System |
Normal ageing |
Pathophysiological changes common in older
age |
Cardiovascular |
- 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
|
Respiratory |
- 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
|
Alimentary |
- 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
|
Hepatobiliary |
- Reduced hepatic mass and
metabolic reserve but maintenance of normal function
|
- Jaundice
- Deranged
liver function tests, including abnormal clotting
|
Renal |
- 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
|
Genitourinary |
- 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
|
Endocrine |
- Pituitary
dysfunction
- Abnormal thyroid function
- Pancreatic function
- Reduced
adrenal response to stress
|
- Hyponatraemia
- Hypothyroidism
- Impaired glucose tolerance and frank diabetes mellitus
|
Musculoskeletal |
- Increased body fat and
loss of muscle mass (although this may be retarded with exercise)
|
- Osteoarthritis and
vertebral spondylosis
- Osteoporosis
|
Dermatological |
- 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
|