average life expectancy for women in US?
79.5 years
average life expectancy for men in US?
72.7 years
what ethnic groups are expected to have a lower life expectancy? what are the #’s?
african american men and women expected to live on average 6 and 5 years less than caucasian counterparts
native americans have shortest life expectancy at 45-50 yo
aging is typically a “loss” of what?
loss of social role
loss of income
loss of friends and family
loss of vital health
can diet or nutriceuticals or drugs serve to reverse aging?
maybe
can diet or nutriceuticals or drugs be used in order to extend life expectancy?
yes
can diet or nutriceuticals or drugs be used to optimize the quality of life?
definitely
theories on aging? (5)
- cellular ‘supply limits’ theory
- free radical damage theory
- AI theory
- programmable cell death theory
- telomere length theory
what is the cellular supply theory?
decreased supply of nutrients to cells and tissues due to diminished blood flow into and out of cells= diminished nutrients= cell death, tissue atrophy and loss of tissue fxn
also related to accumulation of intracellular and extracellular waste products and toxins
free radical theory of aging?
uncontrolled buildup of free radicals causes accumulated damage to cellular membranes and the contents of the cell, including DNA and RNA= death of cell
*free radicals scavenging our already paired electrons or can attach directly to the gene
AI theory of aging?
B and T cells of the immune system weaken w/age and malfunction; B cells lose ability to attack bac, viruses, CA and T cells lose ability to adequately attack CA and transplant cells
often attack normal healthy body cells as well
programmable cell death theory?
apoptosis
diverse range of cell signals which may originate EC or IC- signals either promote or suppress apoptosis
telomere theory of aging?
telomeres are non-coding DNA sequence at end of chromosome, they are essential for DNA replication during cell division
process of cellular division permanently destroys a tiny fragment w/each division–> by definition have a limited # of possible cell divisions
limited # of divisions of the cell (telomere theory) is referred to as what?
Hayflick’s limit
where do you find telomerase in adults?
specialized cells, certain adult stem cells, precursor cells to sperm and in activated WBCs
CANCER CELLS have so much telmoerase that they can divide indefinitely
can we add telomerase or drugs that mimic the effects of telomerase to a cell culture to lengthen telomeres
yes- but results have been mixed
purpose of inflammation?
eliminate the initial cause of cell injury, clear out dead and dying cells and damaged tissue
what is “inflammaging?”
Miller’s made-up word that he associates with why we age: b/c all conditions, esp chronic disease states cause inflammation and this is why we age
how long can it take to change gene expression when looking specifically at lifestyle changes and genes?
3 months
utilizing lifestyle changes and mind-body modalities was shown to turn on dz preventing genes and turn off genes that promote CA and CVD
greater activity of what appears to be associated w/more rapid accumulation of plaque w/in coronary arteries?
greater telomerase activity
ARDs of esomeprazole?
greater risk of hip fratures, c. diff-associated diarrhea decrease the complications in gastritis and ulcer formation if using long-term
what antacid class has been shown to increase complications in gastritis and ulcer formation?
H2 blockers
SSRIs deplete what vitamins?
B6, B12 and folic acid
PPIs and H2 blockers diminish levels of what nutrients and minerals?
diminish levels of B12, calcium, iron, magnesium and other minerals and nutrients that are dependent upon an acidic environment for optimal absorption
metformin causes what deficiency?
B12
statins cause what deficiency?
CoQ10
BC pills cause what deficiencies?
B5, B6, B12
anti-seizure meds cause what deficiency?
folic acid
ways we can reduce inflammation?
utilize mind-body modalities
pay more attention to our diets
pay more attention to moving (exercise)
take supplements or pharmaceuticals when benefit: risk ratio appears to be to our advantage
what happens to lean body mass, total body water content, muscle content and total body fat as we age?
lean body mass and total body water content decreases
total muscle content decreases
total body fat increases and locates in the upper body (visceral and subQ)
what happens to spinal curvatures as we age? which gender is this more prominent in?
kypohosis increases esp in females, slight bending at the knees and hips which leads to shortened stature
increased cervical extension as compensatory mech
changes in bone mass often lead to increased susceptibility to vertebral fractures and a decrease in height
what %age of men and women over 65 yo are overweight?
15% of men and 20% of women over 65 are overweight
obesity in the geriatric population usu reflects weight obtained in what decades of life?
first 5 decades of life
% decrease in lean body mass for men and women as they age?
~25% for males and 15% for females in US (mostly dt loss in muscle mass)
what happens to hair as we age?
generalize decrease in total body hair
scalp hair thins and diminishes
axillary and pubic hair also thins as individuals age
what is enophthalmos?
loss of subQ fat behind the eyes resulting in a sunken eye appearance, on average lose ~10 mm in depth
aside from enophthalmos, what are some other eye features that can change along with general changes in facial features?
Can get ptosis which can lead to visual obstruction (esp w/peripheral vision)
progressive resorption of bone from mandible and maxilla= diminished prominence of jaw
nose may broaden and lengthen
ears lengthen
how does skin change as we age?
diminished # and fxn of sweat and sebaceous glands= more trauma, infxn and decubitus ulcers
things overall w/decreased production of cells
fewer melanocytes= increased risk of skin cancer
vitiligo becomes more common
vascular fragility increases= more hemorrhages and ecchymosis
how does vision change as we age?
lens becomes less elastic
focusing becomes a problem
visual acuity often decreased and adaptation to darkness and accommodation often impaired
reduction in tear formation
which visual change causes central vision loss? peripheral visual loss?
central visual loss caused by macular degeneration
peripheral visual loss caused by glaucoma
aside from macular degeneration and glaucoma, what is another visual pathology that can appear with aging? when does it especially cause problems
cataracts- causes problems esp w/night driving when oncoming headlights produce glare
what is glaucoma?
P w/in the eye is elevated to the point where the visual cells and nerves are affected- major visual loss and blindness
often leads to loss of peripheral vision before central vision affected
what changes w/hearing as we age?
increased threshold for higher frequencies (can’t hear high pitched sounds as well)
more common in men
speak in a deeper voice to elder patients not louder
decrease in taste and smell may be dt what possible processes?
atrophy of the parietal lobes
but can also be a result of polypharmacy or a zinc definicency
after what age do we start to lose bone mass?
after 40 yo
long bones will appear to have externally enlarged but internally have less bone-y matrix and diminished density
what is osteoarthritis?
breakdown of cartilage leading to bones of a joint rubbing together
often time get bits of bone floating in the joint space which can be a cause of crepitus, possible increased pain and decreased ROM
5 RFs for osteoarthritis?
increasing age
obesity
joint injuries caused by work or sports
concomitant dzs that change the structure, fxn of cartilage
hereditary condition such as defective cartilage and malformed joints
what is RA?
AI condition resulting in inflammation of synovial membrane
as space b/w joints diminishes the joint will lose shape and normal alignment
what is the leading cause of death in the US?
atherosclerotic dz
what happens to conduction in the heart as we age?
SA and AV nodes show a decrease in # of pacemaker cells
ectopic beats are more frequent
what happens to lung surface and capacity as we age?
reduction in pulmonary function
lung surface reduced by 4% per decade after 30 yo
decrease in # of alveoli but alveolar size increases in a compensatory mechanism therefore get an increase in AP diameter with reduction in base to apex diameter
what happens to residual volume versus total lung capacity as we age?
increase in residual volume
modest decline in total lung capacity
predisposes elderly to more infxns of the lungs
RFs for increased risk of pneumonia in elderly?
reduced gag and cough reflexes
reduced respiratory muscle strength and diminished mucociliary cell activity
what happens to the KDs as we age? what can this lead to?
decrease in size, fewer, smaller and more sclerotic nephrons
increased BM thickening of the glomeruli
atherosclerosis of renal vasculature
can lead to increased medication complications w/meds that are metabolized and/or excreted by the KDs
what happens to our bladder as we age?
diminished bladder capacity
in men further complicated by prostatic hypertrophy/hyperplasia
in women vaginal atrophy and altered pelvic support can lead to urinary dysfxn
what GI changes occur as we age?
esophagus may have decreased motility= greater chance of aspiration when recumbent
hypochlorhydria and achlorhydria are common findings
increased incidence of atrophic gastritis and gastric polyposis
oral and pancreatic amylase decrease
gallstones are more common after 65 yo
how do liver enzyme and bilirubin values change as we age?
they shouldn’t! should only see a change if there is concomitant liver or biliary dz
increased incidence of fecal incontinence as we age is dt decreased tone in which sphincter?
external sphincter
what happens to our tolerance to sugar as we age? how do our adrenals function with age? how do sex hormones change?
tolerance to sugar decreases so can see higher serum glucose levels
cortisol shows same diurnal variation but at lower levels
aldosterone levels also decrease
androgens decrease by ~50% from early adulthood levels
how might cognitive abilities change as we age? mental status?
cognitive ability should remain unimpaired with only minor loss in recent memory
mental status however can be influenced by anatomic changes in the brain that accompany aging
why might elderly be more predisposed to falling?
postural reflexes and autonomic regulation decrease as we age
poor control of BP leading to syncope or postural hypotension
visual changes
MC cause of dementia in elderly population? 2nd MC cause of dementia?
Alzheimer’s dz #1
multi-infarct dementia #2 (series of strokes)
how do sleep patterns change as we age?
require less sleep
include more waking periods during the night- more exaggerated in men than women
characteristics of anemia of chronic dz?
iron, B12 or folate deficiencies
causes normochromic, normocytic RBCs
how does our immune system change as we age?
overall decline in fxn
decreased cell-mediated immunity and decreased antibody response
more susceptible to CA and infxn
