2/12/2017

GER-502,L3
Etiology, Pathophysiology and
Complications

Dr. Sura Ali Ahmed Fuoad

A.P & Associate Dean college of Dentistry/GMU
B D S , M D S , Ph D in oral medicine.
Diploma in health professional education

February 12, 2017

www.gmu.ac.ae

Content

• Etiology of aging
• Normal aging
• Successful aging and Usual aging
• Causes of changes in health and in reaction to disease
• Pathophysiology and Complications
• Homeostatic regulators appear to be affected by aging
• Selected age –related changes and their consequences

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Learning objectives
By the end of the lecture the student should be able to :
• Analyze what happens in normal aging
• Distinguish Successful aging from Usual aging
• Correlate Healthful strategies and Successful aging
• Identify the area of decline in Usual aging
• Enumerate the causes of changes in health and in reaction to
disease
• Describe Pathophysiology and Complications of aging
• Understand and describe homeostatic regulators appear to be
affected by aging

Etiology

Normal
aging

Successful Usual
aging aging
With normal aging, many things do not change.' Many hormone levels, liver enzymes, electrolytes, body
temperature, and basal glucose remain constant throughout life." 0 age-related anemia has been reported (a slight
decline does occur in hematocrit in men 'owing to decreasing testosterone levels).'

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• Successful aging describes • Usual aging refers to the

individuals who demonstrate minimal more common
physiologic decline from aging alone. mode of aging. It is associated,
for example, with an
Healthful strategies
 exercise, Observed decline in
modification of diet,  renal,
 social and intellectual stimulation, immune,
 cessation of smoking  visual,
enhance a person's quality of life and  musculoskeletal,
promote  hearing function.
successful aging.

As individuals age, changes occur in their health and reaction to disease. These changes are due to
-variations in physiology that occur with aging,
-the presence of other diseases that develop over time,
-genetic predisposition for certain diseases,
-Lifestyle factors (diet, exercise, expo- sure to medicines and toxins, smoking, alcohol taken in excess),
-the variation intrinsic to diseases.'

Older Adults' Life Expectancy and Number of Years Free of Dependency in Activities of
Daily Living

The estimated life expectancy and number of years free of dependency in activities of
daily living for different age groups.

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Pathophysiology and Complications

• Physiologic deterioration takes place after the age of 40 years .
However, this decline is highly variable among older persons and
within organ systems of any given individual .

• Studies suggest that by maintain good nutrition, exercise, and

social activities, older adults can maintain better health. For
example, this approach has been reported to delay the onset of
type 2 diabetes in older adults who are genetically programmed
for this disease.

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Homeostatic regulators appear to be affected by aging

• Muscle mass decreases, body fat increases, and total body water decreases with
aging.

• The increase in body fat and the reduction in body water have
an important impact on drug usage in older adults. The
increase in fat volume affects the actions of lipophilic
drugs, such as diazepam, by decreasing their initial effects
and prolonging their action.

• Reduction in total body water has the opposite effect on water-soluble drugs,
such as acetaminophen, in that it produces an exaggerated initial effect. These
drugs often must be given in reduced dosage to older adults.

• Baroreflex sensitivity is impaired with aging. This leads to increased risk for orthostatic
hypotension and decreased thermoregulation.

Baroreflex is one of the body's homeostatic mechanisms for maintaining blood pressure. It
provides a negative feedback loop in which an elevated blood pressure reflexively causes
heart rate and thus blood pressure to decrease; similarly, decreased blood pressure
depresses the baroreflex, causing heart rate and thus blood pressure to rise.

• Increased orthostatic hypotension increases the risks of falls and serious injury.
Also, the hypotensive effects of antidepressants, nitrates, and antihypertensives may be
compounded by decreased baroreflex sensitivity.

• Impaired thermoregulation results in the absence of shivering, failure of the metabolic rate
to rise, poor vasoconstriction, and insensitivity to low body heat. These effects increase the
risk for hypothermia and heat stroke in older adults. Some drugs such as chlorpromazine and
alcohol should be used with caution in these individuals because they may cause
hypothermia.'

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• The level of activity of aortic and carotid chemorecep-

tors has been reported to decrease in older adults.

• The use of normal adult dosages of morphine can lead to

severe respiratory depression in these individuals.

• Neurologic control of bowel and bladder function may be

altered in older adults.

• Anticholinergic drugs such as antidepressants, antihistamines, antipsychotics,

and many cold preparations must be used with care.

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