Aging and Immune system

and
the Covid 19 pandemia
• Aging changes in immunity
• Effects of aging on immune system development
 Aging and immune system
As grow older, immune system changes and does not work as well:
• It is slower to respond. This increases risk of getting sick. Flu shots or other
vaccines may not work as well or protect as long as expected.
• An autoimmune disorder may develop. This is a disease in which the immune
system mistakenly attacks and destroys healthy body tissues.
• Healing is also slowed in older persons. There are fewer immune cells in the body
to bring about healing.
• The immune system's ability to detect and correct cell defects also declines. This
can result in an increase in the risk of cancer
Aging and immune system
• The changes that occur in the aged immune and
hematological system mainly involve altered T and B
cell functioning and a decrease in hematopoietic
reserve
Aging and immune system
The consequences of these changes include
• an increased susceptibility to infection,
• increases in auto antibodies and monoclonal immunoglobulins, and
• tumorigenesis
These common aging changes coupled with the stress, malnutrition,
and number of invasive procedures seen in the critical care
environment may heighten an older adult’s risk for a nosocomial
infection.
Aging and immune system
Furthermore, because an older adult’s ability to mount a
febrile response to infection diminishes with age (related to a
decline in hypothalamic function), an older patient may even
be septic without the warning of a fever and instead may
exhibit only a decline in mental status.
• Close assessment of other nonfebrile signs of infection (i.e.,
restlessness, agitation, delirium, hypotension, and
tachycardia) is essential and warranted
Immunosenescence
 Immunosenescence refers to the gradual deterioration of
the immune system brought on by natural ageing process.
 Progressive deterioration in the ability to respond to
infections.
 This age-associated immune deficiency is common and
found in both long and short-living species as a function of
their age relative to life expectancy.
 Immunosenescence is not a random deteriorative
phenomenon, rather it appears to inversely repeat
an evolutionary pattern.
 Immunosenescence can also be sometimes happen
as the result of the continuous unavoidable exposure
to a variety of antigens such as viruses and bacteria.
 CONSEQUENCES OF AGING

 Atrophy of the thymus.

 Changes in the innate immunity

 Changes in the function of both B and T cells.

 Changes in both the total numbers and subsets of

lymphocytes
 Changes in the patterns of secretion of cytokines and
growth factors.
 Disruption of intracellular signaling.
 IMPACT OF ADVANCING AGE ON INNATE
IMMUNITY
• Aged phagocytes include a reduced expression of Toll-like
receptors on macrophages.
• There is a decline in the phagocytic capacity and reduced
superoxide anion production(ROS) in macrophages and
neutrophils in the aged.
• Activation of neutrophils by formyl-methionyl- leucyl-
phenylalanine (fMLP) is impaired in old compared to young ,
linked to a reduction of intracellular Ca2+mobilization.
 INFLAMM-AGEING
Ageing is associated with the increased production of pro-
inflammatory cytokines( IL-1 and TNF) by macrophages
and fibroblasts.
For example.
Elevated levels of these mediators are responsible for the
age-associated diseases such as diabetes, osteoporosis
and atherosclerosis hence called Inflammatory
Pathogenesis.
TWO MECAHNISMS RESPONSIBLE FOR
IMPAIRMENT

1. Decreased production of long-term immunoglobulin-

producing B lymphocytes because of intrinsic and
microenvironmental defects in bone marrow.
2. The loss of immunoglobulin diversity and affinity.
 THYMIC INVOLUTION
Thymic involution the shrinking of the thymus with age,
resulting in changes in the architecture of the thymus and a
decrease in tissue mass.
TCR diversity drops drastically around age 65.

Loss of thymic function and TCR diversity is thought

contribute to weaker immunosurveillance of the elderly
Older people & COVID-19
• COVID-19 is changing older people’s daily routines,
the care and support they receive,
• their ability to stay socially connected and how they
are perceived.
Older people & COVID-19
Older people are being challenged by
• requirements to spend more time at home, lack of physical
contact with other family members, friends and colleagues,
• temporary cessation of employment and other activities; and
• anxiety and fear of illness and death – their own and others.
It is therefore important that we create opportunities to foster
healthy ageing during the pandemic.
Older people & COVID-19

Older adults are considered a vulnerable population for a

multitude of reasons. Besides age,
• multiple diseases;
• long-term drug use; and
• poor social habits, nutrition, and living conditions increase
the vulnerability of older adults to infection.
EFFECTS OF SOCIAL DISTANCING AND
ISOLATION ON OLDER PEOPLE
Although social distancing could save the lives of older people, it also
adds to their loneliness.
• Social constraints subsequent to social distancing and isolation lead to
significant limitations of daily activities, inaccessibility to health workers
on whom the older people are reliant, financial constraints, and
difficulty in adjusting to new social barriers created in activities such as
online shopping.
• Social distancing and isolation have significant health and psychological
effects on older adults. Unlike younger adults, older people are often
unable to use technology to mitigate isolation and its psychological
effects.
MARGINALIZATION OF OLDER
ADULTS IN THE COVID-19 PANDEMIC
• Some reports have indicated the marginalization of
the health of older adults during the current COVID-
19 pandemic, especially in countries with mitigation
strategies.
• This is probably an attempt to bring about herd
immunity.
older people who lives in long-term care
facilities
• The COVID-19 pandemic has affected older people disproportionately,
especially those living in long-term care facilities.
• In many countries, evidence shows that more than 40% of COVID-19
related deaths have been linked to long-term care facilities, with
figures being as high as 80% in some high-income countries.
• Concerted action is needed to mitigate the impact across all aspects
of long-term care, including home- and community-based care, given
that most users and providers of care are those who are vulnerable to
severe COVID-19.