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Adaptation and vulnerability, polymorbidity

Manifestation of Novel Social Challenges of the European Union 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.

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Adaptation and vulnerability, polymorbidity

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  1. Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat the University of Pécs and at the University of Debrecen Identification number: TÁMOP-4.1.2-08/1/A-2009-0011

  2. Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat the University of Pécs and at the University of Debrecen Identification number: TÁMOP-4.1.2-08/1/A-2009-0011 Miklós Székely and Márta Balaskó Molecular and Clinical Basics of Gerontology – Lecture 2 Adaptation and vulnerability, polymorbidity

  3. Correlation ofmorbidity ratesand age • Morbidity rate • increase peaksat 60y, • deceleratesafter 80y, • remains linearafter 110y 60 Sinusitis Asthma 50 Renal disease Arthritis 40 Diabetes Cancer 30 % with disease Cardiac disease 20 10 0 0 20 40 60 80 100 Age (years)

  4. Fat, fat-free mass and cell mass ofmales and females at various ages Fat , fat-free mass, and cell massofmales () and females ()at various ages, values are given, and the number of subjects in each age group is noted. 60 58 33 27 37 42 50 18 40 44 33 89 72 Absolute weight (kg) 54 13 30 20 10 18–25 25–35 35–45 45–55 55–65 65–85 Age (years)

  5. Age-related changesin different functions 100 Hypothetic function (%) 50 0 80 70 60 40 30 90 20 50 Age (years)

  6. Average age differences in physiological functions among normal male subjects Conduction velocity 100 Basal metabolic rate 90 Standard cell water 80 Cardiac index 70 Standard glomerular filtration rate (inulin) Percent property remaining (average) 60 Vital capacity 50 Standard renal plasma flow (diodrast) 40 30 Standard renal plasma flow (PAH) 20 Maximal breathing capacity 0 30 40 50 60 70 80 90 Age (years)

  7. Effect of 50 mmHg incrementinsystolic blood pressure on heart rate,cardiac index and stroke index in young and old rats 50 Young 40 Old 30 20 10 Percent Change 0 < .001 ≤ .05 NS -10 NS NS -20 < .001 ≤ .05 -30 < .001 -40 ≤ .001 Heart rate Cardiac index Stroke index

  8. ADH effect decreases with age 120 Young Middle 110 Old 100 90 80 70 U/P inulin(urine/plasma conc. ratio) 60 50 40 30 ADH 20 10 0 0 1 2 3 4 5 6 7 8 9 10 Urine Collection Period

  9. Glucose tolerance tests*in different age-groups 12 70 11 50 10 60 9 40 30 Blood sugar (mM) 8 20 7 6 Age (years) 5 0 90 0 20 60 120 150 Time (min) * 50 g glucosep.o.

  10. Organ capacity Reserve capacity Functional capacity of an organ Essential functional minimum Healthy (young) Healthy(old) Sick(young or old)

  11. Plasma epinephrine and norepinephrine vs. ageduringwork Resting 2000 250 0% grade 3% grade 1600 200 6% grade 9% grade Plasma Norepinephrine (pg/ml) Plasma Epinephrine (pg/ml) 1200 150 800 100 400 50 0 0 0 20 30 40 50 60 70 80 0 20 30 40 50 60 70 80 Age (years) Age (years)

  12. 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: organspecific symptoms, functional syndromes instead

  13. 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.

  14. Prevalence of multimorbidity Using 24 major diagnostic categories… • 82 percent of people aged65and older had one or more chronic conditions • 65 percent had two or more • 43 percent had threeor more • 24 percent had four or more. • On average there are 2.3 chronic conditions reported by people aged65 and older. 90 80 70 60 50 40 30 20 10 0 1 or more 2 or more 3 or more 4 or more Wolff JL, Starfield B, Anderson G. Arch Intern Med. 2002;162:2269-2276

  15. Characteristics of diseasesin the elderly • Multimorbidity • The number of chronic incurable diseases increases • Necessary compromises during treatment, determinepriorities • Gradual, hidden start • A large number of secondary complications (limited capacity to compensate) • Increased need for rehabilitation(importance of psychological and social factors)

  16. Functional syndromes • Instability, impaired homeostasis • Immobility, falls • Intellectual abnormalities (confusion) • Incontinence • Iatrogenic disorders

  17. Geriatric Giants Immobility(Falls) Incompetence (Confusion) Incontinence Impaired homeostasis Iatrogenicdisorders

  18. Illness-medication problemsto which the elderly are susceptible because of their medical problems Illness Drugadverseeffect Medication Druginteraction

  19. Aims of therapy • Transition from hospital to (nursing) home • Relief of e.g. pain • Improvement in self-care, independence • Improvement of physical activity and fitness • Improvement in functional abilities,better quality of life (QOL) • Complete recovery (?)

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