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

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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

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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

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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

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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

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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

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