Diseases of Aging

Lecture 8

PS Timiras

Recent approaches challenge the inevitability of

function pathology by grouping the aging processes into three categories:

1. Aging with disease and disability2. Usual aging, with absence of overt

pathology but presence of some declines in function

3. Successful or healthy aging, with no pathology and little or no functional loss

Such a grouping of aging processes:1. De-emphasizes the view that aging is

exclusively characterized by declines in functional competence & health

2. Refocuses on the substantial heterogeneity among old persons

3. Underscores the existence of positive trajectories (i.e., without disability, disease, major physiological decline)

4. Highlights the possible avoidance of many, if not all, the diseases and disabilities usually associated with old age

Figure 2.3: Common

causes of death by age in the United States

(also look 3.7)

Pathology: abnormal function leading to disease* COPD:

Chronic Obstructive Pulmonary Disease

** Disease of

Kidney

Tables 3-11 Di seases of the Elderly

Limited to aging

Osteoporosis Osteoarthritis Prostatic adenocarcinoma Polymyalgia rheumatica Temporal arteritis

Associated with aging

Known etiology Septicemia Pneumonia Cirrhosis Nephritis Cerebrovascular disease Myocardial infarction

Unknown etiology Adult-onset, Type 2 diabetes Neoplasm Hypertension Alzheimer's disease Parkinson's disease Emphysema

Disease may be viewed as a process that is :

• Selective (i.e., varies with the species, tissue, organ, cell and molecule)

• Intrinsic and extrinsic (I.e., may depend on environmental and genetic factors)

• Discontinuous (may progress, regress, or be arrested)• Occasionally deleterious (damage is often variable,

reversible)• Often treatable (with known etiopathology, cure may be

available)

Causes of Death According to AgeAll Races, Both Sexes

Ages: 65-84 Ages: 85+2003 2003

1. Heart disease (28.2%) 1. Heart Disease (36.2%)2. Cancer (27.7%) 2. Cancer (11.6%)3. COPD‡ (7.1%) 3. Stroke (9.4%)

4. Stroke (6.6%) 4. Alzheimer’s Disease (5.5%)5. Diabetes Mellitus (3.6%) 5. Pneumonia/Influenza (4.6%)

6. Pneumonia/Influenza (2.4%) 6. COPD‡ (4.4%)7. Alzheimer’s Disease (2.2%) 7. Diabetes Mellitus (2.2%)

8. Nephritis (1.9%) 8. Nephritis (2%)9. Accidents (1.9%) 9. Accidents (1.9%)10.Septicemia (1.5%) 10.Septicemia (1.4%)

- All others (17%) - All others (20.9%)

Causes of Death According to Age and Time PeriodAll Races, Both Sexes (1996 vs 2003)

Ages: 85+

2003 19961. Heart Disease (36.2%) 1. Heart Disease

(41.2%)2. Cancer (11.6%) 2. Cancer (11.7%)3. Stroke (9.4%) 3. Stroke (10.5%)

4. Alzheimer’s Disease (5.5%) 4. Pneumonia/Influenza (6.6%)

5. Pneumonia/Influenza (4.6%) 5. COPD‡ (3.5%)6. COPD‡ (4.4%) 6. Diabetes Mellitus

(1.9%)7. Diabetes Mellitus (2.2%) 7. Alzheimer’s

Disease (1.9%)8. Nephritis (2%) 8. Accidents (1.8%)9. Accidents (1.9%) 9.

Atherosclerosis (1.6%)10.Septicemia (1.4%) 10.Nephritis

(1.4%)- All others (20.9%) - All others

(17.9%)

‡ COPD = Chronic Obstructive Pulmonary Disease

Table 3-12 Common Fatal Diseases in Old Age

GENERAL HOSPITAL GERIATRIC UNIT (% AFFECTED) (% AFFECTED)

AGE AGE

DISEASE 65-69 70-74 75-79 80+ 80-89 90+

Cancer 29 27 27 24 Atherosclerosis 21 30

Cardiovascular 25 25 32 36 Myocardial infarct 19 10

Respiratory 14 12 13 1O Bronchopneumonia 17 25

Digestive 12 9 13 16 Cancer 10 7

Nervous System 11 9 8 6 Cerebral thrombosis 9 --

Renal tract 4 7 5 3 Chronic bronchitis 7 --

Other 5 1 2 5 Other* 16 28

*Senile dementia frequent in old age. Due to chronicity patients are placed in long-term care facilities.

Table 3-10 General Characteristics of Disease in the Elderly

Symptoms

Vague and subtle

Atypical

Unreported

Chronic versus acute

Multisystem disease

Altered response to treatment

Increased danger of iatrogenicity (medically induced morbidity and/or mortality)

Table 3-8 Physiologic Parameters in Aging, Physical Inactivity Weightlessness (In Space)* Reduced Increased

Maximum oxygen consumption (VO2 max) Systolic blood pressure and peripheral resistance

Resting and maximum cardiac output Vestibular sensitivity Stroke volume Serum total cholesterol Sense of balance Urinary nitrogen and creatinine Body water and sodium Bone calcium Blood cell mass Lean body mass Glucose tolerance test Variable Sympathetic activity and neurotransmission Endocrine changes Thermoregulation Altered EEG Immune responses Altered sleep

Changes in specific senses

*po s sibly responsive to physical activity

Diseases as a tool for the study of aging

Syndromes in humans: having multiple characteristics of premature (early onset) of aging, or

accelerated (rapid progression) of aging

Are called: progeria-like

progeroidsegmental syndrome.

Progeria-like: Hutchinson-Gilford syndrome, becomes apparent at early age and Werner’s syndrome becomes apparent at later ages

Slow growth, all body characteristics of old age.Advanced cardiovascular disease (generally thecause of death)

Note: Skin changes, some cardiovascular problems,metabolic disturbances,NO Alzheimer’s Disease, dementia, and hypertensionResponsible for WS is the WRN gene located on chromosome 8.

Down Syndrome: Trisomy at chromosome 21. There are somatic malformations, and severe mental disability, early symptoms of Alzheimer’s Disease