in the Teaching Material of
Medical Biotechnology Master’s Programmes
at the University of Pécs and at the University of Debrecen
Identification number: TÁMOP-4.1.2-08/1/A-2009-0011
ADAPTATION AND VULNERABILITY, POLYMORBIDITY
Miklós Székely and Márta Balaskó
Molecular and Clinical Basics of Gerontology – Lecture 2
Medical Biotechnology Master’s Programmes
at the University of Pécs and at the University of Debrecen
Identification number: TÁMOP-4.1.2-08/1/A-2009-0011
Asthma
Renal disease Diabetes
Cardiac disease Arthritis
Cancer
Correlation of
morbidity rates and age
Morbidity rate
• increase peaks
at 60y,
• decelerates after 80y,
• remains linear after 110y
0 20 40 60 80 100
10 30 50
0 20 40 60
% with disease
Age (years)
Sinusitis
Fat, fat-free mass and cell mass of males and females at various ages
Fat , fat-free mass, and cell mass of males () and females () at
various ages, values are given, and the number of subjects in each age group is noted.
27 58 33
37
42
18
89 33 44
72 54 13
18–25 25–35 35–45 45–55 55–65 65–85
Age (years)
Absolute weight (kg)
10 20 30 40 50 60
Age-related changes in different functions
Age (years)
Hypothetic function (%)
20 100
50
0 30 40 50 60 70 80 90
Average age differences in physiological functions among normal male subjects
Basal metabolic rate
Standard glomerular filtration rate (inulin)
Standard renal plasma flow (diodrast)
Maximal breathing capacity
Vital capacity
Standard renal plasma flow (PAH)
Conduction velocity
Cardiac index
Standard cell water
30 40 50 60 70
20 7 0
50
0 30 40 60
Percent property remaining (average)
Age (years)
80 90 8
0 9 0 100
Effect of 50 mmHg increment in
systolic blood pressure on heart rate,
cardiac index and stroke index in young and old rats
Percent Change
Young Old 50
10
-40 40 30 20
0 -10 -20 -30
Heart rate Cardiac index Stroke index
< .001 ≤ .05 NS
NS NS
≤ .05
≤ .001
<
.001
<
.001
ADH effect decreases with age
U/P inulin (urine/plasma conc. ratio)
Urine Collection Period
0 0 10 20 30 40 50 60 70 80 90 100 110 120
1 2 3 4 5 6 7 8 9 10
Young Middle Old
ADH
Glucose tolerance tests*
in different age-groups
Time (min)
Blood sugar (mM)
0 5 6 7 8 9 10 11 12
20 30
40 50 60
70
Age (years)
0 20
60 90 120 150
* 50 g glucose p.o.
Organ capacity
Healthy (old)
Functional capacity of an organ
Healthy (young)
Sick
(young or old) Essential
functional minimum Reserve capacity
Plasma epinephrine and
norepinephrine vs. age during work
Age (years)
0 20 30 40 50 60 70 80 0
400 800 1200 1600 2000
Plasma Norepinephrine (pg/ml)
Age (years)
0 20 30 40 50 60 70 80 0
50 100 150 200 250
Plasma Epinephrine (pg/ml)
0% grade 3% grade 9% grade 6% grade
Resting
Characteristics of aging
Decreased performance and compensation capacity
• Sensitive balance among the failing organ systems
• Interactions: It is always the weakest link that would cause symptoms (not what the original disease is!)
• “Monotonous”, atypical symptoms: organ specific symptoms, functional syndromes instead
Further characteristics of aging
• Frequent changes in symptoms
• Fewer acute syndromes, with less intensive or striking onset
• Opposed to this, more chronic syndromes that impair the quality of life
• Multimorbidity
• Medication related problems.
Distribution and excretion of drugs change with age.
Prevalence of multimorbidity
Using 24 major diagnostic categories…
• 82 percent of people aged 65 and older had one or more chronic conditions
• 65 percent had two or more
• 43 percent had three or more
• 24 percent had four or more.
On average there are 2.3
chronic conditions reported by people aged 65 and older.
Wolff JL, Starfield B, Anderson G. Arch Intern Med. 2002;162:2269-2276 0
10 20 30 40 50 60 70 80 90
1 or more 2 or more 3 or more 4 or more
Characteristics of diseases in the elderly
• Multimorbidity
• The number of chronic incurable diseases increases
• Necessary compromises during treatment, determine priorities
• Gradual, hidden start
• A large number of secondary complications (limited capacity to compensate)
• Increased need for rehabilitation
(importance of psychological and social factors)
Functional syndromes
• Instability, impaired homeostasis
• Immobility, falls
• Intellectual abnormalities (confusion)
• Incontinence
• Iatrogenic disorders
Incompetence (Confusion)
Geriatric Giants
Immobility
(Falls) Incontinence
Iatrogenic disorders Impaired
homeostasis
to which the elderly are susceptible because of their medical problems
Illness
Medication
Drug
interaction Drug
adverse effect
