Chapter 7

Grup 2
About Problem Related to Body
Dwi efendi

Dwiefendy2020@gmail.com

1.1 introduction
Low Immunity Response in the Elderly. Aging is related to a number of changes in
the immunity function, mainly the reducing of Cell Mediated Immunity (CMI). The
immunocompetence of elderly worsen with age including the rate of immune respons against
infection. It means that older people have a high risk of getting diseases such as infection,
cancer, cardiovascular, autoimmune disorder, or other chronic diseases. All of these diseases
occured in elderly due to the immunoglobulin production decrease. Thus, vaccination given
to elderly often might not be effective against diseases. Older people who commonly suffer
from a decrease of macro and micronutrients will have a low function and response of the
immune system. Therefore, malnutrition cases in elderly should have early specific attention
including consideration in given vaccination for preventing diseases. Infectious diseases
mostly suffered by older people can be prevented or reduced through improving nutrition
efforts because the immune system will be improved. If the immune function of the elderly
can be improved, the individual quality of life increases and the health cost can be
suppressed.
In modern times, many people do not pay attention to the intake of nutrients in their daily
food cosumption, especially the vitamin content. Vitamin is a complex substance that is
needed by our body that serves to help the process of body activities. Vitamin deficiency can
lead to an increase in the chances of getting disease in our body and allow the body functions
not to work optimally.

Examples like Muscle mass and muscle strength decreasing in elderly individuals is
an additive problem with high prevalence. Assessing muscle mass and muscle strength loss
associated with age and determining the mechanism for muscle atrophy in the aging process,
muscle structure and composition of muscle fibers have been carried out, using invasive and
noninvasive techniques. Gradual reduction in volume size with age, accompanied by
replacement by fat and connective tissue. The decrease in muscle mass and muscle strength
seems to be caused by the reduction in the number and size of muscle fibers, especially type
2, and to extent caused by a slow progressive neurogenic process. Improving the decrease in
muscle mass and muscle strength can be done by increasing muscle strength by exercising.
1.2 PRELIMINARY

The population of elderly individuals in the world is estimated to increase threefold in

50 years, from 600 million people in 2000 to more than 2 billion in 2050. The number of
elderly people in Indonesia is ranked 5th in the world, reaching 18.1 million in in 2010 and is
expected to increase 2-fold to 36 million in 2025. The increase in the number of elderly
people is influenced by the increasing life expectancy of the Indonesian population. From
67.8 years in 2000-2005 and is predicted to increase to 73.6 years in 2020-2025. The increase
in population is accompanied by an increase in health problems as a result of the aging
process. Skeletal muscle is one of the organs affected by aging, which is known as sarcopenia
(Riviati et al., 2017).

The aging process is related to functional changes in the human body. Increasing age,
followed by changes in body composition, in the form of a decrease in muscle mass and bone
mass. Changes related to the aging process occur after 50 years of life. These changes appear
to be significant in the loss of body mass 1-2% annually and a decrease in strength of 1.5-5%
each year (Keller & Engelhardt, 2013).

Decreased muscle strength is an important factor in decreasing functional activity and

the occurrence of disability in the elderly. To increase muscle strength, physical exercise is
needed (Visser et al., 2005). Muscle mass, muscle strength, and the effect of fat infiltration in
muscles can be modified through movement exercises and pharmacological interventions.
Hormonal supplements, nutritional interventions, and strength training are most commonly
used to increase muscle mass and muscle strength and can decrease the amount of fat
infiltration in muscles. In order to prevent or slow down the decline in physical function with
aging, it is important to know which muscle component contributes greatly to functional loss
independently. Therefore, it will help to optimize a muscle-focused strategy, because various
aspects of muscle integrity can respond to various treatments (Visser et al., 2005).

Muscle Strength

Muscle strength is defined as the ability of a muscle group to exert maximum

contractile force against resistance in a single contraction. Muscle endurance is the ability of
a muscle group to exert submaximal force for a long time (Keller & Engelhardt, 2013). The
aging process changes the pattern of muscle fibers and this causes a slowdown in contraction
time and a slowdown in muscle contraction rate. Therefore, measuring muscle strength and
muscle mass is important (Rolland et al., 2008; Morley et al., 2014).

Muscle strength is highly correlated with muscle mass, but the same amount of
muscle mass can produce different levels of strength. Thus, it is a measure of muscle strength
that should be used to determine decreased muscle strength (Rolland et al., 2008). Ultrasonic
studies show that changes in tendons play an important role in ability generate power while
electro-myography can be used to determine the reduction of motor units (Morley et al.,
2014)
 Muscle Mass

Muscle mass can be assessed using methods such as anthropometry, Bio Impendance
Analysis (BIA), or Dual Energy X-ray Absorptiometry (DXA) scans. However, these tests
cannot distinguish the liquid and solid components of muscle mass. This can increase the
estimated skeletal muscle mass presentation so that inaccurate data is obtained. However,
several studies reported a strong correlation (r> 0.94) between DXA scan and MRI results on
muscle mass (Burini & Maestá, 2012). Better tests to assess muscle mass can be assessed by
computed tomography (CT) or magnetic resonance imaging (MRI) (Rolland et al., 2008).

Figure 1. Relationship between muscle mass, muscle strength and age. Environmental factors
can have an effect on lowering the disability threshold.

The aging process affects the decrease in muscle mass and muscle strength

The pathophysiology of loss of muscle strength and muscle mass by the aging process
is complex. Increasing age will reduce the ability to synthesize muscle protein as well as a
reduced repair capacity which has an effect on muscle mass loss (Keller & Engelhardt, 2013).
Loss of muscle mass is caused by a decrease in the number of muscle fibers and motor units
and a decrease in the size of the muscle fibers. If the muscle fibers have a very minimal size,
then apoptosis occurs due to denervation and loss of neurons. Loss of muscle fiber reduces
muscle strength capacity, muscle metabolism and increases the risk of muscle damage
(Lambert & Evans, 2002).

Muscle fiber atrophy is disproportionately distributed with a significant degree of

atrophy in Type IIa Fast Twitch (FT) muscle fibers and motor units. FT muscle fibers are
more prone to malfunction or loss of function over time. In the 75th year of life more than
50% of FT muscle fibers are lost. One of the main causes of loss of strength and muscle mass
with aging is a decrease in anabolic hormones such as testosterone, dehydroepian-drosterone,
growth hormone, and insulin-like growth factor-I which produce catabolic effects on muscles
and bones. These hormones will change at the age of over 50 years. So that the decrease in
hormone synthesis causes real changes in the human body (Keller & Engelhardt, 2013).

The aging process is associated with both quantitative and qualitative changes to the
motor cortex and bone marrow. The aging process is caused by reduced neurotrophic factors
such as the serotonergic, cholinergic, adrenergic, dopaminergic, γ-aminobutyric, acidergic
and glutamatergic systems. These changes will cause a state of hypoexcitability in the cortex,
reduced motor coordination abilities, and cortical reduction. This will affect the work of the
motor system, especially on the strength of the skeletal muscles. Denervation of type II fibers
and reinnervation of the collateral to the motor unit type I (slow type) occur in elderly
patients. Several studies have shown a 57% reduction in type II and muscle fibers 25%
decrease in type I muscle fibers. Type II myofibrills have an important role in anaerobic type
of metabolism (ie, elevated high glycolysis) for strong muscle contraction and short duration.
Myofibrils type I play a role in aerobic metabolism (i.e. higher oxidation) (Rolland et al.,
2008).

CLOSING
 Increasing age will decrease the number and size of skeletal muscle fibers so that a
progressive decrease in muscle mass results in a loss of muscle strength. To maintain good
muscle condition, physical exercise and adequate nutritional intake are needed. Decrease in
human muscle strength, <40 years, compared with> 40 years ranged from 16.6% and 40.9%

REFERENCE

Burini, R.C., Maestá, N., 2012. The Meaning of Muscle Mass for Health, Disease, and
Strength Exercises. in: Preedy, V.R. (ed.), Handbook of Anthropometry. New
York: Springer Science, 1747–1759.

Keller, K., Engelhardt, M., 2013. Strength and muscle mass loss with aging process. Age and
strength loss. Muscles Ligaments Tendons J. 3(4): 346–350.

Lambert, C.P., Evans, W.J., 2002. Effects of aging and resistance exercise on determinants of
muscle strength. J Am Aging Assoc. 25(2): 73–78.

Morley, J.E., Anker, S.D., von Haehling, S., 2014. Prevalence, incidence, and clinical impact
of sarcopenia: facts, numbers, and epidemiology—update 2014. J Cachexia
Sarcopenia Muscle. 5(4): 253–259.

Riviati, N., Setiati, S., Laksmi, P.W., Abdullah, M., et al., 2017. Factors Related with
Handgrip Strength in Elderly Patients. Acta Med Indones. 49(3): 215–219.

Rolland, Y., Czerwinski, S., Abellan Van Kan, G., Morley, J.E., Cesari, M., Onder, G., et al.,
2008. Sarcopenia: its assessment, etiology, pathogenesis, consequences and
future perspectives. J Nutr Health Aging. 12(7): 433–450.

Visser, M., Goodpaster, B.H., Kritchevsky, S.B., Newman, A.B., Nevitt, M., Rubin, S.M.,
2005. Muscle mass, muscle strength, and muscle fat infiltration as predictors
of incident mobility limitations in well-functioning older persons. J Gerontol
A Biol Sci Med Sci. 60(3): 324–333.

Biodata Singkat
Dwi efendi lahir di sukajadi, Palembang pada tanggal 30
maret 2000. Menyelesaikan sekolah dasarnya di SDN 001
KABUN pada tahun 2012. Pada tahun berikutnya ia
melanjutkan masuk ke SMP 01 KABUN dan lulus pada tahun
2015. Dan tahun berikutnya ia masuk SMK LPMD KABUN
dan lulus pada tahun 2018. Kemudian melanjutkan kuliah di
UNIVERSITAS PAHLAWAN TUANKU TAMBUSAI,
kabupaten Kampar, Bangkinang dan mengambil fakultas
kesehatan S1 Keperawatan.