Aging Process

Hildebrand Hanoch Victor Watupongoh

Departemen Ilmu Penyakit Dalam
Fakultas Kedokteran Universitas Kristen Indonesia
2016
 Definition of Aging
• Old and aging depends on the age and
experience of the speaker
• Chronological age – number of years lived
• Physiologic age – age by body function
• Functional age – ability to contribute to
society
 Menua
• Proses normal
• Dewasa sehat -----------------------“frail”
• Cadangan sistem fisiologis berkurang
• Menurun kemampuan usila berespon
terhadap stres
• Rentan terhadap penyakit
 Frail Elderly
• Characteristics:
– Poor mental and physical health
– Low socioeconomic status
– Predominantly female
– Possibly isolated living condition
– More and longer hospital status
– More money spent on health care and drugs
 Bagaimana Proses Menjadi Tua?
• Genetik, • sel mnejadi mengkerut,
• gaya hidup, • jaringan menjadi rusak,
• Lingkungan • organ tubuh menjadi
tua
 Internal
Genetic
Biological

Normal Aging

External Factor
Environment  Lifestyle
Socioeconomic
Economic
 Teori Radikal Bebas
• Radikal bebas  senyawa kimia yag berisi
elektron yang tidak berpasangan
• Produk sampingan berbagai proses selular
atau metabolisme normal yang melibatkan O2
• Bersifat merusak, sangat reaktif, dapat
bereaksi dengan DNA, protein, asam lemak
tak jenuh
• Contoh: superoksida (O2-), hidrosil (OH),
Peroksida hidrogen (H2O2)
 Teori Glikosilasi
• Proses glikolisasi nonenzimatik, yg
menghasilkan pertautan glukosa –protein 
advanced glication end products (AGEs)
• AGEs menyebabkan penumpukan proten dan
makromolekul  disfungsi pada hewan,
Manusia yg menua
• AGEs berakumulasi di jaringan Kolagen,
hemoglobin, lensa mata
• Jaringan ikat kurang elastis dan kaku
 Teori DNA repair
• Dikemukakan Hart and Setlow
• Ada perbedaan pola laju repair kerusakan
DNA yg diindukasi sinar UV
• Spesies yang mempunyai umur terpanjang 
laju DNA repair terbesar (mamalia dan
primata)
 Pemanjangan Telomer
• Setiap sel mempunyai kemampuan untuk
membelah 50 kali
• Setiap sel membelah, telomer semakin
pendek
• Akhirnya telomer tidak dapat memendek lagi
 kematian sel (proses menua)
 Banyak Teori proses menua
• Aging by program
• Teori gen dan mutasi gen
• Cross linkage theory
• Teori autoimun, dll

Tidak ada satu teori tunggal yang dapat

menjelaskan seluruh proses menua
Physiological Aging of The
Human Body by Systems
 Skin, Hair, and Nails
• Loss of subcutaneous fat
• Thinning of skin
• Decreased collagen
• Nails brittle and flake
• Mucus membranes dries
• Less sweat glands
• Temperature regulation difficulty
• Hair pigment decreases
• Hair thins
 Eyes and Visions
• Eyelids baggy and wrinkled
• Eyes deeper in sockets (karena lapisan lemak
berkurang)
• Conjunctiva thinner and yellow
• Quantity of tears decreases  mata kering  proteksi
bola mata menurun
• Iris fades
• Pupil smaller, let in less light
• Night and depth vision less
• “floaters” can appear
• Lens enlarges
 Eyes And Visions
• Lens become less transparent, Can actually
become clouded  katarak
• Impaired color vision also especially greens
and blues (Cones degenerate)
• Accommodation decreases  Results in
presbyopia
 Eyes and Visions
• Predisposed to glaucoma
• Increase pressure in eye
• Decreased absorption of intraocular fluid
• Can result in blindness
 Ears and Hearing Loss
• Irreversible, sensorineural loss with age
• Men more affected than women
• Loss occur sin higher range of sound
• By 60 years, most adults trouble haring abve
400hz
• Normal speech = 500-2000hz
 Respiratory system
• Lungs become more rigid
• Pulmonary function decreases
• Number and size of alveoli decreased
• Vital capacity declines
• Reduction in respiratory fluid
• Bony changes in chest cavity
 Cardivascular System
• Heart smaller and less elastic with age
• By age 70, cardiac output reduced by 70%
• Heart valve become sclerotic
• Heart muscle more irritable
• More arrhythmias
• Arteries more rigid
• Veins dilate
 Gastrointestinal System
• Reduced GI secretions
• Reduced GI motility
• Decreased weight of liver
• Reduced regenerative capacity of liver
• Liver metabolize less efficiently
 Renal System
• After 40 renal function decreases
• By 90 lose 50% of function
• Filtration and reabsorption reduced
• Size and number of nephrons decrease
• Bladder muscle weaken
• Less able to clear drugs from systems
• Smaller kidneys and bladder.
 Reproductive System
• Male
– Reduced testosterone level
– Testes atrophy and soften
– Decrease in sperm production
– Seminal fluid decrease and more viscous
– Erections take more time
– Refractory period after ejaculation may lengthen
to days
 Reproductive System
• Female
– Declining estrogen and progesterone levels
– Ovulation ceases
– Introitus constricts and loses elasticity
– Vagina atrophies – shorter and dries
– Uterus shrinks
– Breast pendulous and lose elasticity
 Neurological System
• Neurons of central and peripheral nervous
system degenerate
• Nerve transmission slows
• Hypothalamus less effective in regulating body
temperature
• Reduced REM sleep, decreased deep sleep
• After 50% lose 1% of neurons each year
 Musculosceletal System
• Adipose tissue increase with age
• Lean body mass decreases
• Bone mineral contend diminished
• Decrease in height from narrow vertebral
spaces
• Less resilient connective tissue
• Synovial fluid more viscous
• May have exaggerated curvature of spine
 Immune System
• Decline in immune function
• Trouble differentiating between self and non
self – more auto-immune problems
• Decreases antibody response
• Fatty marrow replaced red marrow
• Vitamin B12 absorption might decrease –
decreased hemoglobin and hematocrit
 Endocrine System
• Decreased ability to tolerate stress – best seen
in glucose metabolism
• Estrogen levels decrees in women
• Other hormonal decreases include
testosterone, aldosterone, cortisol,
progesterone
 Implikasi Klinik Proses Menua
ORGAN PERUBAHAN

Paru - Paru Daya pegas dinding dada menurun

Kekuatan otot pernapasan menurun
Kekakuan iga meningkat
Daya pegas jaringan elastik paru menurun
Paru-paru lebih mengembang namun
kaku

Saluran Nafas Refleks batuk menurun

Mudah tersedak
Gerakan bulu getar melambat
 Implikasi Klinik Proses Menua
Jantung Pembuluh - Darah Katup jantung kaku
Jumlah sel pacu berkurang
Sistem konduksi menurun
Penumpukan jar. Ikat di otot jantung  kaku
Pembuluh darah kurang lentur  TD naik
Isi sekuncup menurun; curah jantung berkurang

Ginjal Jumlah nefron, glomerulus <

Fungsi filtrasi menurun
Kepekaan tubulus terhadap ADH<
Reabsorbsi <
LFG menurun 7,5 mL/m/dekade
Tulang, sendi, otot Keropos, cairan <, massa otot <, cairan sendi <,
tulang rawan mulai rusak
 Implikasi Klinik Proses Menua
Saluran Cerna Produksi air liur <
Osteoporosis tulang rahang, gigi tanggal
Gerakan kerongkongan & lambung
melambat
Prouksi enzim pencernaan <
Gerakan usus besar <
Saluran kemih dan kelamin Kelenjar prostat membesar
Selaput mulut rahim kering
Otot dasar panggul melemah
Susunan saraf pusat Pengerasan pembuluh darah otak
Demensia (neurofibril tangie, amyloid)
Mengisut (atrofi)
Terimakasih