1. Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Master’s Programmes at the University of Pécs and at the University of Debrecen Identification number: TÁMOP-4.1.2-08/1/A-2009-0011

2. ADAPTATION AND VULNERABILITY, POLYMORBIDITY Miklós Székely and Márta Balaskó Molecular and Clinical Basics of Gerontology – Lecture 2 Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Master’s Programmes at the University of Pécs and at the University of Debrecen Identification number: TÁMOP-4.1.2-08/1/A-2009-0011

3. TÁMOP-4.1.2-08/1/A-2009-0011Asthma Renal disease Diabetes Cardiac disease Arthritis Cancer Correlation of morbidity rates and age Morbidity rate increase peaks at 60y, decelerate s after 80y, remains linear after 110y 0 20406080100 10 30 50 0 20 40 60 % with disease Age (years) Sinusitis

4. TÁMOP-4.1.2-08/1/A-2009-0011 Fat, fat-free mass and cell mass of males and females at various ages Fatfat-free masscell mass Fat, fat-free mass, and cell mass of males ( ) and females () at various ages, values are given, and the number of subjects in each age group is noted. 27 58 33 37 42 18 89 33 44 72 54 13 18–2525–3535–4545–5555–6565–85 Age (years) Absolute weight (kg) 10 20 30 40 50 60

5. TÁMOP-4.1.2-08/1/A-2009-0011 Age-related changes in different functions Age (years) Hypothetic function (%) 20 100 50 0 30405060 7080 90

6. TÁMOP-4.1.2-08/1/A-2009-0011 Average age differences in physiological functions among normal male subjects Basal metabolic rate Standard glomerular filtration rate (inulin) Standard renal plasma flow (diodrast) Maximal breathing capacity Vital capacity Standard renal plasma flow (PAH) Conduction velocity Cardiac index Standard cell water 3040506070 20 7070 50 0 30 40 60 Percent property remaining (average) Age (years) 8090 8080 9090 100

7. TÁMOP-4.1.2-08/1/A-2009-0011 Effect of 50 mmHg increment in systolic blood pressure on heart rate, cardiac index and stroke index in young and old rats Percent Change Young Old 50 10 -40 40 30 20 0 -10 -20 -30 Heart rateCardiac index Stroke index <.001≤.05NS ≤.05 ≤.001 <.001

8. TÁMOP-4.1.2-08/1/A-2009-0011 ADH effect decreases with age U/P inulin (urine/plasma conc. ratio) Urine Collection Period 0 0 10 20 30 40 50 60 70 80 90 100 110 120 12345678910 Young Middle Old ADH

9. TÁMOP-4.1.2-08/1/A-2009-0011 Glucose tolerance tests* in different age-groups Time (min) Blood sugar (mM) 0 5 6 7 8 9 10 11 12 20 30 40 50 60 70 Age (years) 20 0 6090120150 * 50 g glucose p.o.

10. TÁMOP-4.1.2-08/1/A-2009-0011 Organ capacity Healthy (old) Functional capacity of an organ Healthy (young) Sick (young or old) Essentialfunctionalminimum Reservecapacity

11. TÁMOP-4.1.2-08/1/A-2009-0011 Plasma epinephrine and norepinephrine vs. age during work Age (years) 020304050607080 0 400 800 1200 1600 2000 Plasma Norepinephrine (pg/ml) Age (years) 020304050607080 0 50 100 150 200 250 Plasma Epinephrine (pg/ml) 0% grade 3% grade 9% grade 6% grade Resting

12. TÁMOP-4.1.2-08/1/A-2009-0011 Characteristics of aging Decreased performance and compensation capacity Sensitive balance among the failing organ systems Interactions: It is always the weakest link that would cause symptoms (not what the original disease is!) “Monotonous”, atypical symptoms: organ specific symptoms, functional syndromes instead

13. Further characteristics of aging Frequent changes in symptoms Fewer acute syndromes, with less intensive or striking onset Opposed to this, more chronic syndromes that impair the quality of life Multimorbidity Medication related problems. Distribution and excretion of drugs change with age.

14. TÁMOP-4.1.2-08/1/A-2009-0011 Prevalence of multimorbidity Using 24 major diagnostic categories… 82 percent of people aged 65 and older had one or more chronic conditions 65 percent had two or more 43 percent had three or more 24 percent had four or more. On average there are 2.3 chronic conditions reported by people aged 65 and older. Wolff JL, Starfield B, Anderson G. Arch Intern Med. 2002;162:2269-2276 0 10 20 30 40 50 60 70 80 90 1 or more2 or more3 or more4 or more

15. TÁMOP-4.1.2-08/1/A-2009-0011 Characteristics of diseases in the elderly Multimorbidity The number of chronic incurable diseases increases Necessary compromises during treatment, determine priorities Gradual, hidden start A large number of secondary complications (limited capacity to compensate) Increased need for rehabilitation (importance of psychological and social factors)

16. TÁMOP-4.1.2-08/1/A-2009-0011 Functional syndromes IInstability, impaired homeostasis IImmobility, falls IIntellectual abnormalities (confusion) IIncontinence IIatrogenic disorders

17. TÁMOP-4.1.2-08/1/A-2009-0011Incompetence (Confusion) Geriatric Giants Immobility (Falls) Incontinence Iatrogenic disorders Impairedhomeostasis

18. TÁMOP-4.1.2-08/1/A-2009-0011 Illness-medication problems to which the elderly are susceptible because of their medical problemsIllness Medicatio n Drug interacti on Drug adverse effect

19. TÁMOP-4.1.2-08/1/A-2009-0011 Aims of therapy Transition from hospital to (nursing) home Relief of e.g. pain Improvement in self-care, independence Improvement of physical activity and fitness Improvement in functional abilities, better quality of life (QOL) Complete recovery (?)