Transcript Ageing (Aging)

Gerontology &
GERIATRICS
By: Dr. Benjamin Policarpio
MARCH 2010
Definition:
Ageing (Aging) is a syndrome of changes that
are deleterious, progressive, universal and
thus far, irreversible. Aging damage occurs to
molecules (DNA, proteins, lipids), to cells, to
tissues and organs.
Senescence – derived from French, means the
same.
• Gerontology – the study of the aging process.
• Geriatrics – application of such knowledge to
the health care of the elderly.
Symptoms of Aging - even laymen are familiar
with the changes observed with age.
- Hard of hearing – higher frequencies
- Decline in the ability to taste: salt and bitter –
sweet and sour much less affected.
- At age 65 – some form of arthritis. 1/3 of
men, ½ of women
- At age 65 – ½ loss of all their teeth
- Insulin requirement for glucose uptake doubled
Symptoms of Aging
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Increase in body fat
Decrease in muscle strength
Decrease in reaction time
Presbyopia and cataracts
Shorter sleep
Disability – inability to use public transport
Baldness, white hair, wrinkled skin
At age 85 – presence of 3 to 9
pathological conditions
frequently causing “unknown”
death, or death from “natural”
causes.
Theories of Aging
• 2 major Classifications
a. Programmed aging – control mechanism in
the organism that force elderliness and
deterioration.
b. Wear and Tear aging – not due to control
mechanisms but due to sum effect of many
kinds of environmental assaults.
* Programmed death – pacific salmon.
Environmental Assaults:
Radiation
Toxic chemicals
Metal ion
Free- radicals
Hydrolysis
Glycation
Disulfate bond cross-linking
Target:
Genes
Proteins, DNA
Cell membrane
Enzyme function
Blood vessels
Consequences:
- cell death
- failure of proliferation, no replacement
Theories of Aging:
I. METABOLIC DAMAGE
- Free Radicals – product of living.
- Glycation – consequence of staying alive:
utilization of glucose for energy.
- AGEs-irreversible end product of oxidation
“The Central Cause of Ageing” is
genetic damage, particularly gene
loss.
Experimental Gerontology, 21: 283-319 - 1986
Gene Loss as the Primary Cause of Aging
Background:
>every cell in the body contains about 30,000
genes.
>mostly responsible for passing hereditary
traits to offspring.
>4000 - extremely important; active most of
the time; controlling-guiding-instructing any
particular cell’s function. Turned on or off
depending upon organism’s needs.
What causes depletion?
DNA damage – genes are made of DNA-RNA
stuff.
Recall protein cross linking, glycation – a price
paid for glucose utilization – chemicals
produced by metabolism and body’s defense
mechanisms.
There is a “programmed” loss of DNA
as aging progresses
Tissue
DNA loss
Lymphocytes
Brain-SS Cortex
Hippocampus
Heart Muscle
Average DNA loss
.45% per year
0.79% per year
0.80% per year
0.60% per year
.61% per year
This loss can be slowed down or accelerated
depending on life style and attitude.
If there is an inexorable loss of genes as aging
progresses, then it is possible to plot organ
system loss of function with time.
The Central Factors of importance in
‘living` and longevity
-
Diet
Exercise
Avoidance of poisons (smoking)
Positive attitude
Connectedness (societal)
What are te so called diseases of old age?
-Atherosclerosis
-stroke
-heart disease
-Alzheimer’s Disease
-Degenerative Joint Disease
-Cancer
-Osteoporosis
*MELANCHOLIA OF ISOLATION*
Issues in the Management of Diseases of
old age. Biomedical Science seems to
focus only on one thing – Pharmacologic
Intervention.
Cholesterol, the culprit?! It has vital
functions.
• Neurotransmitter synthesis acetylcholine.
• Androgen metabolism for sexual function.
• Essential for adrenal corticosteroid synthesis.
Patients are very special people.
Elderly patients much more so.
• They need attention
• They are 6x more sensitive to drugs, a greater
degree of drug side effects and interaction.
• Drug interaction in the elderly is largely
ignored, if not, forgotten.
Cholesterol, aging and statins – has
become a multibillion dollar business and
is still growing.
• The U.S. spends 45 million U.S. dollar a year
on Lipitor for its citizens.
• More than 11 million Americans are using it.
• There are plans to expand this to 36 million.
Cholesterol is NOT in itself, per se, responsible
for atherosclerosis and related diseases.
Supporting Evidence:
Primary Prevention of Heart Disease
Oslo, Norway – 1200 men with cholesterol levels of over
300mg/dL, four fifths of whom are smokers. Dietary advice,
no smoking, and exercise over control group, 10 years study.
Secondary Prevention of heart Disease
The Lyon Diet Heart Study, Mediterranean Diet versus Statin
Group. Over four years.
Nurses Health Study, New England.
DATA strongly recommending
a healthy lifestyle
JAMA 2004, researchers from US Centers for Disease
Control and national Academy of Sciences.
“There is strong evidence that behavior and
environment are responsible for 70% of avoidable
mortality in the US”
435,000 due to Tobacco
400,000 due to obesity and physical inactivity
144,000 due to poverty
Healthy Lifestyle
better than STATINS
It is interesting to note that in the OSLO and
WOSCOP studies where an advised healthy
lifestyle for 600 men bested the control group
over 10 years by attaining 44% fewer heart
disease and 39% less deaths...even if the
cholesterol levels remained elevated.
Healthy Lifestyle superior to Statins
in Secondary Prevention of H.D.
The mediterranean Diet and Exercise Regimen
clearly proved superior to the control group
with 70% less heart disease, 3x the reduction
in risk of further heart disease compared to
that achieved with Statin drugs (12% vs. 4%)
The world and the medical
profession itself has been
deceived and continuously
deceived by this cholesterol
myth.
Cholesterol by itself is not the
root cause of atherogenesis and
its consequences. After the age
of 65, cholesterol levels appear to
be a non-dominant factor with
relation to morbidity and
mortality.
JAMA, 1999. Poor fitness is
more of a health risk than
elevated cholesterol.
“Hopes” for the Discovery of the
Fountain of Youth
- Stem Cell Research
- Nanotechnology
- elimination of diseases related to
aging
How must we take
care of the Elderly?
- Give them attention and address their societal
needs... Interconnectedness versus isolation
- Senior Citizen Clubs, Centers
- Community services for homecare
- Telephone-visit reassurance
- Home Inspectors
The Four Healing Systems
When Illness occurs, address all four healing
systems, think biopsychsocialspiritual.
- Homeostasis- primarily
- Biomedicine as necessary
- Mind/Body System
- Spiritual System
... Taking care of the Elderly
- Minimize medicines – give only necesssary ones,
affordable as well. The lesser the better.
- Healthy living advise
- Diet (CRAN), exercise
- Supplementary vitamins
- avoidance of toxins (Tobacco and strong
spirits)
- Pneumonia and Influenza vaccines for those over
60
What do they need?
• They really do not need care , support
sympathy and feeding but rather societal
interaction , oppurtunities for expression and
experience, autonomy and accomplishments.
Aging Population
• Practical focus on health improvement in the
erderly over the next decades
1. chronic rather that accute diseases
2. morbidity rather than mortality
3. quality of life rather than its duration
4. postponement rather than cure
Concept Shift
• Premature organ dysfunction whether muscle,
heart, lung or joint is due to disuse rather than
overuse.”use it or lose it”!EXERCISE!
End of Life Care
71% prefer to die at home, not in the hospital
86% of people with terminal illness, prefer,
and is best managed at home