Physiological features of aging process and modulation of thermal parameters required by application of balneal factors in elderly

Authors: O. Surdu 1, 2, V. Marin1, T. V. Surdu2, V. Rusu 1, D. Profir 1. Balneal and Rehabilitation Sanatorium Techirghiol 2. Ovidius University Constanta Leonardo Proyect:Thermal Baths for Active Ageing Montecatini Terme October, 22th 2011
1

Demographic aging

Demographic aging is an undeniable fact which, globally speaking, has economic, social, occupational, cultural consequences and, last but not least, medical pressures that can not be ignored. The last two decades we can also talk about a demographic aging of the elderly a phenomenon that refers to an increase percentage of population over 75 years.

This fact led to the concept of 4-th age, targeting a segment of population extremely fragile, among which 20-30% of people are dependent on someone.

The actual and future percentage increase of elder population in USA .

(by Bontke & Bontke)
Year All ages 65+years 64-74 years 75-84 years 85+years

% 1900 1930 1960 1990 2020 2050 76.303 122.775 179.323 249.657 296.597 309.488 4 5.4 9.2 12.7 17.3 21.8

% 2.9 3.8 6.1 7.2 10.1 9.7

% 1 1.3 2.6 4.1 4.9 6.9

% 0.2 0.2 0.5 1.3 2.4 5.2

~ 4x

~ 5x

~ 3x

~ 7x

~ 25x

The actual and future percentage increase in Romanian elder population

The population of Romania during 1990-2009 followed a steady downward trend from 23206720-21469959 in 2009 (July 1) due in large part, emigration after the revolution, but also decrease the birth rate, mortality by maintaining the high, even increasing it in some years. Consequently, natural increase since 1992 was negative (-0.2% o). As a result of sharply lower in the younger population, aged 0-14 years (from 23.6% in 1990 to 15.1% in 2009), and increased the age of 65 years and older (from 10.3 % in 1990 to 14.9% in 2009), leading to socalled "demographic ageing of the population"

The actual and future percentage increase in

,8 14 ,8 14 ,8 14 ,2 17 ,9 16 ,4 52 ,2 16 ,4 52 ,6 15 ,7 17 ,1 52 ,4 15

,1 18

,8 51

,3 15

Romanian elder population

2004

,5 14

2005 2006

2007 2008

,9 14

,4 18

,5 51

,2 15

2009

,9 14

,7 18

,3 51

,1 15

STRUCTURA POPULATIEI ROMANIEI PE GRUPE DE VARSTA IN PERIOADA 1990 - 2009

,3 14 ,1 14 ,5 16 ,2 16 ,4 52 ,3 52 ,3 52 ,3 52 ,1 52 ,7 51 ,1 51 ,5 50 ,9 16 ,2 11 ,8 10 ,3 10 ,2 17 ,0 17 ,3 17 ,9 49 ,4 11 ,2 49 ,2 49 ,8 48
la suta din total populatie

,8 16 ,1 52 ,8 17 ,3 18 ,7 18 ,1 19 ,4 19 ,9 19 ,5 20 ,1 21 ,8 21 ,4 22 ,0 23 ,6 23 ,3 17

,6 13 ,3 13 ,0 13 ,8 12 , 6 5, 9 12 1 ,2 12 ,0 12 ,7 11 ,4 16 ,7 16 ,2 16 ,8 15 ,0 16 ,1 16

2000 2001

2002 2003

,2 52

,7 16

1998 1999

1996 1997

1990

1991 1992

1993 1994

1995

0-14 ani

15-49 ani

50-64 ani

65 ani si peste

Age distribution for patients hospitalized in SBTR in 2011

Patients age distribution
16 544 1571 108 362 959 15-24 25-34 35-44 45-54 55-64 1952 3031 65-77 75-84 <84

Age distribution for patients hospitalized in SBTR in 2011

Age patients distribution

6% 18%

0% 1% 4%

15-24 11% 25-34 35-44 45-54 55-64 24% 65-77 75-84 <84

36%

Disease distribution for patients hospitalized in SBTR in 2011

Patients diseases distribution
5 112 90397 7 360 2402 3331 67 580 inflamatory arthritis postlaminectomy slipped disk hernia neurological diseases osteoarthritis osteoporosis dermatologycal diseases 594 598

slipped disk hernia postraumatic status gynecological diseas vertebral static disfunction abarticular syndroms vascular disease

Disease distribution for patients hospitalized in SBTR in 2011

Patients diseases distribution
0% 0% 4% 1%1% 5% 28% 39% 1% 7% inflamatory arthritis postlaminectomy slipped disk hernia neurological diseases osteoarthritis osteoporosis dermatologycal diseases 7% 7%

slipped disk hernia postraumatic status gynecological diseas vertebral static disfunction abarticular syndroms vascular disease

Cure in a balneary resort

Request/Desire/Demand

Need Increase in the quality of life

Aging process is a natural disease

(Aristotel)

Aging process is not a disease or a dysfunction itself. It only represents a decrease of the optimal physiological levels of all ongoing processes within the organism. This global malfunction does not occur equally within all systems and does not start precisely from a certain moment. The human body can or cannot be affected previously to this moment.

Aging process is a natural disease

(Aristotel)

From the biological point of view, fundamental for aging process is a decrease of adaptability of both functions of various systems and cellular level, so that adaptive mechanisms that lead to maintenance of internal environment balance - homeostasis - are slowing down and sometimes are ineffective in elderly. Homeostasis is disturbed especially under physical (including heat stress and climate), chemical and physical stress, consequently adaptive mechanisms are restoring slowly or insufficiently the perturbed parameters.

Nowadays, there are two currents for the most frequent accepted intimate mechanisms of aging process:

Genome based theories

Theories that do not involve direct genetic determination

Aging as a genetically programmed phenomenon

Without genetic determinati on

Organ disturbances immune and/or neuroendocrin e induced

Primary and secondary physiological disturbances

Decrease of the accommodation capacity

The disturbance of the major homeostatic functions: immune, neurologic, endocrine, thermoregulatory, together with alteration of self-control mechanisms, they all generate the transformation of the normal stress within a relationship into a pathogenic stress. The main targeted tissue structures for physiological aging whose senescence influences the global rhythm of aging are the blood vessels and the neurons. The complex aging changes to these structures have as general results aterosclerosis and neurodegeneration.

The thermoregulatory function and senescence

Risk for hypothermia (decrease of thermogenesis and heat storage capacity) or hyperthermia (decrease of thermolysis and increase of temperature value which triggers thermolysis)

Accommodation disturbances in peripheral circulation

The aging of the nervous system (disturbances in signal transmission, in thermic receptors, in the transmission and/or integration of information, in the transmission of afferent stimuli)

Immuno-senescence
Older people have particular characteristics in relationship with warm balneal prescriptions:
-

the decrease of immune systems response capacity to new antigenic challenges the increase of the quantity of endogenous antigenic products and, in addition, propensity for autoimmune phenomena the alteration of expression phenomena of surface antigens, of their products and also of the subtle mechanisms of presentation /recognition /cooperation /connection from the major complex of histocompatibility

Aging of the endocrine system itself has consequences on the direct control of endocrine functions through neurotransmitters and also on the indirect through hormones/secretive pathways The endocrine system role in the aging ACTH and cortisol process is that of secretions and their neuroendocrine circadian rhythm are programmer through slightly influenced by epiphysis due to the age, but post aggression axes: negative feed-back is (cerebro) The endocrine slower, thus the increased hypothalamusblood levels of these system and pituitary-(tiro)hormones can resist for a senescence gonadic longer period of time hypothalamuspituitary-adrenal

The cardio-vascular system senescence and adaptive demands for balneal application
Morphophysiological parameter Systolic flow Morpho-physiological changes connected to age Decreases with 1% /year, from 7 l/min, in terms of effort, at 40 years old, to 4 l/min at 80 years old
Adaptability decreases by increasing the frequency to requests; decreases the chronotropic and inotropic adrenergic reply

Required adaptive demands for physical activity Increases 2-3 times compared with resting phase Request an increase of cardiac frequency (limited to max.140 beats/min in elder people) Decreases the arterial blood pressure Decreases, due to vasodilatation produced by local metabolites: adenosine, K+, Ach, ATP, lactic acid, CO2 Increases Increases to 85-90 ml O2 per kg.body/min

Change/Request report

Discordant

Cardiac frequency

Discordant

Arterial blood pressure Peripheral resistance

Increased, normal, low adaptive deficit to environment requirements Increases, because of the decrease of vascular walls elasticity

Relatively discordant

Discordant

Speed of blood circulation Maximum oxygen consumption

Decreases Decreases from 45-50 ml O2 per kg.body/min, in an adult, to 18-23 ml O2 per kg.body/min in adults over 60 years old

Discordant

Discordant

Respiratory system senescence and balneal application

Morphophysiological parameter

Morphophysiological changes connected to age

Adaptive needs required by physical activity

Change/Request report

Respiratory system

Progressive deterioration of the pulmonary tissue (parenchyma and interstitial). The decrease of chest elasticity and respiratory muscles activity. The increase of the residual volume.

The respiratory rhythm (tachypnea) and amplitude increase. The CO2 partial pressure in the alveolar air decreases.

Relatively discordant

Hematopoetic system senescence and the physical effort

Morpho-physiological parameter
Plasmatic volume The number of redblood cells White-blood cells

Morpho-physiological changes connected to age

Decreases due to intercellular water loss Does not modify The incapacity to trigger calcium signals because of decreased intercellular calcium and low synthesis of phosphoinositol and diacilglycerol. Status trombofilicus: The activation mainly of the coagulation system with the imbalance of the fluidcoagulant status Decreases the consumption and extraction of O2 from the arterial blood

Adaptive needs required by physical activity

Increases due to blood mobilization from deposits Decreases

Change/Request report Discordant Relatively Discordant

Decreases

Concordant

Thrombocytes

Decreases blood coagulation

Discordant

Variation of concentration of the dissolved gases in the peripheral blood

Decreases arterial CO2 concentration due to hyperventilation and amino acids loss through perspiration

Concordant

The nervous system senescence and physical activity

Morphophysiological parameter Morpho-physiological changes connected to age Adaptive needs required by physical activity Change/Request report

Cellular populations

Decreases the number of neurons: Synaptic plasticity changes; apoptosis; neurofibrillary damage; loss of myelin sheath; decrease of speed transmission along the nerve; granular-vacuolar degeneration; Levi corps in high number; areal accumulations of lipofuscine; occurrence of Hirano corps; senile plates

Compensatory proliferation of conjunctive tissue between the neurons Changes of the hemato-cerebral barrier permeability

Nervous structures able to gather and transmit information, to elaborate the reply and to carry it to the effective organs, in order to realize the vegetative feed-back

Discordant

Central nervous system circulation

1. Decompensation of self-control mechanisms of cerebral circulation 2. Pathological mechanisms: Oclusive (through thrombosis or embolism) Hemorrhagic (straight or through diapedesis)

The acute phase: Contraindicates physical activity and effort The chronic phase: Requires parametrical modulation

Discordant

The vulnerabilities of the elder people

The cardiovascular function vulnerability The motor activity vulnerability The sensitive-sensory function vulnerability The psycho-affective vulnerability

The damage of the tissue trophicity and its consequences The precarity of tegument trophicity
Bedsores

The precarity of muscular trophicity

The decrease of muscular force happens gradually starting from early ages: between 44-55 years old there is a loss of 1% /year

between 55-65 years old there is a loss of 1,5% /year

over 65 years old there is a loss of 2% /year, remaining 30-40% from muscular force value from age 25

The precarity of bone structure trophicity

The risk for osteoporosis

The precarity of near joints structures trophicity

Risk for stretching, loss of continuity of insertions, breakings Limited range of motion

The damage of motion

The decrease of passive mobility usually due to pyramidal muscular hypertonia of the lower limbs, but also due to extrapyramidal hypertonia The increase of support base in upright position and walking; The decrease of the miotatic reflex, usually symmetrical; Conservation of general sensitivity, with the possibility of decreasing the vibratory sensitivity in the lower limbs.

The senile walk An important pathological cause for walk disturbances in elderly people is stroke

Polipathology

Iatrogenetic Risk

Polipragmatic Risk

The therapeutical objectives are:

The maintaining / regaining of articular mobility; The maintaining / regaining of muscular force and resistance; The maintaining / correction of body posture and alignment; The maintaining / correction of motor coordination and control and equilibrium.

The individual kinetotherapy aims:

The

decrease/control of pain; of loss/recover of joint

Prevention

mobility;

Prevention

of loss/recover of muscular force and resistance;

In case of neurological sequelae, the kinetic program aims:

recover of the muscular tonus decrease in muscular hypertonia and increase in muscular hypotonia; prevention of axial deviations; recover the balance between agonists / antagonists, synergists / stabilizers, and also between the physiological alternation contraction / relaxation; the re-establishment of body equilibrium, voluntary motor control, walking and abilities.

Conclusions

Kinetotherapy along with hydrokinetotherapy, with their various prescribing forms, are used in balneal resorts, in procedural complexes, usually belonging to the entire methodological gatherings of our field:

hydrothermotherapy, electrotherapy, masotherapy, balneoclimatotherapy.

Therefore, we should bare in mind a certain margin of vital relationships when discussing and concluding all the conceptual and methodological aspects regarding kinetic prescriptions, the latter ones being unable to react on their own on the elders organism, but all of them together.

Conclusions
One might say which has been proved by statistic analysis that parameter modulation of kinetics and hydrokinetotherapy clinically motivated prescriptions, may allow 3-rd age and even 4-th age patients to do efficient balneal and physical treatments, not only with the purpose of training/stimulating the organisms adaptability, with the delay of global decrease of performance / maladjustment phenomena characteristic for senescence - thus gerontoprophilaxis but also with the purpose of treating ailments and/or chronic dysfunctions gerontorehabilitation, both aspects leading finally to the same objective the improvement of life quality.

Thank you for your attention!