Li Lbm 5 Tumbang

8/12/2019 Li Lbm 5 Tumbang

http://slidepdf.com/reader/full/li-lbm-5-tumbang 1/29

JOKO WIBOWO S (012116424)



1. Why does her skin looks more

saggy/slacker, especially around the

eyes? Observed Skin Changes - Epidermis:

The number of epidermal cells decreases by 10% perdecade and they divide more slowly making the skin lessable to repair itself quickly.

Epidermal cells become thinner making the skin look

noticeably thinner. Changes in the epidermis allows more fluid to escape the

skin.

In Between:

The rete-ridges of the dermal-epidermal junction flatten out making the skin more fragile and making it easier for the skin

to shear.

This process also decreases the amount of nutrients availableto the epidermis by decreasing the surface area in contactwith the dermis.

= slower repair/turnover



Observed Skin Changes – Dermis: These changes cause the skin to wrinkle and sag.

The dermal layer thins

Less collagen is produced

The elastin fibers that provide elasticity wear out.---------

↓ function of sebaceous & sweat glands contribute to dry skin

Observed Skin Changes – SubQ:

The fat cells get smaller This leads to more noticeable wrinkles and sagging

A Note about Sun Worshipers: Solar elastosisrough, leathery looking skin with wrinkles,

irregular pigmentation, plaques, broken blood vessels & actinic

keratosis Due to repeated overdoses of sun exposure.

Physical Changes with Aging; Racquel Daley-Placide,MD, Clinical Assistant Professor Division of Geriatrics,The University of North Carolina.



2. Why does she was lost her weight and

her body shape seems small?

Observed Changes in the MusculoskeletalSystem: Muscles:

Sarcopenia (↓ muscle mass & contractile force) occurs

with age. Some of this muscle-wasting is due todiminished growth hormone production (NEJM 323: 1,1990), but exactly how much is due to aging versusdisuse is unclear.

Sarcopenia is associated with increased fatigue & risk offalling (so may compromise ADLs).

Sarcopenia affects all muscles including, for example,the respiratory muscles (↓ efficiency of breathing) & GItract (constipation).





3. Why does she hasn’t got her period

since 5 years ago?

Age-related changes in the reproductive system: Women The “climacteric” occurs (defined as the period during with

reproductive capacity decreases (ie, ovarian failure) then finallystops = loss of estrogen & progesterone; FSH & LH ↑↑). this is alsodescribed as the transition from perimenopause (~age 40s) to

menopause. Thinning & graying of pubic hair

Loss of subq fat in external genitalia giving them a shrunkenappearance

Ovaries & uterus decreases in size & weight

Skin is less elastic + loss of glandular tissue gives breasts asagging appearance

Other physical changes may include hot flashes (can cause sleepdeprivation if they occur at night), sweats, irritability, depression,headaches, myalgias. Sexual desire is variable. The symptoms aretypically present for about 5 years

Atrophy of vaginal tissues due to low estrogen levels = thinning &dryness occurs; agglutination of labia majora & minora may occur.



Men

Testosterone decreases, testes become softer & smaller

Erections are less firm & often require direct stimulation

to retain rigidity Though fewer viable sperm are produced & their motility

decreases, men continue to produce enough viable

sperm to fertilize ova well into older age.

Less seminal fluid may be ejaculated they may not experience orgasms every time they have

sex

the prostate gland enlarges; this often results in

compression of the urethra which may inhibit the flow ofurine.

Physical Changes with Aging; Racquel Daley-Placide,

MD, Clinical Assistant Professor Division of Geriatrics,

The University of North Carolina.



.vision, hearing loss, esy to fall

especially sitting to standing and feels

so dizzy and imbalance? Blurred vision: More skeris shaped cornea.

Pupillary sphincter arise sclerosis and loss of response tolight.

More bleak lens (lens opacities).

Increased threshold ray observations: the power ofadaptation to darkness more slowly, difficulty seeing indark light.

The loss of power of accommodation.

Decreased wide visual field of view and reduced.

The reduced power distinguish blue or green color on ascale.

Depkes RI. 2003. Pedoman Pengelolaan KegiatanKesehatan di Kelompok Lanjut Usia. Depkes :Jakarta.



Hearing loss:

Presbiakusis (hearing impaired):

The loss of the ability (power) loss in the inner ear,

especially the sound of a voice, among other high-tonetone, the sound is not clear, it is difficult to understand

words, 50% occurred at the age above 65 years old.

Become atrophic tympanic membrane causes

otosclerosis.

The occurrence of wax collection, can harden due to

increased creatine.

Depkes RI. 2003. Pedoman Pengelolaan KegiatanKesehatan di Kelompok Lanjut Usia. Depkes :Jakarta.



Easy to fall, feels so dizzy and imbalance:

According to (suhartono, 2005), postural balance

mechanism requires the cooperation and interaction of

3 components:

1. Visual system:

Visual disturbances that may increase the risk of falling,

such as cataracts.

In elderly commonly have changes in eye structure.

One of them is atrophy and hyalinization of the ciliary

muscle to increase the amplitude of accommodation.

2. Vestibular:

Disorders of vestibular function, for example: vertigo.

Predisposing factors of the emergence of vestibular

function disorders include hearing infections, ear

surgery, aminoglyosides, quinidine, and furosemide.



3. Proprioceptive:

Peripheral neuropathy and cervical degenerative

disease.

This arrangement of proprioceptive gives information tothe CNS about the body position of the condition of the

surrounding (external) and the position of the body

segments of the agency itself (internal) through

receptors in the joints, tendons, muscles, ligaments andskin all over the body, especially that of the vertebral

column and limbs.



5. Physiologiy of aging process?

Physiology of Aging, Brent C. Williams, MD, MPH, AssociateProfessor of Medicine, University of Michigan



Overview of Aging Physiology:

Skin

Body Composition Vision

Special Senses

Nervous System Musculoskeletal System

Renal

GI CardiovascularPhysiology of Aging, Brent C. Williams, MD, MPH, Associate Professor

of Medicine, University of Michigan



Skin:

Physiology of Aging, Brent C. Williams, MD, MPH, Associate Professor

of Medicine, University of Michigan



Physiology of Aging, Brent C. Williams, MD, MPH, Associate

Professor of Medicine, University of Michigan

Body Composition:



Vision:

Visual acuity (cataracts, macular degeneration)

Dark adaptation

Peripheral vision (glaucoma)

Contrast sensitivity

Physiology of Aging, Brent C. Williams, MD, MPH,Associate Professor of Medicine, University of Michigan



Special Senses:

Auditory and Vestibular

Presbycusis: high frequency hearing loss

Vestibular dysfunction

Smell

Oral/Dental

Teeth: 40% of elderly are edentulous

Taste

Salivary function

Physiology of Aging, Brent C. Williams, MD, MPH,

Associate Professor of Medicine, University of Michigan



Nervous system:

CNS: decrease in nerve cell number

Basal ganglia atrophy

Dopamine and muscular rigidity

Step height

Reaction time

PNS: decreased vibratory sensation

Physiology of aging, brent c. Williams, MD, MPH, associate

professor of medicine, university of michigan



Musculoskeletal System:

30% loss in muscle mass 3rd to 8th decade - sarcopenia.

Osteoarthritis

weight bearing (spine/knees/1st metatarsophalangeals)

repeated strain (distal interphalanges/1st

carpometacarpals)

Osteopenia/-porosis (80% women >65 y/o osteopenia) decreased activity, dietary calcium, estrogen withdrawal.





Renal:

GFR 30-46%

Tubular function

Renal plasma flow ~50%

CrCl = [(140 - age) x (BW)]/[72 x SrCr ]

Multiply x 0.85 for females

BW in kg (LBW or IBW with edema or obesity)





GI:

GI absorptive cells

GI motility

or normal

Sphincter activity

GI blood flow

Gastric acid secretion

Active transport





Cardiovascular:

Afterload: Vascular Changes:

Vascular Smooth Muscle

Increased thickness of intima and media

Matrix

Collagen deposition, increased fibronectin, crosslinking (AGEs)

Fragmentation of elastin, calcium deposition

Net result is increased vascular stiffness.





Summary: Age-associated changes in

cardiovascular physiology:

Maintenance of resting left ventricular function. Decreased ability to compensate for stress or

impaired LV function.

Blunted heart rate response to exercise

requires a compensatory increase in strokevolume to increase cardiac output.





6. What is the factor of aging

process?



Endogenic aging, starting with cellular aging

through anatomical tissue aging and the aging

process toward organ. The process is like a

clock that keeps spinning.

Exogenic factor , divided into environmental

causes (environtment) where a person lives and

the socio-economic, socio-cultural, or mostappropriately called lifestyle (life style). Exogenic

factor of aging earlier, now better known as "risk

factors".

(Boedhi-Darmojo, 1994)

a s e corre a on ea y



. a s e corre a on ea ylifestyle, social life and her

condition? The quality of the socio-economic environment in whichindividuals live throughout the life cycle is the major

determinant of health status. (Kaplan 1997, Marmat1996).

It is not just low income, poor diet and so on that impact

on health, but the impact these have on a sense ofwellbeing and subjective experience of quality of life.Social support and integration are key: unemployment, job insecurity and lack of social support are associatedwith high rates of physical and mental morbidity and

mortality even when material factors are controlled for(Cooper et al 1999, Bartley 1994, Uhtera et al 1997,Marmot et al 1998, Brown and Harris 1978, Blaxter1990, Oakley et al 1994, Mathiesen et al 1990, McIntyreet al 1993).



8. What is the methode to adopting a

healthy lifestyle?

10 needs of the elderly:1. Sufficient and healthy food (healthy food)

2. Clothing and completeness (cloth and common accessories)

3. Housing / shelter / shelter (homes, place to stay)

4. And supervision of health care (health care and facilities)

5. Daily practical technical assistance law (technical, judicial ass.)

6. Public transport for the elderly (facilities for public Transportations, etc)7. Visits / interlocutor / information (visits, companies, informations, etc)

8. Recreation and other wholesome entertainment (recreational activities,picnics, etc)

9. Sense of security and peace (feeling of safety)

10. Help sensory devices (glasses, hearing aids) (other assistance / aids).Continuity of funding and facilities (continuetion of Subsidies and facilities)

At a minimum, is very important:

Get enough attention ("in-the-right")

(= Regarded as still existing in the community)

R. Boedhi-Darmojo.Buku Ajar Geriatri.edisi 3. 2006

9 Wh i ki d f ld l



9. What is kind of elderly

disorder?

1. Joint and bone diseases, such as rheumatism, and osteoporosis.2. Cardiovascular diseases, such as hypertension, kholesterolemia,

angina, cardiac attack, stroke, high triglycerides, anemia, and CHD.

3. Digestive diseases such as gastritis, and ulcers pepticum.

4. Urogenital diseases, such as Urinary Tract Infection (UTI), RenalFailure Acute / Chronic, and benign prostate hyperplasia.

5. Diseases Metabolic / Endocrine, such as diabetes mellitus, andobesity.

6. Respiratory diseases, such as asthma, and pulmonary tuberculosis.

7. Malignancy disease, such as carcinoma or cancer.

8. Other diseases, such as senile / dementia / dementia, Alzheimer,

and Parkinson's.Darmojo, Boedhi. 2010. Buku Ajar Geriatri. Jakarta : Balai penerbitFKUI



THANK YOU

Documents

Li Lbm 5 Tumbang