Physiology Exchange

of Aging

dr. Amiruddin Eso, M.Kes

Department of Physiology
Halu Oleo University
Demographics

 Life expectancy has nearly

doubled since the beginning of
the 20th century
 It is estimated that by the year
2020, 47% of the population
will be >50 years of age.
Demographics

 1 of 4 patients undergoing
surgery >65 years
 50% of patients over 65 years
have an operation in the
remainder of their lives
 12% of patients >65 years use
65% of the total medical
resources each year
Metabolism
 There is no consensus on the best method of
assessing nutritional status in the elderly
 Increased mortality in underweight people
 There is a progressive loss of skeletal mass, renal
mass, and liver mass with a reciprocal increase in
lipid composition of the body
 Calcium and phosphorus metabolism are adversely
affected with age thus mineral levels in blood are
maintained by drawing on the body’s resources
(bones) leaving bones pitted, brittle, and porous
Metabolism
 10-15% reduction in metabolic requirements
in elderly versus young
 Decrease in body heat production coupled
with impairment of thermoregulatory
vasoconstriction
 Delayed drug clearing due to reductions in
hepatic and renal elimination
Aging and the Respiratory
System

 Mechanics of Breathing
 Pulmonary Circulation
 Gas Exchange
 Control of Breathing
Mechanics of Breathing

 Rounding of the thorax

 Calcification of the costal cartilages
(Decreased thoracic compliance)
 Decreased space between the
spinal vertebrae and a greater
degree of spinal curvature
Mechanics of Breathing
 Progressive enlargement of the respiratory
bronchioles and alveolar ducts
 Loss of functional alveolar surface area and
alveolar surface tension
 15% reduction by the age of 70 years
 Negative effects on forced expiratory flow
 Decreased respiratory muscle strength and
endurance
Pulmonary Circulation

 Changes in the pulmonary circulation are

difficult to separate from those
attributable to the heart and circulatory
system
Gas Exchange

 Gas exchange declines at 0.5%/yr

 Ventilation-perfusion ratios are adversely
affected by increasing age
Gas Exchange

 Baseline arterial oxygenation is lower

with age
 The risk of hypoxemia and hypercarbia
is higher in patients >70 years and their
respond to supplemental oxygen is
reduced.
Control of Breathing

 Elderly individuals have a significantly

diminished response to hypoxia and
hypercapnia
 There is a markedly diminished
response for vocal cord closure thus
increasing the risk of aspiration and its
consequences
Implications for Clinicians

 Decreased maximum breathing capacity,

vital capacity, and maximal O2 uptake
 Decreased mucociliary clearance and
cellular and humoral lung defense
mechanisms
 Increased risk for respiratory infections
 Acute and chronic respiratory conditions
can have severe consequences as a
result of hypoxemia and hypercapnia
 Aging and the Cardiovascular
System
 Heart
 Blood Vessels
 Central vessels (e.g., aorta)
 Peripheral vessels
 Aging and the Heart
 There is a linear loss of myocardial cells
beginning during infancy (~38 million per
year)
 The remaining myocardial cells
hypertrophy (ventricular wall thickness is
therefore preserved over time)
 Increase in fibrous connective tissue
matrix
 Aging and the Heart
 Systolic function is relatively preserved
 Velocity of myocardial shortening
decreases but the duration of contraction
is prolonged
 Aging and the Heart
 Delayed diastolic relaxation coupled with
increased myocardial stiffness leads to
increased venous filling pressures
 The heart’s inotropic and chronotropic
responses, as well as, the vascular
responsiveness to catecholamines are
reduced
 sympathetic nervous system stimulation is
apparently related to receptor function
 Aging and the Vasculature
 Changes in the systemic arterial wall occur
predominantly in the medial layer
 The changes that occur with aging involve
elastin fibers undergoing progressive
disorientation, fragmentation, and
degeneration, with subsequent collagen
deposition, calcification, and cystic
degeneration.
 Aging and the Vasculature
 Central elastic vessels dilate and become
more tortuous. The increase in stiffness of
the aorta and central elastic arteries is not
found in the peripheral arteries.
 This results in a doubling of the pulse wave
velocity in the aorta, a quadrupling of the
descending aorta impedance, and a progressive
rise in systolic pressure
 Hemodynamic Effects
 Resting cardiac output, stroke volume,
and peak aortic flow may change little
with age
 Systemic Blood Pressure
 Systolic pressure rises 6.0-7.0 mmHg per decade
 Diastolic pressure remains relatively constant (it

may actually fall with increases in systolic

pressure)
 Hemodynamic Effects
 The cardiovascular response to exercise
declines progressively
 Maximal HR, SV, CO, Ejection Fraction, and VO2
decrease
 End-systolic and end-diastolic volumes increase

 The age-related diastolic dysfunction makes the

elderly more susceptible to the effects of

tachycardia
 Perioperative Implications
 Small decreases of venous filling from
narcotics, diuretics, volume depletion, and
positive pressure ventilation can have
profoundly negative effects on stroke
volume and cardiac output.
 Inhalation anesthetics exaggerate the
negative inotropic and chronotropic effects
of calcium channel blockers and beta-
adrenergic blockers
 Perioperative Implications
 Fluid overloads may precipitate heart
failure and pulmonary edema in the
elderly more easily than in young subjects
 Perioperative hypotension is more
frequent and severe in the elderly than in
the young
 Renal System
 Although kidney function declines with
age, it does not cause any major problems
unless blood flow is severely restricted
due to heart problems
 Renal System
Clinical Implications
 The capacity of the bladder does decline significantly (it
may retain 100 mL of urine thus diminishing its overall
capacity.
 The frequency and urgency may be frustrating because the
urgency to urinate does not occur until the bladder is near
capacity
 Incontinence affects about 15% of patients over 65 years and
60% of all patients institutionalized over the age of 65 years
 Bladder problems may result from weakness of the bladder
outlet or distension of the bladder
 In males, prostate problems may increase frequency or loss of
control
 Digestive System
 Eating habits may change due to changes in
ability to taste food, loss of teeth due to
periodontal diseases
 There is an decrease in digestive enzymes and
the beginning of atrophy of glands in the
stomach causing food to move slower through
the digestive tract.
 Increased incidence of diverticulitis and rupture
 Age-Related Neurological
and Psychological Changes
 Decline in receptors, fewer afferent
conduction pathways, fewer brain cells (i.e.,
decreased mass and increase in CSF) and
connections and slower corticospinal
transmission

 Baroreceptor responsiveness, postural

response and vasoconstrictor response are
all impaired in rate and magnitude

 Sensory thresholds for stimuli are blunted

(vision, hearing, taste, pain, temperature)
 Age-Related Neurological and
Psychological Changes
 Psychomotor response-reaction time
 Problem-solving
 Memory
 Cognitive impairment
Delirium
Can results from a variety of causes, including
hypoxia, electrolyte disturbances, hypotension,
and pharmacologic toxicity
Associated with increased perioperative mortality
Dementia
Can result from undernutrition, acute situational
stress, family history of mental illness, and
personal history of substance abuse
Depression
Sensory Issues
 Vision
 Begins to change in mid 40’s in five major
ways:
 Lens thickens
 Lens tends to harden and is more sensitive to
glare
 Lens becomes more yellow which changes
color perception
 Pupil becomes smaller letting in less light
 Muscles controlling opening and closing
respond slower making it harder to perceive
quick-moving objects
 Hearing
 One in three people over 65 years have some
degree of hearing impairment (i.e.,
conductive versus nerve loss).
Sensory Issues
 Touch
 As the skin thins and loses nerve cells, it is more
difficult to distinguish changes in temperature.
 Taste
 Loss of taste alters eating habits.
 Smell
 25% of people between 65 and 80 have major
smell dysfunctions and after 80 years it increases
to 50%.
THANK YOU