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Physiology
Leandro D. Vila, MD, MSc, FPSA
Edmee Martinez, MD
Aging Population
65
years old increasing (more from developing countries)
Philippines 1969 to 1990 Increase of 146% of 65
Females
higher life expectancy
Factors
that resulted in Aging Population
Increase life expectancy
Declines in Fertility (Last 3 decades of 20th century)
Increases
Life Expectancy
Improved Health Care Services
Better Nutrition
More Effective Therapeutic and Preventive Interventions
Aging Population. . .
E
pidemiologic Shift
From acute illnesses and infectious diseases
CHRONIC AND DEGENERATIVE diseases
P
hilippines Statistics (1997)
Cardiovascular disease (1st)
Cerebrovascular disease (2nd)
DM (9th)
Challenge to Health Care:
Provision of Medical and Social
Services
AGING
SENESENCE P
rogressive increase throughout life or after a
given stadium in the likelihood that a given
individual will die during the next succeeding
unit of time. (Comforts The Biology of Senescence)
A
ccumulation of changes responsible for
sequential alterations that accompany
advancing age and the associated progressive
increases in the chance of diseases and death.
(Hartman)
AGING
SENESENCE D
eteriorative changes with time during post-
maturational life that underlie an increasing
vulnerability to challenges thereby decreasing
the ability of the organisms to survive.
(GERONTOLOGISTS)
P
rogressive loss of physiologic processes
I
ncrease probability of death
2 General Characteristics of
the Aging Process
Age - associated disease process
Occur only at an advance age
More prevalent among the aged
e.g. CVA, Parkinsons Disease
A
ge - associated physiologic process
Occur normally in the absence of a disease
US)
(Stochastic Theories)
Program Theories
Genetic Control Theories
Aging is due to something inside an organisms
control mechanisms that triggers ageing
process
Error Theories
due to non-adaptive homeostatic failures
resulting from random assaults from both
external and internal environment
Theories of Aging. . .
G
enetic Theories
Species Theory of Weisman
Biologic Clock or Pacemaker Theory
Immune Theory of Ageing
E
rror Theories
Somatic Mutation Theory
Free-radical Theory
Rate of Living Theory
Error Catastrophe Theory
Antagonistic Pleitropy Theory
Theories of Aging. . .
G
enetic Theory
1. Species Theory of Weisman (August Weisman
19th C)
Aging is an adaptive characteristic that contributes to
the fitness of human species by removing
reproductively inactive individuals from the population
enetic Theory
2. Biologic Clock / Pacemaker Theory
Best example controlled by small number of
genes
enetic Theory
3. Immune Theory of Aging
Involution of immune system
Decreases in competency after 20 y/o
Thymus involutes
Leads to critical age-related infections
Theories of Aging. . .
G
enetic Theories
Species Theory of Weisman
Biologic Clock or Pacemaker Theory
Immune Theory of Ageing
E
rror Theories / Stochastic Mechanisms
Somatic Mutation Theory
Free-radical Theory
Rate of Living Theory
Error Catastrophe Theory
Antagonistic Pleitropy Theory
Theories of Aging. . .
rror Theories
2. Free Radical Theory
First proposed by Denham Harman (1954)
Agents damage biological molecules with time
Damages provide substrates for aging
physiologic deficits
Splitting of covalent bond Highly reactive
Irreversible damage
In the body from fuel radicals
Exogenous UV light, gamma-rays and metal
ions, etc.
Theories of Aging. . .
rror Theories
Free Radical Theory
Superoxide from O2 most common free radical
Lipids and CHON of cell membranes most vulnerable
Aging production of control to production of free
radicals
catalase, glutathione peroxidase and superoxide dismutase
Vitamins C and E good anti-oxidant agents
Theories of Aging. . .
rror Theories
3. Rate of Living Theory
Metabolic Theory
Life span is related to metabolic rate
Finite amount of metabolic lifetime
Higher metabolic rate Shorter life span
1928 Rate of Energy Expenditure (EE) negative
correlation with life span (Pearl)
EE ROS Prolonged Life Span
1935 Energy Restriction Intake - life span (Clive
Mcay)
Theories of Aging. . .
rror Theories
4. Error CatastropheTheory
Leslie Orgel (1963)
Errors occur during transcription or translation
Error in information transfer at sites other than DNA
Error in synthesis of CHON Error-containing CHON
produced Further errors Defective CHONS
Aging
Theories of Aging. . .
rror Theories
5. Antagonistic Pleitropy Theory
George Williams (1957)
Evolutionary Theory Selection and Mutation
2 Assumptions:
1. A particular gene may affect several traits (pleitropy)
2. Pleitropic effects is opposite or antagonistic at different
ages
Higher
Difficulty of remembering
Cortical names and misplacing of
common objects
Function
s tandard Intelligence
Preserved until 80s
Nervous WAIS vocabulary subtest
System (Semantic knowledge or crystallized
knowledge)
Memory
and Decline in efficiency to
Higher perform complex tasks
Cortical
Function Decline in timed tasks
Declines steadily throughout life
s (after 70 y/o)
Slowing down of speech in time
difficult to understand
Nervous
System anagement:
Memory
Education
and
Higher Exercise
Cortical
General Cognitive
Function abilities
s
Nervous
System
ptical Component
Thickening of Cornea
Visual Less corneal curvature
System Less elastic lens
Presbyopia starts at 15 y/o
and clinically significant at
40 y/o
Increase opacity of lens
(cataract)
Nervous
eceptive Component
System Visual acuity poor esp. in low
contrast and low luminance
Photoreceptors begin to
deteriorate at 20 y/o
Difficulty in contrasting green
System
estibular Dysfunction
Unsteadiness,
disequilibrium, vertigo
Somatosensory function
(demyelination)
Nervous 0 60 y/o 50% taste buds
System lost
lfactory threshold
Threshold to other
modalities of sensations
Nervous
System Sleep quality
Developed before 65 y/o
Sleep maintenance
Sleep onset
Sleep
Early morning awakening
isappearance of Stage 4
sleep
Heart iochemical
unctional
Structural
CVS 1 gm / year male
1.5 gm / year
female
0.55% BW 30 y/o
5 10% diastolic
lumen at rest and
myocardial mass
(eccentric
hypertrophy)
CVS ES afterload due to
in aortic stiffness
Heart
in heart volume in relation
to body SA (30 70 y/o) (cell mass
)
actin activation
Lumen of Blood Vessel Blood Vessel
Resistance Wall Thickness Wall Compliance
Vessels
Resting Peripheral
Vascular Resistance
Total Blood
Volume
MAP
FUNCTION
Resting heart rate
CVS
Decrease;
- HR (exercise)
- pacemaker cells
Heart - myocardial
compliance
- systolic function
- diastolic
function
- left ventricular
filling period
Increase;
CVS - depolarization
phase
- repolarization
phase
Heart - refractory period
- duration of
contraction
- isovolumic
relaxation period
SV
CO
Aging and
The Gastro-
intestinal System
MOUTH
COMPONE CHANGE COMPONE CHANG
NT NT E
TEETH DUCTS
SCENT BASAL
RECEPTORS SECRETION
SALIVARY STIMULATED
GLANDS SECRETON
ACINI
CONTENT
ESOPHAG
US COMPONE
COMPONEN CHANG CHANG
T E NT E
STRUCTUR RELAXATION
LATENCY
AL
COMPLIANCE THRESHOLD
MYENTERIC PERISTALSIS
NEURONS PRESSURE
THICKNESS WAVE
VELOCITY
FUNCTION LES BASAL
PRESSURE
AL
UES BASAL
PRESSURE
ESOPHAG
US COMPONE
COMPONEN CHANG CHANG
T E NT E
STRUCTUR RELAXATION
LATENCY
AL
COMPLIANCE THRESHOLD
MYENTERIC PERISTALSIS
NEURONS PRESSURE
THICKNESS WAVE
VELOCITY
FUNCTION LES BASAL
PRESSURE
AL
UES BASAL
PRESSURE
STOMACH
COMPONENT CHANGE COMPONENT CHANGE
STRUCTURAL PG Synthesis
Mucosal Cell Basal HCO3
Number Production
Response Injury Stimulated HCO3
Production
Blood Flow Basal
Glycoprotein
Synthesis
FUNCTIONAL Stimulated
Glycoprotein
Synthesis
Basal Acid Intrinsic Factor
Secretion
Stimulated Acid Liquid Emptying
Secretion Time
Pepsin secretion
Solid Emptying
Time
Gastrin levels Electrical
SMALL
COMPONENT INTESTINES
CHANGE COMPONENT CHANGE
Zinc Absorption
PANCREAS
COMPONENT CHANGE COMPONENT CHANGE
STRUCTURAL FUNCTIONAL
Insulin Levels
Insulin Sensitivity
LIVER
COMPONENT CHANGES COMPONENT CHANGES
STRUCTURAL FUNCTIONAL
Gall Bladder
Emptying Biliary Duct Size
CCK Production
COLON
Elastin Content
RECTU
M
COMPONENT CHANGE COMPONENT CHANGE
STRUCTURAL FUNCTIONAL
TSH No Change
THYROID GLAND
Fibrosis
Insignificant
Thyroid
Follicular Cellularity and Size can sufficiently
maintain Euthyroid
Microscopic Nodularities state
T4
Metabolic Disposal by 50%
Peripheral Conversion of T4
Incidence of Hyperthyroidism
ADRENAL GLAND
CORTEX
Gross Weight
Cortical Nodule Formation
Fibrosis
Pigment Deposition
Unchanged Plasma Steroids (Diurnal
Secretion is Unchanged)
DHEAS
Adrenopause
activity of 17, 20 Desmolase
Aldosterone Renin System response to
salt restriction
ADRENAL GLAND
MEDULLA
Urinary NE
NE Nocturnal secretion
PTH
GIT absorption
Vitamin D availability
Calcitonin
REPRODUCTIVE
Male Female
Menopause
Reproductive Function
Endocrine Symptoms (Bleeding
Rate of Conception irregularities)
Sexual Interest, Nervous System disturbances
(HA, Mood, Insomnia etc.)
Activity, Capacity
Metabolic Changes
(Impotence, Libido and (Osteoporosis)
Ejaculation) Estrogen and Progesterone
Testosterone FSH (15 X)
basal LH LH (13 X)
basal FSH (greater Uterine Size and Weight
than LH due to inhibin) Vaginal Mucosa shrinks and
opening is narrowed
Aging and
The Urinary
System
STRUCTURAL FUNCTIONAL
Renal Mass (10 Cortical) RBF
Na+ Reabsorption C
ortex Atrophy of afferent and
efferent vessels K+ Secretion
J
uxtamedullary continuity of asal pH, pCO2 and HCO3 Unaffected
afferent and efferent arterioles
Concentrating ability V
asa Recta unaffected
Total Body Water ( F > M)
hirst Mechanisms Blunted
PCT Number and Length
Aging and
The Respiratory
System
RESPIRATO ore Pliant
Mean Bronchiolar
Diameter
RESPIRATOR
Y MUSCLES Maximal Inspiratory and
Expiratory Pressures
and
Muscle Strength (Atrophy
CHEST
of muscles)
WALL
iaphragm Thickness
unchanged
RESPIRATO TLC a little
RY SYSTEM
RV (Early airway closure Air trapping)
LUNGS RV / TLC
FUNCTION
VC (Muscle weakness and chest wall
stiffness)
Lung Defense
Laryngeal and Cough Reflex
Mucociliary Transport
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