Topic 17.

Clinical Aspect of Degeneration

Modul Growth & Development
2021
 Outline

Proses Menua

Fisiologi menua pada sistem organ

Sindroma Geriatri
PROSES MENUA
 Age

Usia Kronologis

• Sesuai jumlah waktu tahun

Usia Fisiologis/Biologis -

• Sesuai usia tubuh

Functional age -

• Kemampuan peran dalam masyarakat

4
Usia Secara Kronologis

• Young-Old - ( usia 65 - 74)

• Middle-Old - (usia 75 - 84)

• Old-Old - (usia 85 dan lebih)

5
 Definisi Menua
• proses yang mengubah seorang dewasa sehat
menjadi seorang yang frail (lemah, rentan) dengan
berkurangnya sebagian besar cadangan sistim
fisiologis dan meningkatnya kerentanan terhadap
berbagai penyakit dan kematian secara eksponensial
(Miller, 1994)

• Penurunan seiring waktu yang terjadi pada sebagian

besar makhluk hidup, yang berupa kelemahan,
meningkatnya kerentanan terhadap penyakit dan
perubahan lingkungan, hilangnya mobilitas dan
ketangkasan, serta perubahan fisiologis yang terkait
usia
 Kapan Proses menua dimulai?
Aging begins the day we are born
No single measure of how “old” a person is
Aging is highly individualized
Aging proceeds at different rates in different people, and
within different systems of the body
Beberapa Istilah terkait proses menua
• Aging ( bertambahnya Umur) : efek waktu; suatu proses
perubahan, biasanya bertahap dan spontan
• Senescence ( menjadi tua) : hilangnya kemampuan sel untuk
membelah dan berkembang (seiring waktu akan
menyebabkan kematian)
• Homeostenosis: penyempitan/berkurangnya cadangan
homeostasis yang terjadi selama penuaan pada sistem organ
 Why Aging occurs ?
• Aging process is driven by the progressive lifelong
accumulation of random molecular deffect/ damage within
cells and tissues

• Aging and longevity are influenced by genes, but only account

for 25% of the variance in human life span

• Multiple genes contributes to the aging phenotype

Hazzards, 2017
 Why Do People Age?
Many theories to include:
• Hereditary Factors
• Loss of cellular mass and ability of cells to divide and
replicate
• Accumulation of waste materials that clog cells and cause
them to die
• Changes in structure of connective tissue

No single theory adequately describes the aging process !!!

12
 Classification and brief description
of main theories of aging

Molecular Cellular
Codon restriction Wear-and-tear
Somatic mutation Free radical accumulation
Error catastrophe Apoptosis
Gene regulation. System
Neuro-endocrine
Immunologic
Evolutionary
Disposable Soma
Mutation Accumulation
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 Biologic Theories of Aging
Stochastic theories
 aging as event that occur randomly & accumulate over time
1. Error Theory
2. Free radical Theory
3. Cross-Linkage Theory
4. Wear and Tear Theory
Nonstochastic theories
 aging as certain predetermined, timed phenomena
1. Programmed Theory: Shortened telomeres are found in: Atherosclerosis,
Heart disease, Hepatitis, Cirrhosis
2. Endocrine Theory
3. Immunity Theory
14
 Theories of Aging
1. Biologic
Answering basic question regarding physiologic process
2. Sociologic
Roles & relationship
3. Psychologic
How an individual responds to task of life (influenced
by biology & sociology)
4. Moral/spiritual
Exam how an individual seeks to explain & validate
their existence

15
 Multiple mechanisms of aging

Age-related frailty, disability, and disease

favourable environment
Delayed by good diet, lifestyle, and
Accelerated by stress, poor diet,

Interfere performance & functional

reserves of tissues and organs
adverse environment

Accumulation of cellular defects

Random molecular damage

 Physiological Aging
of The Human Body By Systems
 Age Related Physiological Changes
Three Group Of Physiological Changes
• Changes in autonomic functions and cellular
homeostasis
– Temperature, blood volumes and endocrine
changes
• Reduction in organic mass
– Brain, liver, kidneys, bones and muscles
• Reduction in organic functional reserve
– Lungs and Heart
 Normal Changes of Aging
Changes occur in most body systems, including:
• Body composition
• Musculoskeletal changes
• Nervous system
• Cardiovascular system
• Respiratory system
• Gastrointestinal system
• Renal function
• Hematopoietic tissues
• Skin and connective tissue
• Vision and hearing
• Special senses
Age Associated Changes in Muskuloskeletal System
 Osteoporosis
Sarkopenia
Respiratory System and Aging
 4 effects of Aging on the Respiratory System

• 1. elastic tissues deteriorate:

– Reducing lung compliance
– Lowering vital capacity
• 2. Arthritic changes:
• Restrict chest movements
• Limit respiratory minute volume
• 3. Decreased mucociliary cilia:
– Decrease activity of cilia
– Decreased cough reflex
– Sputum retention
• 4. Emphsema:
• affects individuals over age 50
• Depending on exposure to respiratory
Gastrointestinal System
Renal and Aging
 Bladder and Aging

BLADDER

Physiologic Changes
• Smaller bladder capacity
• Involuntary detrusor
Morphologic changes contractions ↑
• Detrusor contractility ↓
• Trabeculae ↑
 Increase residual volume
• Fibrosis ↑ • Postvoid residual urine ↑
• Autonomic Nervous System ↓  urinary frequency

• Diverticulae (+)

Strohbehn K. Shades of Dry—Curing Urinary Stress Incontinence. N

Engl J Med. 2007;356:2198-2200
 Endocrine System
Productio
n GH
decreases

Production Tsh
increase to try
and stimulate
Thyroid Produce less
cortisol and
Receptor aldosterone
sensitivity to
glucose
decline

No longer respond to
gonadotropin
Aging and the Endocrine System
 Reproductive System and Age
• Male • Female
– Decrease in size and
weight of testes
– Decrease in sperm
production
– Prostate gland enlarges
and increase in cancer
– Impotence is age related
– Decrease in sesexual
activity
– Menopause
– Decrease in size of
uterus and vaginal wall
thins
– Age related increase in
breast, uterine, ovarian
cancer
 Eyes and Vision in Aging

Pupils smaller, let in less light

Conjunctiva thinner and yellow

Quantity of tears decreases

Night and depth vision less

Lens enlarges Impaired color vision, also - especially greens
Cataracts presbyopia and blues because cones degenerate
Ears & Hearing Loss

• Irreversible, sensori-neural loss

with age
• Men more affected than women
• Called presbycusis
• Loss occurs in higher range of
sound
• By 60 years, most adults have
trouble hearing above 4000Hz
• Normal speech 500-2000Hz
 Taste in Aging
Changes Result of changes
• The decline in ability to • Decreased interest in food
taste is slow • Desire for more salty or
• The number of taste buds sweet foods
decreases by the age of 70 • decreased ability to
• Sweet and salty tastes are recognize spoiled foods
affected first
Skin, Hair, Nails
• Loss of subcutaneous fat
• Thinning of skin
• Decreased collagen
• Nails brittle and flake
• Mucous membranes drier
• Less sweat glands
• Temperature regulation
difficult
• Hair pigment decreases
 Changes Skin and Aging

Common Changes:
Decreased ability to perspire
susceptible to hyperthermia
Increases sensitivity to cold
Skin becomes less sensitive to sensations including:
heat,cold ,and injury
Tissues and Aging
 The Implications of Age-Related Physiologic Changes

1. Advancing age results in increasing differentiation

and biologic uniqueness
2. Biologic systems minimally affected by age, are often
profoundly influenced by socioeconomic status and
lifestyle circumstances, such as cigarette smoking,
physical activity, nutritional intake, and economic
advantage.
3. The prospective of living with diminishing resources
with which to meet increasingly complicated
environmental demands
 Degeneration
• a process by which a tissue deteriorates, loses
functional activity, and may become converted
into or replaced by other kinds of tissue.
• the condition produced by such a process.
 DAYA CADANGAN FAALI MENURUN

• Berhubungan dengan perubahan fisiologis

pada semua organ
• Berhubungan dengan perubahan komposisi
tubuh sejalan dengan usia
• Contoh:
– Air  lemak
– Jaringan ikat >>
– Otot jantung kurang lentur, otot rangka
– Jumlah neuritransmiter, kecepatan hantar saraf
DAYA CADANGAN FAALI MENURUN
Massa otot menurun
Air menurun 45%
(usia 30  80 tahun)
Kekuatan menurun
Lemak meningkat
dari 16%  44%
Mudah
imobilisasi

Mudah gagal jantung

Jaringan ikat bertambah Faal diastolik menurun

Kontraktilitas miokard
berkurang
DAYA CADANGAN FAALI MENURUN
Neurotransmiter:
asetilkolin menurun

Kecepatan hantar saraf <<

Koordinasi epiglotis menurun

Refleks batuk menurun

Penyembuhan lambat Mudah aspirasi

Pemulihan lamban Mudah pneumonia
 STATUS FUNGSIONAL BERUBAH

• Status fungsional:
– Kemampuan untuk melakukan aktivitas hidup
sehari-hari
– Kemampuan melakukan activities of daily living
(ADL)
– Duduk, berdiri, berjalan, menggunakan toilet, bab,
bak, membersihkan diri, mandi, berpakaian,
makan, minum, naik-turun tangga
STATUS FUNGSIONAL MENURUN

Peningkatan RESISTENSI INSULIN ↑

LEMAK dan
penurunan Gangguan metabolisme glukosa
OTOT
Kekuatan otot menurun

KONDISI MOBILITAS BERKURANG

AKUT
 Tampilan Klinik atipikal
• Tampilan klinik menyimpang
 SINDROM GERIATRI
 Geriatric Syndromes
• Geriatric Syndromes are multifactorial health
conditions that occur when the accumulated
effects of impairments in multiple systems
renders a person vulnerable to situational
challenges.”

Tinetti, Williams and Gill; Dizziness among Older Adults: A Possible Geriatric Syndrome; Ann
Intern Med. 2000;132:337 - 344
 Geriatric Syndrome
A SERIES OF I’S

1) Immobility = imobilisasi
2) Instability = instabilitas dan jatuh
3) Incontinence = inkontinensia
4) Intellectual Impairment = gangguan
intelektual
5) Infection = infeksi
6) Impairment of vision and hearing =
gangguan penglihatan dan pendengaran
7) Irritable colon = konstipasi
8) Isolation = depresi
9) Inanition = malnutrisi
10) Impecunity = kemiskinan
11) Iatrogenesis = akibat perlakuan
12) Insomnia = gangguan tidur
13) Immune Deficiency = menurunnya
kekebalan tubuh
14) Impotence = impotensi
 GERIATRIC GIANTS
• Acute confusional state/ sindrom delirium
• Jatuh  Instabilitas postural
• Imobilisasi
• Inkontinensia
• Demensia
• Depresi
Instabilitas Postural
The multi-factorial and interacting causes of falls

Intrinsic risk factors

• Gait and balance impairment
• Peripheral neuropathy
• Vestibular dysfunction Precipitating causes
• Muscle weakness • Tips & slips
• Vision impairment • Drop attack
FALL
• Medical illness • Syncope
• Advanced age • Dizziness
• Impaired ADL • Acute medical illness
• Orthostatic
• Dementia
Extrinsic risk factors
• drugs • Environmental
hazard
Fraktur
• Poor footwear
• Restraints Rubenstein, LZ, Josephson, KR. Falls and their prevention in
elderly people: What does the evidence show? Med Clin North
America 2006; 90:807.
 Fungsi sensorik persepsi
Ketrampilan motorik
Status fungsional Perubahan
IMOBILISASI
Tingkat kognitif
Cadangan fisiologis
Faktor ekstrinsik

 Kehilangan gerakan anatomik akibat perubahan fungsi fisiologis

 Ketidakmampuan untuk melakukan aktivitas mobilitas di tempat tidur,
transfer, atau ambulasi.
 Sindrom degenerasi fisiologis akibat aktivitas dan deconditioning

Penyulit sistemik, masalah sosial dan lingkungan

Komplikasi Imobilitas
 Instabilitas Obat

Jatuh Inkontinensia urin Infeksi

Fraktur Delirium

Hipotermia Imobilisasi
Depresi Gangguan
Ulkus dekubitus tidur
Trombosis vena
Pneumonia
ISK Dehidrasi konstipasi
Atrofi otot
Asupan makanan Malnutrisi
Asupan cairan
 Instabilitas Obat

Jatuh Inkontinensia urin Infeksi

Fraktur Delirium

Hipotermia Imobilisasi
Depresi Gangguan
Ulkus dekubitus tidur
Trombosis vena
Pneumonia
ISK Dehidrasi konstipasi
Atrofi otot
Asupan makanan Malnutrisi
Asupan cairan
 GERIATRIC PEOPLE PROBLEMS

• Health /Functional problems

1.Joint problems
2.Impairment of special senses
3.Cardio vascular disease
4.Hypothermia
5.Cancer, Prostate enlargement, Diabetes &
Accidental falls Geriatric
Syndrome
• Psychological problems
1. Emotional problems
2. Suicidal tendency
3. Senile dementia, Alzheimer’disease

• Social problems
Poverty, Loneliness, Dependency, Isolation,
Elder abuse, Generation Gap
Geriatric assessment is needed to:
• Identify geriatric syndromes/functional
decline

• Evaluate and manage these geriatric

syndromes/functional decline
- address reversible causes
- apply general measures

• Determine the type/extent of follow-up

needed to sustain gains achieved
 Summary
• Physiologic changes in most organ systems contribute to the
diminished reserve capacity
• Geriatric patients have special characteristics that need to be
considered that are inter-correlated and should be evaluated
in all geriatric patients
• Physiologic changes have clinical consequences, particularly
when older adults are stressed with an acute illness
• The assessment and management of geriatric
patients holistic comprehensive
• Reference:
• Hazzard’s Geriatric Medicine and Gerontology
7th ed. 2017
• Biology of Aging. 2nd ed. Roger B. Mc Donald.
2019