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Prof.dr.Hardi Darmawan, MPH&TM, FRSTM, AIF
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Sriwijaya Medical SchoolPalembang, South Sumatra - Indonesia
Greta Garbo
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Indonesian Life Expectancy2000 2005 : 67.8 years
2020 2025 : 73.6 years
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Saparman,Sragen (143 yrs) Mak Encuh, Bandung (131 yrs)
Aging is not an inevitable process leading to disease and
deterioration4
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NORMAL AGING
Despite stereotype most of the elderly age well !
Most of our images are based on the frail sub-set who frequently use medical services
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Normal Aging
Generally normal aging in associated with a reduction in functional reserve capacity in tissues and organs.
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Normal Aging
At advanced age more common to see evidence of impaired homeostasis and response to external insults e.g. illness.
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Temperature Regulation and Aging
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Risk Factors for Hypothermia in Elderly
Decreased thermogenesis
Decreased vasoconstriction in response to cold
Decrease in intensity of shivering
Medications e.g. Chlorpromazine
Socio-economic (nutrition, heating, etc)
Co-morbidities including falls / immobility
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Decreased ability to sweat
Decreased ability to redirect heat :
Reduced capacity for vasodilation peripherally
Modest ability to increase cardiac output
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Risk Factors for Hypothermia in Elderly
Summary of Normal Aging Changes
Despite stereotype most of the elderly age well!
Most of our images are based on the frail sub-set who frequently use medical services
Generally normal aging in associated with a reduction in functional reserve capacity in tissues and organs
At advanced age more common to see evidence of impaired homeotasis and reponse to external insults eg. Illness.
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Characteristic of AgingMortality increases exponentially
Biochemical composition of tissue changes
Physiologic capacity decreased
Ability to maintain homeostasis diminishes
Susceptibility and vulnerability to disease increases
Environmental and Genetic factors influence
the rate of age
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Characteristic of Aging
Loss of physiologic reserve and decreased homeotatic control may result from :
Allostatic load (persistent activation of normal neuroendrocrine, immune and autonomic responses to stress)
Development of homeostasis (altered response to physiologic stresses)
Changes are generally irreversible
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Theories of Aging : Oxidative Stress
Synopsis : Oxygen converted during metabolism causes protein, lipid and DNA damage over time
In support :
Mutations in oxidative stress pathway can extend life span
Mutations in other pathways that increase longevity resist oxidative damage
In opposition : antioxidants do not delay human senescence or disease
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Systemic Inflammatory = Silent, Minimally Persistent InflammationAA, arachidonic Acid (Omega 6) high in
contemporary diet Higher AA in cell membranes
AA reacts avidly than EPA with cyclo-oxygenase enzyme
AA-eicosanoids > EPA-eicosanoids systemic inflammation
Silent inflammation = inflammation without the 5 cardinal signs
Pain, red, swell, heat and loss of function
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Glycation Theory
Occurs in everyone, but a faster rate in diabetics
Reaction with glucose with macromolecules
Devastating effects on macromolecules
Condition related to AGE
Senile dementia
Vascular Stiffening
Cataract
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Oxidative Stress Bodily Damage
Heart disease
Hypertension
Cancer
Inflammatory bowel disease (IBD)
Arthritis
Diabetes
Alzheimers disease
Stroke
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Free Radical TheoryOxidative Stress = Free Radicals > Antioxidants Effect
Free Radical overactivity
Imbalance between antioxidant Free radicals
Oxidative stress
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Free Radical TheoryOxidative Stress = Free Radicals > Antioxidants
Accelerated Aging
Diabetes
Sun exposure
Poor Nutrition
Stress
21revisi ke-2
Physiology of Aging
Why do we need to know the physiology of aging?
to tell the difference between physiological and pathologicalphenomena in the geriatric population
To appreciate the impact of normal age-related degeneration on diseases and their management.
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Goals of Successful Aging
Compression of debilitating disease into final portion of life
Maintain high-level of function until end of life
Death with dignity and comfort
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Health ModelAnti aging internal health
Aesthetic external health
Regenerative - rejuvenation
24revisi ke-2
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Why do we age?2 categories of theories :
Aging events occur randomly and accumulate in time : Stochastic Theory
Accumulated errors in making bodily and cell proteins Error Catastrophe Theory
Cross-linking of big molecules such as proteins accumulates over time Cross-linking theory
Repeated damage to DNA and incomplete repair wear and Tear Theory
Aging is inevitable : Nonstochastic Theory26
Why do we age?
2 categories of theories :
Aging is inevitable : Nonstochastic Theory
Certain organ-systems such as hypothalamus, immune and neuroendocrine systems have in-built pacemakers that involute with agepacemaker theory
There is familiar predisposition for longevity and thus there may be a genetic basis for aging genetic theory
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SarcopeniaBetween ages 30 and 75:
Lean body mass decreases due to loss of skeletal muscle mass
Number and size of muscle fibers progressively decrease.
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Endocrine Changes with Aging
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Hormone Deficiencies many if not most of the signs, complaints, causes of Senescence
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Age-related
physiology :- Intestinal transit- cardiac output- kidney function- liver function
Age-related signs :- wrinkles- skin & hair thinning- hair loss- muscle atrophy- abdominal obesity
Age-related symptoms :
- fatique- cognition
- depression
Age-related
diseases :- cardiovascular- cancer- obesity- diabetes- osteoporosis- dementia
5 Strategies of Healthy Aging
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Balanced Diet
Energy intake 50/25/25
50% Carbohydrate fruits & vegetables
25% Protein 2/3 plant, 1/3 meat preferably fish
25% Fat (mono & poly) unsaturated
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Balanced Anti Aging Diet
Caloric restriction Keep low end of ideal body weight
Okinawan diet
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Okinawan Diet 7 servings of vegetables
7 servings of grains
4 servings of fruits
Abundance of soy
3 times per week fish
Alcohol in moderation
Low caloric diet
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Positive Food Intake
Fruits Minerals & Vitamin
Vegetables Fibres & Phytonutrients
Spices Hormone modulator, Cancer Preventive
Mushrooms/Ginsengs -Adaptogen
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Killer Intake - Delicious
Avoid high fat, salt, sugar
Avoid trans fatty acid cooked fat
Avoid acralamide heated carbohydrate
Avoid preservatives & additives
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Colour Agents
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Dietary Risk Factors
American Cancer Society Study
150000
20 year study
53% higher risk of distal colon cancer in red meat eater
John Hopkins Bloomberg Study
Higher sugar intake increase cancer risk
Eat nut & Beans
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Hydration
Drink liquids (ml) = 33 x body weight (kg)/day
Hydrate before during & after exercise
Test hydration status
Specific gravity - 1020
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Precision of Anti Aging Exercise
Exercise to be stronger, younger & healthier
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Aim of Anti Aging Exercise
Balance Coordination
Strength: Muscular Cardiovascular
Stretch: flexibility, posture & range of motion
Better circulatory system
Lymphatic massage
Mental alertness
Degenerative Disease Prevention
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Balance
Musculoskeletal Composition & Deterioration in Aging
30 year old 75 year old
30% - muscle 15% - muscle
20% - adipose tissue 40% - adipose tissue
10% - bone 8% - bone
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Types of ExerciseFive main types of exercise
Strength build muscle, HGH stimulation
Aerobics cardiopulmonary conditioning
Intervals accommodate heart size to demand
Stretching flexibility
Eastern balance & coordination
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Osteoporosis and Fractures
Low dietary intake of calcium
Loss of endocrine protection
Reduced endogenous production of vitamin D
Disuse
Disease Chronic Renal Disease, Rheumatoid Arthritis, Thyroid Disease
Medications Steroids, Thyroxin.
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Osteoporosis
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Age related disorder,
aging disease major morbidity/mortality
atherosclerosis CV diseases
metabolic syndrome
tumors
neurodegenerative diseases
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Asymptomatic bone fracture & complication
bone mineral density
Loss of architectural integrity
Should understand physiologypathophysiology
Immuno senescence & inflammatory of aging
Immuno senescence lifelong antigenic load chronic immune system activation
proinflammatory
till
Fragility fracturerisk
hyper
production
Osteoporosis
Proinflammatory cytokines - IL-1, IL-6, TNF inverse CRP
Immuno senescence shape the same immunological cell & cytokine
TNF, IL-1, Rank-L, M-CSF expression osteoclast precursor
Why not build the osteoblast
aging & estrogen deficiency : most important risk - osteoporosis
Immune Mechanism of Osteoporosis
The skeleton is physiologically in a state of dynamic equilibrin between
formation vs reabsorption
osteoblasts vs osteoclasts
tuning by cytokins
growth factors
accumulation Age immune profile
memory/effector cells expressing
Rank L resident in bone
secreting
osteoclastogenic
proinflammatory cytokins
Natural Bone Building Plan
1. Hormones
2. Minerals
3. Vitamins
4. Diet
5. Digestion
6. Exercise
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HormonesVit D is a steroid hormones
Determinant for bone
health & all ages determinant
Summary of Hormones to treat bone loss (1)
1. Estrogen to prevent bone loss : estradiol transdermal titrated area 1 mg/ml
2. Progesterone To build bone & balance estrogen
50-300mg oral / transdermally53
Summary of Hormones to treat bone loss (2)3. DHEA/testosterone
Start DHEA (5-25 mg/day)
Testosterone 1-5 mg/night
4. Melatonin (0.5 3 mg/night)
5. GH if IgF -1 low or below mid range
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Summary of Vitamins to treat Bone Loss
1. Vitamin D3 2000-5000 u/d
2. Vitamin K2 50-150 mcg/d
3. Vitamin C 1000mg 4000mg/d
4. Vitamin B 100mg/d, if homocysteine not
improving use Methyl B12/ folic acid
5. Vitamin E 200-800 U
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1. Magnesium
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Summary of Mineral to treat Bone Loss
Diet & Bone Health Enzyme function optimally at PH neutral
Acidic by products accelerate bone loss
High protein & diary (western diet) chronic metabolic acidosis
Bones ability to neutralize acid load -- depend on KT
stores
K+ intertitial fluid
K+ Ca++ from bone to buffer in a place of KTchronic high steroids
diuretics
Eating alkaline diet
Rich fresh fruit vegetables
Limited protein & diary
Artificial sweetness
Preservatives 57
KT
Acidifying FoodsSugar
Yeast, wheat breads
Soft drinks, alcohol, tea, coffee
Cranberries
Sweet potato
Salt
HOPS
Corn oil
White balsamic vinegar
Saccharine, aspartame benzoate
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Alkalinizing Foods
Honey, maple syrup, stevia
Goats milk
Soy milk
Umeboshi plums
Sea salt
Most herbal teas
Lemon, limes, grapefruit, onion
Olive oil
Miso
Most fruits & vegetables
Healthy Ageing
L
Unhealthy Ageing
Mrs. B.Gozali,MD 84 years oldShe was doing her flying fox (30 meters height from ground).
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Implicated in
SIRT1
Audrey Hepburn
is
a
SIRT 1
A key mediator of beneficial effects of :
Caloric restriction
Regulates lipid
Regulates glucose
Regulates metabolism
By deacetylating metabolic regulators
SIRT1 levels are regulated by microRNAs (miRs)
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Telomerase Theory of Aging
Geron Corporation (Menlo Park, California)
Telomeres : sequences of nucleic acids extending from the ends of chromosoms
Telomeres : maintain integrity of chromosoms
Telomeres shortened cellular damage
Cellular death
aging
ld
64revisi ke-2
with unhealthy aging and a shorter life span
Telomeres from the ends of human chromosome
Telomeres shortened limit proliferation of human cells, by inducing :
Replicative senescence
Differentiation
Apoptosis
Increasing cancer risk
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Telomere Shortening & Aging (2007). H.Jiang, Z.Ju, K.L Rudolph: Z Gerontol. Geriat 40:314-324
revisi ke-2
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Short Telomeres have been associated with maladies in these tissue :
Immune cells-memory and nave
Heart cardiomyocytes
Hematopoietic stem cells
Lung alveolar cells
Skin dermis, epidermis, vasculature
Vascular intima (endothelium)
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Osteoblasts, MSCs
Retinal pigmented tissue of eye
Chondrocytes
Skeletal muscle
Kidney cortex
Neurons
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The Seven Step Program :
1. Nutritional Modification2. Nutrient Supplementation3. Herbs4. Pharmaceuticals5. Hormone Replacement Therapy6. Mental Training7. Mind / Body Exercise
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Maria Olivia da Silva
132 tahun
Brasil
Lahir : 28 Feb 1880
2 x menikah
Anak 14
ld