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What’s Normal? What’s Not? · Physiology of Aging What’s Normal? What’s Not? Dr. Rick...
Transcript of What’s Normal? What’s Not? · Physiology of Aging What’s Normal? What’s Not? Dr. Rick...
Physiology of Aging
What’s Normal?What’s Not?
Dr. Rick MachemerAdult Abuse Training Institute
“Exploring Justice and Support for Victims of Adult and Elder Abuse”
Albany, New York, October 30, 2019
Current “Focus”~ Aging “just” happens~ Little to no control;
everything is genetic~ Outcomes: not good to
very poor
Goals of Seminar~ Describe biological aging~ Understand biological aging –
dispel myths; perhaps diminish ageism
~ Distinguish between aging & disease
~ NO attempt to change your emotional reaction to aging
What’s the “Big Fuss”?
“Aging is growing old, becoming less functional, developing disease,
becoming fully dependent…then dying…all alone, in constant pain,
and in an institution.”
The Real Issues~ What’s successful
aging? ~ How to do it?~ How to separate
aging from disease?
The Mythology of Aging* Being old means being sick* Aging is a disease…looking for a
cure * More of the same…nothing new
can be learned or done
Myths - 2* Once there’s a ‘problem’, there’s
always a ‘problem’* Aging is entirely genetic – no
individual control – it just ‘happens’
Myths - 3
* ALL physical and mental abilities decline (markedly)
* Persons who are older are a serious drain on all of society
Myths - 4* Nothing can be done about aging;
accept it; get out of the way (i.e., disengage from life)
What is “Reality”?
* Not all persons who are older are sick; function is less
* Likelihood of a disease is higher among persons who are older
Realities - 2* Aging is a normal process; have
significant control* Control does not mean one can
slow/“stop” process
Realities - 3* Learning is life-long activity,
not simply “school-based”; occurs more slowly
* Social engagement must continue
Realities - 4* Bad habits => diminished
health status can be changed…
* Damage may be “reversed”; e.g., with smoking, metabolic syndrome
Realities - 5* Outward look/function in aging…
more due to the environment and the life-long decisionsthan to genetics
Realities - 6* Functions change; without
disease/disuse/disability, change is minimal; littledaily impact until “late” in life
Realities - 7
* Persons who are older contribute in numerous ways: large amounts of time, energy, insight, wisdom, money
Realities - 8* Attitude is critical (e.g., don’t
accept negative stereotypes)* Ageism is alive, well, and
prospering…BUT can be fought
Challenges (of aging)
* Focus should be on health and wellness promotion… not on changing aging
Challenges - 2
* Early detection of altered function and risk factors is critical
* Intervention with renewed focus on prevention is essential
Challenges - 3
* Some diseases may not be avoided but can be substantially postponed
* Striving for “compression of morbidity”; i.e., (less time being “sick”)
Challenges - 4
* Emergence of concept of the FRAILTY SYNDROME…A syndrome that’s as problematic as many specific chronic diseases
Frailty – “New Kid”A biological syndrome of decreased
reserve and resistance to stressors resulting from cumulative declinesacross multiple systems causing increased vulnerability to developing adverse outcomes.
Frailty – Phenotype~ Weight loss: >10 lbs. or 5% of
body weight~ Weakness: grip strength lowest
20%~ Exhaustion
Frailty, Phenotype - 2
~ Slowness: slowest 20% for 15 feet
~ Low physical activity: lowest 20% of Kcal expended/week
NOT =>
Challenges - 5
* Exercise is an ABSOLUTE MUST!* Physical exercise often seriously
lacking; mental function helped by physical activity
Challenges - 6
* Sound nutrition: ABSOLUTE MUST!
* Fad diets and pills/potions are to be avoided
Challenges - 7
* Solitary lives “don’t work”* Social and emotional support
affects physical function (mind-body connection => brain changes)
Challenges - 8
* HETEROGENEITY OF AGING: tremendous variety/variability among persons who are older
* Variety of approaches needed to meet needs of all persons
Challenges - 9
ATTITUDE ABOUT AGING: need realism; difficult to change; must permeate society~ neutral view; positive is better~ difficult to teach; must emulate
when modeled
Remember…Aging at societal level
is NOT viewed as ‘positive’ situation
(focus: issues, problems, concerns)
Upside (of Aging)~ Living much longer~ Living much healthier~ Adequate knowledge to prepare
for next stages~ Realistic interest, not just anti-
aging
Downside (of Aging)
~ Little individual preparation~ Minimal societal preparation;
reactive, seldom proactive~ Service systems – past era design~ Unrealistic focus – to stop aging
How long do we live?
Life Expectancy Life Span
LIFE EXPECTANCY~ How long one can live (beyond some specified point in time)
~ Changeable; better environment => L.E.↑
Facts/FiguresIn 2019, % of persons in population who are older (> 65y):
~ 15.2%; 49.2MBy 2050, will climb to:
~ 19-20%; 79.6M
Demographics - 2
Current numbers/projections:~ 5.9 million over 85~ 19.7 million by 2060 (~334%↑…to 4.7% of total US pop.)
LIFE EXPECTANCY General Population
Dramatic increase during past 119 years (due primarily to meeting needs of children):
1900: ~ 47 yrs.2019: ~ 79.25 yrs. (as mixed
non-adjusted L.E.; 43rd in the world; Monaco #1 (89.37 yrs.); shortest Chad 50.96 yrs.; female L.E. always greater
LIFE EXPECTANCY - 3
WHY the dramatic change?Better: nutrition, public health, sanitation, immunization, antibiotics, environment in general; more preventative than curative
LIFE EXPECTANCY - 3
WHERE have the years been added in life cycle?~ Primarily early in life (infancy,
childhood)~ Less in “old age” (may change with
more effective medical interventions)
LIFE EXPECTANCY - 4
Will this continuing increase in L.E. continue?
~ “Perhaps” in Baby Boomers~ Stabilizing in Generations X,
Y (Millennials), and Z (New Silent); now decreasing overall
LIFE EXPECTANCY - 5
~ Widening gap between U.S. and Canada, Germany, Mexico, France, Japan, UK ~ L.E. inequity (between rich and poor) shrink ing in rest of world; increasing in U.S.~ Differs by city and by city vs. rural setting~ Decrease in L.E. may be due to diseases of despair (opioids, alcohol, suicides) & general lifestyle (obesity, lack of physical exercise)
LIFE SPANMaximum time member of any particular species has been observed to live.
LIFE SPAN - 2
Genetically-determinedHuman:
> 122.5 years
LIFE SPAN - 3
Jeanne Calment, Paris, France. 122 years, 164 days (2/21/1875 to 8/4/1997)
But......what is the phenomenon
we call AGING?
Brain is a fresh, new delicate egg. Aging is iron frying pan. Frying pan hits egg…it’s all over! Aging is this process but carried out more slowly. Yes? No?
Another perspective:left hand falls off onto sidewalk…“Nothing to worry about. It’s all part of the aging process.” Yes? No?
Aging...Everything that happens from
conception to death; = CHANGEGrow, develop, maintain,
repair/renew/replace, decline, eventually die
Model of AgingFunctional:~ Successful~ Usual~ Pathological
“Gene/environmental interaction”
GenesContinuum: from most positive (confer greatestpotential) to the most negative (confer leastpotential)
(Positive=> Neutral=>Negative)
EnvironmentContinuum: from most positive circumstances (=> greatest potential) to most negative circumstances (=> least potential)
(Positive=> Neutral=>Negative)
SUCCESSFUL(The “Narrow” Biological Description)
* Positive genes – positive environment
* Minimal functional change, 25-75 years; i.e., can do at 75 almost what was done at 25
SUCCESSFUL - 2
* “Look” different; function is OK
* NO DISEASE
USUAL(The “Narrow” Biological Description)
* Less positive genes in less positive environment
* “Obvious” functional loss; no testing needed to determine this; obvious to “everyone”
USUAL - 2
* SOME DISEASE* Requires compensation by person or modification of environment for full function
PATHOLOGICAL(The “Narrow” Biological Description)
* Negative genes in a negative environment
* Major disease leads to the “serious” functional limitations
* SUSTAINED INTERVENTION needed to sustain life
Control and Coordination
NOTHING in the body functions… without constant control and coordination
(under normal and non-disease conditions)
Homeostasis…A condition of relative functional constancy
within a continually and rapidly changing environment
“Current Model”ABSOLUTE UPPER LIMIT
DEATH
“UPPER RESERVE” USUAL UPPER LIMIT
“NORMALCY”
USUAL LOWER LIMIT“LOWER RESERVE”
DEATH ABSOLUTE LOWER LIMIT
“New Model”ABSOLUTE UPPER LIMIT
DEATH
“UPPER RESERVE”USUAL UPPER LIMIT
“NORMALCY”USUAL LOWER LIMIT
“LOWER RESERVE”
DEATH ABSOLUTE LOWER LIMIT
Usual limits widen =Relaxation of
homeostatic limits~ changes are successful aging ~ nothing to “fix”; (nothing “wrong”;
normal; happens in everyone)
Cause of deviation from normalcy?
STRESS(…and what is stress?)
Stress !ANY physical or emotional change
that causes a function to move outside usual homeostatic limits
Problem…~ Time for an adequate stress response may be “too long”;~ Function exceeds absolute limit => death~ Medical focus: intervene to prevent this change
What’s an effective counter to the slower
stress response?MINIMIZE the
environmental press (i.e. make the environment less “hostile”)
So…...if this slowed stress response and change in homeostasis is
“aging”, what isSUCCESSFUL
AGING?
Remember…Aging seems to be the only available way to
live a long life.Daniel-Francois-Esprit Auber
(French [opera] composer, 1782-1871)
Successful Aging
What happens when one ages w ithout
any disease? (to mid-70s and perhaps beyond)
NERVOUS SYSTEMFewer cells in some areasSlower information movementFewer connectionsNew connections can be made with continued use
MENTAL FUNCTIONNO decline in IQ; (changes)Memory intact; slowerSome interference with short term memory
General slowing of cognition
“BRAIN FITNESS” – How?Mental exercise - ??Physical exercise - YESChallenging leisure activities - ??Achieve mastery - ??Strong social relationships – YES?Technology use - ??
SENSORYVISIONLens stiffens; more farsightedMore difficult to see small itemsLess light into eye; need some
increase in brightness
SENSORY - 2AUDITIONHear fewer of high tonesMore difficult to screen out
background noise
SENSORY - 3
TASTESome decrease in sense of
tasteMore attention to flavors in
foods
SENSORY - 4
SMELLLess sensitive to many odorsMay affect sense of taste
SENSORY - 5
TOUCH/PRESSURELess sensitivityResponses vary widely due to
emotional impact
SENSORY - 6
THERMALFewer sweat glandsLose heat less effectivelyThinner skin; less fat More sensitive to temperature
MUSCULOSKELETALFewer muscle cells, more fatDecreased strengthContract more slowlyLess calcium in bonesJoints less flexible
INTEGUMENTThinner skin; less protection to underlying blood vessels
WrinklingFewer sweat glandsLess hair, more gray
DIGESTIVELess salivaSlowed swallowing reflexDecrease surface area in small intestine
Slower muscle movements
CARDIOVASCULARSmall decrease in cardiac reserve
No change in rate or forceResponse rate to stress slowed
CARDIOVASCULAR-2
Blood vessels slightly less elastic; slight/some ↑ B/P
Little to no change in capillary function
RESPIRATORYLungs slightly stifferSmall decrease in surface areaLittle to no change in respiratory activity
Slight increase in work to breathe
URINARYSlower filtrationNo change in selectivityBladder wall may weakenInfections more common in female; may mimic dementia
ENDOCRINESome slowing of responses to variety of hormones
Only major change is with female reproductive system
REPRODUCTIVEFEMALEMenopause, less estrogenReproductive activity ceasesSlight change in secondary sex
characteristics
REPRODUCTIVEMALEFewer sperm producedLess testosteroneProstate gland enlarges
Words used to describe system changes?
Slight, small, very small, no change; no decline; slower; fewer
In view of the challenges of aging,
what do we do?
Use Our Resilience
Resilience ‘Simplified’
Stuff happens …it’s the bounce-back that
ultimately matters
Emerging Issue
What does it take to live more quality years, not just more years?
Living Successfully –Characteristics
(“Non-Biological” Meaning of Successful)
* Genetics: no control – not to worry; know history; epigenetics
* Health: manage current issues; screen for new conditions
* EXERCISE: physical and mental
Successful - 2
* Safety: be reasonable* Engagement: reason to live* Creativity: actively stimulate; try
new things, master something* Attitude: positive but realistic
Successful - 3
* Education: gain as much as can* “Work”: continue “something”* Relational status: network of
friends; make new ones * Nutrition: eating habits
Successful - 4
* Living arrangements: lesschallenging – more appropriate
* Reliance: less on social programs and more on individuals
* Embrace change
Successful - 5
Use it (with a positive attitude)…
or lose it
Successful AgingNOT EASY; NOT SIMPLE
Lifestyle – BIG roleGenetics – smaller role
YEAHBUT…Are we ready to participate?Will we plan…and change? Will it take a crisis/many crises?
There is choice…and it is our choice.
Physiology of Aging
What’s Normal? What’s Not?
Dr. Rick Machemer([email protected])
Adult Abuse Training Institute“Exploring Justice and Support for Victims of
Adult and Elder Abuse”Albany, New York, October 30, 2019