Abdul Gofir

Faculty of Medicine
Universitas Gadjah Mada
 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).
 Aging
1. Physiological process
2. Individual changes
3. Organ changes
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
 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

 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
 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

 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
 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
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
Overall effectiveness decreases, leading to:
Increased infection risk

Decreased ability to fight diseases

Slowed wound healing

Autoimmune disorders

Cancers
 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
 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 mans capacity
to enjoy sexual relationships
 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
 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
 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
 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
 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
 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
 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
 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