What’s Normal? What’s Not? · Physiology of Aging What’s Normal? What’s Not? Dr. Rick...
Transcript of What’s Normal? What’s Not? · Physiology of Aging What’s Normal? What’s Not? Dr. Rick...
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Physiology of Aging
What’s Normal?What’s Not?
Dr. Rick MachemerAdult Abuse Training Institute
“Exploring Justice and Support for Victims of Adult and Elder Abuse”
Albany, New York, October 30, 2019
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Current “Focus”~ Aging “just” happens~ Little to no control;
everything is genetic~ Outcomes: not good to
very poor
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Goals of Seminar~ Describe biological aging~ Understand biological aging –
dispel myths; perhaps diminish ageism
~ Distinguish between aging & disease
~ NO attempt to change your emotional reaction to aging
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What’s the “Big Fuss”?
“Aging is growing old, becoming less functional, developing disease,
becoming fully dependent…then dying…all alone, in constant pain,
and in an institution.”
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The Real Issues~ What’s successful
aging? ~ How to do it?~ How to separate
aging from disease?
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The Mythology of Aging* Being old means being sick* Aging is a disease…looking for a
cure * More of the same…nothing new
can be learned or done
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Myths - 2* Once there’s a ‘problem’, there’s
always a ‘problem’* Aging is entirely genetic – no
individual control – it just ‘happens’
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Myths - 3
* ALL physical and mental abilities decline (markedly)
* Persons who are older are a serious drain on all of society
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Myths - 4* Nothing can be done about aging;
accept it; get out of the way (i.e., disengage from life)
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What is “Reality”?
* Not all persons who are older are sick; function is less
* Likelihood of a disease is higher among persons who are older
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Realities - 2* Aging is a normal process; have
significant control* Control does not mean one can
slow/“stop” process
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Realities - 3* Learning is life-long activity,
not simply “school-based”; occurs more slowly
* Social engagement must continue
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Realities - 4* Bad habits => diminished
health status can be changed…
* Damage may be “reversed”; e.g., with smoking, metabolic syndrome
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Realities - 5* Outward look/function in aging…
more due to the environment and the life-long decisionsthan to genetics
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Realities - 6* Functions change; without
disease/disuse/disability, change is minimal; littledaily impact until “late” in life
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Realities - 7
* Persons who are older contribute in numerous ways: large amounts of time, energy, insight, wisdom, money
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Realities - 8* Attitude is critical (e.g., don’t
accept negative stereotypes)* Ageism is alive, well, and
prospering…BUT can be fought
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Challenges (of aging)
* Focus should be on health and wellness promotion… not on changing aging
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Challenges - 2
* Early detection of altered function and risk factors is critical
* Intervention with renewed focus on prevention is essential
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Challenges - 3
* Some diseases may not be avoided but can be substantially postponed
* Striving for “compression of morbidity”; i.e., (less time being “sick”)
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Challenges - 4
* Emergence of concept of the FRAILTY SYNDROME…A syndrome that’s as problematic as many specific chronic diseases
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Frailty – “New Kid”A biological syndrome of decreased
reserve and resistance to stressors resulting from cumulative declinesacross multiple systems causing increased vulnerability to developing adverse outcomes.
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Frailty – Phenotype~ Weight loss: >10 lbs. or 5% of
body weight~ Weakness: grip strength lowest
20%~ Exhaustion
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Frailty, Phenotype - 2
~ Slowness: slowest 20% for 15 feet
~ Low physical activity: lowest 20% of Kcal expended/week
NOT =>
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Challenges - 5
* Exercise is an ABSOLUTE MUST!* Physical exercise often seriously
lacking; mental function helped by physical activity
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Challenges - 6
* Sound nutrition: ABSOLUTE MUST!
* Fad diets and pills/potions are to be avoided
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Challenges - 7
* Solitary lives “don’t work”* Social and emotional support
affects physical function (mind-body connection => brain changes)
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Challenges - 8
* HETEROGENEITY OF AGING: tremendous variety/variability among persons who are older
* Variety of approaches needed to meet needs of all persons
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Challenges - 9
ATTITUDE ABOUT AGING: need realism; difficult to change; must permeate society~ neutral view; positive is better~ difficult to teach; must emulate
when modeled
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Remember…Aging at societal level
is NOT viewed as ‘positive’ situation
(focus: issues, problems, concerns)
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Upside (of Aging)~ Living much longer~ Living much healthier~ Adequate knowledge to prepare
for next stages~ Realistic interest, not just anti-
aging
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Downside (of Aging)
~ Little individual preparation~ Minimal societal preparation;
reactive, seldom proactive~ Service systems – past era design~ Unrealistic focus – to stop aging
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How long do we live?
Life Expectancy Life Span
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LIFE EXPECTANCY~ How long one can live (beyond some specified point in time)
~ Changeable; better environment => L.E.↑
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Facts/FiguresIn 2019, % of persons in population who are older (> 65y):
~ 15.2%; 49.2MBy 2050, will climb to:
~ 19-20%; 79.6M
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Demographics - 2
Current numbers/projections:~ 5.9 million over 85~ 19.7 million by 2060 (~334%↑…to 4.7% of total US pop.)
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LIFE EXPECTANCY General Population
Dramatic increase during past 119 years (due primarily to meeting needs of children):
1900: ~ 47 yrs.2019: ~ 79.25 yrs. (as mixed
non-adjusted L.E.; 43rd in the world; Monaco #1 (89.37 yrs.); shortest Chad 50.96 yrs.; female L.E. always greater
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LIFE EXPECTANCY - 3
WHY the dramatic change?Better: nutrition, public health, sanitation, immunization, antibiotics, environment in general; more preventative than curative
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LIFE EXPECTANCY - 3
WHERE have the years been added in life cycle?~ Primarily early in life (infancy,
childhood)~ Less in “old age” (may change with
more effective medical interventions)
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LIFE EXPECTANCY - 4
Will this continuing increase in L.E. continue?
~ “Perhaps” in Baby Boomers~ Stabilizing in Generations X,
Y (Millennials), and Z (New Silent); now decreasing overall
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LIFE EXPECTANCY - 5
~ Widening gap between U.S. and Canada, Germany, Mexico, France, Japan, UK ~ L.E. inequity (between rich and poor) shrink ing in rest of world; increasing in U.S.~ Differs by city and by city vs. rural setting~ Decrease in L.E. may be due to diseases of despair (opioids, alcohol, suicides) & general lifestyle (obesity, lack of physical exercise)
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LIFE SPANMaximum time member of any particular species has been observed to live.
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LIFE SPAN - 2
Genetically-determinedHuman:
> 122.5 years
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LIFE SPAN - 3
Jeanne Calment, Paris, France. 122 years, 164 days (2/21/1875 to 8/4/1997)
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But......what is the phenomenon
we call AGING?
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Brain is a fresh, new delicate egg. Aging is iron frying pan. Frying pan hits egg…it’s all over! Aging is this process but carried out more slowly. Yes? No?
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Another perspective:left hand falls off onto sidewalk…“Nothing to worry about. It’s all part of the aging process.” Yes? No?
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Aging...Everything that happens from
conception to death; = CHANGEGrow, develop, maintain,
repair/renew/replace, decline, eventually die
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Model of AgingFunctional:~ Successful~ Usual~ Pathological
“Gene/environmental interaction”
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GenesContinuum: from most positive (confer greatestpotential) to the most negative (confer leastpotential)
(Positive=> Neutral=>Negative)
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EnvironmentContinuum: from most positive circumstances (=> greatest potential) to most negative circumstances (=> least potential)
(Positive=> Neutral=>Negative)
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SUCCESSFUL(The “Narrow” Biological Description)
* Positive genes – positive environment
* Minimal functional change, 25-75 years; i.e., can do at 75 almost what was done at 25
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SUCCESSFUL - 2
* “Look” different; function is OK
* NO DISEASE
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USUAL(The “Narrow” Biological Description)
* Less positive genes in less positive environment
* “Obvious” functional loss; no testing needed to determine this; obvious to “everyone”
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USUAL - 2
* SOME DISEASE* Requires compensation by person or modification of environment for full function
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PATHOLOGICAL(The “Narrow” Biological Description)
* Negative genes in a negative environment
* Major disease leads to the “serious” functional limitations
* SUSTAINED INTERVENTION needed to sustain life
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Control and Coordination
NOTHING in the body functions… without constant control and coordination
(under normal and non-disease conditions)
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Homeostasis…A condition of relative functional constancy
within a continually and rapidly changing environment
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“Current Model”ABSOLUTE UPPER LIMIT
DEATH
“UPPER RESERVE” USUAL UPPER LIMIT
“NORMALCY”
USUAL LOWER LIMIT“LOWER RESERVE”
DEATH ABSOLUTE LOWER LIMIT
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“New Model”ABSOLUTE UPPER LIMIT
DEATH
“UPPER RESERVE”USUAL UPPER LIMIT
“NORMALCY”USUAL LOWER LIMIT
“LOWER RESERVE”
DEATH ABSOLUTE LOWER LIMIT
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Usual limits widen =Relaxation of
homeostatic limits~ changes are successful aging ~ nothing to “fix”; (nothing “wrong”;
normal; happens in everyone)
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Cause of deviation from normalcy?
STRESS(…and what is stress?)
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Stress !ANY physical or emotional change
that causes a function to move outside usual homeostatic limits
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Problem…~ Time for an adequate stress response may be “too long”;~ Function exceeds absolute limit => death~ Medical focus: intervene to prevent this change
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What’s an effective counter to the slower
stress response?MINIMIZE the
environmental press (i.e. make the environment less “hostile”)
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So…...if this slowed stress response and change in homeostasis is
“aging”, what isSUCCESSFUL
AGING?
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Remember…Aging seems to be the only available way to
live a long life.Daniel-Francois-Esprit Auber
(French [opera] composer, 1782-1871)
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Successful Aging
What happens when one ages w ithout
any disease? (to mid-70s and perhaps beyond)
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NERVOUS SYSTEMFewer cells in some areasSlower information movementFewer connectionsNew connections can be made with continued use
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MENTAL FUNCTIONNO decline in IQ; (changes)Memory intact; slowerSome interference with short term memory
General slowing of cognition
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“BRAIN FITNESS” – How?Mental exercise - ??Physical exercise - YESChallenging leisure activities - ??Achieve mastery - ??Strong social relationships – YES?Technology use - ??
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SENSORYVISIONLens stiffens; more farsightedMore difficult to see small itemsLess light into eye; need some
increase in brightness
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SENSORY - 2AUDITIONHear fewer of high tonesMore difficult to screen out
background noise
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SENSORY - 3
TASTESome decrease in sense of
tasteMore attention to flavors in
foods
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SENSORY - 4
SMELLLess sensitive to many odorsMay affect sense of taste
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SENSORY - 5
TOUCH/PRESSURELess sensitivityResponses vary widely due to
emotional impact
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SENSORY - 6
THERMALFewer sweat glandsLose heat less effectivelyThinner skin; less fat More sensitive to temperature
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MUSCULOSKELETALFewer muscle cells, more fatDecreased strengthContract more slowlyLess calcium in bonesJoints less flexible
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INTEGUMENTThinner skin; less protection to underlying blood vessels
WrinklingFewer sweat glandsLess hair, more gray
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DIGESTIVELess salivaSlowed swallowing reflexDecrease surface area in small intestine
Slower muscle movements
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CARDIOVASCULARSmall decrease in cardiac reserve
No change in rate or forceResponse rate to stress slowed
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CARDIOVASCULAR-2
Blood vessels slightly less elastic; slight/some ↑ B/P
Little to no change in capillary function
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RESPIRATORYLungs slightly stifferSmall decrease in surface areaLittle to no change in respiratory activity
Slight increase in work to breathe
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URINARYSlower filtrationNo change in selectivityBladder wall may weakenInfections more common in female; may mimic dementia
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ENDOCRINESome slowing of responses to variety of hormones
Only major change is with female reproductive system
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REPRODUCTIVEFEMALEMenopause, less estrogenReproductive activity ceasesSlight change in secondary sex
characteristics
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REPRODUCTIVEMALEFewer sperm producedLess testosteroneProstate gland enlarges
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Words used to describe system changes?
Slight, small, very small, no change; no decline; slower; fewer
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In view of the challenges of aging,
what do we do?
Use Our Resilience
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Resilience ‘Simplified’
Stuff happens …it’s the bounce-back that
ultimately matters
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Emerging Issue
What does it take to live more quality years, not just more years?
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Living Successfully –Characteristics
(“Non-Biological” Meaning of Successful)
* Genetics: no control – not to worry; know history; epigenetics
* Health: manage current issues; screen for new conditions
* EXERCISE: physical and mental
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Successful - 2
* Safety: be reasonable* Engagement: reason to live* Creativity: actively stimulate; try
new things, master something* Attitude: positive but realistic
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Successful - 3
* Education: gain as much as can* “Work”: continue “something”* Relational status: network of
friends; make new ones * Nutrition: eating habits
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Successful - 4
* Living arrangements: lesschallenging – more appropriate
* Reliance: less on social programs and more on individuals
* Embrace change
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Successful - 5
Use it (with a positive attitude)…
or lose it
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Successful AgingNOT EASY; NOT SIMPLE
Lifestyle – BIG roleGenetics – smaller role
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YEAHBUT…Are we ready to participate?Will we plan…and change? Will it take a crisis/many crises?
There is choice…and it is our choice.
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Physiology of Aging
What’s Normal? What’s Not?
Dr. Rick Machemer([email protected])
Adult Abuse Training Institute“Exploring Justice and Support for Victims of
Adult and Elder Abuse”Albany, New York, October 30, 2019