Physiology Geriatric Physiology

Dr. Leo Bunag | May 19. 2015

Slides|Audio|References
Generalizations according to the body
Geriatric Physiology systems

Introduction:
 Ageing begins at conception
 Factors:
1. Genetic-individual capacity for
adaptation and repair
-there are certain factors in a
bloodline that makes a person age
faster or slower than others
2. Environment- the different
aspects of the environment
delivers a cumulative effect to
ageing; contributes to disease
processes
-increased aging in the presence of
too much stress
-development of concomitant
diseases as we age; occurrence of
common diseases, example is
hypertension
SKIN:
 The skin is our protection against the
environment. Primary anatomic barrier
serving as protecting against harmful
environmental factors
1. It is a BARRIER. It is responsible for
temperature regulation
2. It also functions for the
RETENTION OF FLUID (Fluid and
electrolyte balance), ABSORPTION
OF SHOCK & UV RADIATION
 Ageing: Changes in skin
1. Decreased thickness (dermis =
20% reduction)
2. Loss of vascularity, cellularity and
sensitivity- compromised
protective function of the skin
3. Diminished ability for exchange
and retention of internal heat

 Geriatric Age group:

1. Young old: 65-74 years old
2. Middle old: 75-84 years old
3. Old old: 85 years old and above
** Elderly: more than 65 years old
** Field of Geriatrics: (>75 years old)
are qualified –standard in geriatric
practice

 Advancing Age: Effects

1. Body systems: will have reduced
efficiency - has something to do
with a decrease in functions in
general especially of the major
organ systems
2. Tissues: exhibit an actual loss and
problems with slowed building & **the skin of the elderly is thin, fragile
to all sorts of traumatic factors and
replacement of damaged tissues
3. The effects vary according to slow to heal. Reduction in the
epidermis and dermis,
unique individual experiences
  Aging affects the glands: decrease
o Eccrine and Apocrine glands:
 Decrease in size, number
and function
*sweat glands play a major role
in thermoregulation
o Sebaceous glands:
 Increase in size
 Decreased sebum, leading
to water evaporation,
leaving the skin dry and
cracked, and more
susceptible to damage
*Apply moisturizers
 Decrease in sensory neurons= 30% (10
years old to 90 years old)
 Alterations are present, such as
subcutaneous fat deposition
*figures 1 and 2 on the left are those of a younger
adult, figures 3 and 4 on the right are those of an
older adult. Fats in elderly individuals have the
tendency to become redistributed in the central
parts of the body, resulting in the development of
CENTRAL OBESITY; the subcutaneous fat in the
periphery will be reduced, that is why the
extremities are thin, with obvious blood vessels
and bones.
Short quiz given during the lecture:
- Describe a change in the skin of elderly
individuals and its concomitant effects.
MUSCLE:
 Muscle mass: is the primary source of
metabolic heat
 Muscle contraction: results to generation
of heat contributing to the maintenance
of body temperature (thermoregulation)
 this will ensure the normal functioning
of the body and its chemical processes
(this is disrupted with loss of normal body
temperature)
 Muscle changes with age:
o On the 3rd decade of life, there is
general reduction in: size, elasticity
and strength of muscles
Critical mass: how muscles decline as we age
**blue: normal-density muscle
**green: low-density muscle
** red-orange: fat
Male: 42 years old
BMI= 22.7
Male: 70 years old
BMI= 24.7 (inc)
 Old age decreases muscle fiber diameter.
This is due to a reduction in:
1. Reserves: ATP, Glycogen and
Myoglobin
2. Number of myofibrils
 The elderly has less efficient muscle
activity, and therefore need to exert more
effort in performing a task
 Less efficiency in heat generation and
chemical reactions essential for life
2
 LUNGS:  Common metabolic disorders in the
 Changes in the respiratory system: elderly:
 Increased residual volume o Water and electrolytes
(increased air remaining in the o Carbohydrates, proteins and lipids
lungs after the most complete o Vitamins and mineral deficiencies
expiration possible) o Nutritional deficiencies: Anorexia-
 Reduced vital capacity underlying mechanism is a lower
(decreased capacity to inhale, satiety threshold
hold and exhale breath)
 High risk for respiratory
infection such as
pneumonia
 In general, decreased lung capacity


*also, steroid hormones that play an important

role in metabolism – carbohydrate, fat and
 Diminished lung function- Major
protein metabolism
contributing factors:
*reduction of sex hormones-
 Progressive loss of elastic recoil
menopause/andropause
of the lung tissues
o Increased incidence of Diabetes
 Stiffening of the chest wall Mellitus- because of :
 Decrease alveolar surface area  Delay and insufficient
** These will lead to diminished release of insulin from the
efficacy for gas exchange Beta cells of the pancreas-
leading to insulin resistance.
CARDIOVASCULAR:  Reduced ability to
 A resting healthy elderly will have metabolize glucose,
adequate cardiac function and meet the resulting to higher blood
body’s needs glucose- hyperglycemia
 A healthy, exercising elderly can maintain  the inability of the skeletal
cardiac output with moderate, continued muscle to absorb glucose
physical activity (involving the GLUT 4
 Not significantly affected in healthy transporter)
individuals **Less response of skeletal muscle
because of the effects of insulin
ENDOCRINE AND METABOLIC FUNCTIONS:
 There is general reduction of hormone
production and activity – affecting the
metabolic functions of the body

3
NEUROSENSORY CHANGES:
 The brain and spinal cord experiences loss
of neurons
 Loss of dendrites will lead to decreased
synaptic transmission. The dendrites are
primarily affected
 There will be diminished senses over time
(visual, hearing, smell, taste and touch)
 Because of disruption of
neurotransmission, neurotransmitters
important in maintaining normal mood
and affect are affected (Norepinephrine,
Serotonin and to a lesser extent,
Dopamine) Increase incidence of
depression:
o Due to impairment of synaptic
activity
o 25% incidence in US nursing
homes
o Depression becomes a major cause
of reversible weight loss
SUMMARY
Disadvantages of elderly in generating metabolic
body heat
 Less muscle mass= less heat generating
apparatus
 Less alveolar surface  less oxidative
reserve
 Impaired neurotransmission  less
ability or desire to initiate activity
With all these risk factors, the patient becomes at
risk of HYPOTHERMIA
Environmental circumstances:
 Heat loss > Resting heat generating
capacity = Hypothermia
ADDITIONAL READING: a “nice to know” clipping from
Lippincott’s Review of Physiology
Physiologic aging:
Individual physiologic responses to aging vary
widely and can be significantly impacted by physical fitness
and underlying disease, but aging is generally accompanied
by progressive decreases in cell numbers and in the
functionality and responsiveness of remaining cells in most
organs. Coinciding with these changes are overall decreases
in tissue compliance. The effects of aging on the
cardiovascular system, for example, include reduced
myocardial sensitivity to adrenergic agonists, which is why
maximal heart rate (HR) attained during exercise is
estimated from 220 minus age in years. Arteries stiffen with
age due to elastin cross-link breakage, increased collagen
deposition, and calcification, causing a compensatory
increase in arterial blood pressure. Similar changes occur
throughout the body’s various tissues. The deep wrinkles
that develop in Caucasian skin are the most obvious
external indicator of aging, but wrinkles develop largely
through Photoaging (tissue damage induced by ultraviolet
light), not by the intrinsic aging process.
ADDITIONAL READING: a “nice to know” clipping from
Principles of Anatomy and Physiology by Tortora
Aging is a normal process accompanied by a progressive
alteration of the body’s homeostatic adaptive responses. It
produces observable changes in structure and function and
increases vulnerability to environmental stress and disease.
The specialized branch of medicine that deals with the
medical problems and care of elderly persons is geriatrics.
Gerontology is the scientific study of the process and
problems associated with aging.
Another aspect of aging involves telomeres, specific DNA
sequences found only at the tips of each chromosome.
These pieces of DNA protect the tips of chromosomes from
erosion and from sticking to one another. However, in most
normal body cells each cycle of cell division shortens the
telomeres. Eventually, after many cycles of cell division, the
telomeres can be completely gone and even some of the
functional chromosomal material may be lost. These
observations suggest that erosion of DNA from the tips of
our chromosomes contributes greatly to aging and death of
cells. It has recently been learned that individuals who
experience high levels of stress have significantly shorter
telomere length.
Glucose, the most abundant sugar in the body, plays a role
in the aging process. It is haphazardly added to proteins
inside and outside cells, forming irreversible cross-links
between adjacent protein molecules. With advancing age,
more cross-links form, which contributes to the stiffening
and loss of elasticity that occur in aging tissues.
Free radicals produce oxidative damage in lipids, proteins,
or nucleic acids by “stealing” an electron to accompany their
unpaired electrons. Some effects are wrinkled skin, stiff
joints, and hardened arteries. Normal metabolism—for
example, aerobic cellular respiration in mitochondria—
produces some free radicals.
Note taker:
Tolentino, Lethmar