what’s normal? what’s not? · physiology of aging what’s normal? what’s not? dr. rick...

Physiology of Aging

What’s Normal?What’s Not?

Dr. Rick MachemerAdult Abuse Training Institute

“Exploring Justice and Support for Victims of Adult and Elder Abuse”

Albany, New York, October 30, 2019

Current “Focus”~ Aging “just” happens~ Little to no control;

everything is genetic~ Outcomes: not good to

very poor

Goals of Seminar~ Describe biological aging~ Understand biological aging –

dispel myths; perhaps diminish ageism

~ Distinguish between aging & disease

~ NO attempt to change your emotional reaction to aging

What’s the “Big Fuss”?

“Aging is growing old, becoming less functional, developing disease,

becoming fully dependent…then dying…all alone, in constant pain,

and in an institution.”

The Real Issues~ What’s successful

aging? ~ How to do it?~ How to separate

aging from disease?

The Mythology of Aging* Being old means being sick* Aging is a disease…looking for a

cure * More of the same…nothing new

can be learned or done

Myths - 2* Once there’s a ‘problem’, there’s

always a ‘problem’* Aging is entirely genetic – no

individual control – it just ‘happens’

Myths - 3

* ALL physical and mental abilities decline (markedly)

* Persons who are older are a serious drain on all of society

Myths - 4* Nothing can be done about aging;

accept it; get out of the way (i.e., disengage from life)

What is “Reality”?

* Not all persons who are older are sick; function is less

* Likelihood of a disease is higher among persons who are older

Realities - 2* Aging is a normal process; have

significant control* Control does not mean one can

slow/“stop” process

Realities - 3* Learning is life-long activity,

not simply “school-based”; occurs more slowly

* Social engagement must continue

Realities - 4* Bad habits => diminished

health status can be changed…

* Damage may be “reversed”; e.g., with smoking, metabolic syndrome

Realities - 5* Outward look/function in aging…

more due to the environment and the life-long decisionsthan to genetics

Realities - 6* Functions change; without

disease/disuse/disability, change is minimal; littledaily impact until “late” in life

Realities - 7

* Persons who are older contribute in numerous ways: large amounts of time, energy, insight, wisdom, money

Realities - 8* Attitude is critical (e.g., don’t

accept negative stereotypes)* Ageism is alive, well, and

prospering…BUT can be fought

Challenges (of aging)

* Focus should be on health and wellness promotion… not on changing aging

Challenges - 2

* Early detection of altered function and risk factors is critical

* Intervention with renewed focus on prevention is essential

Challenges - 3

* Some diseases may not be avoided but can be substantially postponed

* Striving for “compression of morbidity”; i.e., (less time being “sick”)

Challenges - 4

* Emergence of concept of the FRAILTY SYNDROME…A syndrome that’s as problematic as many specific chronic diseases

Frailty – “New Kid”A biological syndrome of decreased

reserve and resistance to stressors resulting from cumulative declinesacross multiple systems causing increased vulnerability to developing adverse outcomes.

Frailty – Phenotype~ Weight loss: >10 lbs. or 5% of

body weight~ Weakness: grip strength lowest

20%~ Exhaustion

Frailty, Phenotype - 2

~ Slowness: slowest 20% for 15 feet

~ Low physical activity: lowest 20% of Kcal expended/week

NOT =>

Challenges - 5

* Exercise is an ABSOLUTE MUST!* Physical exercise often seriously

lacking; mental function helped by physical activity

Challenges - 6

* Sound nutrition: ABSOLUTE MUST!

* Fad diets and pills/potions are to be avoided

Challenges - 7

* Solitary lives “don’t work”* Social and emotional support

affects physical function (mind-body connection => brain changes)

Challenges - 8

* HETEROGENEITY OF AGING: tremendous variety/variability among persons who are older

* Variety of approaches needed to meet needs of all persons

Challenges - 9

ATTITUDE ABOUT AGING: need realism; difficult to change; must permeate society~ neutral view; positive is better~ difficult to teach; must emulate

when modeled

Remember…Aging at societal level

is NOT viewed as ‘positive’ situation

(focus: issues, problems, concerns)

Upside (of Aging)~ Living much longer~ Living much healthier~ Adequate knowledge to prepare

for next stages~ Realistic interest, not just anti-

aging

Downside (of Aging)

~ Little individual preparation~ Minimal societal preparation;

reactive, seldom proactive~ Service systems – past era design~ Unrealistic focus – to stop aging

How long do we live?

Life Expectancy Life Span

LIFE EXPECTANCY~ How long one can live (beyond some specified point in time)

~ Changeable; better environment => L.E.↑

Facts/FiguresIn 2019, % of persons in population who are older (> 65y):

~ 15.2%; 49.2MBy 2050, will climb to:

~ 19-20%; 79.6M

Demographics - 2

Current numbers/projections:~ 5.9 million over 85~ 19.7 million by 2060 (~334%↑…to 4.7% of total US pop.)

LIFE EXPECTANCY General Population

Dramatic increase during past 119 years (due primarily to meeting needs of children):

1900: ~ 47 yrs.2019: ~ 79.25 yrs. (as mixed

non-adjusted L.E.; 43rd in the world; Monaco #1 (89.37 yrs.); shortest Chad 50.96 yrs.; female L.E. always greater

LIFE EXPECTANCY - 3

WHY the dramatic change?Better: nutrition, public health, sanitation, immunization, antibiotics, environment in general; more preventative than curative

LIFE EXPECTANCY - 3

WHERE have the years been added in life cycle?~ Primarily early in life (infancy,

childhood)~ Less in “old age” (may change with

more effective medical interventions)

LIFE EXPECTANCY - 4

Will this continuing increase in L.E. continue?

~ “Perhaps” in Baby Boomers~ Stabilizing in Generations X,

Y (Millennials), and Z (New Silent); now decreasing overall

LIFE EXPECTANCY - 5

~ Widening gap between U.S. and Canada, Germany, Mexico, France, Japan, UK ~ L.E. inequity (between rich and poor) shrink ing in rest of world; increasing in U.S.~ Differs by city and by city vs. rural setting~ Decrease in L.E. may be due to diseases of despair (opioids, alcohol, suicides) & general lifestyle (obesity, lack of physical exercise)

LIFE SPANMaximum time member of any particular species has been observed to live.

LIFE SPAN - 2

Genetically-determinedHuman:

> 122.5 years

LIFE SPAN - 3

Jeanne Calment, Paris, France. 122 years, 164 days (2/21/1875 to 8/4/1997)

But......what is the phenomenon

we call AGING?

Brain is a fresh, new delicate egg. Aging is iron frying pan. Frying pan hits egg…it’s all over! Aging is this process but carried out more slowly. Yes? No?

Another perspective:left hand falls off onto sidewalk…“Nothing to worry about. It’s all part of the aging process.” Yes? No?

Aging...Everything that happens from

conception to death; = CHANGEGrow, develop, maintain,

repair/renew/replace, decline, eventually die

Model of AgingFunctional:~ Successful~ Usual~ Pathological

“Gene/environmental interaction”

GenesContinuum: from most positive (confer greatestpotential) to the most negative (confer leastpotential)

(Positive=> Neutral=>Negative)

EnvironmentContinuum: from most positive circumstances (=> greatest potential) to most negative circumstances (=> least potential)

(Positive=> Neutral=>Negative)

SUCCESSFUL(The “Narrow” Biological Description)

* Positive genes – positive environment

* Minimal functional change, 25-75 years; i.e., can do at 75 almost what was done at 25

SUCCESSFUL - 2

* “Look” different; function is OK

* NO DISEASE

USUAL(The “Narrow” Biological Description)

* Less positive genes in less positive environment

* “Obvious” functional loss; no testing needed to determine this; obvious to “everyone”

USUAL - 2

* SOME DISEASE* Requires compensation by person or modification of environment for full function

PATHOLOGICAL(The “Narrow” Biological Description)

* Negative genes in a negative environment

* Major disease leads to the “serious” functional limitations

* SUSTAINED INTERVENTION needed to sustain life

Control and Coordination

NOTHING in the body functions… without constant control and coordination

(under normal and non-disease conditions)

Homeostasis…A condition of relative functional constancy

within a continually and rapidly changing environment

“Current Model”ABSOLUTE UPPER LIMIT

DEATH

“UPPER RESERVE” USUAL UPPER LIMIT

“NORMALCY”

USUAL LOWER LIMIT“LOWER RESERVE”

DEATH ABSOLUTE LOWER LIMIT

“New Model”ABSOLUTE UPPER LIMIT

DEATH

“UPPER RESERVE”USUAL UPPER LIMIT

“NORMALCY”USUAL LOWER LIMIT

“LOWER RESERVE”

DEATH ABSOLUTE LOWER LIMIT

Usual limits widen =Relaxation of

homeostatic limits~ changes are successful aging ~ nothing to “fix”; (nothing “wrong”;

normal; happens in everyone)

Cause of deviation from normalcy?

STRESS(…and what is stress?)

Stress !ANY physical or emotional change

that causes a function to move outside usual homeostatic limits

Problem…~ Time for an adequate stress response may be “too long”;~ Function exceeds absolute limit => death~ Medical focus: intervene to prevent this change

What’s an effective counter to the slower

stress response?MINIMIZE the

environmental press (i.e. make the environment less “hostile”)

So…...if this slowed stress response and change in homeostasis is

“aging”, what isSUCCESSFUL

AGING?

Remember…Aging seems to be the only available way to

live a long life.Daniel-Francois-Esprit Auber

(French [opera] composer, 1782-1871)

Successful Aging

What happens when one ages w ithout

any disease? (to mid-70s and perhaps beyond)

NERVOUS SYSTEMFewer cells in some areasSlower information movementFewer connectionsNew connections can be made with continued use

MENTAL FUNCTIONNO decline in IQ; (changes)Memory intact; slowerSome interference with short term memory

General slowing of cognition

“BRAIN FITNESS” – How?Mental exercise - ??Physical exercise - YESChallenging leisure activities - ??Achieve mastery - ??Strong social relationships – YES?Technology use - ??

SENSORYVISIONLens stiffens; more farsightedMore difficult to see small itemsLess light into eye; need some

increase in brightness

SENSORY - 2AUDITIONHear fewer of high tonesMore difficult to screen out

background noise

SENSORY - 3

TASTESome decrease in sense of

tasteMore attention to flavors in

foods

SENSORY - 4

SMELLLess sensitive to many odorsMay affect sense of taste

SENSORY - 5

TOUCH/PRESSURELess sensitivityResponses vary widely due to

emotional impact

SENSORY - 6

THERMALFewer sweat glandsLose heat less effectivelyThinner skin; less fat More sensitive to temperature

MUSCULOSKELETALFewer muscle cells, more fatDecreased strengthContract more slowlyLess calcium in bonesJoints less flexible

INTEGUMENTThinner skin; less protection to underlying blood vessels

WrinklingFewer sweat glandsLess hair, more gray

DIGESTIVELess salivaSlowed swallowing reflexDecrease surface area in small intestine

Slower muscle movements

CARDIOVASCULARSmall decrease in cardiac reserve

No change in rate or forceResponse rate to stress slowed

CARDIOVASCULAR-2

Blood vessels slightly less elastic; slight/some ↑ B/P

Little to no change in capillary function

RESPIRATORYLungs slightly stifferSmall decrease in surface areaLittle to no change in respiratory activity

Slight increase in work to breathe

URINARYSlower filtrationNo change in selectivityBladder wall may weakenInfections more common in female; may mimic dementia

ENDOCRINESome slowing of responses to variety of hormones

Only major change is with female reproductive system

REPRODUCTIVEFEMALEMenopause, less estrogenReproductive activity ceasesSlight change in secondary sex

characteristics

REPRODUCTIVEMALEFewer sperm producedLess testosteroneProstate gland enlarges

Words used to describe system changes?

Slight, small, very small, no change; no decline; slower; fewer

In view of the challenges of aging,

what do we do?

Use Our Resilience

Resilience ‘Simplified’

Stuff happens …it’s the bounce-back that

ultimately matters

Emerging Issue

What does it take to live more quality years, not just more years?

Living Successfully –Characteristics

(“Non-Biological” Meaning of Successful)

* Genetics: no control – not to worry; know history; epigenetics

* Health: manage current issues; screen for new conditions

* EXERCISE: physical and mental

Successful - 2

* Safety: be reasonable* Engagement: reason to live* Creativity: actively stimulate; try

new things, master something* Attitude: positive but realistic

Successful - 3

* Education: gain as much as can* “Work”: continue “something”* Relational status: network of

friends; make new ones * Nutrition: eating habits

Successful - 4

* Living arrangements: lesschallenging – more appropriate

* Reliance: less on social programs and more on individuals

* Embrace change

Successful - 5

Use it (with a positive attitude)…

or lose it

Successful AgingNOT EASY; NOT SIMPLE

Lifestyle – BIG roleGenetics – smaller role

YEAHBUT…Are we ready to participate?Will we plan…and change? Will it take a crisis/many crises?

There is choice…and it is our choice.

Physiology of Aging

What’s Normal? What’s Not?

Dr. Rick Machemer(rmachemer@verizon.net)

Adult Abuse Training Institute“Exploring Justice and Support for Victims of

Adult and Elder Abuse”Albany, New York, October 30, 2019