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Functional age
A measure of how well a person can function in a physical & social
environment as compared to other people of the same chronological
age
A 70-year-old who is young at heart may be functionally younger
than a 50 year-old who finds lifes challenges overwhelming
Gerontologists, scientists who study aged people & aging process
divide todays older people into two categories
1. The young-old (55-75) majority of them are vital, vigorous & active
2. The old-old (75 & above) experience more changes in health & may
become more frail or experience major health & psychological
changes (Neugarten & Neugarten, 1987)
Three Components of Functional Age
Psychological age
Ability to deal with demands of environment such a move, accident, change of
job
How well in comparison with same-aged peers, a person can cope with
environmental challenges
A 50-year-old who lives with parents, has no job, & cannot form a meaningful
personal relationship maybe psychologically younger than a 20-year-old who
is independent & exerts control over life choices
Social Age
Depends on how closely behavior conforms to norms, expectancies, & roles a
person of a certain chronological age is expecgted to play in society
A woman having first child in mid-forties is adopting role of parent later than
most of her peers
She thus has a younger social age
Older people who sign up for college courses are socially younger than their
peers
A 23-year-old widow is relatively advanced in social age
Three Components of Functional Age
Biological Age
Measure of how far
person progressed
along potential lifespan
Predicted by persons
physical condition
Measure biological age
by examining how well
vital organ systems
such as respiratory,
cardiovascular systems
are functioning
50-year-old exercised
regularly likely
biologically younger
than 40-year-old
Physiological Changes on Eyes
Schirmer's I Test
Increased ATR
horizontal meridian becomes steeper and vertical meridian
varies very little if any
Pupil
Yellowing
Mellerio (1971 and 1987)
lenticular pigment distribution remains unchanged. Lens
thickness increase cause yellowing
Leberman (1983)
chronic UV exposure induces photochemical generation and
accumulation of at least two chromophores that absorb light
@ 360 and 435nm and fluoresce at 440 and 520 nm
Fluorescent compounds increase in concentration
resulting in a progressive decrease of visible and UV light
transmission, increasing the yellow color of the lens
CATARACT
Refraction and accommodation
4. Collagenous fibers
1. Sclera
5.
2. Choroid Chromatophores
6. Blood vessel
7. Pigment epithelium
8. Rods and cones
9. Outer limiting
membrane
3. Retina 10. Outer nuclear layer
Rhodopsin
Retinal (11-cis retinal)
Opsin :
- Scotopsin in rods
- Photopsin in cones
Nyctalopia (buta senja)
Macula and fovea
funduscopy with ophthalmoscope
Macula lutea yellow spot
Neural and Retinal Changes
Triceps Brachii M.
Bone remodelling
Why Do Bones Break?
When load exceeds strength
Loads applied
to the bone
Applied Load
>1 FRACTURE
Bone Strength
Bouxsein, 2001
Pathogenesis of Bone Loss Due to
Calcium/Vitamin D Deficiency in
the Aged
Decreased sunlight
exposure
BONE LOSS
Trabecular
bone with
Normal resorption
trabecular bone areas
Trabecular Osteoporotic
bone with trabecular
microcracks bone
Microarchitecture and Bone Strength
180 kg 20 kg
180 kg 20 kg
ventricles contracting
Diastole: (0.5sec)
ventricles relaxing
370
(e) Ventricular diastoleearly: msec (d) Ventricular systole
As ventricles relax, pressure second phase: As ventricular
in ventricles drops; blood pressure rises and exceeds
flows back against cusps of pressure in the arteries, the
semilunar valves and forces semilunar valves open and
them closed. Blood flows blood is ejected.
into the relaxed atria.
Cardiac Output (CO) and Cardiac Reserve
Results in:
Normal atrophy of the heart muscle
Calcification of the heart valves
Arteriosclerosis ("hardening of the arteries")
Atherosclerosis (intra-artery deposits)
Cardiovascular Function and Aging
BP = CO X pR
Extrinsic Innervation of the Heart
Vital centers of medulla
Cardiac Center
Cardioaccelerator center
Activates sympathetic
neurons that increase HR
Cardioinhibitory center
Activates parasympathetic
neurons that decrease HR
Cardiac center receives input
from higher centers (hypotha-
lamus), monitoring blood
pressure and dissolved gas
concentrations
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
Natural
Natural History
History and
and Main
Main
Consequences
Consequences
American
American Heart
Heart Association
Association classification
classification of of human
human athero-sclerotic
athero-sclerotic
lesions
lesions from
from the
the fatty
fatty dot
dot (type
(type I)I) to
to the
the complicated
complicated type
type VI
VI
Varicose Veins
Heart to Heart
Acute Myocardial
Infarction
Silent MI more common
Commonly presents with dyspnea only
May present with signs, symptoms of
acute abdomen--including tenderness,
rigidity
Acute Myocardial
Infarction
Possibly just vague symptoms
Weakness
Fatigue
Syncope
Incontinence
Confusion
TIA/CVA
Acute Myocardial Infarction
ITS AN MI!
HEART FAILURE
Mechanics of Muscle Contraction:
Tension Sarcomere Length Relationship
Thin Filaments
Thick Filaments
Hypovolemia & Shock
Bronchioles
Respiratory
bronchioles
Right Left
Alveolar duct
Lung Lung
Alveoli
The Muscles of
Breathing
Inspiratory muscles
Diaphragm (75%)
External
Intercostalis
Sternocleido-
mastodeus
Scalenus
Seratus (anterior)
Expiratory muscles
Internal
Intercostalis
Abdominal
Muscles
Spirometry
LUNG VOLUMES Dead space
Residual
Volume
Tidal volume
Vital capacity
Inspiratory reserve
volume
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
Respiratory Changes With Aging
.
Age VO2max % change from
(years) (ml . kg -1. min -1 ) 25 years
25 47.7
35 43.1 -9.6
45 39.5 -17.2
52 38.4 -19.5
63 34.5 -27.7
75 25.5 -46.5
Changes in Aerobic Capacity and Maximal
Heart Rates With Aging in a Group of 10
Highly Trained Masters Distance Runners
.
VO2max
Age Weight HRmax
(years) (kg) (L/min) (ml kg1 min 1) (beats/min)
21.3 63.9 4.41 69.0 189
(1.6) (2.2) (0.09) (1.4) (6)
46.3 66.0 4.25 64.3 180
(1.3) (0.6) (0.05) (0.8) (6)
Areas
Areas identified as
Motility Hormone
Hormone
Motility
responsiveness
responsiveness important
important to
to aging
aging
are:
are:
Pathophysiology
Pathophysiology of
of
Visceral
Visceral
sensitivity
sensitivity
Drug
Drug
metabolism
swallowing
swallowing disorders
disorders
metabolism
Esophageal
Esophageal reflux
reflux
Dysmotility
Dysmotility symptoms
symptoms
Liver
Liversensitivity
sensitivity Pancreas:
Pancreas:
to
tostress
stress Structure
and
Structure GI
GI immunobiology
immunobiology
andfunction
function
Cellular
Cellular mechanisms
mechanisms
of
of neoplasia
neoplasia in
in the
the GI
GI
Immunity
Immunity Lithogenic
Lithogenic tract
tract
bile
bile
Decreased
Decreased visceral
visceral
Colonic
Colonic
function
function
sensitivity
sensitivity
Hall
Hall KE,
KE, et
et al.
al. Gastroenterology.
Gastroenterology. 2005;129:1305-1338.
2005;129:1305-1338.
CURRENT
CURRENT HOT TOPICS
Esophageal Aging
Decreased Increased
Clearance of liquids from Contact time with NSAIDs or
stomach other noxious agents in delayed
Perception of gastric distention emptying
Tendency for gastric mucosal
Cytoprotective factors
injury in delayed emptying
Mucosal blood flow and
Prevalence of H. pylori
impaired sensory neuron
associated with increased risk
function in animal models
of bleeding peptic ulcer,
pernicious anemia, and
lymphoma
Hall
Hall KE,
KE, et
et al.
al. Gastroenterology.
Gastroenterology. 2005;129:1305-1338.
2005;129:1305-1338.
Cullen
Cullen DJE,
DJE, et
et al.
al. Gut.
Gut. 1997;41:459-462.
1997;41:459-462.
CURRENT
CURRENT HOT TOPICS
PPIs in the elderly
Overuse of PPIs is associated with
CMAJ
CMAJ August
August 12,
12, 2008;
2008; 179 (4).Targonik LE,
LE, Lix
Lix LM,
LM, et
et al
al
CMAJ
CMAJ September
September 26,
26, 2006;
2006; 175
175 (7)
(7) Dial S, Delaney
Delaney C,
C, et alal
CURRENT
CURRENT HOT TOPICS
Gastric Acidity
20%-25% GI bleeding
in the lower tract
Terminal ileum
Colon
Rectum
Hall
Hall KE,
KE, et
et al.
al. Gastroenterology.
Gastroenterology. 2005;129:1305-1338.
2005;129:1305-1338.
CURRENT
CURRENT HOT TOPICS
Gastrointestinal Bleeding in the
Elderly
Hall
Hall KE,
KE, et
et al.
al. Gastroenterology.
Gastroenterology. 2005;129:1305-1338.
2005;129:1305-1338.
Image
Image courtesy
courtesy of
of David
David C.
C. Metz,
Metz, MD.
MD.
CURRENT
CURRENT HOT TOPICS
Colorectal Cancer in the Elderly
An estimated 106,680
cases of colon and 41,930
cases of rectal cancer
were expected to occur in
2006
90% of all cases occur in
individuals aged > 50
years
American
American Cancer
Cancer Society.
Society. Cancer
Cancer Facts
Facts and
and Figures
Figures 2006.
2006. Atlanta:
Atlanta: American
American Cancer
Cancer Society;
Society; 2006.
2006.
Burt RW. Gastroenterology. 2000;119:837-853.
Burt RW. Gastroenterology. 2000;119:837-853.
Image
Image courtesy
courtesy of
of Subhas
Subhas Banerjee,
Banerjee, MD.
MD.
CURRENT
CURRENT HOT TOPICS
Colorectal Cancer in the Elderly
In
In aa study
study of
of 1244
1244 participants divided into 3 age groups who
underwent
underwent screening
screening colonoscopy, increasing age may be
associated
associated with
with an
an increased
increased prevalence
prevalence of neoplasia
of neoplasia
Prevalence of
Prevalence (%)
neoplasia (%)
n = 1034 n = 147 n = 63
Age
Age group
group (years)
(years)
Lin
Lin OS,
OS, et
et al.
al. JAMA.
JAMA. 2006;295:2357-2365.
2006;295:2357-2365.
CURRENT
CURRENT HOT TOPICS
Aging-Associated Changes in
Colonic Motility
Hall
Hall KE,
KE, et
et al.
al. Gastroenterology.
Gastroenterology. 2005;129:1305-1338.
2005;129:1305-1338.
Petruzziello
Petruzziello L, et al. Aliment Pharmacol Ther. 2006;23:1379-1391.
L, et al. Aliment Pharmacol Ther. 2006;23:1379-1391.
CURRENT
CURRENT HOT TOPICS
Prevalence of Constipation Compared
to Other Common Diseases
Prevalence
Prevalence of
of Selected Diseases in US Adults
Coronary
Coronary heart
heart disease
disease 14
14
Asthma
Asthma 16
16
Diabetes
Diabetes 16
16
Migraines
Migraines 33
33
Hypertension
Hypertension 49
49
Constipation
Constipation 63*
63*
00 20
20 40
40 60
60 80
80
Prevalence
Prevalence in
in millions
millions
Pleis JR and Lethbridge-Cejku M. Summary health statistics for U.S. adults:
National health interview survey, 2005. National Center for Health Statistics.
*Prevalence
*Prevalence in
in North
North Americans
Americans Vital Health Stat 10(232). 2006. Available at:
http://www.cdc.gov/nchs/data/series/sr_10/sr10_232.pdf. Accessed 3.5.07.
Higgins PDR, et al. Am J Gastroenterol. 2004;99:750-759.
CURRENT
CURRENT HOT TOPICS
Diverticular Disease
An
An abnormality in the aging colon
involving
involving decreased tensile strength of
the
the muscle
muscle wall
By
By age
age 50
50 years,
years, one third of Americans
will
will have
have diverticulosis
diverticulosis coli;
coli; by
by age
age 80
80
years,
years, two
two thirds
thirds will be affected
Incidence
Incidence less
less than
than 5%
5% among
among those
those aged
aged
<< 40
40 years
years
Incidence
Incidence greater
greater than
than 60%
60% byby age
age 85
85 years
years
Mean
Mean age
age atat presentation
presentation is
is 60
60 years
years
The
The majority
majority of those affected are
asymptomatic
asymptomatic
Hall
Hall KE,
KE, et
et al.
al. Gastroenterology.
Gastroenterology. 2005;129:1305-1338.
2005;129:1305-1338.
Cooperman
Cooperman A,
A, et
et al.
al. Diverticulitis.
Diverticulitis. eMedicine
eMedicine Web
Web Site.
Site. Available
Available at:
at:
www.emedicine.com/MED/topic578.htm. Accessed
www.emedicine.com/MED/topic578.htm. Accessed 11/3/06. 11/3/06.
Image
Image courtesy
courtesy of
of Jennifer
Jennifer Christie,
Christie, MD.
MD.
CURRENT
CURRENT HOT TOPICS
Diverticular Disease (Cont.)
Hall
Hall KE,
KE, et
et al.
al. Gastroenterology.
Gastroenterology. 2005;129:1305-1338.
2005;129:1305-1338.
CURRENT
CURRENT HOT TOPICS
Diarrhea
Definition:
Loose
Loose stools
stools of
of more
more than 200 grams per day in at least
33 bowel
bowel movements
movements per
per day
day
Hoffmann
Hoffmann JC,
JC, et
et al.
al. Best
Best Pract
Pract Res
Res Clin
Clin Gastroenterol.
Gastroenterol. 2002;16:17-36.
2002;16:17-36.
Hall
Hall KE, et al. Gastroenterology. 2005;129:1305-1338.
KE, et al. Gastroenterology. 2005;129:1305-1338.
CURRENT
CURRENT HOT TOPICS
Causes of Diarrhea in the Elderly
Malabsorption Thyrotoxicosis
Hoffmann
Hoffmann JC,
JC, et
et al.
al. Best
Best Pract
Pract Res
Res Clin
Clin Gastroenterol.
Gastroenterol. 2002;16:17-36.
2002;16:17-36.
Hall
Hall KE, et al. Gastroenterology. 2005;129:1305-1338.
KE, et al. Gastroenterology. 2005;129:1305-1338.
CURRENT
CURRENT HOT TOPICS
Fecal Incontinence
Fecal
Fecal incontinence
incontinence isis uncommon
uncommon in in the
the general
general population
population
(2.2%)
(2.2%) but
but has
has aa significantly
significantly higher
higher prevalence
prevalence (10%)
(10%) in
in the
the
older
older population
population
Fecal incontinence
can result from:
Fecal impaction Decreased
and subsequent rectal or anal
overflow sensation
Internal anal
sphincter
incompetence
Hall
Hall KE,
KE, et
et al.
al. Gastroenterology.
Gastroenterology. 2005;129:1305-1338.
2005;129:1305-1338.
CURRENT
CURRENT HOT TOPICS
Fecal Incontinence
Hall
Hall KE,
KE, et
et al.
al. Gastroenterology.
Gastroenterology. 2005;129:1305-1338.
2005;129:1305-1338.
Akhtar
Akhtar AJ, et al. JJ Amer
AJ, et al. Amer Med
Med Dir
Dir Assoc.
Assoc. 2005;6:54-60.
2005;6:54-60.
CURRENT
CURRENT HOT TOPICS
Hepatobiliary Function With Aging
Dynamic
Dynamic assessments
assessments of of liver function decrease with aging
Compared
Compared to
to younger
younger adults, in healthy subjects
subjects there
there is
is a
decrease
decrease of
of 30%
30% -- 40%*
40%* in:
in:
Liver
Liver size
size
Blood
Blood flow
flow
Perfusion
Perfusion
Nonalcoholic
Nonalcoholic steatohepatitis (NASH) is a common
complication
complication of
of obesity
obesity and
and diabetes
diabetes mellitus
mellitus
Diabetes
Diabetes affects
affects 12%
12% ofof the
the US
US population;
population; >> 70%
70% ofof affected
affected
individuals
individuals are
are in
in the
the geriatric
geriatric age
age range
range
NASH
NASH may
may progress
progress toto cirrhosis
cirrhosis in
in up
up to
to ~25%
~25% ofof patients
patients
NASH
NASH increases
increases the
the risk
risk of
of hepatic
hepatic side
side effects
effects of
of certain
certain drugs
drugs
*Decreases
*Decreases occur
occur between
between the
the 33rdrd and
and 10
10thth decade
decade of
of life
life
Hall
Hall KE,
KE, et
et al.
al. Gastroenterology.
Gastroenterology. 2005;129:1305-1338.
2005;129:1305-1338.
Reynaert
Reynaert H, et al. Aliment Pharmacol
H, et al. Aliment Pharmacol Ther.
Ther. 2005;22:897-905.
2005;22:897-905.
CURRENT
CURRENT HOT TOPICS
Gallbladder Function with Aging
149
Skin Cells
150
Layers of Skin (3)
Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
Epidermis Stratified
squamous
Dermis epithelium
Subcutaneous layer
AKA hypodermis Dense irregular
connective
tissue
Beneath dermis
Some also call it the
superficial fascia
Some consider it not
Adipose tissue
part of the skin
The McGraw-Hill Companies, Inc./Al Telser, photographer
151
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
Epidermis
Lacks blood vessels
Keratinized
Thickest on palms and
soles (0.8-1.4mm)
Melanocytes provide melanin
Rests on basement membrane
Stratified squamous epithelium
tissues
Sweat
Stratum corneum
Epidermis Stratum basale
Capillary
(a)
Hair follicles
With aging less h20 more
Glands crosslinking of collagen therefore
155
thinner and less elastic- fissures
Subcutaneous Layer
AKA hypodermis Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
tissue and
Sweat
Stratum corneum
Epidermis Stratum basale
Capillary
Dermal papilla
present
Dermis Sebaceous gland
Arrector pili muscle
Sweat gland duct
Lamellated (Pacinian) corpuscle
Insulates Subcutaneous
Hair follicle
Sweat gland
layer Nerve cell process
Adipose tissue
present
With aging
decreased fat: decreased cushion, callous/corns
less skin support: increased sheer force 156
***Typically the subcutaneous tissue is poorly vascularized.
DEFINITION OF A PRESSURE ULCER
Localized area of
tissue breakdown
resulting from
compression of soft
tissue between a bony
prominence and an
external surface
Touch
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
Nails
Lunula Nail bed Nail plate
Protective coverings
160
Body Defenses
Immune System
Autoimmune disorders
Cancers
Geriatric Abuse & Neglect
Physical, psychological injury of
older person by their children or
care providers
Knows no socioeconomic bounds
Acting with Empathy:
Empathy Sympathy
Avoid patronizing speech remarks that
reflect stereotypes of incompetence and
dependence.
Intervention
Age
Birth Chronic disorder 1 Complication
Chronic disorder 2
Food
intake
Food
intake
pro-opiomelanocortin (POMC)