PHYSIOLOGY OF AGING

1. PHYSIOLOGY 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”

2. AGING 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

3. Changes in Physiology with Aging • 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.

10. “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

11. Factors affecting aging of facial features Smoking Exposure to sun Use of alcohol BMI BMI = kg/m² <18.5 = Underweight 18.5-24.9 = Normal 25-29.9 = Overweight 30 or more = Obesity

12. “O” Complex of Geriatric Medicine

13. Changes in Physiology with Aging • 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.

14. Changes 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

15. For older people this means: • Sensory Deprivation • Increased risk for falls • Decreased quality of life

16. Vision

17. Eyes – 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

18. SYMPTOMS • Cannot get glasses clean • Difficulty night driving • Difficulties reading • Double vision (in one eye)

20. Normal Lens

21. Cataract

22. What is your vision like with cataract?

23. Monet’s painting - Before

24. Monet’s painting - With

25. זווית פתוחהGlaucoma

26. Age-Related Macular Degeneration

27. Risk factors for AMD • Increased age • Female gender • Lighter iris color • Race • Smoking • Sunlight Exposure

29. Diabetic Neuropathy

30. Hearing Loss

31. Ears – Loss of elasticity in inner ear leading to loss of high frequency hearing. – Sounds from speech is distorted due to poor quality amplification

32. Changes in Auditory and Visual Function with Age • Sensorineuralhearing 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.

33. Overview 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.

34. Signs 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

37. Changes 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

38. For older people this means: • Sensory Deprivation • Increased risk for falls • Decreased quality of life

39. Changes in Heart

40. The Cardiac Cycle Cardiac Cycle Cardiac Output (CO) = Stroke Volume (SV) x Heart Rate (HR)

41. Changes in Cardiovascular Physiology • 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

42. 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.

44. Disease 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

45. For older people this means: • Decrease in capacity to cope with the demands of physical activity. • Simple daily tasks become less achievable.

46. Changes in Pulmonary Physiology

47. Changes in Pulmonary Physiology • Decreased elasticity • Decreased vital capacity • Increased residual volume • Decreased structural support for small airways • Decreased number of small airways open during normal breathing

48. 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

49. Respiratory 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

50. Respiratory 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)