Theories; Mortality and Morbidity Typical Aging Frality

Developmental Genetic Theories

–aging is genetically controlled and programmed

–cell death by apoptosis

–evidence for = maximum life span (within and between species)

Stochastic Theories

relate to changes in structure and function at molecular/cellular level due to accumulation of insults from the environment

Primary Aging

Biological factors such as molecular and cellular changes

Secondary Aging

aging that occurs due to controllable factors such as lifestyle, lack of physical exercise, poor diet, etc.

Aging is a complex process with BLANK biomarkers

NO DEFINITIVE

NO gold standards/development milestones

it is accepted that the aging adult has a diminished capacity to return to BLANK after physical stressors

homeostasis

hallmark of aging

Normal aging can increase vulnerability to disease but is BLANK from disease

distinct from

Chronic conditions are BLANK

modifiable

No. 1 is heart disease

4 key lifestyle risks for chronic disease

tobacco use, poor nutrition, lack of physical activity, excessive alcohol use

Factors to chronic diseases and top causes of death (4)

genetics

inc life expectancy

-inc vulnerability to infection/disease

-falls, MVAs, suicide

improvements in dx and reporting

lifestyle

-smoking, poor nutrition, excessive alcohol use

physical inactivity

Presbyopia

impaired vision as a result of aging

far-sighted

normalPr

Presbycusis

sensorineural loss at higher frequencies

BILATERAL

Pathological Hearing Loss

usually unilateral

Cataracts (pathological)

–Dense, cloudy areas in the lens due to protein clumps

–Blurring, clouding of images, sensitivity to light, decreased contrast, “halos” decreased night vision

–50% by age 80

Glaucoma (pathological)

–Increased intraocular pressure resulting in loss of peripheral vision

–Older African Americans are twice as likely to have glaucoma as older whites (15% versus 7%)- leading cause of blindness

who is more likely to have gluacoma?

Older African Americans are 2x likely to have glaucoma

Age-Related Macular Degeneration (AMD)

-Central vision lost, peripheral intact

-Leading cause of vision loss in the aging population

-Leading cause of blindness among whites

greatest influence in physiological aging? Overarching idea?

confounding factors

Confounding Factor: Inactivity

•Most common cause of losses in functional capabilities is INACTIVITY / IMMOBILITY!

Environmental barriers to inactivity

-bed rails, restraints, improper chair/bed height, stairs, curbs, doors (home and community)

-lack of assistance

-social isolation

-fear

BLANK out of 10 leading causes of death are chronic diseases

7 out of 10

Frailty

Biologic syndrome of decreased reserve and resistance to stressors, resulting from cumulative declines across multiple physiologic systems, and causing vulnerability to adverse outcomes

Sacropenia

Age-related (+) loss of skeletal muscle mass (decreased CSA)

Sacropenia is d/t what physiology?

–Decrease in alpha motor neurons and mitochondrial function

•Collateral sprouting of AMN = larger motor units = decreased coordination

BOTH BLANK and BLANK share weakness and slow gait speed

Sarcopenia and frality

Frality as a result of physiologic changes and NOT disease?

•Genetic predisposition

•Aging related sarcopenia

•Low hormonal levels and/or immunological changes

Lifestyle

Frality as a result of disease or comorbidtiy?

•Low grade inflammatory response" (CVD?)

•"Decreased glucose processing" (diabetes?)

the 2 models of frality

Phenotype of Frality

most commonly used method to ID frality

Frality Index

# of health deficits accumulated over time

Frality Index; if they have BLANK or more cormorbid conditions, 40x more likely to be frail

4 or more

what do we risk when utilizing self report measures?

risk of missing preclinical signs

Frality concept is a syndrome with 3 or more of what criteria present?

unintentional weight loss (>5% of BW or 10lbs in a year)

self-reported exhaustion (fatigue)

weakness (grip strength (in lowest 20%)

slow walking speed (>6-7 sec to walk 15'=1.4 mph)

low activity (less than 3x/wk, or needs help to leave home)

how to manage frality?

physical activity and resistance training

moderate-vigorus activity most effective means to reduce progression to of frality*******

vitamin D and protein intake

education

pathological aging: hearing: Conductive Loss

changes in middle or outer ear that block the acoustic energy

-wax, rigid tympanic eardrum, damage to eardrum, pressure

hearing aids

pathologic aging: hearing: sensorineural loss

dysfunction in iner ear (cilia, cochlea) or with auditory nerve

hearing aids maybe, cochlear implants