Chronic disease and

death in USA, JAMA

Risk factor Attributed deaths
Cholesterol high 253,194/year
No regular exercise 205,254
Obesity 190,456
Hypertension 171,121
Smoking 148,879
Diabetes mellitus 77,709
 Aging may start early
 25,000 low birth weight babies from
1911 in UK studied.
 3 times more type II diabetes
 Increased fibrinogen
 Increased cardiovascular disease
 Decreased liver function
(British Medical Journal)
[Is this a stress reaction?
What does this mean for modern low
birth weight babies?]
 Common diseases in the
old
 Cardiac diseases 30% (37% of
deaths in Canada 2001)
 Cancer 29%
 Strokes 15% (2000)
 Expenses are 3 times higher than
in young.
 Half of life expenditure on health
is in the last few months.
 Theories of aging:
1. Genetic development:
 Genetic
 Immune
 Neuroendocrine.
2. Random error:
 Somatic mutation error catastrophe
 Free radical.
 1986 Richard Weindruch
UCLA
348 mice bred for longevity. 3 groups.
2. Unlimited food, n=49, at 36 months
all dead. Average 27 months.
3. 50-75% of food of first group.
4. 40% of food of first group. At 36
months 4 of 60 dead.
This group had increased fertility,
hormones, immune function and
decreased senility.
 Globe and Mail 2006 04
05
 48 Humans, overweight not obese (25-
30% of body weight fat)
 6 month study, 4 groups,
 25% calories less - restricted, 25% half
diet and increased activity - restricted,
890 calories/day, control.
 Restricted only: Insulin levels fell.
 Metabolism, body temperature down.
 Less DNA damage.
 Organ systems that
decline in healthy aging:
 Lungs
 Heart
 Renal
 Hepatic
 Immune
 Nervous
 Endocrine:
 Thyroid
 Adrenal
 Gonads.
 Nutritional status in the
elderly:
 Undernourished 5-20% USA medical
causes 93%.
 Obese over 65 years in USA men 25%,
women 50%
 Elderly hospitalized 65% starving
 Nursing homes 60% starving
 Elderly Americans 16% eat half what
they need even if they can afford to.
 Carbohydrate and fat preferred.
 Malnutrition’s effects in
elderly:
 Apathy,
 Confusion,
 Forgetful,
 Incontinence,
 Senile
behaviour.
 Metabolic changes in
elderly:
 Carbohydrate
 Protein
 Lipid
 Vitamin needs
 Calcium needs
 Magnesium needs
 Zinc needs
 Selenium needs.
 Plasma changes in
healthy elderly compared
to youth:
 Increased: glucose, cholesterol,
globulin and alkaline phosphatase
 Perhaps increased: creatinine
urea and potassium.

 Decreased: calcium, phosphate,

protein, albumin, iron.
 In elderly:
 Clinical presentation is often atypical.
 Differential diagnosis usually involves
several diseases.
 The risk to life from any illness is
greater than when younger.
 Polypharmacy likely.
 Poverty.
 Communication problems.
Special health risks of the
elderly:
 Falls.
 Hypothermia.
 Malnutrition.
 Poor immune function.
 Poisonings, e.g. CO,
polypharmacy.
 Recommended tests for
patients over 65 years:
 Potassium  Hypokalaemia
 Urea,
creatinine  Renal disease
 Calcium,  Bone disease
phosphate, ALP
 Protein,  Malnutrition
albumin.
 Recommended test for
old:
 Glucose  Diabetes
mellitus
 Hypothyroid
 Thyroid
 Blood,
 Haematology bleeding
investigations disorders.
 Faecal blood  Colon cancer.
Common laboratory tests
investigations of elderly:
 Neurological – heavy metals, TSH,
vitamin B12, VDRL.
 Musculoskeletal – PTH, vitamin D,
calcium, albumin, phosphate, ALP,
ESR, RF, ANA.
 Cardiopulmonary – CRP
 Incontinence- PSA, urinalysis
 Endocrine/metabolic- glucose, HbA1c,
TSH.
Common laboratory tests
investigations of elderly:
 Nutritional problems – Ca, Mg,
ferritin, albumin, prealbumin,
vitamin B12.
 Malignant disease- PSA, CEA,
faecal occult blood, oestrogen
receptors.
 Alzheimer’s disease:
 2-5% of the elderly.
 Onset can be at age 40 years but
usually is > 65.
 Inherited 50%
 Loss of speech, memory, motor co
-ordination, comprehension of sounds,
sights and feelings.
 Characteristic senile plaques,
neurofibrillary tangles and A4 amyloid
fibrils.
 Alzheimer's disease,
evidence for Al toxicity:
 Al, accidentally, in water supply.
 Al in plaques and tangles.
 Amyloid precursor protein and A4
amyloid in Al toxicity from an
obsolete treatment of renal
disease.
 Removing Al slows down
Alzheimer’s disease.
 Alzheimer’s disease,
laboratory tests useful:
 Glucose
 Renal function tests.
 Serum electrolytes.
 Calcium
 Thyroid function tests.
 Vitamin B12
 Syphilis
 HIV.
 79 year old woman,
confused, apathetic
 On drugs for high blood pressure and
arteriosclerosis.
Plasma chemistries:
 Potassium 3 mmol/L (3.5-5)
 Glucose 7 mmol/L (4-6)
 Magnesium 0.5 mmol/L (0.7-1.1)
 Albumin 30 g/L (35-50)
 What do these results mean?
80 year old man wants to
compete at WMA
Championships.
 Takes performance enhancing
pills.
 These may include
amphetamines, anabolic steroids
and growth hormone.
 Evidence for toxicity.

 What tests are indicated?

 Post script, athletic
performance and aging:
 Theories
 Lung capacity and or
 Heart function and or
 Neuromuscular problems, but are
they
 chemical
 structural
 nerve malfunction?
 Aging=weakness.
Theories
 No nerve connection?
 Poisoned nerve?
 Poisoned central nervous system?
 Poisoned muscle?
 Lack of mitochondria.
 Changes in fibre structure.
?