Physiology of Aging

Question 1

Reduced Homeostatic Responses Common in Elderly: How do the following change?
1. Baroreceptor responsiveness?

2. Thermoregulatory responses?
3. Cardiac reserve?
4. Thirst?
5. Dark adaptation?

Answer 1

1. increased postural hypotension
2. Higher hypothermia, hyperthermia
3. fluid overload
4. dehydration
5. night driving hazardous

Question 2

Host Defense Against Infection: How do the following change?

1. Skin, mucous membranes?
2. Mucociliary defenses?
3. Gastric?
4. BPH?
5. Infection signs that may be absent? 3

Answer 2

1. primary barrier – thinner, less blood supply
2. cough reflex diminished
3. achlorhydria
4. residual urine
5. • Absence of fever
   • PMN’s altered,
   • t-cells altered

Question 3

1. The most common early sign of aging is what?

2. Hair thinning in men begins often in the what?

Answer 3

1. -difficulty staying up all night and
   working the next day.
2. 20’s.

Question 4

Sign’s of Aging: Early signs in 30s?

5

Answer 4

1. Easier weight gain
2. Graying hair, thinning hair
3. wrinkling forehead and eyes
4. concern about biologic clock, financial security, family obligations
5. injuries “weekend warrior”

Question 5

Signs of Aging: 40s?
1. Reflection on mortality, life’s limitations, unreached dreams and goals. Could lead to what?

2. Skin changes? 4
3. 40’s (cont)
   Vision Changes?
4. Osteoarthritis
   By age 40, all adults have OA changes visible in what?
5. Most of these changes are not symptomatic at this point: Common sites for pain? 3

Answer 5

1. mid-life crisis

2.

• sagging, wrinkling
• thinning
• benign and malignant lesions
• sweat glands

3. Presbyopia
   -Most common age-related eye problem in this age group
   Require reading glasses.
4. radiographs of the cervical spine
5. • Hands,
   • joints,
   • back

Question 6

Signs of Aging: 50’s and early 60’s?

8

Answer 6

1. Sense of aging
2. Menopause
3. Becoming a grandparent
4. Death of parents, friends
5. Oldest at work
6. Physical limitations, medical problems
7. Senior citizen discounts!
8. AARP membership

Question 7

Signs of Aging: 70’s and 80’s
1. Common problems? 6

2. Pschological and social losses examples? 6

Answer 7

1. • Arthritis,
   • hypertension,
   • hearing loss,
   • heart conditions,
   • visual problems,
   • bone problems
2. Psychologic and social losses:
   - Retirement,
   - death of spouse/close family member
   - Children moving away,
   - friends dying or moving
   - Moving into apartment or retirement living
   - Inability to socialize from sensory or physical impairments

Question 8

Aging Changes and the Rule of Thirds

3

Answer 8

1/3 of functional decline is the result of disease

1/3 is due to inactivity (disuse)

1/3 of decline is caused by aging itself

Question 9

Adaptation to disability and to role losses: Reflects certain advantages that older adults have over younger individuals. Such as?
4

Answer 9

1. Greater independence
2. Fewer responsibilities
3. Reduces concern about day to day inconveniences
4. Financial security
   - Social security
   - Retirement programs

Question 10

Aging Changes in Organ Systems
Hematologic system
1. After age 65, what decreases slightly? 3
2. WBC’s increase in __________ and decrease in ___________?
-why?

3. Total __________ unchanged, subsets change
4. ___ increases slightly
5. Physiologic anemia of aging
   why?

Answer 10

1. • RBC,
   • Hgb,
   • Hct
2. lobulation, granulation
   - impairment of phagocytic activity
3. lymphocyte
4. ESR
5. Decreased reserve of red cell mass

Question 11

Musculoskeletal system:
1. Height – average loss of what?  (40-80yrs)
Weight 
2. Men: peaks in \_\_\_’s, then declines
3. Women: peaks \_\_’s, then declines

Answer 11

1. 2-4 inches
2. 50
3. 60

Question 12

Musculoskeletal system
1. Increase in density, decrease in the what of connective tissues?

2. Loss of skin elasticity, joint stiffness. Why?
3. Calcification of connective tissue. From what? 2

Answer 12

1. water content
2. (increased fibrous tissue)
3. • Atherosclerotic changes
   • Degenerative joint disease

Question 13

Musculoskeletal system

1. Decreased bone mineral content causes changes leading to?

Answer 13

osteoporosis

• Age 20 bone mass: women>men
• Age 50 women=men
• Age 65 women2x

Question 14

Bone loss in women due to:

2

Answer 14

1. Decreased estrogen production

2. Vitamin D absorption declines = decrease calcium absorption

Question 15

Describe the effect of estrogen on bone density?

3

Answer 15

1. Increase in osteoclastic activity,
2. parathyroid hormone production,
3. decrease in calcitonin

Question 16

Musculoskeletal system
1. Decrease in muscle mass due to what?

2. Change in muscle strength begins age ___?
3. Degree of muscles loss varies –Which muscles are affected more?

Answer 16

1. reduction in number and size of muscle fibers – 30%
2. 35
3. Large muscles affected more than smaller muscles

Question 17

Changes in skin as a person ages?

5

Answer 17

1. Decreased tone and elasticity
2. Decline in subq adipose tissue- poor thermal insulation (susceptible to hypothermia)
3. Yellowing of nails, rigid nails
4. Hair loss after 30 in men
5. Decrease in pigment

Question 18

Respiratory system
1. Physiologic work capacity of 70 year old only what of a 20 year old?

2. Decrease in what
   reduces total surface area for gas exchange?
3. What decreases progressively 30-70 years old (17%)?
4. What decreases due to changes in collagen?

Answer 18

1. half
2. alveolar size
3. Vital capacity
4. Elastic recoil

Question 19

Respiratory system:
1. What increases 60% by age 80,

2. What causes decrease in ventilatory function? 3
3. How do expiratory flow velocities change?
4. All timed pulmonary functions _______ with age?

Answer 19

1. Forced residual capacity
2. • changes in chest wall muscles,
   • bone and
   • connective tissue
3. Reduced
4. decrease

Question 20

CV system
1. What leads to reduced vascular compliance in the aging? 2

2. Cardiac output decreases by __% per year between 25-70 years of age
3. Stroke volume decreases by ___ %/year
4. Change in resting heart rate?
5. Maximum heart rate ________?

Answer 20

1. • Increased collagen in vascular smooth muscle +
   • decreased elastic tissue
2. 1
3. 0.7
4. Slight reduction
5. decreases

Question 21

1. What causes Decreased organ perfusion?
2. Age 80, blood flow reduced by 50% in the _______ 20% in the _____________?
3. What leads to increased systolic BP? 2

Answer 21

1. (Increased PVR and decreased CO)
2. kidneys, cerebral hemisphere
3. • Increased peripheral resistance +
   • decreased vascular compliance

Question 22

Renal
1. After age ___, decrease in nephron units

2. kidney begins to lose what?
3. What happens to the renal blood vessels?
4. Medullary connective tissue increases, replaces what?
5. decrease in medullary ________?
6. Loss of what cells?
   - Which leads to? 2

Answer 22

1. 40
2. mass
3. Renal blood vessels thicken, lose elasticity
4. interstitial cells
5. hydration
6. juxtamedullary glomeruli
   Account for
   -decreased renal concentrating ability and
   -decreased renal perfusion

Question 23

Renal:
1. what else declines after age 40 (1%/year)? 2

2. By age 80, the glomerular filtration rate has decreased by ___%?
3. Creatinine clearance decreased by ___%

Answer 23

1. • Glomerular filtration rate and
   • creatinine clearance decline
2. 50
3. 33

Question 24

Renal
1. Peak ________ capacity reduced

2. Residual ______ increases
3. Blood flow best when?
   - why?
4. What would this lead to? 2
5. What doubles in size (20-80 yrs)?

Answer 24

1. bladder
2. urine
3. at night,
   - decreased renal perfusion
4. • nocturia,
   • frequency
5. Prostate gland

Question 25

Alimentary Canal 1. Loss of teeth occurs secondary to what? 2 2.What percent of the pop > 65 is edentulous? 3. Periodontal disease more common in middle and old age. What complication does this cause? - Which leads to?

Answer 25

1. - bone and - connective tissue changes 2. ½ 3. decreases ability to chew food adequately - All contribute to poor nutritional status

Question 26

Alimentary Canal 1. What fails to relax with peristaltic waves = uncoordinated? 2. What does this cause? 3

Answer 26

1. Lower esophageal sphincter 2. - Delayed entry of food into stomach - Decrease in gastric emptying time - GERD

Question 27

Gastric 1. Age-related changes in stomach lead to what? 2 2. Gastric secretions _______? 3. Unable to absorb _____!

Answer 27

1. - atrophic gastritis and - pernicious anemia. 2. reduced (achlorhydria). 3. B-12

Question 28

Colon Changes in aging? | 4

Answer 28

1. Decreased motor function 2. Depression of defecation reflex 3. Decreased colonic muscle tone 4. Decreased perfusion of GI tract secondary to vascular changes

Question 29

What do the following lead to: 1. Depression of defecation reflex? 2. Decreased colonic muscle tone? 3. Decreased perfusion of GI tract secondary to vascular changes?

Answer 29

1. Lead to chronic constipation 2. leads to diverticulosis 3. bowel ischemia

Question 30

Pancreas 1. Decrease in pancreatic lipase activity = May affect what? 2. No alteration in hepatic or biliary function, however increased incidence of what?

Answer 30

1. may have effect on digestion | 2. cholelithiasis.

Question 31

Men 1. Increase in fibrous tissue of what of testes? 2. Thickening of the basement membrane around the seminiferous tubules = leads to? 3. Sperm production only decreases ___% from age 20 - 80

Answer 31

1. intertubular spaces 2. decrease in sperm transport 3. 50

Question 32

Parathyroid hormones 1. At age 20, _____ as high in women vs men 2. Levels decrease in women at age ___? 3. Rise in __________, very high in those who develop __________? 4. In men, progressively rise until age ___, then decline

Answer 32

1. twice 2. 40 3. late middle age, osteoporosis 4. 60

Question 33

Decrease cerebral blood flow (20%) 1. By age 80, 7% reduction in what mass? 2. What, especially in basal ganglia, decrease? 3. Delay in what? leading to? 4. Motor time ________ with aging - What does this cause?

Answer 33

1. cerebral hemisphere 2. Neurotransmitters, esp dopamine 3. monosynaptic reflex arc, slowed reflexes 4. increases - slowing of activity from reduction in conduction velocity.

Question 34

Sensory and motor changes? | 4

Answer 34

``` 1. Decreased vibratory sensation Decreased 2. hand grip, 3. strength, 4. coordination, writing ```

Question 35

90% of older adults complain of some problems sleeping | What causes this?

Answer 35

1. Slowing of the alpha rhythm and altered sleep patterns 2. More time in bed, less time sleeping 3. Frequent night time urination 4. Arthritic pain

Question 36

What is a symptom of normal aging rather than Alzheimer’s, which the sufferer is generally unaware of any mental impairment?

Answer 36

Worrying about memory loss itself

Question 37

Ocular changes Common problems? 3

Answer 37

1. Cataracts (most common in the world/DM in the US) 2. macular degeneration (amsler grid) 3. decrease in visual receptors 4. Presbyopia 5. Decreased number of retinal rods, dark vision

Question 38

1. Amount of light reaching the retina diminished by ____% 2. Reduced ____________? 3. What happens to the lens? 2

Answer 38

1. 70 2. pupillary size 3. - Yellowing - clouding

Question 39

Hearing Decrease with age, varies with individual 1. What sounds specifically? 2. Descrease in vestibular function becaus of? 3. Leads to what problems?

Answer 39

1. High pitched sounds 2. Loss of hair cells in crista ampullaris 3. Leads to balance problems

Question 40

Taste 1. What descreases on the tongue (70%)? 2 2. Issues with this? 3. Olfaction declines Leads to? Don’t want to eat because they can’t taste or smell Leads to weight loss

Answer 40

1. Number of tongue papillae and taste buds 2. adverse effect on appetite and nutrition 3. poor nutrition

Question 41

Psychological Aspects of Aging | 5

Answer 41

1. Role Changes - Retirement 2. Coping with Medical Illness 3. Loss of spouse 4. Friends dying 5. Children are adults and far away or occupied with their own family matters.

Question 42

Laboratory Value Changes 1. Which increase? 3 2. Which decrease? 3

Answer 42

1. - ESR increases - Blood Glucose rises - Cholesterol rises 2. - Albumin falls - T3 falls - Creatinine Clearance decreases

Question 43

Successful or healthy aging appears to include three factors?

Answer 43

1. Low probability of disease and disability 2. Higher cognitive and physical functioning 3. An active engagement in life

Question 44

What is the disengagement theory? 3 What is Prototypical disengaged person? 3 What is the activity theory? What is the Continuity theory? 2

Answer 44

Disengagement theory 1. Voluntary cutting back on work, social and even family ties. 2 Becomes more satisfied with vicarious activities and especially with reminiscence. 3. Comes to terms with and accepts past failures. Prototypical disengaged person 1. Well known 2. Loved by neighbors 3. Happily spends all day rocking on the front porch, offering a cheerful word to everyone who passes by. Activity theory 1. Staying as active as possible 2. Continued professional or volunteer work 3. Social activities, family , hobbies Continuity theory: 1. Successful psychologic adaptation to aging involves allowing personal preferences from earlier years to manifest themselves as the individual responds to the stress and challenges of older age. 2. Thus, some individuals will remain more active because it suits their personality, whereas others will become more disengaged.