COMPREHENSIVE

GERIATRIC ASSESSMENT

DR.dr.RA.Tuty Kuswardhani, SpPD, KGer, M.ARS

* GERIATRIC INSTALATION SANGLAH HOSPITAL

* GERIATRIC DIVISION INTERNAL MEDICINE DEPARTEMENT
MEDICAL FACULTY UDAYANA UNIVERSITY
2012
•GERONTOLOGY : GERONTOS AND LOGOS
•GERIATRY SCIENCE :A SCIENCE WHICH LEARNS THE
ELDERLY AND THE TREATMENT
•GEROS = ELDERLY
•IATRY = TO TREAT
•THE TERM : IGNAS LEO VASCHER TAHUN 1909
•PROGRESSIVE DEVELOPMENT : DR. MARJORI WARREN
(THE PIONEER OF GERIATRY IN THE WORLD)
 HEALTH AGING CONCEPT
(WHO)

THE AIM OF THE HUMAN IS

HEALTHY AGING

GERONTOLOGY IS CONCERN PRIMARILY WITH

PROBLEM OF HEALTHY AGING RATHER
THAN PREVENTION OF AGING
ELDERLY POPULATION
 INDONESIA : ≥ 60 Y.O
 WHO : ≥ 60 Y.O
 DEVELOPED COUNTRY : ≥ 60 Y.O
 ELDERLY PATIENT :
≥ 60 Y.O + MULTIPLE DISEASE/
COMPLEXITY
Table 1
THE PREDICTION OF THE ELDERLY POPULATION 2020

CHINA 198. 343

INDIA 107.713
INDONESIA 24.816
BRAZIL 21.945
UK 12.912
MEXICO 12.829
NIGERIA 9.115
CENTRAL BUREAU OF STATISTICS, 1992
Table 2
THE CHARACTERISTIC DIFFERENT DISEASE IN THE ADULT AND
THE ELDERLY

PARAMETER THE ADULT THE ELDERLY

The cause of disease From Outside (external) From inside (internal)

clear, actual hidden
Specific/single Cumulative/multy
Acute Chronic
Onset Very clear Not clear

Process acute Chronic

Self limited Progresive
Stimulate immune Non immune

Individual variation Small Large

Complex disease

(STIEGLITZ, 2004)
Schematic 1
SCHEMATIC DIFFERENT OF ADULT & ELDERLY PATIENT (Hadi Martono, 2004)

MEDICAL MODEL GERIATRIK MODEL (BIO-PSYCHO-SOCIAL)

Social-economic
environment

Sign/symptome
disease
Impairment of
Anatomic & function
 14 IMPAIRMENTS (14 I)
 Immobility  Isolation
 Instability  Inanition
 Incontinence  Impecunity
 Impairments of cognitive  Iatrogenesis
 Impaction  Insomnia
 Impairments of Vision,  Impotence
Hearing, skin integrity, taste  Immunodeficiency
 Infection
 Evaluating The Elderly Patient
 The factors interact in complex ways
 influence the health & functional
status of the elderly
 Comprehensive evaluation will require
an assessment of each of these
domains.
 Functional abilities  a central focus
of the comprehensive evaluation of an
elderly individual. Diagnoses-
physical-laboratory findings are useful
in dealing with underlying etiologies
& detecting treatable conditions, in the
elderly, measures of function are often
essential in determining overall health.
Figure 1 : Components of assessment of the elderly
(David B Reuben, )
 Comprehensive evaluation of an the elderly
individual’s health status is one of the most
challenging aspects of clinical geriatrics. Most
importantly, it requires a perspective different from
that used in the evaluation of younger individuals.
Progress may be measured on a finer scale.

 Special tools are needed to ascertain relatively small

improvements in chronic conditions and overall
function, compared with the more dramatic cures of
acute illnesses often possible in younger patients
Schematic 2.
INTERACTING DIMENSIONS OF GERIATRIC ASSESSMENT (David B Reuben, )
 THE PRINCIPAL OF HEALTH
TREATMENT IN THE ELDERLY
peventive
HOLISTIC promotive
curative
rehabilitatic

The elderly > the human
entirely, including the
environment,
psychology,social
economic,cultural, spiritual
Geriatric assessment
comprehensive > all organs
& its system,
psychology,social
economic,cultural, spiritual
vertical > the service in the society to the
highest referral : subspecialistic/
geriatric department.
horizontal > part of elderly phosperity
service comprehensive, join with other
department/ fondation conceted.

HAZZARD,
 Figure 2.

Most intensive Least intensive

Setting CGA,GEM, and CGA consultation, Community-based and in

rehabilitation units inpatient or outpatient home outreach programs

Targeting Most restrictive Least restrictive

Process Large team, extensive Screening and referral

evaluations

cost Very expensive Relatively inexpensive

Spectrum of CGA-like interventions (CGA, comprehensive geriatric assessment ; GEM, geriatric

evaluation and management) (David B Reuben)
Table 3.
Multidimensional Case-Finding Instruments used, with
references and Average Performance Time (David B Reuben)
Average time Cost per case
Problem Instrument (Rederence) to perform Receiving a new
(MN) (n=37) diagnostic or treatment

Cognitive impairment Mini mental state examination 9,2 $68

Depression Geriatric depression scale 5,1 $17

Gait instability Performance oriented assessment of mobility 2,5 $15

Malnutrition Midarm circumference using gender specific criteria 1,0 $15

Review of weights in chart
Recent weight loss 0,275 $8
Whisper test
Hearing impairment 0,55 <$1
Hand-held Snellen chart
Vision impairment 2,1 $10
Specific question
Urinary incontinence 0,275 <$1
Question regarding general function and specific
Sexual problem problems 0,825 $14
Table 4.
THE KEY ELEMENTS OF THE PROCESS OF CARE RENDERED BY
CGA TEAMS CAN BE DIVIDED INTO SIX STEPS (David B Reuben)

Date gathering
Discussion among the team

Development of a treatment plan

Monitoring response to the treatment plan

Revising the treatment plan

Table 5.
STRATEGY FOR EFFICIENT OFFICE BASED ASSESSMENT (David B Reuben)
Aspect being Previsit Office staff Clinician Clinician as Referral as needed
assessed questionnaire administered routine needed
Past medical history D R

Medical geriatric
problems
Visual imp. B B R Ophthalmologist or optometrist

Hearing imp. B B (if needed) R Audiologist

Urinary incontinence B R D (office Geriatrician,urologist,or

urodynamics) gynecologist
Malnutrition D R Dietitian, or social worker

Sexual dysfunction B R Urologist,or geriatrician

Polypharmacy B R Pharmacist

Dental problems B R Dentist

Gait,balance,falls B B D Physical theraoist

Affective programs D R D Psychiatrist

Cognitive programs B R D Geriatrician,psychiatrist,or

neurologist
Functional impairment D R D physical or occupational
therapy,social worker
Environmental problems D R Home health

Preventive services D R
Disease diagnosis in the elderly
should include 4 levels

Disease
Impairment

Disability

Handicap
 THE ELDERLY HEALTH REPORT

IDENTIFICATION PATIENT

 Name  ………………………………….
 Age  ………………………………….
 Sex  ………………………………….
 Address  ………………………………….
 Telephone  ………………………………….
 Occupation  ………………………………….
 Care giver  ………………………………….
 No Record  ………………………………….
 Date of the first treatment  ………………………………….
 Location ward  ………………………………….
 Doctor  ………………………………….

GERIATRIC INSTALATION
SANGLAH HOSPITAL DENPASAR
DIPONEGORO STREET
TELP/ FAX. (0361) 246663, (0361) 227911-14 EXT. 258
I. PATIENT CHARACTERISTIC

I.01 No. Medical Record :

I.02 No. Pasien :
I.03 Nama Pasien :
I.04 Nama Suami / Isteri :
I.05 Alamat :
I.06 Telepon :
I.07 Jenis Kelamin : 1. Pria
I.08 Tanggal Lahir 2. Wanita
I.09 Umur : ____ / ____ / ____ (tgl / bulan / tahun)
I.10 Nama Orang Terdekat : ___________ tahun
I.11 Jumlah Anak :
Jumlah Cucu : _________ laki-laki ________ perempuan
Jumlah Cicit : _________ laki-laki ________ perempuan
: _________ laki-laki ________ perempuan
II. MEDICAL HISTORY
II.01 Keluhan utama pasien Lama Keluhan
(mohon diisi salah satu saja)
A. Pusing-pusing 1. Ya 2. Tidak ___________
B. Nyeri kepala 1. Ya 2. Tidak ___________
C. Kesadaran menurun 1. Ya 2. Tidak ___________
D. Selera makan berubah 1. Ya 2. Tidak ___________
E. Berat badan menurun cepat 1. Ya 2. Tidak ___________
(± 2,5 – 3 kg/bln)
II.02 Riwayat Penyakit sekarang :

II.03 Riwayat Penyakit Dahulu Tahun

A. Gangguan pembuluh darah otak/stroke 1. Ya 2. Tidak ___________
B. Katarak 1. Ya 2. Tidak ___________
C. Nyeri Jantung (Angina) 1. Ya 2. Tidak ___________
D. Serangan jantung IMA (MCI) 1. Ya 2. Tidak ___________
E. Paru-paru (TBC/BPOK/Asma) 1. Ya 2. Tidak ___________
II.04 Riwayat Pembedahan Jenis Pembedahan
Tgl ……….bl………..th.………..
II.05 Riwayat Inap rumah Sakit
Tgl .....…….bl…….…..th.…………..RS..……………Diagnosa…..……….

II.06 Riwayat kesehatan lain :

Selama 1 bulan terakhir, apakah Bapak/Ibu melakukan pemeriksaan kesehatan berikut ini :
a. Gigi 1. Ya 2. Tidak
b. Mata 1. Ya 2. Tidak
c. ……… 1. Ya 2. Tidak
II.07 ALERGIC HISTORY

II.08 Obat-obatan saat ini :

A Dengan resep dokter Dosis dan Pemakaian
________________ Dosis_______pemakaian________

B Tanpa resep dokter Dosis dan pemakaian

________________ Dosis_______pemakaian________

II.09 Social History

A. Rekreasi 1. Tidak pernah 2. Jarang 3. Sering
B. Kegiatan keagamaan 1. Tidak pernah 2. Jarang 3. Sering
C. Silaturahmi dgn keluarga 1. Tidak pernah 2. Jarang 3. Sering
D. ………………………….. 1. Tidak pernah 2. Jarang 3. Sering
II.10

Finansial analysis

A Apakah pekerjaan utama Bapak/Ibu sebelum usia 55 1. Peg. Negeri/ABRI/BUMN

tahun 2. Peg. Swasta
3. Tani
4. Lainnya, sebutkan…..

B Apakah saat ini Bapak Ibu bekerja? 1. Ya

2. Tidak
II.12 NUTRITION ASESSMENT
A. SUBYECTIVE NUTRITION
NAIK/ TETAP/ TURUN
1. Apakah 1-2 bulan terakhir ada perubahan berat badan ______ ______ ______
2. Apakah ada perubahan nafsu makan
YA TIDAK
3. Apakah ada : perubahan ________ ________
pengecapan lidah ________ ________
4. Apakah ada masalah : - mengunyah, ________ ________
- menelan ________ ________
5. Apakah ada masalah dengan gigi
6. Apakah ada gangguan pencernaan ________ ________
a. Mencret ________ ________
b. Sembelit ________ ________
c. Mual ________ ________
d. Muntah
7. Apakah hidup sendiri di rumah? ________ ________
Bila tidak, siapa yang menyediakan makanan?

B. POLA MAKAN YA TIDAK

1. Kebiasaan makan pagi : _______ _______
2. Kebiasaan makan siang : _______ _______
3. Kebiasaan makan sore : _______ _______
4. Kebiasaan selingan/ ngemil _______ _______
 Recall 24 Hours

Banyak Banyak
Makan pagi g Urt Selingan pagi g Urt

Banyak Banyak
Makan siang g Urt Selingan siang g Urt

Banyak Banyak
Makan malam g Urt Selingan malam g Urt
III. SYSTEM ANAMNESTIC
III.01 Menurut pendapat Bapak/Ibu, bagaimana keadaan kesehatan Baik sekali, Baik, Cukup/lumayan, Buruk,
Bapak/Ibu secara umum saat ini ? Buruk sekali
III.02 SKV
Nyeri/rasa berat di dada 1. Akut 2. Kronik
Sesak nafas pada waktu kerja 1. Akut 2. Kronik

III.03 PULMO
Sesak nafas 1. Ya 2. Tidak

III.04 GIT
Nafsu makan 1. Ya 2. Tidak

III.05 GUT
Gangguan BAK 1. Ya 2. Tidak

III.06 HEMATO
Mudah timbul lebam kulit 1. Ya 2. Tidak

III.07 REMATO
Kekakuan sendi 1. Ya 2. Tidak

III.08 ENDOKRIN
Benjolan di leher depan samping 1. Ya 2. Tidak

III.09 NEUROLOGI
Pusing/ sakit kepala 1. Ya 2. Tidak

III.10 JIWA
Sering lupa 1. Ya 2. Tidak
IV. DEPRESSION DESCRIPTION
YA TIDAK

IV.01 Apakah Anda pada dasarnya puas dengan kehidupan anda? 0 1

IV.02 Apakah Anda tidak dapat melakukan sebagian besar kegiatan Anda? 1 0

V. BARTHEL ADL INDEKS (BAI)

Fungsi Skor Keterangan

V.01 Mengontrol BAB 0 Inkontinen tak teratur

1 kadang-kadang inkontinen
2 kontinen teratur

V.02 Mengontrol BAK 0 Inkontinen/pakai keteter & tak terkontrol

1 kadang-kadang inkontinen
2 mandiri

BAI SCORE
20 Mandiri 5–8 Ketergantungan berat
12 – 19 Ketergantungan ringan 0–4 Ketergantungan total
9 – 11 Ketergantungan sedang
VI. PHYSICAL EXAMINATION
VI.01 Tanda vital
A Kesadaran Cm/delirium
B Tekanan darah Berbaring : mmHg
(setelah 2 menit pada posisi tersebut) Duduk : mmHg
Berdiri : mmHg
C Nadi/menit …………………….

D Laju respirasi Kali/menit

E Suhu tubuh Derajat celcius
F C.ANTROPOMETRI : ………………………….kg
1. Berat badan : ………………………….cm
2. Tinggi badan : ………………………….cm
3. Tinggi lutut
Lingkaran (circumference) : ………………………….cm
1. Lingkar lengan atas : ………………………….cm
2. Lingkar pinggang (waist) : ………………………….cm
3. Lingkar panggul (hip) : ………………………….cm
4. Lingkar kaki (calf)
……………………………………. ……………………………………….
Komposisi Tubuh
1. IMT (BMI) : ……………… kg / m2
2. BMA : ……………… kg / m2
3. WHR : ……………… kg / m2
4. Massa lemak tubuh (TBF) : ……………… mm
5. Massa bebas lemak tubuh (FFM) : ……………… mm
VI.02 Kulit
A Kekeringan 1. Kering 2. Biasa 3. Basah lembab
VI.03 Pendengaran
 Dengar suara normal 1. Ya 2. Tidak
 Dengar garpu tala 1024 Hz 1. Ya 2. Tidak
VI.04 Penglihatan
A. Membaca huruf koran dengan kaca mata 1. Ya 2. Tidak
B. Jarak penglihatan 1. Kanan ….. 2. Kiri …….
VI.05 Mulut
A. Hygiene mulut 1. Baik 2. Buruk
B. Gigi palsu 1. Ada 2. Tidak
VI.06 Leher
 Derajat gerak 1. Normal 2. Abnormal, jelaskan …………
 Kelenjar tiroid 1. Normal 2. Abnormal, jelaskan…………

VI.07 Dada
A. Masa teraba 1. Tidak 2. Ya
B. Bila ya, bagaimana ? 1. Kanan 2. Kiri
VI.08 Paru-paru Kiri Kanan
Perkusi ……….. ………. 1. Sonor
. 2. Redup
3. Pekak
VI.09 Jantung dan pembuluh
 Irama 1. Reguler 2. Ireguler
 Bising 1. Tidak 2. Ada
 Gallop 1. Tidak 2. Ada
VI.10 Perut
Hati membesar ……………… 1. Tidak 2. Ya, ukuran….………..

VI.11 Rektum/anus (atas indikasi)

Tonus sphincter ani - Lemah - Baik,kekuatan ………
Pembesaran prostate 1. Tidak 2. Ya, ukuran …………

VI.12 Alat kelamin/ panggul kecil

VI.13 Otot dan kerangka Blk Bahu Siku Tangan
Deformitas Tidak/Ya Tidak/Ya Tidak/Ya Tidak/Ya
Gerak terbatas Tidak/Ya Tidak/Ya Tidak/Ya Tidak/Ya

VI.14 Saraf
Saraf otak :
A. Penghidu 1. Normal 2. Abnormal, a. Kiri b. Kanan
1. Normal 2. Abnormal, a. Kiri b. Kanan
B. Ketajaman penglihatan
VI.15 Motorik Kekuatan Tonus Refleks Hasil
Anggota tubuh atas 1. Hipo 2. Normal Biseps
 Bahu 3. Hiper Triseps
 MMSE

VI.18.2 Kuesioner Mini Mental State Exam (MMSE)

Nama Responden :………………… Nama pewawancara : …………………

Umur Responden :………………… Tgl wawancara : …………………
Pendidikan :………………… Jam mulai : …………………

Skor Maks Skor Lansia

ORIENTASI
5 ( ) Sekarang (hari),(tanggal),(bulan),(tahun) berapa,(musim) apa?
5 ( ) Sekarang kita berada di mana ?
(jalan),(nomor rumah),(kota),(kabupaten),(propinsi)
VII. ENVIRONMENTAL ASSESMENT

1 Apakah tersedia kamar khusus untuk penderita? Ya / tidak

Kamar tidur Ya / tidak
Dipakai sendiri / bersama dengan ……………
2 Daftar keamanan Ya Tidak
Apakah penderita dapat :
1.
-membuka/ mengunci pintu
-mencapai sakelar lampu

3 Daftar bahaya / penyebab jatuh : Ya Tidak

Dari lingkungan rumah, pastikan bahwa hal berikut ini terpasang baik :
1.
1.Lantai dan karpet dalam keadaan baik dan tidak menonjol di sana-

sini, yang mungkin menyebabkan terpeleset/ jatuh

2.Pencahayaan cukup terang dan tidak silau

Kamar mandi :
1. Ya Tidak
Terdapat ril pegangan di daerah toilet dan bak mandi dan mudah
1.
dicapai bila diperlukan
Kamar tidur :
1. Ya Tidak
Keset tidak merupakan hambatan yang memungkinkan terpeleset
1.
atau tergelincir, terutama yang di jalan lalu ke kamar mandi
Dapur
1. Ya Tidak
1. Lantai terbuat dari bahan yang tidak licin
 GERIATRIC INSTALATION
SANGLAH HOSPITAL DENPASAR

PERSONAL ASSESMENT RECAPITULATION

Date o f recapitulation assessment : …………………………………………

I. IDENTYTY
Nama : ……………………………………………………… LK / PR
Umur : ……………….Th.CM……………………………………….
Alamat : ……………………………………………………………….
Pekerjaan : ……………………………………………………………….

II. DIAGNOSIS (NO. ICD)

1.………………………………………………………………………………..
2.………………………………………………………………………………..

III. IMPAIRMENT (NO. ICIDH)

1.………………………………………………………………………………..
2………………………………………………………………………………..

IV. DISABILITY (NO.ICDH)

1………………………………………………………………………………..
2………………………………………………………………………………..

V. HANDICAP (NO.ICDH)
1………………………………………………………………………………..
2………………………………………………………………………………..

VI. REKOMENDATION
1………………………………………………………………………………..
2 ………………………………………………………………………………..

Keterangan :
ICD : International Classification of Disease X 1994
ICIDH : International Classification of Impairment. Disability and Handicaps (WHO). 1980

Ketua Tim Geriatri Terpadu

(…………………………………)
 AGING PROCESS

Maria Esther Heredia de Capovilla ,116 y.o

Ekuador (Guinness Book – Dec’ 2005)

DR.dr.RA.Tuty Kuswardhani, SpPD, KGer, M.ARS

* GERIATRIC INSTALATION SANGLAH HOSPITAL

* GERIATRIC DIVISION INTERNAL MEDICINE DEPARTEMENT
MEDICAL FACULTY UDAYANA UNIVERSITY
2012
 BIOLOGIC AGING
 The importance of genetics in the regulation of
biologic aging is demonstrated by the
characteristic longevity of each animal
species. Several theories of aging have been
promulgated and recently reviewed (Goldstein,
1989; Abrass, 1991). These theories fall into
two general categories: accumulation of
damaged to informational molecules, or the
regulation of specific genes
 Why do we Age?

“WE DO NOT SEE THE WORLD AS IT IS,

WE SEE THE WORLD AS WE CARE”

The Tolmud
 AGING :
IS A PROCESS TO RELEASE THE ABILITY OF
TISSUE SLOWLY TO REPAIR/TO CHANGE IT
SELF & TO KEEP THE STRUCTURE & THE
NORMAL FUNCTION SO IT CAN NOT STAND
TOWARD INJURY & TO DEVELOP THE
DAMAGE.

(Constantine,1994)
 Progressively the human
will loose the defence of
infection & it will
accumulate more
metabolic and structural
dystortion which is
called :
“DEGENERATIVE
DISEASE”
 AGING PROCESS THEORY
1. GENETIC CLOCK THEORY
 In this theory  aging has been programmed genetically for
certain species.
 Every species has nucleus like a genetic clock which has been
winded according to a certain replication.
 This clock will count the mytocys
Mytocys  will stop

The cell replication if it is not winded

 This concept is supported by the reality that
the explanation : Why on some species get a
real different of life expectation

Figure 1. Record in life span (Eudililin et al, 1993)

Turtle 170 y.o
Elephant 70 y.o
Horse 62 y.o
Gorilla 48 y.o

Bear 47 y.o
Cat 30 y.o
Dog 27 y.o
 Theoritically  it is possible to rewind this
clock eventhough just for small time, with
same external interverences, such as :
 Health development
 Disease prevention with medicine/ treatment

• The theory supported by experiment : nucleus

which determines the replication  Aging 
Death
2. THE DAMAGE OF IMMUNE SYSTEM
 The repeated mutation/ the changing protein post translation
 decrease the immune system ability to recognized  it self
 The somatic mutation  antigen disorder in the cell  to
cause immune system  treat the changing cell as a strange
cell and destroy it.
 Auto immune process  antigen antibody reaction in different
tissues  aging effect  histo incontability reaction in multi
tissue  auto antibody prevalency
 All somatic cell will set aging process, except sexual cell &
cell which is getting mutation to be a cancer.
 IMMUNE SYSTEM
Is all mechanism used by the body to keep the
unity of the body as the prevention against the
danger caused by the material in the
environment

 IMMUNE RESPON
Interaction of some immune system
component of the body in human
 natural immune system
(Non specific)

Immune system

specific immune system

 NON SPECIFIC IMMUNE SYSTEM
Body defence against the attack of different microorganism  non
specific caused it is not led to specific microorganism

 THE COMPONENTS OF NON SPECIFIC IMMUNE SYSTEM

1. MECHANISM PHYSIC DEFENCE
 Skin
 Mucus membran
 Cillia breathing
2. BIOCHEMISTRY DEFENCE
 Secret of nucans secretion

 Sebaceus gland skin

3. HUMORAL DEFENCE
 It contains of complement, interferon, CRP
 Specific immune system  different ability from non
specific immune system in recognizing a strange cell.
 The first strange cell appears in the body is soon
recognized by specific immune system.
 It stimulate the sensctation of the cell in the immune
system.
 If again the immune system cell is facing the same
strain cell  it will be more easily to recognized it 
to destroy
 Specific immune system
 Humoral specific immune system
 The roler : lymphocyte B (cell B)  comes from
multipoten cell
 B cell  stimulated by strange
 Cell  proliferate & differensiate  plasma cell 
antibody substation  serum
 The function of antibody : to prevent the body against
the bacterial (infection,virus and can do toxin
neutralizing)
 cellular specific immune system
 The roler is lymphocyte T (T cell)
 T cell from multipoten cell but it proliferate &
differentiate in the thymus gland
 It is different from B cell, T cell contain of several
subset cell which has different function.
 The main function of T cell is to help B cell in
producing antibody, recognizing & destroying the
virus infected cell, activate macrophag in
phagocytosis, and controlling limit and the quality of
immune system.
 T cell contain of T helper (Th), T supresor (Ts), T
cytotoxix (Tc)
 In the elderly  in immune system is thymus
gland atrophy  changing humoral & cellular
immune.
 Aging process causes the immune senescene
 infection, cancer, autoimmune disease.
Specific Immune
 The changing of specific immune :

I. CELLULAR IMMUNITY
a. Thymus gland
Thymus hormone stimulates diferensiation, expression
& function of lympocyte T  because involution
gland occurs in the early life  T lymphocyte cell
diferensiation is decreasing during the aging process.
Thymus involution causes immune system dysfunction
T lymphocyte cell proliferation disorder
 In the elderly the T lymphocyte cell
proliferation responseis decreasing  no
percentage cell
 In the blood  enzym phosporilation
II. HUMORAL IMMUNITY
 The lost of the body ability to prevent the antigen

a. Volume of B lymphocyte cell volume of B cell 

apoptotis
b. Function of B lymphocyte cell  specific antibody
production.
c. Immunoglobulin
 In the elderly  the increasing of IgG and IgA 
IgM and IgD
 IgE constant  except atopic patient  IgE
3. METABOLIC AGING THEORY
 From the experiment  it get a longer life

span caused by the retriction of the calorie. It

is caused by one of metabolism process  the
decrease of hormone excretion will stimulate
cell proliferation, such as insulin
 The modification of under exercise to be more

active will cause the longer life span

Mechanism of Caloric Restriction
 The degree of Caloric Restriction needed to achieve
an anti aging effect is far too severe to be a practical
preventive regimen for more than a tiny fraction of
the human population.
 to define the biochemical mechanism by which
Caloric Restriction alters age dependent physiologic
decline is likely to provide the best clues to clinically
useful preventive strategies.
 One line of inquiry starts with the set of known,
dramatic changes induced by the Caloric Restriction
protocol & attempts to see whether any of these can
by itself accomplish some or all of the Caloric
Restriction effect.
4. FREE RADICAL THEORY
 The free radical are : super oxide (O2), Hydroxcyl
radical (COH), Hydrogen peroxide (H2 O2).
 Free radical is destroyer  it is very reactive  it
can react to DNA
 *The body itself is able to prevent free radical with its
enzymes : superoxide dismutase (SOD) : Zn, Cu, Mn
 it change superoxide  2O2

2 O2- + 2H+ SOD H2 O2 + O2

 *Catalase enzyme with Fe element in the “haem”  to burst
 hydrogen peroxide become water & oxygen :
CATALASE

2H2 O2 2H2O + O2

 *Glutathion peroxide enzyme with selenium (Se) element 

burst peroxide hydrogen through the reaction :

H2O2 + GSH GSSH +H2O

5. WEAR-AND-TEAR THEORY
 Supports the concept that aging is a programmed
process.  each animal-each cell, has a specific
amount of metabolic energy available to it & that the
rate at whish this energy is used determines the
animal’s length of life.
 In addition to the depletion of available energy,wear-
and-tear theories  include the effects of the
accumulation of harmful by products of metabolism
& of faulty enzymes due to random errors as
contributing to aging changes
Table Major theories on aging
Theory Mechanisms Manifestations
Accumulation of Spontaneous mutagenesis Copying errors
damaged to Failure in
informational DNA repair systems
molecules Errors in DNA, Error catastrophe
RNA, and protein synthesis
Superoxide radicals and loss of Oxidative cellular
scavenging enzymes damage
Regulation of Appearance of specific Genetically
specific genes protein(s) programmed
senescene
THANK YOU
Thank you