1. Physical Changes with Aging Dr. Mohamed seyam PHD.PT

2. Physical Changes with Aging Chronologic age is not an accurate predictor of physical condition or behavior” Sue Saxon & Mary Jean Etten, Physical Change & Aging

3. Physical condition seems to be driven by: Lifestyle choices  Exercise  Nutrition  Stress management Genetics Environment

4. Our Objective  Distinguish between “normal aging” and pathologic changes  Describe changes observed in various organ systems.

5. Theories of Aging  Programmed Aging Theory Hayflick Phenomenon Telomere shortening  Somatic Mutation Theory/Error Theory  Wear & Tear Theory  Cross-linking Theory  Free Radical Theory/Accumulation Theory  Immunological Theory

6. Cells  The cells of the elderly (regardless of when they last underwent mitosis) look the same as young cells.  However, old cells do not withstand a variety of challenges quite so well as younger cells.

7. Observed Changes in the Heart Deposits of the "aging pigment," lipofuscin, accumulate.  The valves of the heart thicken and become stiffer.  The number of pacemaker cells decrease and fatty & fibrous tissues increase about the SA node. These changes may result in a slightly slower heart rate.  A slight increase in the size of the heart, especially the left ventricle, is common. The heart wall thickens, so the amount of blood that the chamber can hold may actually decrease.  The heart may fill more slowly. To compensate, elderly subjects demonstrate a doubling of percent atrial contribution to filling.

8. Age and the Immune System The immune system declines with age, but this is variable among persons.  Nonspecific defenses become less effective  The ability of the body to make antibodies diminishes.  Autoimmune disorders are increased in older adults. Not everyone believes that the increased incidence of autoimmune disease is an expected part of aging. but all acknowledge the increase in findings of positive rheumatoid factor, anti- nuclear antibody, and false-positive syphilis screens in healthy older adults.  The thymus gland (which produces hormones that activate T cells) atrophies throughout life.  The peripheral T-cells proliferate much less exuberantly in old age.

9. Observed Changes in the Lungs  The number of FUNCTIONAL alveoli decreases  Decreased elasticity of the lungs may be due to collagen cross-linking.  The loss of elasticity accounts for "senile hyperinflation o FEV1 drops by 30 mL/year o VC is diminished by about 20% o RV increases by about 50%

10. Observed Changes in the Lungs The number of cilia & their level of activity is reduced.  Glandular cells in large airways are reduced.  Decreased number of nerve endings in larynx.  The cough reflex is blunted thus decreasing the effectiveness of cough.  Decreased levels of secretory IgA in nose & lungs  decreased ability to neutralize viruses.  The number of alveoli do not change significantly.

11. Observed Changes in the Kidney  Renal blood vessels become smaller & thicker reducing renal blood flow.  Kidney size decreases by 20-30% by age 90. This loss occurs primarily in the cortex where the glomeruli (# of gloms decrease by 30-40% by age 80) are located.  There is a decline in the number of renal tubular cells,  Overall kidney function, remains normal unless there is excessive stress on the system.

12. Observed Changes in the Bladder & Such….  The muscular ureters, urethra, & bladder lose tone & elasticity.  The bladder may retain urine. This causes incomplete emptying.  Decline in bladder capacity from about 500-600mL to about 250ml  less urine can be stored in the bladder. This causes more frequent urination. The warning period between the urge and actual urination is shortened or lost as one ages.

13. Observed Changes in the Muscles Muscles Sarcopenia ( ↓ muscle mass & contractile force) occurs with age. Sarcopenia is associated with increased fatigue & risk of falling (so may compromise ADLs). Sarcopenia affects all muscles including, for example, the respiratory muscles ( ↓ efficiency of breathing) & GI tract (constipation).

14. Observed Changes in theBone/Tendons/Ligaments Gradual loss of bone mass (bone resorption > bone formation) starting around age 30s. Decreased water content in cartilage  the “wear-&-tear” theory regarding cartilage destruction & activity doesn’t hold up as osteoarthritis is also frequently seen in sedentary elders. Decreased water in the cartilage of the intervertebral discs results in a ↓ in compressibility and flexibility. This may be one reason for loss of height. There is also some decrease in water content of tendons & ligaments contributing to ↓ mobility.

15. Observed Neurologic Changes  There is neuronal loss in the brain throughout life  Slowed neuronal transmission  Changes in sleep cycle: takes longer to fall asleep, total time spent sleeping is less than their younger years, awakenings throughout the night, increase in frequency of daytime naps  Sense of smell markedly decreases  The lens of the eye loses fluid and becomes less flexible, making it more difficult to focus at the near range.  Dry eyes

16. Observed Hair Changes  Men:  men loose the hair about their temples during their 20s  hairline recedes or male pattern baldness may occur  increased hair growth in ears, nostrils, & on eyebrows  loss of body hair  Women  Usually do not bald, but may experience a receding hairline  hair becomes thinner  Increased hair growth about chin & around lips  loss of body hair

17. Observed Toenail Changes  Become thicker & more difficult to cut Grow more slowly May have a yellowish color

18. Observed Skin Changes  The number of epidermal cells decreases by 10% per decade  These changes cause the skin to wrinkle and sag:-  The dermal layer thins  Less collagen is produced  The elastin fibers that provide elasticity wear out.  ↓ function of sebaceous & sweat glands contribute to dry skin  The fat cells get smaller, This leads to more noticeable wrinkles and sagging