Theories of Aging Flashcards by Alex Stein

Aging

Gradual and spontaneous changes that occur in maturation from infant to young adult - these changes create a normal physiologic decline seen in middle and late adulthood

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Senescence

To grow old
The way scientists approach changes associated with aging
A degenerative process

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Most health care dollars are spent on

managing diseases

5% healthcare dollars –> preventative care in 2015

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Ageism

Can be seen as a process of systematic stereotyping of and discrimination against people because they are old

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Old people are stereotypically chategorized as

Senile, rigid in thought and manner, old fashioned in morality and skills

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Primary Aging

Aging that is independent of disease and environmental influences (intrinsic aging)
Determined by genetics

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Secondary Aging

Aging superimposed upon genetic environment (extrinsic aging)
Changes due to environment and disease
May be modified

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Aging (1/3..)

1/3 disease + 1/3 disuse + 1/3 normal aging

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Aging - decreased

homeostatic reserve
less ability to restore baseline function
major loss leads to immobility

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Aging - dec homeostatic reserve - consequences

inc dependence
inc risk of falls
inc types of aging

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Disease vs. Normal aging (5) - Peola Timiras

Aging is universal process shared by all living organisms
Aging is intrinsic, dependent on genetic factors where disease is intrinsic or extrinsic
Aging is always progressive where disease may progress or regress
Aging is always deleterious whereas disease is occasionally deleterious
Aging is irreversible where disease can be treated

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Age related changes

Changes associated with aging through adulthood into age are gradual

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Adults and aging rate

Factors impact aging

Adults age at different rates

Unique combination for each individual of biological, social, economic, psychological factors impacting aging

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Factors affecting rate of aging - Biological changes

Changes in anatomy/physiology
Usually first to be noticed
Used to stereotype person as old

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Theories of aging

No universally accepted theory

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2 categories of aging theories

Programmed theories - aging as internal biological clock
Error theories - aging is result of internal and external assaults that damage cells or organs so they can no longer function properly

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Programmed theories

Hayflick limit theory
Telomere theory
Endocrine/Hormonal Theory
Immunologic Theory

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Hayflick Limit Theory

Aging is intrinsic - cells can only divide so many times and then shut off/die
Accumulation of improper functioning cells are responsible for aging
Dec DNA

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Telomeric Theory

Cells keep track of their age through shortening of telomeres
Creates gap where end of chromosome can’t be copied
Telomere shortening alters expression of other genes which enables detrimental genes to become active

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Telomeric theory - shorted telomere are found in

Atherosclerosis
Heart disease 
Hepatitis
Cirhosis
Cancer - cancer cells have telomerase which can fill the gaps so they continue to develop and divide

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Endocrine/Hormone Theory

Functional decrements in neurons and their associated hormones impact aging - effect growth, metabolism, temp, inflammation, and stress

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Immunologic Theory

Decline in immune system
Inc vulnerability to disease, aging, death
Immune system is coded overtime to erode

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Error theories

Somatic Mutation theory
Wear and Tear theory 
Rate of Living theory 
Cross Linking 
Free Radical

Somatic Mutation Theory

Accumulation of harmful factors injure genes

Environmental factors like radiation, toxic chemicals, free radicals

Wear and Tear Theory

Cells, organs and tissues gradually wear out over continued use Overcomes the bodies capacity for maintenance and repair Viewed as result of aging, not the cause of it

Rate of living theory

Inverse correlation between basal metabolic rate and longevity The greater the basal metabolic rate, the shorter the life span

Cross linking

The accumulation of cross linked proteins damage cells and tissues Slows down the bodily processes and functions Leads to loss of flexibility of CT, microvascular changes in arteries, lungs, tendons

Free radical theory

any atom or molecule that has an unpaired electron in the outer ring Damages DNA, proteins, Lipids Theory is that the FR grabs an electron from any molecule in the vicinity and damages the other molecule

What can we do - skin aging

Be careful with sun exposure and wear sunscreen

What can we do - Osteoporosis

Weight bearing, exercise, diet

What can we do - Serum cholesterol

Diet, weight control, exercise

What can we do - Glucose tolerance

Weight control, exercise, diet

What can we do - Memory

Training, practice

What can we do - Intelligence tests

Training, practice

What can we do - Social ability

Practice

What can we do - Cardiac reserve

Exercise, nonsmokign

What can we do - Systolic BP

Limit salt, weight control, exercise

What can we do - Physical endurance

Exercise, weight control

What can we do - Physical strength

Exercise

What can we do - Pulmonary reserve

Exercise, nonsmoking

What can we do - Reaction time

Training, practice

What can we do - Dental decay

Prophylaxis, diet

Unique aspects of the older person

Have diff types and numbers of diseases Have altered reactions to disease Have altered response to tx Have unique qualities

Diff types and numbers of diseases

No single dx Accumulation of non-lethal dx Serious degenerative dx Coexistence of normal age changes with pathology

Aged have altered reactions to disease

``` Altered presentation of dx - tendon reflexes, pain perception Inc mental disturbance (what do you expect at my age) Inc mortality (inability to maintain homeostasis) ```

Altered presentations

``` Presentation in wrong system Depression without sadness Mass without sx Silent infection Silent surgical abdomen MI without chest pain Non-dyspneic pulmonary edema Nonspecific presentations Brain altered functioning ```

Explanation for altered presentation in aged

``` Altered central processing Inc negativity Fear of illness, tx, hospitalization, loss of ind Fear promotes denial Ignorance of body changes Loss of peripheral sens Depression ```

Factors influencing presentation of disease

Misconception of what is normal aging Diff physiologic response to disease Effect of multiple chronic diseases Polypharmacy

Why doesn't aged adult seek medical help

``` Fear of hospitalization Fear of unpleasant investigations Fear of treatment Risk of being put in res. care Lack of info Imagining sx not amendable to tx Low health expectations Failure to recognize the problem ```

Aged adult has altered response to treatments

``` Inc vulnerability to drug effects Dec ability to compensate Tx interactions Drug effects Aging complicates acute and chronic illness ```

Focus of care for the aged adult - Management of disability -

Focus on function and then diagnosis Care before cure Independence before freedom from disease Interdisciplinary

Iatrogenesis

Harm to patient caused by professional treatment

Major causes of iatrogenesis

Relocation which contributes to disruption, confusion, falling, anorexia, malnutrition Drugs Hospitalization

Causes of increased dependence

Geriatric syndromes - common final pathways manifest in multi organ system failure Confusion, falls, dizziness, immobility, incontinence, fatigue, weight loss, dementia, delirium, hearing or visual impairment...

Red flags in geriatric care

``` Functional decline Loss of appetite Mood changes Social withdrawal Failure to thrive ```

Acute illness in aged adult

``` Aging itself Atypical presentation of dx Affect of patient Advance directives Bleeding Baseline Balance Bowel and bladder ```

Acute illness in aged adult can be caused by

``` Change Confusion Complications as presenting feature Caregivers Dx Drugs Dehydration Diarrhea Discharge from hospital ```