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Normal ageing and changes in body systems

Proses Penuaan Normal dan Perubahan Pada Sistem Tubuh

System Normal ageing Pathophysiological changes common in older age
  • Slight increase in heart size
  • Normal stroke volume and left ventricular ejection fraction
  • Exertional oxygen consumption declines
  • 7.5-10% per decade; thus exercise tolerance is reduced
  • Ischaemic heart disease
  • Heart failure
  • Valvular heart disease
  • Peripheral vascular disease
  • Aneurysms
  • Vital capacity: 40% reduction by age 70
  • FEV1 and FVC: 30% reduction by age 80
  • Progressive reduction in PEFR after age 30
  • Haemoptysis
  • Chronic obstructive pulmonary disease (COPD)
  • Lung fibrosis
  • Lung cancers
  • Reduced and abnormal peristalsis: 'presby-oesophagus'
  • Slower colonic transit
  • Reduced absorption of some nutrients; reduced energy requirements
  • Weight loss
  • Dysphagia
  • Change in bowel habit
  • Bleeding from the upper or lower
  • GI tract
  • Reduced hepatic mass and metabolic reserve but maintenance of normal function
  • Jaundice
  • Deranged liver function tests, including abnormal clotting
  • Reduced GFR and numbers of functional tubules and glomeruli
  • Reduced serum creatinine due to loss of muscle mass
  • Renal impairment with raised serum creatinine
  • Haematuria
  • Men - Reduced testosterone
  • Normal FSH/LH
  • 50% of men over 70 have 'abundant spermatogenesis'
  • Women - postmenopausal low oestradiol; raised FSH and LH
  • Loss of female reproductive capability
  • Atrophic vaginitis due to low oestrogen levels
  • Loss of sexual interest may also occur, but this is complex and multifactorial
  • Erectile dysfunction
  • Prostatic enlargement
  • Bladder outflow tract symptoms
  • Postmenopausal bleeding (PMB)
  • Urinary incontinence
  • Painful intercourse
Nervous system, including higher senses
  • High-frequency hearing loss
  • Vision: Close focusing declines from age 40
  • Distinguishing fine detail (reduced acuity) declines after 70 years.
  • Loss of muscle mass leads to decline in strength
  • Reduced mental agility and minor loss of mental ability
  • Deafness, tinnitus and vertigo
  • Glaucoma, macular degeneration
  • Cataracts
  • Dementia and delirium
  • Hemiparesis, paraparesis
  • Many other factors, including reduced distal sensation, vascular disease, poor balance
  • Pituitary dysfunction
  • Abnormal thyroid function
  • Pancreatic function
  • Reduced adrenal response to stress
  • Hyponatraemia
  • Hypothyroidism
  • Impaired glucose tolerance and frank diabetes mellitus
  • Increased body fat and loss of muscle mass (although this may be retarded with exercise)
  • Osteoarthritis and vertebral spondylosis
  • Osteoporosis
  • Loss of collagen in the skin leads to thin, paparaceous skin
  • Ecchymoses and senile purpura
  • Basal and squamous cell carcinoma
  • Solar keratoses
  • Malignant melanoma
Haematological and immune system
  • Loss of T-cell function with age may be associated with late-onset autoimmune disease
  • Possible link between changes in immune system and:
    • (a) Age-related cancers
    • (b) Response to disease
  • Anaemia
  • Myelodyplasia
  • Haematological malignancies
  • Chronic lymphatic lymphoma and myeloma

Davidson's Principles and Practice of Medicine 20th Edition (Churchill Livingstone) 2007

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