/toxins; hormones, and heredity

PHYSICAL IMPLICATIONS OF AGING

Skin & Nails

Hair: Shows obvious signs of aging Hair color is due to pigment ‘melanin’- gradually

decreases after age 30-40 Loses pigmentation → turns hair gray/white Manifests earliest in scalp, followed by facial/body

hair Occurs earlier in Caucasians compared to Asians Alopecia- baldness/ hair loss is the norm Coarsening of hair common

Nails: Become dull, brittle, ridged, thickened, grow slower due to reduced blood flow to connective tissues

Overall reduction in blood flow occurs as we age Heart of a 20-year old can pump 10 times the amount

actually needed to preserve life After age 30, about 1% of reserve is lost/ yearResults in: Normal atrophy of the heart muscle Calcification of the heart valves Arteriosclerosis ("hardening of the arteries") Atherosclerosis (intra-artery deposits)

The Cardiovascular System

Reduced Brain, Liver and Kidney

Function

Vulnerable to Drug Toxicity

↑ Risk of HBP, Heart Attack, Stroke, Heart Failure

Poor Response to

Stress

Slower Healing rate

CVD Changes↓

Poorer Cell Oxygen

The reduced blood flow results in less strength due to: diminished oxygen exchange reduced kidney and liver function less cellular nourishment

Other problems: Intermittent pain in the legs with walking Varicose veins Predilection for Blood clots

Maximum lung function decreases with age Diminished elasticity of airways and lung tissue Reduced ciliary activity→ decreased oxygen

uptake/exchange Muscles of the rib cage atrophy, further reducing

the ability to: breathe deeply cough expel carbon dioxide

Changes in Respiratory System

Aggravating factors: Smoking, Pollution Results in:

Lower stamina for work; easily fatigued

Shortness of breath Oxygen lack can increase anxiety Suspectibility to pneumonia

increased

Changes in Respiratory System

Manifest changes that affect QOL significantly Osteoporosis is a common condition characterized by:

progressive loss of bone density Increased vulnerability to fractures Thinning of vertebrae → loss of height; spontaneous

fractures Reduction in height occurs by1 cm (0.4 inches) every 10

years after age 40 Height loss is even greater after 70 years The vertebrae calcify increasing rigidity, making bending

difficult

Skeletal System Changes

Skeletal System Changes

Osteoarthritis- degenerative disease, most common chronic condition in elderly

Rheumatoid arthritis- common connective tissue disorder

Both impair mobility and the performance of daily activities of living

Joints

Progressive loss of muscle mass occurs as we age → change in body shape

Accelerated after age 65- causes weight loss Changes in body shape can affect balance,

contributing to falls Elderly individuals with weak muscles are at greater

risk for mortality than age-matched individuals Increase in amount and rate of loss of muscle

increases risk of premature death Physical inactivity is 3rd leading cause of death;

plays role in chronic illnesses of aging

Muscular System

Sex Hormones Men may exhibit slightly decreased levels of

testosterone Women have decreased levels of estrogens,

progesterone and prolactin after menopauseInsulin The normal fasting glucose level rises 6-14 mg/dL

every 10 years after age 50 Probably due to loss in number of insulin receptor

sites in cells Can lead to diabetes-annual testing recommendedOther Hormones Not significantly affected

Hormones

Overall effectiveness decreases, leading to: Increased infection risk Decreased ability to fight diseases Slowed wound healing Autoimmune disorders Cancers

Immune System

Prolapse- descent of uterus may occur due to lax tissues

Urinary stress incontinence common Breasts lose tissue and subcutaneous fat→

flatten and sag Breast cancer risk increases with age The genital tissue atrophies; more prone to

infections

Physical manifestationsin Women

Men do not experience a sudden ‘andropause’ Age is not a good predictor of male fertility Testosterone levels maintained/decrease slightly Decreases in the sex drive (libido) may occur Normal for erections to occur less frequently Aging alone does not impair a man’s capacity to enjoy

sexual relationships

Male Reproductive System

Prostate grows in size- urinary problems Cancer of prostrate or bladder is commoner in older

men

Erectile dysfunction Erectile dysfunction may occur Is frequently related to diseases (diabetes) or

medicines 90% of erectile dysfunction- has medical rather than

psychological origin May be amenable to treatment

Physical Manifestations in Men

Normally no change Usually affected by diseases like high BP,

diabetes and cancer Lead to increased risk for acute and chronic

kidney failure Urinary tract infections are common

Changes in Kidneys

Fall of teeth is an obvious sign of aging All people eventually lose teeth- rate depends

on several factors Proper hygiene can preserve teeth longer Increased sensitivity to cold/heat common

with attrition Loss can interfere with healthy eating habits-

malnutrition common

Teeth and Mouth

Aging has profound effects on mental faculties Brain tissue is irreparable – changes are permanent Speed of communication between nervous tissues is

decreased Transmission of messages within nerve cells

becomes slower The brain and spinal cord lose nerve cells and weight Waste products collect in brain, causing plaques and

tangles

Nervous Tissue and Aging

Changes result in: Lost or reduced reflexes → problems with

movement and safety Slight slowing of thought, memory, and

thinking- a normal part of aging A change in thinking/memory/behavior are

important indicators of disease ALL ELDERLY PEOPLE DO NOT BECOME

‘SENILE’

Delirium, dementia, and severe memory loss are NOT normal processes of aging

Caused by degenerative brain disorders such as Alzheimer's disease

Illnesses unrelated to brain can cause changes in thinking/ behavior

Severe infections can lead to confused states Diabetes- fluctuations in glucose levels can cause

thinking/behavioral disorders

CHANGES IN SENSES

TOUCH-Gradual reduction after 50- injuries,

hypothermia

SMELL- Decreases after

70 yrs- may affect hygiene

TASTE- Minimal changes

VISION-Usually need glasses by 55-Only 15-20% have ↓ driving

ability

HEARING30% people over

age 65 have impairment

SENSES

Normal acuity ↓ with age

Small changes normal - do not significantly change our sense of who the person is

Personality and social interaction often change due to neurodegenerative diseases

Drastic changes in personality reflect a disease process- difficult for caregivers to cope with/accept

“Senility” or “senile” is an out-dated term- now replaced with “Dementia” Senility or Dementia should NOT BE EQUATED TO AGING- DEMENTIA IS A

DISEASE STATE

Social Behavior & Personality Changes with Age

Dementia – ‘condition where one has a progressive decline in memory and other cognitive functions that results in a change in the ability to conduct one's usual activities’

Dementia is characterized by multiple cognitive deficits with memory impairments as an early symptom

Diagnosis of dementia- not given in absence of impairment in social functioning/independent living

Social Behavior & Personality Changes with Age

With a healthy lifestyle, few changes seen that are deleterious to QOL

In fact, some actions may grow more correct as we age (within limits)

Learning The ability to learn continues throughout life Often require more time and effort to absorb new

information Need more effort to organize and understand new

information Tendency to avoid learning new things not perceived as

beneficial Reasons – unknown; may be partly attributed to decline in

senses as we age

Psychological and Social Impact

Older adults must often deal with physical, medical or social stressors

Stress can precipitate many diseases like diabetes, high BP, anxiety attacks etc

Common stresses for older people are: diseases or health conditions, possibly chronic (e.g.,

heart disease, arthritis, cancer) perceived loss of social status after retirement death of a spouse/child/sibling

Stresses

A growing problem among older adults, particularly alcohol

Causes physical/mental health problems commonly, especially older men

Exaggerated effects seen in older people Has negative effects on self-esteem, coping skills, and

interpersonal relationships Warning flags are less obvious in older adults e.g. less

likely to be caught on the job, in public

Substance abuse

Normal Effects of Aging on the Body

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