10. Health concerns of elderly. Aging societies

The society is aging – elderly health is becoming more and more important
Ageing (= greying) of Europe
- Refers to the increase in elderly population relative to the workforce
- Due to decreased fertility, decreased mortality, and higher life expectancy
Most deaths in developed countries are due to diseases closely related to ageing, like cancer, stroke, heart disease
There is no evidenced-based proof that dietary supplements delay or stop ageing
- The fact that free radical scavengers doesn’t slow ageing is a counterargument to the free radical theory of ageing
Theories of ageing
- Researching ageing is difficult, because it is very variable in people, and it occurs over such a long time
- Biological theories
  - Programmed theories = ageing occurs due to a programmed change, a biological clock
    - Programmed senescence theory
      - = senescence (cellular ageing) occurs after a set number of cell divisions (“Hayflick’s limit”)
      - Perhaps due to telomeres, which shorten with each cell division
    - Endocrine theory
      - = hormones control the biological clock
      - Especially seen during menopause
    - Immunology theory
      - = the immune system is programmed to decline over time, increasing the vulnerability to infectious disease, ageing and death
  - Damage or error theories = ageing occurs due to environmental assaults, which cause cumulative damage
    - Wear and tear theory = wear and tear of the body wears out cells
    - Free radical theory = accumulating free radicals accumulate damage on cells
    - Somatic mutation theory = unrepairable DNA damage accumulates
    - Catastrophe theory = enzyme systems are damaged, causing faulty proteins to be synthesized and accumulate
    - Cross-linking theory = cross-linked proteins accumulate and cause dysfunction of proteins
- Psychosocial theories – focus on the psychosocial aspect of ageing
  - Disengagement theory = with age decreased engagement of the person in the society is inevitable
  - Activity theory = satisfaction of life depends on maintaining interests, hobbies, relationships
Caloric restriction
- Restriction of calories, as long as malnutrition doesn’t occur, delays ageing and extends lifespan in many species
- A type of protein called sirtuins may be involved in this mechanism
Hutchinson-Gilford Progeria syndrome
- Progeria means “early ageing” in Greek
- Rare genetic disorder that causes rapid ageing of children
- Death due to age-related diseases occurs at young age
- Due to unstable nuclear envelope
Werner syndrome (= adult progeria)
- Rare genetic disorder which causes earlier ageing
- Death occurs at around 40 – 50
- Somatic mutation in WRN gene, which encodes for a DNA repair protein
Physiological changes in ageing
- Decreased height, increased/decreased weight
- Changed posture
- Skin changes
- Dental changes
- Decreased muscle mass
- Decreased brain mass
- Slower neural conduction
- Decreased kidney function
- Decreased lung function
- Presbyopia
- Presbycusis
- Sense of thirst and hunger decreases
Health problems of elderly
- Often have multiple conditions at the same time
- These conditions may affect each other, and affect the possibilities of treatment
- Symptoms may be different than in younger adults or completely absent
  - Silent myocardial infarction
  - Pneumonia without fever
  - Thyroid dysfunction without typical symptoms
- The pharmacodynamics and pharmacokinetics change, changing how drugs affect the patient
5 “I”s of geriatric care – Immobility, incontinence, instability, intellectual decline, iatrogeny
Hospice care – care of terminally ill patients
- Complex treatment; physical, psychosocial, and spiritual
- Goal: to improve quality of life, relieve physical and mental suffering
- Involves palliative medicine, which focuses on reducing pain and other symptoms
Main causes of morbidity in elderly
- Cardiovascular disease
- Cancer
- Musculoskeletal disease
- Metabolic disorders
- CNS disorders
- Depression
- Falls
  - The most common cause of injury
  - Due to physical, sensory, and cognitive changes like slow reflexes, hypotension, etc.
Main causes of death in elderly
- Heart disease
- Cancer
- Chronic lower respiratory disease
- Stroke
- Alzheimer disease
Prevention of elderly morbidity and mortality
- Aim: increase number of health life years, reduce damage
- Primary prevention
  - Proper nutrition
  - Encourage and enable physical activity
    - 3x a week
  - Avoid risk factors (alcohol, smoking, etc.)
  - Prevent falls (by adapting the environment, etc.)
  - Ensure social support
- Secondary prevention
  - Screen for hypertension, diabetes, hearing and vision loss, osteoporosis, cancer, depression, etc.
- Tertiary prevention
  - Reduce relapse and complications of diseases
  - Early rehabilitation