Physiology of aging

1. Physiology of aging Katarzyna Szczerbińska, MD PhD Institute of Public Health Jagiellonian University Medical College Krakow, Poland CHANGE Project

2. Aging is a physiological process The essence of aging is gradual limiting of efficiency reserves of particular: • organs, • systems and • the body as a whole. CHANGE Project

3. Characteristics of aging process: • Genetic predisposition • Not even among older people • Many chronic diseases (3-4) • Symptoms of pathology often unrecognized • Geriatric giant syndroms (falls, pressure ulcers, dementia etc.) CHANGE Project

4. Aging of the cardiovascular system • myocardial walls are more rigid, whichhinders left ventricular diastole, and as a result, prevents the increase in diastolic volume The ventricles cannot be adequately filled with blood ! • reduced sensitivity of beta-receptors The heart is not able to increase its rate sufficiently! CHANGE Project

5. The result of aging of heart • A reduced tolerance of physical effort ! CHANGE Project

6. Aging of blood vassels • Arteriosclerosis causes stiffness of arteries. • Some individuals develop a tendency to a sudden hypotension soon after getting up (orthostatic hypotension). • A venous valve dysfunction promotes the development of varices Some advices concerning life style • avoiding a passive lifestyle and obesity • modified diet may prevent those conditions CHANGE Project

7. Ageing of the respiratory system- changes in the chest • increased chest rigidity (barrel-shaped chest) • reduced strength of the intercostal muscles • abdominal mode of breathing • A result: • lung vital capacity (VC) and • tidal volume (TV) become reduced. An elderly person has a shallow breath and is unable to inhale a lot of air during a deep breath. Impaired ventilation promotes lung and bronchial infections. CHANGE Project

8. Ageing of the respiratory system–changes in lungs • lung elasticity decreases • fine bronchioles collapse • alveoli are unevenly ventilated and • the lung surface of oxygen and carbon dioxide exchange is reduced • the sensitivity to O2 is reduced by 50%, and to CO2 - by 40% CHANGE Project

9. Ageing of the respiratory system–changes in lungs Result: • Maximum Breathing Capacity (MBC) of the respiratory system is reduced by 40% and • the blood oxygen saturation (oxygen pressure in blood) is decreased by 0.3% with each year of life. • Effort tolerance is reduced ! CHANGE Project

10. Ageing of the alimentary system • drying of the oral mucosa, • loss of teeth, • gum inflammation caused by maladjusted dentures, • all of them impair munching food. • A reduced oesophageal peristalsis • prolongs the process of swallowing. • impaired sense of smell and taste (‘tasteless food’ ) • use too much salt or sugar • loss of appetite • reaction of the hypothalamic thirst centre to water deficiency is reduced • dehydratation CHANGE Project

11. Ageing of the alimentary system • Atrophy of parietal cells in the stomach causes decreased secretion of digestive juice • deficiency of vitamin B12 (megaloblastic anemia, neurological symptoms) • Lactase deficiency in the small intestine • manifested as diarrhoea after milk ingestion. • Reduced intestinal absorption • deficiency of vitamins (e.g. folic acid, vitamin D3) and minerals (calcium, iron, zinc) may causeanemia, osteoporosis • Reduced intestinal muscle tonus and decreased peristalsis • constipation • Decreased tonus of the rectal sphincter • faecal incontinence CHANGE Project

12. These problems my be prevented by: • a well-adjusted denture • modification of meals, involving food fragmentation • drinking adequate amounts of liquids • salt and suger reduction in food • use of herbs, peper, citron, vinigar to improve taste • avoiding lasting for months intervals in drinking milk, • taking vitamin B12 and • keeping high-fiber diet CHANGE Project

13. Aging of liver • reduced potential of liver regeneration • decreased liver mass by aprox. 20%. • reduced proteins synthesis • reduced drug metabolism Result: • Danger of drug accumulation • Need to adjust drug doses to age, liver condition and health status CHANGE Project

14. Aging of kidneys • reduction of kidney mass by approx. 25-30% and • glomerulosclerosis, leading to • the reduction of blood flow and glomerular filtration by 50-60% • impaired tubular absorption and secretion • As a result silent renal failure CHANGE Project

15. Aging of kidneys • Kidneys of older people are very sensitive to: • even a short-term ischaemia (due to sudden drop in arterial blood pressure caused by blood loose or dehydration due to vomiting, diarrhoea or low fluid supply), • nephrotoxic effects of drugs and • the consequences of urinary tract infections. Each of these conditions may lead to thedevelopment of renal failure and death. CHANGE Project

16. Changes in the lower urinary tract • reduced urinary bladder volume, • increased urine retention after urination, • shortened urethra and loosened sphincter in women, • and a benign prostate hypertrophy in approx. ¾ males older than 70 years. CHANGE Project

17. Changes in the lower urinary tract These changes lead to impaired urination, including: • nocturnal urination (1-2 times per night) (nycturia), • frequent urination, • tendency to urinary tract infections, • effort urinary incontinence in women, • difficulties in the initiation and completion of urination, and interrupted urine stream in men. Urination disorders may be a reason for reduced fluid intake by elderly people. CHANGE Project

18. Ageing of the immune system • disregulation of the immune system affecting the activity of T and B lymphocytes • disorders of cellular and humoral immune response • decreased production of antibodies • increased production of pathological antibodies (autoantibodies and monoclonal antibodies) CHANGE Project

19. The results of ageing of the immune system • Elderly people are more susceptible to infectious diseases. • Infections last longer and often have a more serious and untypical course. • Vaccinations are less effective • Higher incidence of neoplastic diseases CHANGE Project

20. Educational barriers for elderly people Katarzyna Szczerbińska, MD PhD Institute of Public Health Jagiellonian University Medical College Krakow, Poland CHANGE Project

21. Hearing deterioration with age • In 30% of the elderly the cause is ear wax • loose the ability to hear high frequency tones after age of 40 In order to convey information to a person hard of hearing: • the source of noise should be removed • turn off the radio, television, • ask people in a room to quiet down • approach the patient speaking clearly face to face, so as to enable lip-reading. CHANGE Project

22. Language impairment of aphasia type • sensory aphasia – auditory comprehension impairment • motor aphasia – articulation impairment • mixed aphasia – sensory-motor impairment of comprehension and articulation. • Establishing the type of aphasia may make communication with a patient easier. CHANGE Project

23. Vision disorders • Visual acuity impairment due to hypermetropia • Reduced reaction to light • decreased accomodation ability, • a prolonged psycho-motor reaction • limitation of reading • a risk of injury CHANGE Project

24. Prevention of results of vision disorders • Visual acuity should be examined at least once a year by means of the Snellen chart and • an ophthalmological consultation should take place every 2 years • to detect vision impairment and cataract, glaucoma, age-related macular degeneration CHANGE Project

25. Education of older person requires: • Attention at old age is: • indivisible • largely dependant on sight • Learning older people requires: • greater number of repetitions • handouts • written in large font sizes. • Language used in health education of the elderly: • should besimple and precise • medical terms (medical jargon), metaphors should be avoided • long, complex sentences should be avoided • jokes should be told carefully CHANGE Project

26. References: • Abrams W.B., Berkow R., Fletcher A.J. The Merck Manual of Geriatrics. Merck Sharp & Dohme Research Laboratories Rathway, N.J. 1990. CHANGE Project