Post on 04-Apr-2018
7/29/2019 Physiological Features of Aging Process and Modulation of Thermal Parameters Required by Application of Balneal Factors in Elderly
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Physiological features of
aging process andmodulation of thermal
parameters required byapplication of balnealfactors in elderly
Authors: O. Surdu1, 2, V. Marin1, T. V. Surdu2, V. Rusu1, D. Profir11. Balneal and Rehabilitation Sanatorium Techirghiol
2. Ovidius University ConstantaLeonardo Proyect:Thermal Baths for Active Ageing
Montecatini TermeOctober, 22th 2011
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Demographic aging
Demographic aging is an undeniable fact which, globallyspeaking, has economic, social, occupational, culturalconsequences and, last but not least, medical pressuresthat can not be ignored.
The last two decades we can also talk about ademographic aging of the elderly a phenomenon thatrefers to an increase percentage of population over 75years.
This fact led to the concept of 4-th age, targeting asegment of population extremely fragile, among which20-30% of people are dependent on someone.
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.Year All ages 65+years 64-74 years 75-84 years 85+years
% % % %1900 76.303 4 2.9 1 0.21930 122.775 5.4 3.8 1.3 0.21960 179.323 9.2 6.1 2.6 0.51990 249.657 12.7 7.2 4.1 1.32020 296.597 17.3 10.1 4.9 2.42050 309.488 21.8 9.7 6.9 5.2
~ 4x ~ 5x ~ 3x ~ 7x ~ 25x
The actual and future percentage
increase of elder population in USA(by Bontke & Bontke)
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The actual and future percentage increasein Romanian elder population
The population of Romania during 1990-2009 followed asteady downward trend from 23206720-21469959 in2009 (July 1) due in large part, emigration after therevolution, but also decrease the birth rate, mortality by
maintaining the high, even increasing it in some years.Consequently, natural increase since 1992 was negative(-0.2% o).
As a result of sharply lower in the younger population,
aged 0-14 years (from 23.6% in 1990 to 15.1% in2009), and increased the age of 65 years and older(from 10.3 % in 1990 to 14.9% in 2009), leading to so-called "demographic ageing of the population"
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The actual and future percentage increase in
Romanian elder population
STRUCTURA POPULATIEI ROMANIEI PE GRUPE DE VARSTA IN PERIOADA 1990 - 2009
23,6
23,0
22,4
21,8
21,1
20,5
19,9
19,4
19,1
18,7
18,3
17,8
17,3
16,7
16,2
15,6
15,4
15,3
15,2
15,1
48,8
49,2
49,2
49,9
50,5
51,1
51,7
52,1
52,3
52,3
52,3
52,4
52,1
52,2
52,4
52,4
52,1
51,8
51,5
51,3
17,3
17,0
17,2
16,9
16,7
16,4
16,2
15,9
15,
8
16,0
16,1
16,
2
16
,5
16
,8
16
,9
17
,2
17,7
18,1
18
,4
18
,7
10,3
10,8
11,2
11,4
11,7
12,0
12,2
12,6
12,8
13,0
13,3
13,6
14,1
14,3
14,5
14,8
14,8
14,8
14,9
14,9
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
la
suta
din
totalpop
ulatie
0-14 ani 15-49 ani 50-64 ani 65 ani si peste
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Age distribution for patientshospitalized in SBTR in 2011
Patients age distribution
108 362959
1952
3031
1571
544
16
15-24
25-34
35-44
45-54
55-64
65-77
75-84
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Age distribution for patientshospitalized in SBTR in 2011
Age patients distribution
1% 4% 11%
24%
36%
18%
6% 0%
15-24
25-34
35-44
45-54
55-64
65-77
75-84
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Disease distribution for patientshospitalized in SBTR in 2011
Patients diseases distribution
360
2402
59859458067
3331
90397 71125
inflamatory arthritis slipped disk hernia
postlaminectomy slipped disk hernia postraumatic status
neurological diseases gynecological diseasosteoarthritis vertebral static disfunction
osteoporosis abarticular syndroms
dermatologycal diseases vascular disease
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Disease distribution for patientshospitalized in SBTR in 2011
Patients diseases distribution
28%
7%7%7%1%
39%
5%0% 4%0%
1%1%
inflamatory arthritis slipped disk hernia
postlaminectomy slipped disk hernia postraumatic status
neurological diseases gynecological diseas
osteoarthritis vertebral static disfunction
osteoporosis abarticular syndroms
dermatologycal diseases vascular disease
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Cure in a balneary resort
Request/Desire/Demand
Need
Increase in the quality of life
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Aging process is a natural disease(Aristotel)
Aging process is not a diseaseor a dysfunction itself. It onlyrepresents a decrease of theoptimal physiological levels ofall ongoing processes within
the organism. This global malfunction does
not occur equally within allsystems and does not startprecisely from a certainmoment. The human body can
or cannot be affectedpreviously to this moment.
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Aging process is a natural disease(Aristotel)
From the biological point of view, fundamental for agingprocess is a decrease of adaptability of both functions ofvarious systems and cellular level, so that adaptivemechanisms that lead to maintenance of internal
environment balance - homeostasis - are slowing downand sometimes are ineffective in elderly.
Homeostasis is disturbed especially under physical(including heat stress and climate), chemical and physical
stress, consequently adaptive mechanisms are restoringslowly or insufficiently the perturbed parameters.
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Nowadays, there are two currents for the most
frequent accepted intimate mechanisms of
aging process:
Genome based theories
Aging as a
genetically
programmed
phenomenon
Without
genetic
determinati
on
Theories that do not
involve direct genetic
determination
Organ
disturbances
immune and/or
neuroendocrin
e induced
Primary and
secondary
physiological
disturbances
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Decrease of theaccommodation capacity
The disturbance of the major homeostatic functions:immune, neurologic, endocrine, thermoregulatory, together
with alteration of self-control mechanisms, they all generatethe transformation of the normal stress within a relationshipinto a pathogenic stress.
The main targeted tissue structures for physiological agingwhose senescence influences the global rhythm of agingare the blood vessels and the neurons. The complex agingchanges to these structures have as general resultsaterosclerosis and neurodegeneration.
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The thermoregulatory function and senescence
Risk for hypothermia
(decrease of thermogenesis
and heat storage capacity) or
hyperthermia (decrease ofthermolysis and increase of
temperature value which
triggers thermolysis)
The aging of the nervous system (disturbances in
signal transmission, in thermic receptors, in the
transmission and/or integration of information, in
the transmission of afferent stimuli)
Accommodation disturbances
in peripheral circulation
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Immuno-senescence
Older people have particular characteristics inrelationship with warm balneal prescriptions:
- the decrease of immune systems response capacity tonew antigenic challenges
- the increase of the quantity of endogenous antigenicproducts and, in addition, propensity for autoimmunephenomena
- the alteration of expression phenomena of surfaceantigens, of their products and also of the subtlemechanisms of presentation /recognition /cooperation/connection from the major complex of histocompatibility
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The endocrine system
role in the aging
processis that of
neuroendocrine
programmer throughepiphysis due to the
axes:
(cerebro)
hypothalamus-pituitary-(tiro)-
gonadic
hypothalamus-
pituitary-adrenal
Aging of the endocrine system itself
has consequences on the direct control of endocrine functions through
neurotransmitters and also on the indirect through hormones/secretive
pathways
ACTH and cortisol
secretions and their
circadian rhythm are
slightly influenced byage, but post aggression
negative feed-backis
slower, thus the increased
blood levels of thesehormones can resist for a
longer period of time
The endocrine
system andsenescence
i i
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The cardio-vascular system senescence and adaptive demands
for balneal applicationMorpho-
physiological
parameter
Morpho-physiological changes
connected to age
Required adaptive
demands for physical
activity
Change/Request
report
Systolic flow Decreases with 1% /year, from 7l/min, in terms of effort, at 40 years
old, to 4 l/min at 80 years old
Increases 2-3 timescompared with resting
phase
Discordant
Cardiac
frequency
Adaptability decreases by increasing the
frequency to requests; decreases the
chronotropic and inotropic adrenergic
reply
Request an increase of
cardiac frequency
(limited to max.140
beats/min in elder people)
Discordant
Arterial blood
pressure
Increased, normal, lowadaptive
deficit to environment
requirements
Decreases the arterial
blood pressure
Relatively
discordant
Peripheral
resistance
Increases, because of the decrease
of vascular walls elasticity
Decreases, due to
vasodilatation produced
by local metabolites:
adenosine, K+, Ach, ATP,
lactic acid, CO2
Discordant
Speed of blood
circulation Decreases Increases Discordant
Maximum
oxygenconsumption
Decreases from 45-50 ml O2 per
kg.body/min, in an adult, to 18-23ml O2 per kg.body/min in adults
over 60 ears old
Increases to 85-90 ml O2
per kg.body/min Discordant
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Respiratory system senescence andbalneal application
Relatively discordant
The respiratory rhythm
(tachypnea) and
amplitude increase.
The CO2 partial
pressure in thealveolar air decreases.
Progressive
deterioration of the
pulmonary tissue
(parenchyma and
interstitial). The
decrease of chest
elasticity andrespiratory muscles
activity. The increase
of the residual volume.
Respiratory system
Change/Request
report
Adaptive needs
required by physical
activity
Morpho-
physiological changes
connected to age
Morpho-
physiological
parameter
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Hematopoetic system senescence and the physicaleffort
Morpho-physiological
parameter
Morpho-physiological
changes connected to age
Adaptive needs required by
physical activity
Change/Request
report
Plasmatic volume Decreases due to intercellular
water loss
Increases due to blood
mobilization from deposits
Discordant
The number of red-
blood cells
Does not modify Decreases Relatively
Discordant
White-blood cells The incapacity to trigger
calcium signals because of
decreased intercellular calcium
and low synthesis of
phosphoinositol and diacil-
glycerol.
Decreases Concordant
Thrombocytes Status trombofilicus: Theactivation mainly of the
coagulation system with the
imbalance of the fluid-
coagulant status
Decreases blood coagulation Discordant
Variation of
concentration of the
dissolved gases in the
peripheral blood
Decreases the consumption and
extraction of O2 from the
arterial blood
Decreases arterial CO2
concentration due to
hyperventilation and amino
acids loss through perspiration
Concordant
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The nervous system senescence and physicalactivity
Morpho-physiological
parameter
Morpho-physiological changesconnected to age
Adaptive needs required byphysical activity
Change/Requestreport
Cellularpopulations
Decreases the number of neurons:Synaptic plasticity changes; apoptosis;
neurofibrillary damage; loss of myelin
sheath; decrease of speed transmission
along the nerve; granular-vacuolardegeneration; Levi corps in high number;
areal accumulations of lipofuscine;
occurrence of Hirano corps; senile plates
Compensatory proliferation ofconjunctive tissue between theneurons
Changes of the hemato-cerebral
barrier permeability
Nervous structures able to
gather and transmitinformation, to elaborate
the reply and to carry it to
the effective organs, in
order to realize the
vegetative feed-back
Discordant
Centralnervoussystem
circulation
1. Decompensation of self-control
mechanisms of cerebral
circulation
2. Pathological mechanisms:
Oclusive (through thrombosis
or embolism)
Hemorrhagic (straight or
through diapedesis)
The acute phase:
Contraindicates physical
activity and effort
The chronic phase:
Requires parametrical
modulation
Discordant
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The vulnerabilities of the elder people
The cardiovascular function vulnerability
The motor activity vulnerabilityThe sensitive-sensory function vulnerability
The psycho-affective vulnerability
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The damage of the tissue trophicity and its consequences
The precarity of tegument trophicity
The precarity of muscular trophicity
The decrease of muscular force happens gradually starting from early ages:
between 44-55 years old there is a loss of 1% /year
between 55-65 years old there is a loss of 1,5% /year
over 65 years old there is a loss of 2% /year, remaining 30-40% from muscular force value
from age 25
The precarity of bone structure trophicity
Bedsores
The risk for osteoporosis
The precarity of near joints structures trophicity
Risk for stretching, loss of continuity of
insertions, breakings
Limited range of motion
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The damage of motion
The decrease of passive mobility usually due to pyramidal muscular hypertonia of the lower limbs, but
also due to extrapyramidal hypertonia
The increase of support base in upright position and walking;
The decrease of the miotatic reflex, usually symmetrical;
Conservation of general sensitivity, with the possibility of decreasing the vibratory sensitivity in the
lower limbs.
An important pathological cause for walk disturbances in elderly
people is stroke
The senile walk
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Polipathology
Iatrogenetic Risk Polipragmatic
Risk
The therapeutical objectives
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The therapeutical objectivesare:
The maintaining / regaining of articularmobility;
The maintaining / regaining of muscularforce and resistance;
The maintaining / correction of bodyposture and alignment;
The maintaining / correction of motorcoordination and control and equilibrium.
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The individualkinetotherapyaims:
The decrease/control of pain;
Prevention of loss/recover of jointmobility;
Prevention of loss/recover ofmuscular force and resistance;
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In case of neurological sequelae,the kinetic program aims:
recover of the muscular tonus decrease inmuscular hypertonia and increase in muscularhypotonia;
prevention of axial deviations; recover the balance between agonists /
antagonists, synergists / stabilizers, and alsobetween the physiological alternation
contraction / relaxation; the re-establishment of body equilibrium,
voluntary motor control, walking and abilities.
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Conclusions
Kinetotherapy along with hydrokinetotherapy, with theirvarious prescribing forms, are used in balneal resorts, inprocedural complexes,usually belonging to the entiremethodological gatherings of our field:
hydrothermotherapy, electrotherapy,masotherapy, balneoclimatotherapy.
Therefore, we should bare in mind a certain margin ofvital relationships when discussing and concluding all the
conceptual and methodological aspects regarding kineticprescriptions, the latter ones being unable to react ontheir ownon the elders organism, but all of themtogether.
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One might saywhich has been proved bystatistic analysisthat parameter modulation of
kinetics and hydrokinetotherapy clinically
motivated prescriptions, may allow 3-rd age and
even 4-th age patients to do efficient balneal and
physical treatments, not only with the purpose
of training/stimulating the organisms
adaptability, with the delay of global decrease
of performance / maladjustment phenomena
characteristic for senescence - thusgerontoprophilaxisbut also with the purpose
of treating ailments and/or chronic dysfunctions
gerontorehabilitation, both aspects leading
finally to the same objectivethe improvementof life ualit .
Conclusions
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Thank you for your attention!