The Effects of Aging

Age Management Medicine is the study of how the human body ages with time. Aging affects DNA on the cellular level, thus every organ system is affected. Starting generally, here are changes that occur with aging:

General: Fatigue, headaches, brain ‘fog’, mood swings, depression, memory loss, insomnia and sleep deprivation, water retention, and bloating can occur with aging. Changes in the distribution of fat occur such that fat formation around the abdominal organs occurs preferentially to fat formation under the skin, known as “android fat deposition.” Estrogen dominance can lead to allergies and subsequent manifestations of hives and asthma, as well as autoimmune disorders like Sjogren’s disease.

Vital Signs

Temperature per se does not change, but the body’s ability to compensate to ambient temperature changes. Elders may wear multiple layers of clothing because redistribution of body fat takes away fat from the subcutaneous tissue. In hot weather, sweating does not occur readily, so heat intolerance and heat stroke can occur. Fever: when it occurs, a fever can be the only symptom for several days, requiring a healthcare assessment. An inability to mount a febrile response may occur, so the lack of a fever with illness does not rule out a disease process. Blood Pressure: Orthostatic hypotension, pre-fainting, and fainting can occur. Elder women are at risk for high blood pressure. Heart rate: slow heart rate, fast heart rate, and arrhythmias such as atrial fibrillation. Medications like digitalis or beta-blockers will slow the heart rate.

The Heart

Arteries stiffen and have less compliance, leading to increased blood pressure. Plaque builds up in arterial walls, leading to arteriosclerosis, myocardial infarction, and cerebral vascular accident or stroke. The left ventricular heart wall may thicken, and the ejection fraction may decrease. In patients over age 70, the maximum heart rate decreases, valves stiffen, and heart failure occurs 10 times more commonly.

The Lungs

Starting at age 20, the lungs lose elasticity. At age 30, the rate of air flow through the airways decreases. In older patients, the airways close more readily, leading to atelectasis that can be profound to the point of causing pneumonia for patients that are bed-bound. This is why it is important for patients to get out of bed or use incentive spirometry. Additionally, elders have a decreased cerebral response to both decreased oxygenation and hypercarbia.

Metabolism

Starting at age 45, muscle mass decreases 10% per 10 years. Even with no weight change, muscle mass decreases and body fat increases. This change in body composition is primarily responsible for the increased weight seen with aging. Muscles burn more calories than fat, so there is a need for fewer calories to be consumed.

There is a decreased metabolism rate for medications and alcohol, requiring decreased dosages as age progresses.

The adverse effects of metabolic changes with oxidative damage involve both cancer and aging. These can be blunted with an anti-inflammatory diet, antioxidants and avoidance of chronic metabolic syndrome. Correction of hormone deficiencies and excesses is mandatory to achieve balance.

Bladder

Increased urinary frequency, decreased bladder size and mass, and decreased efficiency occurs. In males, increased prostate gland size may occur.

Brain

Aging causes loss of structures for nerve cell connection, leading to memory loss and “senior moments”. Slowed reflexes occur during driving. There may be an increased risk of falls, leading to hip fractures, extended hospital stay with surgical repair, rehabilitation, and the possible need for a full-time Caregiver.

Vitamin B-12 and folate deficiencies can cause depression, memory loss, psychosis, peripheral neuropathy, and personality changes. Vitamin B-12 deficiency leads to megaloblastosis and degeneration of the dorsal and lateral spinal column, with presenting signs of ataxia, weakness, and loss of proprioception and vibration. Without intervention, mental and neurological changes can become permanent.

Extremities

From about 35 years of age, a decrease in bone replacement occurs, leading to osteopenia and osteoporosis. Either kyphosis (front-to-back curvature) or scoliosis (side-to-side curvature) may occur. Decreased muscle mass occurs, especially with no exercise regimen. Hands and feet can get cold.

Skin

Decreased skin collagen occurs, together with slowed nail growth and brittle nails. Increased skin dryness, wrinkles, and delayed healing may be seen.

Endocrine

Hormone imbalance can lead to cold intolerance, cold hands, weight gain, menstrual irregularities, hypoglycemia or hyperglycemia, and copper, magnesium or zinc deficiency. Insulin resistance and diabetes may occur with chronic inflammation, especially with a high glycemic diet and no exercise. Propensity toward hypogonadism, hypothyroidism, diabetes, and obesity occurs, with all the sequelae of these diseases.

Aging decreases Growth Hormone (GH), IGF-1 production, and immune function. If one looks at 24 hour GH secreted by a normal-aged patient with an organic pituitary lesion and a diagnosis of hypopituitarism, the laboratory features are indistinguishable from an adult who is over 60 years old (Toogood et al, 1996).

Gastrointestinal

Increased abdominal girth, less subcutaneous fat, and increased fat around the organs can lead to android body habitus, gallbladder disease, and fatty liver. Atrophic gastritis can occur because the stomach’s parietal cells progressively decrease hydrochloric acid production, leading to hypochlorhydria and Vitamin B12 deficiency. High homocysteine levels (over 20 μmol/L) can be found with aging, increasing cardiovascular and dementia risk.

Sexual

Menses become irregular, then eventually stop, causing infertility. The following hormones change through pre-menopause, menopause, and post-menopause: estrogen, progesterone, and testosterone.

The loss of progesterone influence that occurs with menopause leads to “estrogen dominance”; this occurs whether the estrogen levels are high, moderate, or low. Hot flashes can occur, as well as decreased libido and pain during sex. Decreased vaginal lubrication and atrophy of labia majora and labia minora may be accompanied by irritability and insomnia, increased blood clotting and increased risk of stroke, polycystic ovaries, uterine cancer, uterine fibroids, fibrocystic breasts, and breast cancer.

In men, “manopause” decreases sperm production, increased prostate size, decreased testosterone, decreased libido, and erectile dysfunction (ED).

Today

The great news is that today’s age management doctors are trained to identify subtle changes that lead to disease and death, then reverse them. This includes reversal of obesity and its complications: diabetes, high blood pressure, high cholesterol, joint pain, infections, and injury due to falls.