AGING PROCESS and

Clinical Implications of the

Aging Process

Ni KETUT RAI PURNAMI

Geriatric division of Internal Medicine Department,
Udayana University, Sanglah Hospital 2017
Objectives
 To understand the normal and abnormal
physical and mental health changes
associated with aging

 Preservation of good health, and prevention

of chronic diseases that compromise healthy
aging
 Old Age

Memory is short, and braine is dry.

My Almond-tree (gray haires) doth flourish now,
And back, once straight, begins apace to bow.
My grinders now are few, my sight doth faile
My skin is wrinkled, and my cheeks are pale.
No more rejoyce, at musickes pleasant noyse.

Anne Bradstreet (1612-1672)

The Aging World
 Increased longevity has resulted in an ‘Aging World’
 Affluent nations/societies most affected by baby
boomers reaching > age 60
 The older population (> 65 years) was 36.8 million in
2005 in USA
 Represented 12.4% of U.S. population- about one in
every eight Americans
 Expected to be 20% by year 2030- about 75 million
 Will comprise 1 in 5 Americans by 2030
Definition of Ageing
 Can be defined as a progressive, generalized
impairment of function resulting in a loss of
adaptative response to a stress and in a
growing risk of age-associated disease
(Kirkwood, 1996).
21st Century Phenomenon of Global
Ageing
 20th century – saw a global phenomenon of longevity – a
triumph and a challenge
 Average life expectancy at birth- increased by 20 years since
1950 to 66 years
 Is expected to increase another 10 years by 2050
 By 2050, the population of older people will exceed that of
children (0-14 yrs)
 Is a social phenomenon without historical precedent
 In 2002, number of persons > 60 years was 605 million;
expected
 By 2050, number is expected to reach almost 2 billion
Population ageing

 Refers to a decline in the proportion of

children and young people and an increase in
the proportion of people age 60 and over.
 As populations age, the triangular population
pyramid of 2002 will be replaced with a more
cylinder-like structure in 2025
Impact on Society

 Affect family solidarity and relationships

within families
 Equity across generations
 Lifestyles
 How Old is ‘Old’?
 We call ourselves 3 years ‘old’ or 80 years ‘old’
 Some say ‘I am running in my 10th year’ or ‘I am
running in my 75th year’
 So we can be old at 3 and running at 75!
 Old is a relative term- I call friends my age ‘girls’,
while to ‘youngsters’ we are ‘older’ females or even
old!
 However, Aging is a Reality- Prepare to Accept
Gracefully
Definitions
 Defined as latter part of animate life
 Old, elderly, senior citizens- commonly used
 Calendar age is not necessarily synonymous with
biological age
 "Successful aging," "productive aging," and "vital
aging" commonly used now
 UN – defines 60 +; Indonesia: 60+
 Gerontology- The scientific study of the biological,
psychological, and sociological phenomena
associated with old age and aging.
 Geriatrics- treats the clinical problems of later life
Senescence
 In biology, senescence is the process of ageing
 Senescence is the steady deterioration of cell function following
the period of development in youth
 Cellular senescence- cells lose the ability to divide in response to
DNA damage -cells either senesce, or self-destruct (apoptosis) if
the damage is irreparable
 Organismal senescence is the aging of whole organisms. Aging
↔ Senescence
 Species have different "rates of aging"- a mouse is elderly at 3
years; humans at 85 yrs
 Apart from species specific genetics, chance events determine
the probability of death
Ageing

Is characterized by:
 Declining ability to respond to stress

 Increasing homeostatic imbalance

 Increased risk of disease

 Death is ultimate consequence of ageing

Biological definition
 Pre-Conception - Ovum, Spermatozoon
 Conception - Fertilization
 Pre-birth Conception - 9 months
 Infancy Birth - 2 yrs
 Childhood 3 – 12 yrs
 Adolescence 13 - 19 yrs
 Early Adulthood 20 - 39 yrs
 Middle Adulthood 40 - 64 yrs
 Late Adulthood 65+ yrs
 Death – Cessation of vital body (somatic) functions
History
 Desire to live forever is ancient
 Zeus(Greek God), granted Tithonus the gift of immortality, but
not of perpetual youth, when requested by his wife Eos.Tithonus
grew progressively ancient, and begged for death to overcome
him
 ‘Immortalized’ in Tennyson’s poem “Tithonus”:
 “Man comes and tills the field and lies beneath,
And after many a summer dies the swan.
Me only cruel immortality
Consumes: I wither slowly in thine arms”
 Living longer without youthful vitality is not pleasant
THEORIES OF AGING
 How and Why we age are still not clear
WHY DO WE AGE?
 Many theories, none fully explain aging
 The rate of living theory of aging –rejected
 The oxidative-damage/free-radical hypothesis of
aging-topical area
 The evolutionary senescence theory of aging-
most accepted
 The reliability theory of aging
 The neuron-endocrine hypothesis of aging
The Rate Of Living Theory Of Aging- rejected by modern
scientists
 Ancient philosophers- Death occurs when a finite amount of “vital
substance” consumed
The Oxidative-Damage/Free-Radical Hypothesis of Aging
 Mitochondrial ability to repair DNA damage ↓ with age →
Decreased cell efficiency
 Too much mitochondrial damage → cell death
 Oxidative damage →free radicals → DNA damage, cross-linking
of proteins, formation of age pigments
 Injury caused by free radicals initiates a self-perpetuating cycle in
which oxidative damage impairs mitochondrial function, which
results in the generation of even greater amounts of oxygen-free
radicals.
The Oxidative-Damage/Free-Radical Hypothesis
Of Aging

Self–perpetuating
Oxidative cell
Cycle of Impaired
damage
Function
↓
↓
Mitochondrial
Increased Oxygen
Damage
-free radicals

-DNA Damage
-Cross-linking
proteins
Oxygen-free
-Mitochondria
radicals release
Damage
-Form age
pigments
BIOLOGIC AGING

 The importance of genetics in the regulation of

biologic aging is demonstrated by the
characteristic longevity of each animal species.
Several theories of aging have been
promulgated and recently reviewed (Goldstein,
1989; Abrass, 1991). These theories fall into two
general categories: accumulation of damaged to
informational molecules, or the regulation of
specific genes
 AGING :
IS A PROCESS TO RELEASE THE ABILITY OF
TISSUE SLOWLY TO REPAIR/TO CHANGE IT
SELF & TO KEEP THE STRUCTURE & THE
NORMAL FUNCTION SO IT CAN NOT STAND
TOWARD INJURY & TO DEVELOP THE
DAMAGE.

(Constantine,1994)
AGING PROCESS THEORY
1. GENETIC CLOCK THEORY
 In this theory, aging has been programmed genetically
for certain species. Every species has nucleus like a
genetic clock which has been winded according to a
certain replication. This clock will count the mitosis. And
the mitosis will stop if it’s already reach a certain amount.
This concept is supported by the reality, Why on
some species get a real different of life
expectation
Figure 1. Record in life span (Eudililin et al, 1993)
Turtle 170 y.o
Elephant 70 y.o
Horse 62 y.o
Gorilla 48 y.o

Bear 47 y.o
Cat 30 y.o
Dog 27 y.o
2. The Damage of Immune System
Innate Immunity :
The first line of defense against pathogens
Mediated by :

 Physical
barriers
 Chemical compounds

 Phagocytes (macrophages, neutrophils, NK

cells)
Adaptive Immunity :
Develops as a response & adapts to the infection
Mediated by B & T lymphocytes

Together, innate and adaptive immunity prevent

most infectious disease or cure infections
 The repeated mutation/ the changing protein post
translation  decrease the immune system ability to
recognized  it self
 The somatic mutation  antigen disorder in the cell
 to cause immune system  treat the changing cell
as a strange cell and destroy it.
 Auto immune process  antigen antibody reaction in
different tissues  aging effect  histoincompatibility
reaction in multi tissue  auto antibody prevalence
 All somatic cell will set aging process, except sexual
cell & cell which is getting mutation to be a cancer.
3. METABOLIC AGING THEORY
 From the experiment  it get a longer life span

caused by the restriction of the calorie. It is

caused by one of metabolism process  the
decrease of hormone excretion will stimulate cell
proliferation, such as insulin
 The modification of under exercise to be more

active will cause the longer life span.

Mechanism of Caloric Restriction
The degree of Caloric Restriction needed to
achieve an anti aging effect is far too severe to be
a practical preventive regimen for more than a
tiny fraction of the human population.
To define the biochemical mechanism by which
Caloric Restriction alters age dependent
physiologic decline is likely to provide the best
clues to clinically useful preventive strategies.
One line of inquiry starts with the set of known,
dramatic changes induced by the Caloric
Restriction protocol & attempts to see whether
any of these can by itself accomplish some or all
of the Caloric Restriction effect.
4. FREE RADICAL THEORY
 The free radical are : Super oxide (O2), Hydroxyl

radical (COH), Hydrogen peroxide (H2 O2).

 Free radical is destroyer  it is very reactive  it
can react to DNA
 The body itself is able to prevent free radical with
its enzymes : Superoxide dismutase (SOD) : Zn,
Cu, Mn
 it change superoxide  2O2

2 O2- + 2H+ SOD H2 O2 + O2

 Catalase enzyme with Fe element in the “hem”  to
burst  hydrogen peroxide become water & oxygen :

Catalase
2H2 O2 2H2O + O2

 Glutathione peroxide enzyme with selenium (Se)

element  burst peroxide hydrogen through the
reaction :

H2O2 + GSH GSSH +H2O

5. WEAR-AND-TEAR THEORY
 Supports the concept that aging is a programmed

process  each animal-each cell, has a specific

amount of metabolic energy available to it & that
the rate at whish this energy is used determines
the animal’s length of life.
 In addition to the depletion of available energy,

wear-and-tear theories  include the effects of

the accumulation of harmful by products of
metabolism & of faulty enzymes due to random
errors as contributing to aging changes
6. The Shortening of Telomere
The Evolutionary Senescence
Theory of Aging
 Most widely accepted overall theory
 Species prone to die to predation (e.g. Mice) invest more energy in
reproduction than in health maintenance
 Humans, less prone, can allocate more resources to repairing
physical damage
 Humans able to reproduce over a longer period of time
 Thomas Kirkwood (1970’s)- disposable soma theory- organisms
have to balance the demands of maintaining their body, or soma,
cells and reproducing
 States that humans have long life spans because we are much
better at repairing our bodies than short-lived animals
 Steven Austad (early 1990s)-provided evidence that perilous
environments support early reproduction and short life spans,
whereas safer environments favor the opposite
 Most agree that it is currently the best explanation for why we and
other organisms age
The Reliability Theory Of Aging

 Applies mathematical theories of reliability to predict

systems failure in machines
 Natural selection programs animals to live long
enough to reproduce;
 Takes variable lengths of time after reproductive
failure for animal’s subsystems to fail and make
animal vulnerable to death
 This theory does not explain why certain species
live longer than others
 Endorses numerous facets of evolutionary
senescence theory of aging
The Neuroendocrine Hypothesis Of
Aging
 The neuron-endocrine system –complex system
linking brain, nervous system and hormonal glands
 Becomes less functional with age- can lead to HBP,
diabetes, and sleep abnormalities
 Effects of hormones on different facets of aging
studied extensively
 Some late-life functional changes linked to reduced
levels- e.g. menopause
 However, recent evidence reveals the opposite:
reduction in some hormones can prolong life
Current Areas Of Research To
Decrease Aging
 Caloric Restriction
 Altered dietary intake
 Insulin-like growth factor (IGF)
 Pharmaceuticals
 Most target reactive oxygen species,
underscoring substantial role of oxidants in
the aging process
The Physiology of Aging
 Aging is both visible and invisible
 Visible changes occur on surface of the body;
invisible affect internal organs to impair function
 Affects all systems to varying extent; if vital
functions involved, cause death
 Gerontologists - aging is the cumulative effect of
many lifelong influences
 Influenced by heredity, environment, culture, diet,
exercise, past illnesses, etc
 Genetic factors chiefly determine variations in
aging/lifespan- we exert no control
 However, we can control our
environmental/lifestyle insults to aging and
health
 Normal aging in the absence of disease is
a remarkably benign process
 Biologic and chronologic ages are not the
same
 Most organs gradually lose some function;
noticeable only during exertion/stress
 Slower reaction times are common
How are Adolescence and Senescence
Different?
 Changes of adolescence follows predictable norms -
can be graphed
 Aging affects individuals uniquely; norms not
established
 Some systems begin aging by age 30 (bones);
others much later (mental faculties)
 Senescence should not be viewed as a “disease”
 Cannot put a ‘Time Clock’ on aging
PHYSICAL IMPLICATIONS OF AGING
Skin:
 Exhibits most obvious sign of aging
 Loss of underlying connective tissue, fat and oil
glands → wrinkles, sagging skin
 Aging skin appears thinner, paler, and translucent
 Increased sensitivity to heat/cold, bruising, and
bedsores
 Develops "age spots" due to deposits of melanin
pigment
 Ability to perspire is decreased
 Contributing factors: nutrition; exposure to sun,
chemicals/toxins; hormones, and heredity
Hair:
 Shows obvious signs of aging
 Hair color is due to pigment ‘melanin’- gradually decreases after
age 30-40
 Loses pigmentation → turns hair gray/white
 Manifests earliest in scalp, followed by facial/body hair
 Occurs earlier in Caucasians compared to Asians
 Alopecia- baldness/ hair loss is the norm
 Coarsening of hair common

Nails:
 
 Become dull, brittle, ridged, thickened, grow slower
 due to reduced blood flow to connective tissues
The Cardiovascular System
 Overall reduction in blood flow occurs as we age
 Heart of a 20-year old can pump 10 times the
amount actually needed to preserve life
 After age 30, about 1% of reserve is lost/ year

Results in:
 Normal atrophy of the heart muscle

 Calcification of the heart valves

 Arteriosclerosis ("hardening of the arteries")

 Atherosclerosis (intra-artery deposits)

 Slower
Healing rate

Reduced
Brain, Liver Poor Response
and Kidney to Stress
Function CVD Changes
↓
Poorer Cell
Oxygen

↑ Risk of HBP,
Vulnerable to Heart Attack,
Drug Toxicity Stroke, Heart
Failure
 The reduced blood flow results in less
strength due to:
 diminished oxygen exchange

 reduced kidney and liver function

 less cellular nourishment

Other problems:
 Intermittent pain in the legs with walking

 Varicose veins

 Prelediction for Blood clots

Changes in Respiratory System
 Maximum lung function decreases with age
 Diminished elasticity of airways and lung tissue
 Reduced ciliary activity→ decreased oxygen uptake/exchange
 Muscles of the rib cage atrophy, further reducing the ability to:
 breathe deeply

 cough

 expel carbon dioxide

 Aggravating factors: Smoking, Pollution
 Results in:
 Lower stamina for work; easily fatigued

 Shortness of breath

 Oxygen lack can increase anxiety

 Susceptibility to pneumonia increased

Skeletal System Changes
 Manifest changes that affect QOL significantly
Osteoporosis is a common condition characterized by:
 progressive loss of bone density

 Increased vulnerability to fractures

 Thinning of vertebrae → loss of height; spontaneous fractures

 Reduction in height occurs by1 cm (0.4 inches) every 10 years

after age 40
 Height loss is even greater after 70 years

 The vertebrae calcify increasing rigidity, making bending difficult


Joints

 Osteoarthritis- degenerative disease, most

common chronic condition in elderly
 Rheumatoid arthritis- common connective
tissue disorder
 Both impair mobility and the performance of
daily activities of living
Gastrointestinal System

A reduction in stomach hydrochloric acid,

digestive enzymes, saliva causes:
 Bloating and flatulence

 Impaired swallowing

 Reduced breakdown and absorption of foods

 Deficiencies in vitamin B, C, and K ;

malnutrition is a real possibility

Muscular System
 Progressive loss of muscle mass occurs as we age → change in
body shape
 Accelerated after age 65- causes weight loss
 Changes in body shape can affect balance, contributing to falls
 Elderly individuals with weak muscles are at greater risk for
mortality than age-matched individuals
 Increase in amount and rate of loss of muscle increases risk of
premature death
 Physical inactivity is 3rd leading cause of death; plays role in
chronic illnesses of aging
Hormones
Sex Hormones
 Men may exhibit slightly decreased levels of testosterone
 Women have decreased levels of estrogens, progesterone and
prolactin after menopause
Insulin
 The normal fasting glucose level rises 6-14 mg/dL every 10
years after age 50
 Probably due to loss in number of insulin receptor sites in cells
 Can lead to diabetes- annual testing recommended

Other Hormones
 Not significantly affected
Immune System

Overall effectiveness decreases, leading to:

 Increased infection risk

 Decreased ability to fight diseases

 Slowed wound healing

 Autoimmune disorders

 Cancers
Female Reproductive System
 Menopause is obvious milestone of aging (cessation
of periods > 1year)
 Loss of Reproductive Capacity occurs
 Normal around 50 years; occurs by age 40 in 8%
women
 Secretion of estrogens, progesterone, and prolactin
hormones are reduced
 Sex drive is not necessarily diminished
 Aging does not impair a woman’s capacity to have
or enjoy sexual relationships
Physical manifestations
in Women
 Prolapse- descent of uterus may occur due to
lax tissues
 Urinary stress incontinence common
 Breasts lose tissue and subcutaneous fat→
flatten and sag
 Breast cancer risk increases with age
 The genital tissue atrophies; more prone to
infections
Male Reproductive System
 Men do not experience a sudden ‘andropause’
 Age is not a good predictor of male fertility
 Testosterone levels maintained/decrease slightly
 Decreases in the sex drive (libido) may occur
 Normal for erections to occur less frequently
 Aging alone does not impair a man’s capacity to
enjoy sexual relationships
Physical Manifestations
in Men
 Prostate grows in size- urinary problems
 Cancer of prostrate or bladder is commoner in older
men
Erectile dysfunction
 Erectile dysfunction may occur
 Is frequently related to diseases (diabetes) or
medicines
 90% of erectile dysfunction- has medical rather than
psychological origin
 May be amenable to treatment
Changes in Kidneys

 Normally no change
 Usually affected by diseases like high BP,
diabetes and cancer
 Lead to increased risk for acute and chronic
kidney failure
 Urinary tract infections are common
Teeth and Mouth

 Fall of teeth is an obvious sign of aging

 All people eventually lose teeth- rate
depends on several factors
 Proper hygiene can preserve teeth longer
 Increased sensitivity to cold/heat common
with attrition
 Loss can interfere with healthy eating habits-
malnutrition common
IMPLICATIONS OF AGING ON
MENTAL FACULTIES

The quality, not the longevity, of one's life is

what is important. — Martin Luther King Jr.
(1929-1968)
Nervous Tissue and Aging

 Aging has profound effects on mental faculties

 Brain tissue is irreparable – changes are permanent
 Speed of communication between nervous tissues is decreased
 Transmission of messages within nerve cells becomes slower
 The brain and spinal cord lose nerve cells and weight
 Waste products collect in brain, causing plaques and tangles
Changes result in:
 Lost or reduced reflexes → problems with movement and safety
 Slight slowing of thought, memory, and thinking- a normal part of aging
 A change in thinking/memory/behavior are important indicators of
disease
 ALL ELDERLY PEOPLE DO NOT BECOME ‘SENILE’

Disease States
 Delirium, dementia, and severe memory loss are NOT normal
processes of aging
 Caused by degenerative brain disorders such as Alzheimer's disease
 Illnesses unrelated to brain can cause changes in thinking/ behavior
 Severe infections can lead to confused states
 Diabetes- fluctuations in glucose levels can cause thinking/behavioral
disorders
CHANGES IN SENSES

HEARING
30% people over
age 65 have
impairment

VISION
TOUCH-
-Usually need
Gradual reduction
glasses by 55
after 50- injuries,
-Only 15-20%
hypothermia SENSES have ↓ driving
ability
Normal acuity
↓ with age

SMELL-
Decreases after
TASTE- Minimal
70 yrs- may affect
changes
hygiene
SENSES
 All senses are controlled totally by the brain
 Aging increases minimum amount of stimulation
before a sensation is perceived
 Any compromise in senses has tremendous impact
on lifestyle
 Hearing and vision changes- dramatic effect on
QOL
 Many changes can be improved with glasses,
hearing aids, and lifestyle modifications
 Communication problems common- lead to social
isolation and loneliness
HEARING
 Ears perform two functions – 1. Hearing 2. Maintaining body
balance (equilibrium)
 Equilibrium (controlled by the inner ear)
 Hearing is ruled by the outer ear– disorders respond better
 Aging adversely affects both structures
 Acuity of hearing declines slightly after age 50
 30% people > 65 have significant hearing impairment
 Impacted ear wax commoner with increasing age → deafness,
easy to treat
 Persistent, abnormal ear noise (tinnitus) - common in older
adults
VISION
 Visual acuity may gradually decline- not universal
 After age 55, most people need glasses at least part
of the time
 Driving ability is impaired in 15% to 20% due to bad
vision
 5% become unable to read
 Trouble adapting to darkness or bright light
 Significant difficulty with night driving may be the
first sign of a cataract
 Color Perceptions Change
 As we age, it is harder to distinguish blues and greens
than reds and yellows
 Elderly should use yellow, orange, and red contrasts at
home- improves ability to locate things
 Using a red nightlight is better than a conventional bulb
 "Floaters" in vision- harmless; sudden ↑ needs
consultation
 Reduced peripheral vision occurs- cannot see
adjacent people- may cause offense to friends
 Blindness- usually caused by diseases like
diabetes and high BP
Taste and Smell
 Taste does not seem to decrease until after age 60,
if at all
 Sense of smell may diminish, especially after age
70- leads to poor hygiene, and unawareness of gas
leaks etc
Touch, Vibration, And Pain
 Aging can reduce sensations of pain, vibration, cold,
heat, pressure, and touch
 Decreased temperature sensitivity increases the risk
of frostbite, hypothermia, and burns
 After age 50, many people have reduced sensitivity
to pain.
 Reduced feel of vibrations- loss of stability in motion
Social Behavior & Personality
Changes with Age
 Small changes normal - do not significantly change our sense of who the person
is
 Personality and social interaction often change due to neurodegenerative
diseases
 Drastic changes in personality reflect a disease process- difficult for caregivers
to cope with/accept
 “Senility” or “senile” is an out-dated term- now replaced with “Dementia”
 Senility or Dementia should NOT BE EQUATED TO AGING- DEMENTIA IS A
DISEASE STATE
 Dementia – ‘condition where one has a progressive decline in memory and
other cognitive functions that results in a change in the ability to conduct one's
usual activities’
 Dementia is characterized by multiple cognitive deficits with memory
impairments as an early symptom
 Diagnosis of dementia- not given in absence of impairment in social
functioning/independent living
Psychological and Social Impact

 With a healthy lifestyle, few changes seen that are deleterious to QOL
 In fact, some actions may grow more correct as we age (within limits)

Learning

 The ability to learn continues throughout life

 Often require more time and effort to absorb new information
 Need more effort to organize and understand new information
 Tendency to avoid learning new things not perceived as beneficial
 Reasons – unknown; may be partly attributed to decline in senses
as we age
Reaction time
 Information processed at a slower pace
 Reaction to stressful situations is delayed; uncertainty on how to
act may manifest
 A + for older people- tend to make fewer mistakes than younger
people in decisions taken
Intelligence
 Whether intelligence declines as we age is hotly debated- usually
maintained
 Older people perform lower on many standardized intelligence
tests
 In formal tests of performance, older people slow down, but
make fewer mistakes!
 However, most intelligence tests do not address situations in our
daily lives
 Value correctness as we age- answers are more accurate,
though response may be slower
 More cautious; less liable to make mistakes in judgment/ action
Life skills
 As we age, perform most life skills better with

experience
 As we age, majority are better at managing

daily affairs
 May fail only in times of stress or loss

 Reliable support network maintains QOL

longer
 Younger people can gain from experiences of

elders-meaningful exchanges can occur

Stresses
 Older adults must often deal with physical, medical
or social stressors
 Stress can precipitate many diseases like diabetes,
high BP, anxiety attacks etc
 Common stresses for older people are:
 diseases or health conditions, possibly chronic (e.g.,
heart disease, arthritis, cancer)
 perceived loss of social status after retirement
 death of a spouse/child/sibling
Loss and grief
 Loss of a spouse is particularly stressful
 In 2003, more than 1 million spouses (mostly women) were
widowed
 This number is estimated to increase to 1.5 million every year by
2030
 Loss of sight, hearing, and physical disabilities can induce
profound grief and loss
 Retirement/job loss with loss of social status is a major cause
 Most people grieve intensely for 6-12 months after a major loss-
withdraw from others
 Takes about 1 year to accept the loss and start normal
interaction
Substance abuse
 A growing problem among older adults, particularly
alcohol
 Causes physical/mental health problems commonly,
especially older men
 Exaggerated effects seen in older people
 Has negative effects on self-esteem, coping skills,
and interpersonal relationships
 Warning flags are less obvious in older adults e.g.
less likely to be caught on the job, in public
Memory Decline in Normal Aging

Definition: Memory refers to the storage,

retention and recall of information including
past experiences, knowledge and thoughts
 Only some types of memory loss are

associated with normal aging

 Other types are typical of disease states
Types of Memory and Loss
 Working (intermediate term) – loss occurs with normal aging
 Episodic- especially impaired in normal aging e.g. ability to
process recent information
 Semantic (e.g. vocabulary) – Improves with age; lost in
dementias
 Procedural (long-term memory of skills) - shows No Decline with
age; affected by diseases
 Very long-term memory (months to years)- increases upto age
50; maintained until well after 70
 Short-term memory- shows little decline; loss associated with
diseases
 Older adults tend to be worse at remembering the source of their
information
Abnormal Memory Loss in Aging

 Forgetting things much more often than you used to

 Forgetting how to do things you've done many times
before
 Trouble learning new things
 Repeating phrases or stories in the same
conversation
 Trouble making choices or handling money
 Not being able to keep track of what happens each
day
Risk Factors for Cognitive Decline

 High blood pressure, diabetes, poor nutrition,

and social isolation
 Heart disease
 Family history of dementia
 Psychological factors like stress and
depression
Normal Cognition
 Executive Functioning include:
 Organization: attention, decision-making,
planning, sequencing, problem solving
 Regulation: initiation of action, self-control, self-
regulation
 Language- coherent, sensible
 Working (immediate) Memory
 Spatial Memory
 Verbal Memory
Dementia
 The word dementia is used to describe the condition where one
has a progressive decline in memory and other cognitive
functions that results in a change in the ability to conduct one's
usual activities
 Dementias are neurodegenerative diseases which cannot be
cured
 Each type characterized by specific effects on cognitive and
motor function
 Diagnosis of dementia is not generally given in absence of
impairment in social functioning and independent living.
 Dementia seriously affects a person’s ability to carry out daily
activities
 People with dementia lose their abilities at different rates
 Eventually, patients may need total care
Symptoms of Dementia

Dementia symptoms may include:

 asking the same questions repeatedly,

 becoming lost in familiar places,

 being unable to follow directions,

 getting disoriented about time, people, and

places, and
 neglect of personal safety, hygiene, and

nutrition.
Alzheimer's Disease (AD)
 Definition: Is a progressive, neurodegenerative disease characterized in
the brain by abnormal clumps (amyloid plaques) and tangled bundles of
fibers (neurofibrillary tangles) composed of misplaced proteins
 AD is the most common dementia in older adults
 Incidence expected to more than double by 2050- from 377,000 in 1995
to 959,000
 The proportion of new cases >85 will increase from 40% in 1995 to 62%
in 2050
 The annual incidence expected to shoot up by 2030 (baby boomers
[persons born between 1946 and 1964] will be over age 65)
 Most of the increase will occur among people age 85 or older
 Early symptoms of AD, which include forgetfulness and loss of
concentration, are often missed because they resemble natural signs of
aging
Multi-infarct dementia
 Caused by a series of strokes in the brain
 Infarcts result in irreversible death of brain tissue
 Location/severity of compromised area governs
severity of symptoms/loss of function
 Symptoms – abrupt onset; progress step-wise as
strokes recur
 Treatment to prevent further strokes is very
important
Other Mental Conditions
Anxiety
 Anxiety disorders- commoner as we get older as medical,
psychological, and social problems build up
 One in five older adults suffers anxiety symptoms severe enough to
necessitate treatment
 Persistent or extreme anxiety can seriously decrease QOL
 Can be a sign of other problems like depression, dementia, physical
illness
 Anxiety is often associated with over-arousal
 Specific anxiety disorders include the following:
 General Anxiety Disorder –Most Common
 Panic Attacks –Previous History Present
 Phobias- E.G. Unable To Urinate In Public Bathrooms; Inability To Eat In
Public
 Obsessive Compulsive Disorder –Usually Present At Younger Age
 Post-Traumatic Stress Disorder
Delirium
 Delirium, or acute confusion, is a sudden change in mental
function
 Delirium is usually a short-term, temporary problem
 May persist for weeks to months in a substantial number of
people
 Is a common complication of medical illness in elderly
 One-third of older adults arrive at hospital emergency
departments in delirious state
 Is strongly associated with poor outcomes among hospitalized
patients
 Can be mistaken for dementia or schizophrenia
 Delirium common in people with dementia
Parkinson's Disease

 Parkinson's disease is a slowly progressive degenerative disease of the

nervous system
 About 50,000 Americans are diagnosed with PD each year
 Many more undiagnosed as attribute symptoms to old age
 Average age of onset is 60; commoner as we grow older
 Caused by loss of nerve cells in brain that produce dopamine
 Usually familial
 Exposure to high levels of manganese, carbon disulfide or certain
pesticides increases risk
 An increased risk in people who live in rural areas in advanced
countries (unproved)
Depression
 Depression is a serious medical illness characterized by:
 Persistent sad, anxious, or "empty" mood

 Feelings of hopelessness, pessimism

 Feelings of guilt, worthlessness, helplessness

 Loss of interest or pleasure in hobbies and activities that were

once enjoyed
 1%—2% of older women, and < 1% of older men have major
depression
 Is a continuation of problem from earlier life in 30%—50% of cases
 Major depression may accompany disorders that result in dementia
 Many older adults face cancer or grief that promote depression
 There is a strong link between major depression and increased risk of
dying from heart disease.
 Alcohol abuse causes depressed mood
Dizziness
 Dizziness is lightheadedness, feeling like you might faint, being
unsteady, loss of balance, or vertigo (a feeling that you or the room is
spinning or moving)
 Most causes of dizziness are not serious; quickly resolve on their own
or are easily treated
 Common complaint of people over age 65, affecting 13%—38% of older
Americans
 Dizziness increases the risk of falling and decrease QOL
 Lightheadedness happens when there is insufficient blood supply to the
brain- often seen on sudden change in position
 Near-fainting/fainting not uncommon in elderly while straining at stools
or coughing
 Vertigo is dizziness accompanied by a sensation of spinning – due to
ear problems/infections
 Benign positional vertigo is commonest; happens on sudden change in
position of head
 Disturbances in heart rhythm
 Dizziness due to drugs not uncommon in elderly
Active Ageing (WHO)
 Active ageing is the process of optimizing opportunities for
health, participation and security in order to enhance quality of
life as people age
 Ageing is a social phenomenon – involves friends, work
associates, neighbors, family
 Interdependence and intergenerational solidarity are important
tenets of active ageing
 “Yesterday’s child is today’s adult and tomorrow’s grandmother
or grandfather”
 Healthy life expectancy is also a synonym for “disability-free life
expectancy”
 “Disability-free life expectancy” is important to an ageing
population
Measures of Independent Living

 Autonomy is the perceived ability to control, cope with and

make personal decisions about how one lives on a day-to-day
basis, according to one’s own rules and preferences – difficult to
quantify
 Independence is commonly understood as the ability to perform
functions related to daily living – i.e. the capacity of living
independently in the community with no and/or little help from
others
 ADL’s (Activities related to daily living) - can be measured; e.g.
bathing, eating, using the toilet and walking
 IADL (Instrumental activities of daily living); measurable; e.g.
shopping, housework, making meals
Quality of life (QOL)
 QOL is “an individual’s perception of his or her position in life in
the context of the culture and value system where they live, and
in relation to their goals, expectations, standards and concerns
 Incorporates a person’s “physical health, psychological state,
level of independence, social relationships, personal beliefs and
relationship to salient features in the environment.” (WHO, 1994)
 As people age, their QOL is determined by their ability to
maintain autonomy and independence
 ADL and IADL are important measures of QOL
 Age-Related Changes as Risk Factors

 Age-related sensory and physical impairments occur among senior farm

operators at various rates

Vision
 To see objects as clearly as at age 20, many 45-year-olds need four times as
much light
 By age 60, the amount of light required is double that needed by 45-year-olds
 Decline in visual acuity o detect normal environmental stimuli → impaired
reactions
 Older farmers routinely work in situations with inadequate lighting → more prone
to injury

Hearing
 Farm workers of all ages have higher levels of noise-induced hearing loss than
the general population
 Senior farmers who have difficulty hearing words or sounds may not be able to
detect warning signals
Sense of Balance
 Loss of balance and a feeling of dizziness increase the risk of injury for
senior farmers :
 May lead to loss of concentration while driving/ performing tasks
 Walking across an uneven surface such as hay, or moving in a small
fishing boat
 Falls around tractors and farm machinery poses a particularly serious
safety risk
Muscular capability impairment
 Farmers need strength and flexibility in all limbs and joints to work
safely
 Aging eventually reduces agility and strength - regulate/ delegate heavy
work
 Compensate by providing invaluable practical experience to younger
workers
Advantages of Physical Activity

 The more physically active you are, the less likely to gain weight
 Improves your strength, endurance, and flexibility
 Regular physical activity helps avoid obesity, diabetes, heart
disease/stroke, arthritis, high BP, and mental disorders
 Reduces functional declines associated with aging
 Lowers stress and boosts your mood and energy
 Meet new friends by joining a class or walking group
 Reduces risk of bone fractures/other injuries
 Improves immunity; recovery from illness is faster
 Enhances QOL- keeps one mentally alert and physically
independent
How Much Physical Activity?
 Levels vary from person to person
 Consult your healthcare provider for safe limits
 A gym is not at all necessary
 Most people require 30 minutes of moderate
physical activity daily
 Exercise intensity is less important than total
amount spent exercising
 Intermittent exercise is as effective as continuous
activity
 Spurts of three 10 minute walks are effective
Tips for Safe Physical Activity
 Take time to warm up, cool down, and stretch.
 Start slowly and build up to more intense activity.
 Stop the activity if you experience pain, dizziness, or shortness
of breath.
 Drink plenty of water.
 When you are active outdoors, wear lightweight clothes in the
summer and layers of clothing in the winter.
 Wear sunscreen, sunglasses, and a hat for sun protection.
 Wear shoes that fit well and are right for your activity.
Steps to Healthy Aging
 MONITORING YOUR OWN HEALTH IS A GOOD ADAGE
 Chronic diseases like diabetes, high BP, obesity, etc cause most problems in
old age
 Most chronic diseases can be delayed or severity reduced
 Adopt healthy lifestyle behaviors from childhood
 Keep weight at BMI < 26
 Be physically active within limitations
 Eat nutritious foods
 Eat sparingly
 Avoid misuse of alcohol/drugs; abstinence best
 Avoid smoking
 Make a social network
 Save for care in old age
 Regular screening for cancer/diabetes, high BP etc
 Regular medical examinations/dental checks
Be Good To Yourself
 Get adequate sleep
 Maintain contacts with family and friends
 Join a social group
 Surround yourself with people whose company you enjoy
 Volunteer or get active with groups in your community.
 Try a part-time job at a place you would enjoy working for a few hours a
week
 Indulge in activities you always yearned to do, but never had the time
for when younger!

"The secret of life is enjoying the passage of time.“ James Taylor

Thank you
Learning Task

 Please describe, pathogenesis of

agieng based on The Oxidative-
Damage/Free-Radical Hypothesis Of
Aging
 Describe several age related changes
in elderly patient