HD 11.10- Gerontology

Question 1

Name 3 cardiovascular changes that happen as you become elderly?

Answer 1

•	Chemical changes
o	Reduced nitric oxide production
o	Increased pro-inflammatory chemicals 
o	Delayed Angiogenesis- formation of new blood vessels
•	Anatomical changes 
o	Thickening of the ventricle walls 
o	Change in shape of the heart- more spherical, increased amounts of collagen, increased muscle 
o	Stenosis

Question 2

Name 5 endocrine changes that happen as you become elderly? (there is a lot)

Answer 2

• Somatopause
o Reduced protein synthesis
o Reduced lean body mass (muscle)  Decreased metabolic rate
o Increased adipose tissue (esp. abdomen)
o Reduced bone mass and density  Increased risk of osteoporosis/fractures
o Decrease in immune function
• Pineal gland – synthesise melatonin hormone
o Sleep disturbances
• Thyroid gland – controls calcium levels
o Reduced metabolic rate
o Autoimmune hypothyroidism
• Parathyroid glands – secrete PTH when calcium levels fall
o Reduced bone density
• Pancreas and diabetic risk
o Human cells less sensitive to insulin, possible reduced receptors
o Beta cells less sensitive to glucose
o Exhaustion and depletion of beta cells
o Decreased insulin
• Adrenal cortex
o Decreased aldosterone
o Cortisol – breaks down fat and proteins – not much known with age

Question 3

Name 3 changes in the eyes and the ears that happen as you become elderly?

Answer 3

EYES

•	Vision changes 
o	Presbyopia – inability to see close objects 
o	Cataracts – high amounts of protein 
o	Macular degeneration 
o	Glaucoma
o	Ptosis – drooping upper eyelid
o	Dry eyes – decreased tear production

EARS

• Loss of hair cells and cochlear neurons
• Outer ear changes
o Conductive hearing loss – less ear wax, increases infection
• Inner ear changes
• Presbycusis
o “The sum of all conditions that lead to decreased hearing sensitivity with age”
• Tinnitus
• Loss of balance

Question 4

Name 3 changes in the respiratory system that happen as you become elderly?

Answer 4

•	Anatomical changes
o	Reduced volume of rib cage 
o	Reduction in muscle strength 
•	Airway 
o	Reduced clearance of pathogens, debris and mucous by ciliary escalator 
o	Reduced coughing reflex 
o	Breakdown of alveolar structure – lead to emphysema, exacerbated by smoking 
•	Aerobic capacity decreases

Question 5

Name 5 changes in the skin and the muscular skeletal system as you become elderly?

Answer 5

SKIN

•	Intrinsic 
o	Smooth 
o	Pale
o	Less elastic
o	Dry
o	Fine wrinkles 
•	Extrinsic
o	Course and deep wrinkles
o	Rough texture
o	Spider veins
o	Irregular or mottled pigmentation 
o	Sallow complexion
o	Loss of elasticity 

MUSCULAR-SKELETAL

• Skeletal muscles
o Reduction in protein synthesis
o Reduction in size and number of muscle fibres, particularly in the lower limbs
o Reduction in muscle growth
o Reduction in the ability of muscles to repair themselves
o Replacement of active muscle fibres by collagen-rich, non-contractile fibrous tissue

•	Bones
o	Reduced bone density 
o	Osteoporosis
o	Risk of fracture
o	Joint changes
o	Osteoarthritis

Question 6

Name 3 changes in the digestive system that happen as you become elderly?

Answer 6

• Appetite – normally reduced
o Altered gastric motility – peristalsis weakens
o Dysphagia
o Reflux
• Stomach
o Acid hyposecretion – affect bioavailability of drugs
o Reduced production of goblet cells – stomach lining more prone to damage
o Decreased gastric bicarbonate – more prone to ulcers, particularly from NSAIDs

Question 7

Why is saliva so important?

Answer 7

• Protective against caries and wear
• Denture Tolerance
• Mucositis
• Chewing
• Speech / Swallowing

Question 8

How does the composition and the secretion rate of saliva change as you age?

Answer 8

o Modest decrease in the concentration of mucins and some saliva electrolytes.
o Concentration of those antimicrobial factors which are derived partly or totally from gingival crevicular fluid decreases in whole saliva as a result of tooth loss
• Both stimulated and unstimulated saliva flow rates decrease with age

Question 9

How does the composition of the tooth and its surrounding tissues change as you age?

Answer 9

Enamel 
•	Thins 
•	Loss of features 
•	Loss of translucency 
•	Darkens 
•	Cracks appear – as enamel walls weaker 
•	Coronal and root caries
•	Pathological tooth wear
Dentinal pulp complex 
•	Dentine 
o	Less water contents 
o	Tubule occlusion – sclerosis 
•	Pulp
o	Reduction in pulpal space 
o	Pulp calcifications 
o	Widening of the major apical foramen
o	Vascularity decreases 
o	Cellular content decreases 
•	Clinical implications 
o	Asymptomatic 
o	Pulp testing – electric pulp testing most reliable in older patients
o	Non patent canals 
Periodontium 
•	Fibroblasts
o	Reduced rate of cell proliferations 
o	Diminished protein and collagen production
•	Cementum 
o	Thickness increases (particularly apical 1/3) – to do with occlusal load and impaction 
•	PDL 
o	Increased fibrosis 
o	Decreases cellularity 
•	Physiological ageing of periodontium
o	Limited attachment loss
o	Buccal gingival recession