physiological features of aging process and modulation of thermal parameters required by application...

7/29/2019 Physiological Features of Aging Process and Modulation of Thermal Parameters Required by Application of Balneal Factors in Elderly

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Physiological features of

aging process andmodulation of thermal

parameters required byapplication of balnealfactors in elderly

Authors: O. Surdu1, 2, V. Marin1, T. V. Surdu2, V. Rusu1, D. Profir11. Balneal and Rehabilitation Sanatorium Techirghiol

2. Ovidius University ConstantaLeonardo Proyect:Thermal Baths for Active Ageing

Montecatini TermeOctober, 22th 2011


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Demographic aging

Demographic aging is an undeniable fact which, globallyspeaking, has economic, social, occupational, culturalconsequences and, last but not least, medical pressuresthat can not be ignored.

The last two decades we can also talk about ademographic aging of the elderly a phenomenon thatrefers to an increase percentage of population over 75years.

This fact led to the concept of 4-th age, targeting asegment of population extremely fragile, among which20-30% of people are dependent on someone.


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.Year All ages 65+years 64-74 years 75-84 years 85+years

% % % %1900 76.303 4 2.9 1 0.21930 122.775 5.4 3.8 1.3 0.21960 179.323 9.2 6.1 2.6 0.51990 249.657 12.7 7.2 4.1 1.32020 296.597 17.3 10.1 4.9 2.42050 309.488 21.8 9.7 6.9 5.2

~ 4x ~ 5x ~ 3x ~ 7x ~ 25x

The actual and future percentage

increase of elder population in USA(by Bontke & Bontke)


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The actual and future percentage increasein Romanian elder population

The population of Romania during 1990-2009 followed asteady downward trend from 23206720-21469959 in2009 (July 1) due in large part, emigration after therevolution, but also decrease the birth rate, mortality by

maintaining the high, even increasing it in some years.Consequently, natural increase since 1992 was negative(-0.2% o).

As a result of sharply lower in the younger population,

aged 0-14 years (from 23.6% in 1990 to 15.1% in2009), and increased the age of 65 years and older(from 10.3 % in 1990 to 14.9% in 2009), leading to so-called "demographic ageing of the population"


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The actual and future percentage increase in

Romanian elder population

STRUCTURA POPULATIEI ROMANIEI PE GRUPE DE VARSTA IN PERIOADA 1990 - 2009

23,6

23,0

22,4

21,8

21,1

20,5

19,9

19,4

19,1

18,7

18,3

17,8

17,3

16,7

16,2

15,6

15,4

15,3

15,2

15,1

48,8

49,2

49,2

49,9

50,5

51,1

51,7

52,1

52,3

52,3

52,3

52,4

52,1

52,2

52,4

52,4

52,1

51,8

51,5

51,3

17,3

17,0

17,2

16,9

16,7

16,4

16,2

15,9

15,

8

16,0

16,1

16,

2

16

,5

16

,8

16

,9

17

,2

17,7

18,1

18

,4

18

,7

10,3

10,8

11,2

11,4

11,7

12,0

12,2

12,6

12,8

13,0

13,3

13,6

14,1

14,3

14,5

14,8

14,8

14,8

14,9

14,9

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

la

suta

din

totalpop

ulatie

0-14 ani 15-49 ani 50-64 ani 65 ani si peste


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Age distribution for patientshospitalized in SBTR in 2011

Patients age distribution

108 362959

1952

3031

1571

544

16

15-24

25-34

35-44

45-54

55-64

65-77

75-84


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Age distribution for patientshospitalized in SBTR in 2011

Age patients distribution

1% 4% 11%

24%

36%

18%

6% 0%

15-24

25-34

35-44

45-54

55-64

65-77

75-84


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Disease distribution for patientshospitalized in SBTR in 2011

Patients diseases distribution

360

2402

59859458067

3331

90397 71125

inflamatory arthritis slipped disk hernia

postlaminectomy slipped disk hernia postraumatic status

neurological diseases gynecological diseasosteoarthritis vertebral static disfunction

osteoporosis abarticular syndroms

dermatologycal diseases vascular disease


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Disease distribution for patientshospitalized in SBTR in 2011

Patients diseases distribution

28%

7%7%7%1%

39%

5%0% 4%0%

1%1%

inflamatory arthritis slipped disk hernia

postlaminectomy slipped disk hernia postraumatic status

neurological diseases gynecological diseas

osteoarthritis vertebral static disfunction

osteoporosis abarticular syndroms

dermatologycal diseases vascular disease


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Cure in a balneary resort

Request/Desire/Demand

Need

Increase in the quality of life


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Aging process is a natural disease(Aristotel)

Aging process is not a diseaseor a dysfunction itself. It onlyrepresents a decrease of theoptimal physiological levels ofall ongoing processes within

the organism. This global malfunction does

not occur equally within allsystems and does not startprecisely from a certainmoment. The human body can

or cannot be affectedpreviously to this moment.


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Aging process is a natural disease(Aristotel)

From the biological point of view, fundamental for agingprocess is a decrease of adaptability of both functions ofvarious systems and cellular level, so that adaptivemechanisms that lead to maintenance of internal

environment balance - homeostasis - are slowing downand sometimes are ineffective in elderly.

Homeostasis is disturbed especially under physical(including heat stress and climate), chemical and physical

stress, consequently adaptive mechanisms are restoringslowly or insufficiently the perturbed parameters.


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Nowadays, there are two currents for the most

frequent accepted intimate mechanisms of

aging process:

Genome based theories

Aging as a

genetically

programmed

phenomenon

Without

genetic

determinati

on

Theories that do not

involve direct genetic

determination

Organ

disturbances

immune and/or

neuroendocrin

e induced

Primary and

secondary

physiological

disturbances


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Decrease of theaccommodation capacity

The disturbance of the major homeostatic functions:immune, neurologic, endocrine, thermoregulatory, together

with alteration of self-control mechanisms, they all generatethe transformation of the normal stress within a relationshipinto a pathogenic stress.

The main targeted tissue structures for physiological agingwhose senescence influences the global rhythm of agingare the blood vessels and the neurons. The complex agingchanges to these structures have as general resultsaterosclerosis and neurodegeneration.


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The thermoregulatory function and senescence

Risk for hypothermia

(decrease of thermogenesis

and heat storage capacity) or

hyperthermia (decrease ofthermolysis and increase of

temperature value which

triggers thermolysis)

The aging of the nervous system (disturbances in

signal transmission, in thermic receptors, in the

transmission and/or integration of information, in

the transmission of afferent stimuli)

Accommodation disturbances

in peripheral circulation


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Immuno-senescence

Older people have particular characteristics inrelationship with warm balneal prescriptions:

- the decrease of immune systems response capacity tonew antigenic challenges

- the increase of the quantity of endogenous antigenicproducts and, in addition, propensity for autoimmunephenomena

- the alteration of expression phenomena of surfaceantigens, of their products and also of the subtlemechanisms of presentation /recognition /cooperation/connection from the major complex of histocompatibility


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The endocrine system

role in the aging

processis that of

neuroendocrine

programmer throughepiphysis due to the

axes:

(cerebro)

hypothalamus-pituitary-(tiro)-

gonadic

hypothalamus-

pituitary-adrenal

Aging of the endocrine system itself

has consequences on the direct control of endocrine functions through

neurotransmitters and also on the indirect through hormones/secretive

pathways

ACTH and cortisol

secretions and their

circadian rhythm are

slightly influenced byage, but post aggression

negative feed-backis

slower, thus the increased

blood levels of thesehormones can resist for a

longer period of time

The endocrine

system andsenescence

i i


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The cardio-vascular system senescence and adaptive demands

for balneal applicationMorpho-

physiological

parameter

Morpho-physiological changes

connected to age

Required adaptive

demands for physical

activity

Change/Request

report

Systolic flow Decreases with 1% /year, from 7l/min, in terms of effort, at 40 years

old, to 4 l/min at 80 years old

Increases 2-3 timescompared with resting

phase

Discordant

Cardiac

frequency

Adaptability decreases by increasing the

frequency to requests; decreases the

chronotropic and inotropic adrenergic

reply

Request an increase of

cardiac frequency

(limited to max.140

beats/min in elder people)

Discordant

Arterial blood

pressure

Increased, normal, lowadaptive

deficit to environment

requirements

Decreases the arterial

blood pressure

Relatively

discordant

Peripheral

resistance

Increases, because of the decrease

of vascular walls elasticity

Decreases, due to

vasodilatation produced

by local metabolites:

adenosine, K+, Ach, ATP,

lactic acid, CO2

Discordant

Speed of blood

circulation Decreases Increases Discordant

Maximum

oxygenconsumption

Decreases from 45-50 ml O2 per

kg.body/min, in an adult, to 18-23ml O2 per kg.body/min in adults

over 60 ears old

Increases to 85-90 ml O2

per kg.body/min Discordant


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Respiratory system senescence andbalneal application

Relatively discordant

The respiratory rhythm

(tachypnea) and

amplitude increase.

The CO2 partial

pressure in thealveolar air decreases.

Progressive

deterioration of the

pulmonary tissue

(parenchyma and

interstitial). The

decrease of chest

elasticity andrespiratory muscles

activity. The increase

of the residual volume.

Respiratory system

Change/Request

report

Adaptive needs

required by physical

activity

Morpho-

physiological changes

connected to age

Morpho-

physiological

parameter


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Hematopoetic system senescence and the physicaleffort

Morpho-physiological

parameter


changes connected to age

Adaptive needs required by

physical activity

Change/Request

report

Plasmatic volume Decreases due to intercellular

water loss

Increases due to blood

mobilization from deposits

Discordant

The number of red-

blood cells

Does not modify Decreases Relatively

Discordant

White-blood cells The incapacity to trigger

calcium signals because of

decreased intercellular calcium

and low synthesis of

phosphoinositol and diacil-

glycerol.

Decreases Concordant

Thrombocytes Status trombofilicus: Theactivation mainly of the

coagulation system with the

imbalance of the fluid-

coagulant status

Decreases blood coagulation Discordant

Variation of

concentration of the

dissolved gases in the

peripheral blood

Decreases the consumption and

extraction of O2 from the

arterial blood

Decreases arterial CO2

concentration due to

hyperventilation and amino

acids loss through perspiration

Concordant


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The nervous system senescence and physicalactivity


parameter

Morpho-physiological changesconnected to age

Adaptive needs required byphysical activity

Change/Requestreport

Cellularpopulations

Decreases the number of neurons:Synaptic plasticity changes; apoptosis;

neurofibrillary damage; loss of myelin

sheath; decrease of speed transmission

along the nerve; granular-vacuolardegeneration; Levi corps in high number;

areal accumulations of lipofuscine;

occurrence of Hirano corps; senile plates

Compensatory proliferation ofconjunctive tissue between theneurons

Changes of the hemato-cerebral

barrier permeability

Nervous structures able to

gather and transmitinformation, to elaborate

the reply and to carry it to

the effective organs, in

order to realize the

vegetative feed-back

Discordant

Centralnervoussystem

circulation

1. Decompensation of self-control

mechanisms of cerebral

circulation

2. Pathological mechanisms:

Oclusive (through thrombosis

or embolism)

Hemorrhagic (straight or

through diapedesis)

The acute phase:

Contraindicates physical

activity and effort

The chronic phase:

Requires parametrical

modulation

Discordant


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The vulnerabilities of the elder people

The cardiovascular function vulnerability

The motor activity vulnerabilityThe sensitive-sensory function vulnerability

The psycho-affective vulnerability


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The damage of the tissue trophicity and its consequences

The precarity of tegument trophicity

The precarity of muscular trophicity

The decrease of muscular force happens gradually starting from early ages:

between 44-55 years old there is a loss of 1% /year

between 55-65 years old there is a loss of 1,5% /year

over 65 years old there is a loss of 2% /year, remaining 30-40% from muscular force value

from age 25

The precarity of bone structure trophicity

Bedsores

The risk for osteoporosis

The precarity of near joints structures trophicity

Risk for stretching, loss of continuity of

insertions, breakings

Limited range of motion


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The damage of motion

The decrease of passive mobility usually due to pyramidal muscular hypertonia of the lower limbs, but

also due to extrapyramidal hypertonia

The increase of support base in upright position and walking;

The decrease of the miotatic reflex, usually symmetrical;

Conservation of general sensitivity, with the possibility of decreasing the vibratory sensitivity in the

lower limbs.

An important pathological cause for walk disturbances in elderly

people is stroke

The senile walk


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Polipathology

Iatrogenetic Risk Polipragmatic

Risk

The therapeutical objectives


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The therapeutical objectivesare:

The maintaining / regaining of articularmobility;

The maintaining / regaining of muscularforce and resistance;

The maintaining / correction of bodyposture and alignment;

The maintaining / correction of motorcoordination and control and equilibrium.


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The individualkinetotherapyaims:

The decrease/control of pain;

Prevention of loss/recover of jointmobility;

Prevention of loss/recover ofmuscular force and resistance;


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In case of neurological sequelae,the kinetic program aims:

recover of the muscular tonus decrease inmuscular hypertonia and increase in muscularhypotonia;

prevention of axial deviations; recover the balance between agonists /

antagonists, synergists / stabilizers, and alsobetween the physiological alternation

contraction / relaxation; the re-establishment of body equilibrium,

voluntary motor control, walking and abilities.


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Conclusions

Kinetotherapy along with hydrokinetotherapy, with theirvarious prescribing forms, are used in balneal resorts, inprocedural complexes,usually belonging to the entiremethodological gatherings of our field:

hydrothermotherapy, electrotherapy,masotherapy, balneoclimatotherapy.

Therefore, we should bare in mind a certain margin ofvital relationships when discussing and concluding all the

conceptual and methodological aspects regarding kineticprescriptions, the latter ones being unable to react ontheir ownon the elders organism, but all of themtogether.


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One might saywhich has been proved bystatistic analysisthat parameter modulation of

kinetics and hydrokinetotherapy clinically

motivated prescriptions, may allow 3-rd age and

even 4-th age patients to do efficient balneal and

physical treatments, not only with the purpose

of training/stimulating the organisms

adaptability, with the delay of global decrease

of performance / maladjustment phenomena

characteristic for senescence - thusgerontoprophilaxisbut also with the purpose

of treating ailments and/or chronic dysfunctions

gerontorehabilitation, both aspects leading

finally to the same objectivethe improvementof life ualit .

Conclusions


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Thank you for your attention!

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