PHYSIOLOGY OF AGING “Age is an issue of mind over matter. If you don't mind, it doesn't matter."...
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Transcript of PHYSIOLOGY OF AGING “Age is an issue of mind over matter. If you don't mind, it doesn't matter."...
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PHYSIOLOGY OF AGINGPHYSIOLOGY OF AGING
“Age is an issue of mind over matter.If you don't mind, it doesn't matter." Mark Twain
(1835-1910)
SO
“You're Only As Old As You Feel”
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AGING PROCESSAGING PROCESS• Normal Part of Life.
• Begins around ……..
age 30.
“If I'd known I was gonna live this long, I'd have taken better care of myself.”
Eubie Blake (1883-1983) American Jazz Musician
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Changes in Physiology with Changes in Physiology with AgingAging
• Older people may exhibit no changes in baseline function, but may have decreased ability to adapt to stress.
• Various body systems lose reserve capacity with aging at different rates.
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“I am sick of all this nonsense about beauty being only skin deep.
That’s deep enough. What do you want, an adorable pancreas?”
Jean Kerr
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Factors affecting aging of facial featuresFactors affecting aging of facial features
<18.5 = Underweight18.5-24.9 = Normal25-29.9 = Overweight30 or more = Obesity
Smoking
Exposure to sun
Use of alcohol
BMI
BMI = kg/m²
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““O” Complex of Geriatric MedicineO” Complex of Geriatric Medicine
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Changes in Physiology with Changes in Physiology with AgingAging
• Decreased Homeostasis.
• Older people may exhibit no changes in baseline function, but may have decreased ability to adapt to stress.
• Various body systems lose reserve capacity with aging at different rates.
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Changes in Vision and HearingChanges in Vision and Hearing
Significant visual & hearing impairment is present in up to 75% of elderly people
– Often not reported to the physician – May limit ability to function – May lead to social isolation – May interfere with ability to communicate – May appear demented
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For older people this means:For older people this means:
• Sensory Deprivation
• Increased risk for falls
• Decreased quality of life
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Vision Vision
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EyesEyes
– Loss of fat – sunken appearance; eye bags
– Presbyopia
– Slower adaptation to darkness
– Diminished tolerance to glare
– Increasing impairment to colour discrimination
– Increased lens density
– Macular degeneration
– Degeneration of tear gland
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SYMPTOMSSYMPTOMS
• Cannot get glasses clean
• Difficulty night driving
• Difficulties reading
• Double vision (in one eye)
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Normal LensNormal Lens
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CataractCataract
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What is your vision like with What is your vision like with cataract?cataract?
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Monet’s painting - BeforeMonet’s painting - Before
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Monet’s painting - WithMonet’s painting - With
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GlaucomaGlaucoma זווית פתוחה זווית פתוחה
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Age-Related Macular DegenerationAge-Related Macular Degeneration
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Risk factors for AMDRisk factors for AMD
• Increased age
• Female gender
• Lighter iris color
• Race
• Smoking
• Sunlight Exposure
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Diabetic NeuropathyDiabetic Neuropathy
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Hearing LossHearing Loss
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EarsEars
– Loss of elasticity in inner ear leading to loss of high frequency hearing.
– Sounds from speech is distorted due to poor quality amplification
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Changes in Auditory and Visual Changes in Auditory and Visual Function with AgeFunction with Age
• Sensorineural hearing loss – presbycusis.
• Conductive hearing loss may also occur.
• The lens decreases its elasticity and becomes less mobile.
• Cataracts may develop.
• Loss of fat in the eyelids and reduced tone of the levator muscle causes drooping (ptosis) of the eyelid.
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Overview of Hearing LossOverview of Hearing Loss
• 60% of elderly over 65 have some degree of hearing impairment.
• 90% of people over 75 have some degree of hearing impairment!
• 75% of all people with hearing loss could benefit from an appropriate hearing aid.
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Signs of Hearing LossSigns of Hearing Loss
• Ringing or buzzing in the ears• Talking louder than necessary• Turning up volume on the TV or radio• Complaints that other people “mumble”• Confusion of similar sounding words• Watching a speaker’s face intently• Difficulty “hearing” someone behind you• Having difficulty on the telephone• Inappropriate responses in conversation
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Changes in Vision and HearingChanges in Vision and Hearing
• Significant visual, hearing impairment is present in up to 75% of elderly people – These problems are often not reported to the
physician – May limit ability to function – May lead to social isolation – May interfere with ability to communicate – patients with sensory impairments may
appear demented
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For older people this means:For older people this means:
• Sensory Deprivation
• Increased risk for falls
• Decreased quality of life
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Changes in HeartChanges in Heart
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Cardiac Output (CO) = Stroke Volume (SV) x Heart Rate (HR)
The Cardiac CycleThe Cardiac Cycle
Cardiac Cycle
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Changes in Cardiovascular Changes in Cardiovascular PhysiologyPhysiology
• Changes in cardiac output (CO): – Maximal heart rate decreased with aging (max. heart rate = 220 - age) – Increased end-diastolic and end-systolic left ventricular volumes
• Diastolic dysfunction – Decreased early diastolic filling – Increased reliance on atrial contraction – Increased vulnerability to congestive heart failure, especially with atrial fibrillation
• Decreased compliance of peripheral blood vessels – predisposes to systolic hypertension, left ventricular hypertrophy of heart
• Increased incidence of atherosclerotic cardiovascular disease
• Increased incidence of degeneration of cardiac conduction system
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Cardiovascular System
• The resting cardiac output can remain stable with conditioning exercise in the absence of disease however the output with exercise will be reduced even in healthy aging.
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Disease PresentationDisease Presentation• Atypical symptomatology
- Chest pain less frequent- Exertional dyspnea or fatigue more common- ‘Gastrointestinal’ symptoms more common- Confusion, dizziness, other CNS symptoms
• Non-diagnostic ECG due to co-founding factors
• Most MIs are Non ST Elevation MI
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For older people this means:For older people this means:
• Decrease in capacity to cope with the demands of physical activity.
• Simple daily tasks become less achievable.
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Changes in Pulmonary Changes in Pulmonary PhysiologyPhysiology
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Changes in Pulmonary Changes in Pulmonary PhysiologyPhysiology
• Decreased elasticity – Decreased vital capacity – Increased residual volume
• Decreased structural support for small airways – Decreased number of small airways open
during normal breathing
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For older people this means:For older people this means:
• Poor effort tolerance
• Greater susceptibility to infections• Pneumonia• TB• Viral Infections
• Difficulty to differentiate between ageing process and environmental damage
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Respiratory SystemRespiratory System• Reduced - Lung surface area
- Alveolar elasticity - Forced Expiratory Volume (FEV 1)
- Maximal Oxygen Consumption (VO2 max) - P O2 • Increased - Chest wall stiffness
Osteoporosis and kyphosis can reduce the thoracic capacity. That and alveolar stiffness leads to “senile emphysema” with an FEV1/FVC < 70% of the predicted for age and gender
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Respiratory functionRespiratory function
• Alveolar function unchanged with age
• Noticable change is reduction in lung compliance
• Also loss of elasticity and reduction in strength of muscles of rib cage reduces usable lung capacity to 82% maximum value by age 45; 62% at age 65; and 50% at age 85
• Over time some alveoli replaced by fibrous tissue
• Gas exchange reduced
• Main problems arise with increased demand (exercise)
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SMOKINGSMOKING
Never smoked
Stopped at 45y
Smoker
Stopped at 65y
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Renal System
– Loss of diurnal excretory pattern increasing nocturia
– Loss of nephrons
– Reduced plasma blood flow and GFR
– Serum Creatinine will not reflect the GFR as the muscle mass is reduced.
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Changes in Changes in Renal/Fluid/ElectrolytesRenal/Fluid/Electrolytes
• Decreased glomerular filtration rate, renal blood flow, creatinine clearance.
• Decreased adaptive mechanisms: – Decreased salt conservation – Increased risk of volume depletion – Increased risk volume overload with saline
• Decreased free water conservation – Decreased maximal urine concentration
• Decreased sense of thirst
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Aging and RBFAging and RBF
20 50 80
Age
600
ml/min
300
Note: Arterial collagen deposition increases with age; there is gradual cortical glomerular scarring
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Aging and GFRAging and GFR
20 50 80
Age
150
ml/min
75
Note: Glomerular filtration pressure autoregulation is less effective in the elderly
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Changes in Fluid & Electrolytes
• Relative excess of antidiuretic hormone (ADH)
• Alterations in renal potassium handling
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For older people this means:For older people this means:
• Possible Water intoxication
• Hyperkalemia
• Increased risk for dehydration
• Increased drug toxicity
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Renal functionRenal function
• Vessels supplying nephrons can become atherosclerotic• Fall in GFR may occur• Affect kidneys ability to excrete metabolites and drugs• At age 80, reduced to 50%• Consequences on homeostasis (eg)• Main problem is reduced ability to respond to salt load
or depletion• Acid base balance• Urinary incontinence
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Musculoskeletal ChangesMusculoskeletal Changes
• Decrease in muscle weight relative to total body weight
• Changes in water content of cartilage
• Bone loss in both sexes but more pronounced in women
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For older people this means:For older people this means:
• Chronic pain
• Decrease in functional ability contributing to morbidity
• Lack of independence leading to decreases in quality of life
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Neuromuscular Neuromuscular
• Reduced propioceptive information
• Delayed nerve conduction
• Reduced numbers of motor neurons
• Reduced fast twitch fibers
• Reduced muscle mass
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For older people this means:For older people this means:
Plan simple movement tasks Longer transition times Lots of verbal and visual cues Functional moves.
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Changes in Strength with Aging
• Opening the cap on a jar:
– Completed by 92% of men and women between 40 – 60 years of age
– Completed by 32% of men and women between 71-80 years of age
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The Digestive SystemThe Digestive System
Motility Secretion Absorption
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• General decrease in taste due to
decreased central sensation.
• Decreased salivary volume.
• Formation of fissures and furrows on the
tongue.
Age Related Changes of TasteAge Related Changes of Taste
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Gastrointestinal System:Gastrointestinal System:
• Smooth muscle contraction diminished.
• Deterioration of structures in mouth common.
• Decline in efficiency of liver.– Reduced ability to aid in digestion and metabolism of certain
drugs
• Impaired swallowing.– Stomach sphincter valve loss.
• Decrease in nutrient absorption.
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For older people this means:For older people this means:
• Constipation is common.
• Poor fitting dentures.
• Increase in heartburn.
• Malnutrition due to deterioration of small intestine.
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Standard eating environmentStandard eating environment
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Improved eating environmentImproved eating environment
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“The secret of staying young is to live honestly, eat slowly, and…….
lie about your age.”
Lucille Ball