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DR. SHRINIWAS KASHALIKAR
We have to distinguish the handicap or dysfunction that results from the diseases; and the changes resulting from the natural process of aging that takes place in the absence of diseases. We can appreciate that such distinction is quite difficult. Most of us suffer from ailments such as infections, malignancies, diabetes, IHD, as well as environmental onslaughts in the form of ultraviolet radiation, heat, cold, pollution, food additives, allergic substances, physical and chemical injuries etc apart from psychological inflictions! But still the changes, which take place after forty and fifty; in the absence a history of gross or major diseases or accidents; roughly represents the true aging and is generally attributed to two basic facts 1) Genetic program, which decides the range of the longevity of life for a specific species and determines the time dependent loss in structure and function characterizing senescence and death and 2) Accumulation of injuries or micro insults: Since very little is understood in this respect; there are many theories based on these two tenets meant to explain aging. Since they focus on a specific change, they are inadequate in isolation; but together they do give us some insight into the process of aging. THEORIES OF AGING:
A] The Error Catastrophe Theory: Random increase in errors of protein synthesis i.e. defects in the processes involved in protein synthesis called transcription and translation. But aging processes seem to be posttranslational (i.e. after the proteins are completely synthesized) modifications. Further, in senescent cells accumulation of misspelled proteins is not found and induction of synthesis of erroneous proteins experimentally does not give rise to ageing. Thus there is possibility of that errors are not causes but merely coexisting with aging processes. B] Somatic mutation theory: This suggests that there is age associated increase in chromosomal aberration. This is suggested to give rise to progressive increase in inefficient cells leading to organ dysfunction. C] Free radical theory: Accumulation of metabolic waste products and radical mediated cell damage e.g. hydroxy peroxide, aldehydes and ketones, superoxide radical, singlet oxygen and hydrogen peroxide. If this were so, we would expect lipid peroxidation at cellular level, which is not demonstrated in aging. Further, the antioxidants which we expect to delay aging are not proved to do so! D] Ionizing radiations and such other environmental factors may cause cell injury. This could be so; but the cause and effect
relationship and the quantitative aspects; are not yet demonstrated to cause aging by themselves! E] Cellular dysfunction in tissues such as CNS, endocrine and immune system; influences other systems and causes aging! Thus decreased synthesis, increased breakdown, decreased receptor number, decreased Hormone-Receptor (HR) combination, decrease in HR internalization etc may be responsible for aging. These are merely physiological interactions (associated with aging) amongst tissues; and cannot be called mechanisms or causes of aging. F] Sedentary jobs, late night parties, noise, crowding, stress of highly competitive life, uncertainty of socio-political surroundings, consistent and protracted denial of the recognition and appreciation in life, habits such as excessive smoking, lack of enjoyable job, lack of promotions and incentives in jobs etc. and the plethora of stressors either not thought of or not given due importance and hence not mentioned in the text books; immensely expedite or aggravate (though do not constitute the basic mechanisms or causes as such) the aging process; and are described; in my books viz. “Stress: Understanding and Management” and Conceptual Stress: Understanding and Management”.
CHANGES DURING AGEING:
Overall changes in the body are loss and graying of hair starting with the temporal hair (side buns), drying and wrinkling of skin, loss of teeth, decrease in reaction time, decrease in the height, increase in the length of nose, increase in the length of ears, decrease in the circumference of neck, decrease in the circumference of thighs, osteoporosis, bending of the vertebral column causing kyphotic deformity, reduction in the periorbital fat causing sinking of the eyes etc. Broadly speaking, maximum capacity, tolerance, peak performance and reserve are reduced. The details of the changes can be enumerated as follows. Matrix: Collagen becomes stable, more rigid, more insoluble due to increase in its degradation. In addition there are changes in proteoglycans and plasma proteins. This is due to damage due cross linking, less formation of collagen and reduction in the elastin. Fascia, tendons, ligaments, bones, joints, and peripheral vascular disease become rigid. Skin becomes dehydrated, devoid of subcutaneous fact and less elastic thus skin becomes wrinkled, dry, pale due to reduction in capillary bed, and becomes more susceptible to injury. Blood: Red bone marrow is replaced by yellow bone marrow in the long bones first, flat bones and then vertebrae. Physiological reserve capacity for erythropoiesis and leucopoiesis (Formation of red blood cells and white blood cells); is reduced.
Gastrointestinal tract (GIT): *Enamel, dentin and cement of teeth show decline. There is loss of teeth due to caries, periodontal infection and reduced masticatory efficiency. *Weakness of cricopharyngeus (Muscle of swallowing), reduction in pressure gradient and inability to relax the lower esophageal sphincter cause dysphagia (difficulty in swallowing). *Age related atrophy of inner lining of stomach called mucosa causing achlorhydria (absence of digestive acid in stomach). *Pancreatic lipase (fat digesting enzyme secreted by pancreas) is reduced causing streatorrhoea (presence of fat in the stools). *Motility of GIT is reduced: Hence there is tendency towards constipation. In Ayurveda this is categorized under VAATA VRIDDHI. *Intestinal lactase activity is reduced and villi are reduced and absorption is reduced. *Liver cells reduce in number fibrous tissue increases in the liver and size of liver cells increases. Protein synthesis and microsomal mixed oxidase activity required for metabolism of drugs and steroids; become less. Thus functions are reduced but since the reserve of liver is great; the liver function tests are in normal limit. The immune system: There is decrease in the T cell activity, Antibody (AB) production; but increase in the presence of auto anti bodies.
The auto-antibodies are increased due to reaction with the antigens (which were previously recognized as “self” and not reacted with)! This is called reduced tolerance to “self” antigens. There is susceptibility to infections. Since immunological - surveillance is believed to eliminate neoplastic cells (cancer cells); there is higher incidence of cancer. Following stress of bereavement; there is steep decline in cell mediated immunity (T cells) and this is one of the causes of infections leading to the death that follows the death of spouse or any other near and dear one. Reproductive system: The hormonal secretion reduces and there is stoppage of ova formation, ovulation in females and there is gradual reduction in the spermatogenesis (formation of sperms) causing reduction in the sperm count in males. Females show a distinct and identifiable change in the form of menopause; whereas such change is not distinct in males. There is reduction in sexual performance in terms of number masturbations and number of intercourses in a given time and reduction in the functions such erection, ejaculation and the climax. The infatuation about sex may be increased and provoked
by pornographic and or sexually romantic atmosphere even as the sexual performance is dwindled. Central nervous system and special senses: There is atrophy of the brain and neuronal loss associated with accumulation of lipofuscin and loss of synapses and dendrites. Cholinergic deficit is demonstrated in Alzheimer's disease and Dopamine defect is demonstrated in Parkinson's disease. But, milder form of cholinergic deficit may be responsible for commoner forms of senile dementia and milder form dopaminergic deficit may be responsible for milder form of hypokinesia seen in old age. There is deficit in autonomic responses leading to postural hypotension and impairment of temperature regulation. There is difficulty in getting sleep as well as there is tendency to wake up during night and waking up early. There is development of Presbyopia (age related difficulty in focusing on the near object), cataract, rise in intraocular pressure; Presbyacusis (age related difficulty in understanding speech and localization of sound) decline in perception of smell and taste. Endocrine system: There is decrease in the functioning of sympatho-adrenal axis and there is reduced tolerance to stress. In other words, there is inappropriate production of adrenaline, noradrenalin, cortisol etc.
Cardiovascular system: Aging is associated with atherosclerosis. But even in those without atherosclerosis; there is still reduction in the elasticity of aorta (indicating overall changes in connective tissue); leading to increase in systolic and pulse pressure; but not in diastolic pressure. In addition; there is also atherosclerosis, atrophy of myocardium, accumulation of lipofuscin, fibrosis, deposits of amyloid, diminish in contractility relaxability, decrease in ventricular compliance, stenosis of aortic and incompetence of mitral valves, reduction in pacemaker cells, responses to sympathetic as well as parasympathetic stimulation also reduce (this causes postural hypotension). Maximal Heart Rate during exercise is reduced in aged but cardiac output is maintained by increasing stroke output. Respiratory System: The alveoli (the air pockets in the lungs) become flatter and narrower and ducts enlarge. Alveolar walls become thin, capillaries decrease in number causing reduction in diffusion, surface area decreases by 4 % every decade after the age of 30 and the pulmonary blood vessels show age related increase in wall thickness. Functionally there is decrease in total and timed vital capacity, increase in residual volume, due to reduced elastin lung compliance increases (degree of expansibility) but compliance of the total respiratory system decreases due rigidity of chest wall
after the age of 60 years. Due to loss of elastic recoil the pressure which has to be built during expiration from the alveoli; so that air from alveoli forces open the airways, is decreased. Due to this there is tendency of the airways to collapse. This tendency to collapse; increases during expiration when expiration must become active. The response to hypoxia and hypocapnia (reduced carbon dioxide) are reduced. Thus ventilation, diffusion and regulation are all impaired in elderly individuals. Muscles: There is atrophy, reduction in contractility, decrease in tone, hernia and rupture of inter-vertebral disc etc. Excretory system: As a result of aging; the kidneys reduce in size and their blood flow and rate of formation of urine reduces by 10 % per decade after 30, nephrons (urine forming tubules) and their secretory and absorptive functions; reduce and fibrous tissue increases. Kidney vessels show age related changes irrespective of hypertension (high blood pressure). It has been hypothesized that due to high protein diet there may high solute load on the renal capillaries leading to chronic dilatation of the capillaries leading to extravasation of macromolecules in renal glomeruli leading to mesangial reaction causing renal damage.
PSYCHOLOGICAL CHANGES Frustration, depression, fear, anxiety, insecurity, loneliness, vacuum, dejection, self pity, sadness; are some of the hallmarks of old age. This is because; 1. With aging there is increasing restriction on the kind of accustomed enjoyments (e.g. sexual); and this can lead to frustration or depression. 2. The realization of the increased chances of death; (due to observation of the deaths of the contemporaries); causes alarm, concern, anxiety and excessive fear of death, diseases and debility. 3. Due to lack of job after retirement or physical inability there is always a sense of insecurity. 4. Lack of the children's company due to their being increasingly independent gives a feeling of unwantedness and loneliness, especially due to children going abroad or away from home for their jobs. 5. Since most of the people of younger age groups; have their own pre-occupations we the elderly are left out. 6. Due to generation gap; the ideas, choice, preferences and other areas of interests differ and hence the elderly are cut off from younger generation. This distance gradually increases with advancing age and leads to vacuum, dejection, self pity and sadness. Thus overall we tend to become increasingly melancholic in old age.
ECONOMIC CHANGES The aging almost always associated with reduced income and increasing economic dependence on the others. The medical expenses also swell! SPIRITUAL CHANGES We begin to visit temples and participate in SATSANG. This is because we want a certain kind of solace which we do not get from day to day life and routine activities. This is also to fill the vacuum created due to retirement, and to get company of those who sail in the same boat! When we are aging; we become somewhat disinterested and indifferent towards life. But this is not detached attitude described in Geeta. We get detached because; we cannot participate or oppose the activities of young generation! Thus; this is actually reluctant acceptance of defeat! Sometimes we develop ascetic thoughts due to losing interest in the routine life because we are tired of responsibilities and dynamism required; for a job or a profession. Even as this engenders reduction in income; it is not a spiritually oriented selflessness and sacrifice. It is only fallout of mental apathy. Sometimes we lose interest in the surroundings due to decreasing sensory perception and decreased mobility. We become shy about our deficiency. So we avoid socialization. Gradually we become increasingly self centered and selfish. We become over-
concerned about ourselves and less sensitive to others' problems. We become more rigid, adamant and at times obstinate; in an attempt to assert ourselves; and become unreasonable and erratic. The courage, alertness, enthusiasm and other physical and mental faculties which are extremely important to undertake spiritual pursuit i.e. growth of consciousness; are considerably diminished in old age; unless the spiritual quest has been integral part of life right from childhood. Is this a complete picture of aging? No! For the complete we have to refer to, “Aging: A holistic view”!
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