Gerontology &

GERIATRICSBy: Dr. Benjamin Policarpio

MARCH 2010

Definition:

Ageing (Aging) is a syndrome of changes that are deleterious, progressive, universal and thus far, irreversible. Aging damage occurs to molecules (DNA, proteins, lipids), to cells, to tissues and organs.

Senescence – derived from French, means the same.

• Gerontology – the study of the aging process.

• Geriatrics – application of such knowledge to the health care of the elderly.

Symptoms of Aging - even laymen are familiar with the changes observed with age.

- Hard of hearing – higher frequencies- Decline in the ability to taste: salt and bitter –

sweet and sour much less affected.- At age 65 – some form of arthritis. 1/3 of

men, ½ of women- At age 65 – ½ loss of all their teeth- Insulin requirement for glucose uptake -

doubled

Symptoms of Aging

• Increase in body fat• Decrease in muscle strength• Decrease in reaction time• Presbyopia and cataracts• Shorter sleep• Disability – inability to use public transport• Baldness, white hair, wrinkled skin

At age 85 – presence of 3 to 9 pathological conditions frequently causing “unknown” death, or death from “natural” causes.

Theories of Aging• 2 major Classificationsa.Programmed aging – control mechanism in

the organism that force elderliness and deterioration.

b.Wear and Tear aging – not due to control mechanisms but due to sum effect of many kinds of environmental assaults.

* Programmed death – pacific salmon.

Environmental Assaults:

RadiationToxic chemicals

Metal ionFree- radicals

HydrolysisGlycation

Disulfate bond cross-linking

Target:Genes

Proteins, DNACell membrane

Enzyme functionBlood vessels

Consequences:- cell death- failure of proliferation, no replacement

Theories of Aging:

I. METABOLIC DAMAGE

- Free Radicals – product of living.

- Glycation – consequence of staying alive: utilization of glucose for energy.

- AGEs-irreversible end product of oxidation

“The Central Cause of Ageing” is genetic damage, particularly gene loss.

Experimental Gerontology, 21: 283-319 - 1986

Gene Loss as the Primary Cause of AgingBackground:

>every cell in the body contains about 30,000 genes.>mostly responsible for passing hereditary traits to offspring.>4000 - extremely important; active most of the time; controlling-guiding-instructing any particular cell’s function. Turned on or off depending upon organism’s needs.

What causes depletion?

DNA damage – genes are made of DNA-RNA stuff.

Recall protein cross linking, glycation – a price paid for glucose utilization – chemicals produced by metabolism and body’s defense mechanisms.

There is a “programmed” loss of DNA as aging progresses

Tissue DNA lossLymphocytes .45% per yearBrain-SS Cortex 0.79% per yearHippocampus 0.80% per yearHeart Muscle 0.60% per yearAverage DNA loss .61% per year

This loss can be slowed down or accelerated depending on life style and attitude.

If there is an inexorable loss of genes as aging progresses, then it is possible to plot organ system loss of function with time.

The Central Factors of importance in ‘living` and longevity

- Diet- Exercise- Avoidance of poisons (smoking)- Positive attitude- Connectedness (societal)

What are te so called diseases of old age?-Atherosclerosis

-stroke-heart disease

-Alzheimer’s Disease-Degenerative Joint Disease-Cancer-Osteoporosis

*MELANCHOLIA OF ISOLATION*

Issues in the Management of Diseases of old age. Biomedical Science seems to focus only on one thing – Pharmacologic Intervention.

Cholesterol, the culprit?! It has vital functions.

• Neurotransmitter synthesis acetylcholine.• Androgen metabolism for sexual function.• Essential for adrenal corticosteroid synthesis.

Patients are very special people.Elderly patients much more so.

• They need attention• They are 6x more sensitive to drugs, a greater

degree of drug side effects and interaction.• Drug interaction in the elderly is largely

ignored, if not, forgotten.

Cholesterol, aging and statins – has become a multibillion dollar business and is still growing.

• The U.S. spends 45 million U.S. dollar a year on Lipitor for its citizens.

• More than 11 million Americans are using it.• There are plans to expand this to 36 million.

Cholesterol is NOT in itself, per se, responsible for atherosclerosis and related diseases.

Supporting Evidence:

Primary Prevention of Heart Disease

Oslo, Norway – 1200 men with cholesterol levels of over 300mg/dL, four fifths of whom are smokers. Dietary advice, no smoking, and exercise over control group, 10 years study.

Secondary Prevention of heart Disease

The Lyon Diet Heart Study, Mediterranean Diet versus Statin Group. Over four years.

Nurses Health Study, New England.

DATA strongly recommending a healthy lifestyle

JAMA 2004, researchers from US Centers for Disease Control and national Academy of Sciences.

“There is strong evidence that behavior and environment are responsible for 70% of avoidable mortality in the US”

435,000 due to Tobacco400,000 due to obesity and physical inactivity144,000 due to poverty

Healthy Lifestyle better than STATINS

It is interesting to note that in the OSLO and WOSCOP studies where an advised healthy lifestyle for 600 men bested the control group over 10 years by attaining 44% fewer heart disease and 39% less deaths...even if the cholesterol levels remained elevated.

Healthy Lifestyle superior to Statins in Secondary Prevention of

H.D.

The mediterranean Diet and Exercise Regimen clearly proved superior to the control group with 70% less heart disease, 3x the reduction in risk of further heart disease compared to that achieved with Statin drugs (12% vs. 4%)

The world and the medical profession itself has been deceived and continuously deceived by this cholesterol myth.

Cholesterol by itself is not the root cause of atherogenesis and its consequences. After the age of 65, cholesterol levels appear to be a non-dominant factor with relation to morbidity and mortality.

JAMA, 1999. Poor fitness is more of a health risk than elevated cholesterol.

“Hopes” for the Discovery of the Fountain of Youth

- Stem Cell Research- Nanotechnology- elimination of diseases related to aging

How must we takecare of the Elderly?

- Give them attention and address their societal needs... Interconnectedness versus isolation

- Senior Citizen Clubs, Centers- Community services for homecare- Telephone-visit reassurance- Home Inspectors

The Four Healing Systems

When Illness occurs, address all four healing systems, think biopsychsocialspiritual.- Homeostasis- primarily- Biomedicine as necessary- Mind/Body System- Spiritual System

... Taking care of the Elderly

- Minimize medicines – give only necesssary ones, affordable as well. The lesser the better.

- Healthy living advise- Diet (CRAN), exercise- Supplementary vitamins- avoidance of toxins (Tobacco and strong spirits)

- Pneumonia and Influenza vaccines for those over 60

What do they need?

• They really do not need care , support sympathy and feeding but rather societal interaction , oppurtunities for expression and experience, autonomy and accomplishments.

Aging Population

• Practical focus on health improvement in the erderly over the next decades

1. chronic rather that accute diseases2. morbidity rather than mortality3. quality of life rather than its duration4. postponement rather than cure

Concept Shift

• Premature organ dysfunction whether muscle, heart, lung or joint is due to disuse rather than overuse.”use it or lose it”!EXERCISE!

End of Life Care

71% prefer to die at home, not in the hospital

86% of people with terminal illness, prefer, and is best managed at home