Professional Documents
Culture Documents
WHAT IS AGEING?
Here are two ideas that most people in Western cultures would agree on:
• ageing is something that affects everybody,
• ageing results in functional decline and is at best a challenge, at worst a
burden.
However, in cultures which venerate (=revere) age, the changes that occur
may be viewed as welcome and desirable.
This shows us one important idea about ageing:
The way that we interpret ageing is important because the way that the ageing
population view themselves,
themselves, and th
the
e way that they are viewed by o
other
ther sectors
of society, has a significant impact on the provision of aged care services.
This means that your perceptions impact on the way that you provide care and
on the way that your clients receive care.
To provide the best quality care for the aged, you must have a positive outlook
ou tlook
on ageing and the aged care process.
For the aged to receive the maximum benefit from care, they must be receptive
(= willing
willi ng to listen to or to accept new ideas or suggestions) to it, and actively
participate in it.
Once we accept that the way in which we interpret ageing matters, we need to
think about how we define ageing - in other words what shapes our
perceptions. There is no one right answer; people will think about ageing
variety of ways.
2
occurs over time".
“… a progressive, generalized impairment of function, resulting in an
increasing vulnerability to environmental challenge and a growing risk of
disease and death”.
The common concept in these definitions is the loss of function. This leads us
into the core aim of aged care:
Function determines
1. a person's ability to live independently;
independently;
Preventing or curing disease does not necessarily mean that people will retain
functional capacity, but functional capacity can be maintained in the presence
of disease.
2
Masoro EJ and Austad SN (2001), Handbook of the Biology of Ageing, 5th edn, San Diego:
Academic Press.
This is a critical idea and you need to think carefully about its implications. Is it
more important to be free of disease or to maintain function?
Everybody will think about ageing in a way that reflects their own interests.
Ageing occurs at many levels:
• social,
• psychological,
• physiological,
• morphological,
• cellular, and
• molecular.
To a cell
c ell biologist, agein
ageing
g is primarily a change that occurs at the molecular
level in cells.
To a sociologist, it may be principally a change in a person’s engagement with
society.
However, the changes are not unrelated.
Even complex sociological changes are the result of changes that are occurring
at the level of molecules and cells.
The evolutionary approach says that ageing is part of our genetic make-up.
The term evolution implie
impliess that ageing is something that is selected for
because it enhances the survival of the species.
But why would ageing, which results in our functional decline, enhance
survival?
One explanation is that the genes which are associated with ageing have a
positive effect on survival early in life .
Those early benefits result in the genes being selected for and therefore
passed on to future generations.
The fact that they also cause adverse effects later in life is irrelevant.
Evolution occurs together with sexual reproduct
reproduction.
ion.
Once reproduction has ceased, the direct effects of evolution also cease.
In purely evolutionary terms, we could die as soon as our
o ur reproductive life is
complete, and some species, such as salmon and spiders do this.
Although they are different things, thinking about the relationship between
ageing and longevity helps us to understand the evolutionary theory.
Can you explain the relationship between ageing and longevity? Would the
elimination of ageing lead to immortality?
Ageing and longevity are different, although th
they
ey are related tto
o each other.
An increased rate of ageing will decrease longevity.
However longevity can be shortened by diseases which have no relationship to
the ageing process.
In order to achieve immortality it would be necessary to prevent both ageing
and disease.
3 LeBourg E. Evolutionary theories of aging can explain why we age. Interdisciplinary Topics in Gerontology.
39:8-23, 2014.
Another alternative is that longevity may have a role in the survival of the
family group, and therefore the long term endurance of the genes.
It is easiest to understand this concept by going back to prehistoric
(=connected with the time in history before information was written down)
times-if your family carried genes promoting longevity there would be more
older family members who would be available to care for children while
younger family members were hunting or collecting food.
The fact that your family was long-lived supported better food collection and
childcare and therefore better survival.
The organistic approach describes the most obvious changes associated with
ageing - the effects on the gross function of the individual.
These are the easiest changes to observe, and in practical terms, are of the
greatest significance.
The organistic approach is more concerned with effect than cause, but may
indicate the areas where research can be focused to identify the cause of age-
age -
related changes.
The cellular approach focuses on ageing at the level where the basic changes
▪ Changes at the molecular level affect normal cell function and therefore
ultimately the overall function of the organism.
o rganism.
4 Lopez-Otin
C. Blasco MA. Partridge L. Serrano M. Kroemer G. (2013) The hallmarks of aging. Cell.
153(6):1194-217.
2. WHY DO WE AGE?
Why is an understandin
understanding
g of the mechanism of ageing important?
One good reason is to help us to assess the claims of the various (usually
expensive) anti-ageing strategies that are now available.
More importantly, it helps us understand why people lose function and
become more susceptible to diseases as they age.
threatening diseases.
However, this gratifying (=pleasing and giving satisfaction) longevity rise is
accompanied by growing incidences of devastating age-related pathologies.
Understanding the cellular and molecular mechanisms that underlie (=to be the
basis or cause of something) aging and regulate longevity is of utmost
relevance towards offsetting the impact of age-associated disorders and
increasing the quality of life for the elderly.
Several evolutionarily conserved (=protect something and prevent it from being
changed or destroyed) pathways that modulate (=affect
( =affect something so that it
becomes more regular, slower, etc.) lifespan have been identified in organisms
ranging from yeast to primates (=any animal that belongs to the group
of mammals that includes humans, apes and monkeys).” 5
As we think about individual theories, there is one key concept that you will
need to keep in mind.
The human life span is finite, with an absolute upper limit of about 120 years.
This fact is used to support the view that the lifespan is genetica
genetically
lly
programmed .
The program limits the number of times cells can divide and reproduce
themselves.
Another way to look at the idea is to think that cell death is programmed.
6
Tosato,
M., Zamboni, V., Ferrini, A., & Cesari, M. (2007).
(2007). The aging process and potential
interventions to extend life expectancy.
expectancy. Clinical interventions in aging, 2(3), 401.
7 Mackenbach, JP; Kunst, AE; Lautenbach, H; et al. (1999) Gains in life expectancy after el imination of major
causes of death: revised estimates taking into account the effect of competing causes. Journal of Epidemiology
and Community Health 53: 32-37
One reason for this appears to be that the telomeres shorten
shorten each times a cell
divides.
They “cap” each chromosome and are often likened to (=compare one thing
or person to another and say they are similar) the hard ends of shoe laces that
stop the lace from fraying (=if cloth frays , the threads in it start to come
apart).
Telomeres perform a similar function in the chromosome.
They also adjust the cellular response to stress and growth stimulan
stimulants.
ts.
The telomeres shorten each time a cell divides, and when they become too
short, the chromosomes are unprotected.
Apoptosis, or cellular senescence/death, is triggered when too many
“uncapped” telomeres accumulate. 8
Cells contain the enzyme telomerase which can repair shortening telomeres,
but its activity is limited in most cells.
In long-lived mammals, cells can only divide about 40 times before the
telomeres become too short to function and the cell becomes senescent (=old
and showing the effects of being old).
Senescent cells secrete proinflammatory factors and reactive oxygen species
spe cies
that accentuate (=emphasize something or make it more noticeable) the
ageing process and create the perfect conditions for cancer development.9
Telomeres become shorter as cells divide, and when they become too short
the cell becomes senescent.
A variety of
o f sustained psychosocial stresses in adulthood appear to be
There appear to be other genetic factors that influence ageing, including the
regulation of gene expression.
8 Aubert G, Lansdorp PM. Telomeres and Aging. Physiol Rev 88: 557 – 579,
579, 2008;
9 Pereira B. Ferreira MG. (2013) Sowing the seeds of cancer: telomeres and age-associated tumorigenesis.
Current Opinion in Oncology. 25(1):93-8.
10 Price LH. Kao HT. Burgers DE. Carpenter LL. Tyrka AR. (2013) Telomeres and early-life stress: an overview.
Although mice and bats have only a 0.25% difference in their DNA sequences,
the maximum lifespan of mice is about 2.5 years, compared with 25 years for
bats.
(Remember that longevity is not the same as ageing, but the ageing process
certainly has a significant imp
impact
act on longevity).
Although the genomes are very similar, the expressions of genes, and the
proteins that are produced, differ greatly.
It is the difference in gene expression that accounts for the difference in
longevity.
Silencing specific genes has been shown to increase the lifespan of yeasts.
Although yeasts are very different to mammals, the control of cell division is
similar in both groups.
(Note the difference – with mice and bats we are talking about whether or not
a single gene is being expressed, which means used to produce
pro duce proteins.
Just because genes are present doesn’t mean they are expressed.
In progeria the issue is a mutation that result
resultss in an abnormal copy of a gene.)
To summarise – a person’s genes, and the way in which those genes are
expressed plays a role in determining the rate of ageing.
Damage to the DNA may have a major part to play in the ageing process, and
free radicals (or reactive oxygen species - ROS) are
ar e an important cause of DNA
damage.
ROS are by-products of aerobic metabolism, the energy producing process
which occurs in the mitochondria of cells.
Because aerobic metabolism occurs continuously, ROS are always being
produced.
Because ROS are produced by the basic functions of life, their impact on ageing
is considered to be part of normal “wear and tear”.
ROS are produced by metabolic pathways essential for life, but they can
damage DNA and accelerate ageing.
11 Tezil
T; Basaga H. Modulatio
Modulation
n of cell death in age-related diseases.
diseases. Current Pharmaceutical
Pharmaceutical Design.
20(18):3052-67, 2014.
Glucose, which is essential for life, can damage proteins and accelerate
a ccelerate
ageing.
Other wear and tear related causes of DNA damage include the intrinsic
12 Fulop T; Witkowski JM; Pawelec G; Alan C; Larbi A. On the immunological theory of aging. Interdisciplinary
Topics in Gerontology. 39:163-76, 2014.
Inflammation may accelerate ageing.
Mitochondrial dysfunction
dysfunction is another emerging explanation to ageing.
with ageing.
There is considerable interest in the interactions between gut microbes and
function in various body systems.
It is likely that in the future considerable research will be conducted looking at
the influence of gut microbes on the ageing process.
Listing all the potential contributors to ageing shows just how complex the
process is, and how difficult it will be to stop it from occurring.
Can you describe the two main processes that are believed to drive the
process of ageing?
The two main theories are the genetic theory and the environmental theory.
Each has several component
components.
s.
Can you explain why it is unlikely that there will ever be a single drug that
will prevent ageing?
Ageing is a multi-factorial process.
process.
It has both genetic and environmental components.
Any drug that was to prevent ag
ageing
eing would need to pr
prevent
event all these changes
from occurring.
It is likely
l ikely that many of the factors contributing to ageing are also essential
essential for
life.
Changes in cell and organ function cause the body to lose the ability to control
its internal environment.
In other words, ageing is due to failure of homeostasis.
Once the body is unable to control its internal environment, it loses the
capacity to function normally.
However, appreciating the difference between ageing and disease can be vital
– it can influence how the person manages their own health, and how health
professionals provide care.
Because ageing and disease often coexist, we can extend our key concepts to
include these ideas.
13 Rea
IM; Dellet M; Mills KI; ACUME2 Project. Living long and ageing well: is epigenomics the missing link
between nature and nurture? Biogerontology. 17(1):33-54, 2016
Many of the functional changes which are attributed to ageing may in fact
be due to disease, and be reversible.
In order to survive, we need to be able to cope with stresses that exceed those
normally placed on the body.
To do this, organ systems have a maximum capacity that exceeds the
requirements for normal functioning.
functioning.
This reserve is called upon when the body system is damaged or stressed.
A good example is the cardiovascular system - during exercise our
o ur heart rate
increases to pump extra blood around the body to meet our metabolic needs.
The reserve capacity concept states that body systems are mostly working at
less than the maximum capacity.
Body systems can increase the amount of work they are doing in order to cope
with stress.
The difference between the usual capacity being utilised, and the maximum
possible capacity is known
known as the reserv
reserve
e capacity.
Younger people have a larger reserve capacity than older people because the
maximum capacity in any body system is larger.
As people age the maximum
maximum capacity falls, a
and
nd therefore tthe
he di
difference
fference
between the capacity required for normal function and the maximum capacity
decreases. People may be able to function perfectly well when only normal
capacity is required, but the loss of reserve capacity may diminish the ability to
cope with stress.
Beyond age 30, physiological function declines at a rather consistent linear rate
of 0.5% to 1.3% annually.15 This affects all body systems, as the following
extract shows.
1. Normal ageing
14 Manhapra A. Why is chronic kidney disease the “spoiler” for cardiovascular outcomes:
an alternate take from a generalist. J Am Coll Cardiol. 2004;43(5):924.
15 Strehler BL, Mildvan AS. General theory of mortality and aging. Science. Jul 1
1960;132:14 21.
y
t
i
c
a
p
a
c
l
a
n
o
i
t
c
n
u
F
Age in years
This diagram illustrates the normal change in functional capacity
c apacity that occurs
with ageing.
Functional capacity increases until the third decade of life and subsequently
progressively decreases with age.
In this diagram assume that a functional capacity of 10 units is necessary in
order to avoid disability.
You can see that this level of function is not reached until the person is at an
extremely old age.
A very young child has not achieved this level of function, and consequently
consequently
can’t look after themselves.
The reserve capacity is the distance between the curve and the 10 unit line.
Reserve capacity falls with age even though functional capacity may be
sufficient to enable a person to live a normal life.
y
t
i
c
a
p
a
c
l
a
n
o
i
t
c
n
u
F
Age in years
In this diagram, peak capacity is higher than it was in the preceding diagram.
Although function is lost progressively with age, because the loss began from a
3. Effects of disease
y
t
i
c
a
p
a
c
l
a
n
o
i
t
c
n
u
F
Age in years
In this diagram, the person was affected by disease at about the age of
o f 70, and
as a result there was an increase in the rate at which reserve capacity was lost.
As result, this person experienced disability in later life.
y
t
i
c
a
p
a
c
l
a
n
o
i
t
c
n
u
F
Age in years
5 The effects of temporary stress on function
functional
al capacity
y
t
i
c
a
p
a
c
l
a
n
o
i
t
c
n
u
F
Age in years
At the age of 40, the large reserve capacity meant that the person did not
suffer any disability.
However the age of 80, functional capacity fell below the 10 unit threshold
that signifies (=to be a sign of
o f something) disability.
In this case the person would experience a period of disability.
A good example of this is delirium that develops in people suffering from
severe infections.
It is important to note that functional capacity may return to the previous level
quickly when the stress is removed, or that recovery may be prolonged.
pro longed.
In other words, the disability may last far longer than the disease itself.
In some cases, functional capacity will never return to its previous level.
they have lost 20% to 40% of the contractile strength of voluntary muscles, and
50% by the 9th decade.
16
16 Neustadt J and Pieczenik S. Organ Reserve and Healthy Aging. Integrative Medicine. 7(3): 50-53. 2008
But it is also important to recognise that people age at their own rate – this is
The level of maximal organ reserve does not necessarily correlate with
chronological age because both the onset and the progression of decline show
profound individual variations.
variations.
A study:
They measured cardiac output in 67 male volunteers aged 19 to 86 years
(average 52.5 years) with no diagnosed circulatory disorders.
In regression (=the process of going back to an earlier or less advanced form or
state) analysis, cardiac output showed a significant average decline of
approximately 1% per year after the third decade of life (P<.001), but the
standard deviation was 21.8%.
This large standard deviation means that many participants had much lower or
higher rates of decline.14
Physiological function decreases with age, but the rate of the decrease
d ecrease varies
from person to person.
The main effect of this physiological decrease is a reduction in the reserve
capacity.
The key issues in gerontology (=the scientific study of old age and the process
of growing old)
Although they are not the focus of this unit of study, it is important to
recognise the key goals in the practice of gerontological care. The focus should
always be on maintenance, particularly the maintenance of
• physical and cognitive function,
• quality of life, and
• independence.
Addressing these needs provides the best outcomes for older people.