1. Aging theories
1.1. Programmed theories
1.1.1. Programmed longevity
1.1.2. Endocrine
1.1.3. Hay-flick's limit
1.1.4. Immunological
1.2. Damage/Error theories
1.2.1. Wear & tear
1.2.2. Free radical
1.2.3. Cross link
1.2.4. Somatic mutation
2. Physiological changes
2.1. Primary ( intrinsic aging) VS Secondary ( Extrinsic aging)
2.2. Cardiovascular changes
2.2.1. BP increases ( 1mmHg/ year after the age of 50) meanly because of increase in systolic BP
2.2.2. Arterial walls thicken, harden and loss elasticity ( results in arteriosclerosis)
2.2.3. Barororeceptors decreased sensitivity ( results in postural (orthostatic) hypotension
2.2.4. CO decreases by 1%/ year after the age of 30
2.2.5. Loss in SA node
2.2.6. Reduced response to Beta receptors
2.3. Urological changes
2.3.1. Reduction in renal mass
2.3.2. Decrease of GFR and RPF
2.3.3. Decrease in uinary bladder compliance
2.4. Respiratory changes
2.4.1. Decreased
2.4.1.1. Lung elasticity
2.4.1.2. Vital capacity
2.4.1.3. Inspiratory reserve volume
2.4.1.4. Alveolar surface area
2.4.1.5. Gas exchange
2.4.1.6. Cough reflex
2.4.2. Increased
2.4.2.1. Chest wall rigidity
2.4.2.2. Risk of pneumonia
2.5. Neurological changes
2.5.1. Decreased
2.5.1.1. Neurons
2.5.1.2. Neurotransmitters
2.5.1.3. Brain mass
2.5.1.4. Sensitivity to high frequency sounds
2.5.1.4.1. Hearing problem
2.5.2. Vision problems
2.5.2.1. Presbyopia
2.6. Musculoskeletal changes
2.6.1. Muscles atrophy , lower muscle mass
2.6.2. Bone atrophy, decrease in mass & density leads to fractures & osteoporosis
2.6.3. Compression of intervertebral discs and loss of vertebra, leads to decreased height
2.6.4. Higher liability to osteoarthritis ( 50% of elderly )
2.7. Immunological changes
2.7.1. Decreased Functions of
2.7.1.1. Macrophages
2.7.1.2. B cells
2.7.1.3. T cells
2.7.1.4. Some mediators ex. IL- 1, NO
2.7.2. Increased risk of autoimmunity
2.8. Other common problems
2.8.1. Obesity 75% of elderly
2.8.2. Vision problems
2.8.3. Higher liability to cancer
2.8.4. Dental problems
2.8.5. Problems in maintaining balance ( falling)
3. Pharmacological changes
3.1. Pharmacokinetics changes
3.1.1. Absorption
3.1.1.1. Generally slower due to
3.1.1.1.1. Slow gastric emptying & esophageal motility
3.1.1.1.2. Increased gastric pH
3.1.2. Distribution
3.1.2.1. Less serum albumin levels which increases the concentration unbounded drug form
3.1.3. Metabolism
3.1.3.1. Decreased
3.1.3.1.1. Hepatic blood flow, slowed phase I reactions
3.1.3.1.2. Drug metabolism through cytochrome p-450 enzyme
3.1.3.1.3. First pass effect by 1 %/ year after 40 years ( higher drug circulation levels)
3.1.4. Elimination
3.1.4.1. Decreased renal functions
3.1.4.1.1. Renal blood flow
3.1.4.1.2. GFR
3.1.4.1.3. Tubular secretions
3.1.4.1.4. Creatinine clearance
3.2. Pharmacodynamics changes
3.2.1. Increased sensitivity to many CNS drugs, sedatives and anesthetic
4. Menopause
4.1. Hormonal changes
4.1.1. Lower estrogen
4.1.1.1. Leads to vaginal atrophy
4.1.1.2. Osteoporosis
4.1.1.3. Night sweat
4.1.1.4. Hot flashes
4.1.1.5. Palpitation
4.1.1.6. Fatigue
4.1.1.7. Headaches
4.1.2. No progesterone
4.1.3. Higher ADH
5. Population pyramid
5.1. Describes the make-up of a given population
5.2. Visualize sex and age population composition
5.3. Age categories:
5.3.1. Young population (0-14)
5.3.2. Working Age population (15-60)
5.3.3. Elderly population (60+)
5.4. X-axis : population size
5.5. Y- axis (5 year group intervals) : separates Males (L) from Fmales (R) populations
5.6. Pyramid model
5.6.1. Expanding population
5.6.2. Stable population
5.6.3. Contracting population
6. Active aging
6.1. Optimizing opportunities throughout elderly life
6.1.1. Extended life expectancy
6.1.2. Productivity
6.1.3. Quality
6.2. "Active " refers to continuous contribution to surrounding community
7. Demographic transition
7.1. Population changes over time
7.2. Begun in 1929 to observe changes in birth and death rates in industrialized societies over the past 200 years
7.3. Demographic transition model
7.3.1. High stationary
7.3.2. Early expanding
7.3.3. Late expanding
7.3.4. Low stationary
8. Metabolic pathways in fed state
8.1. Glycolysis
8.2. Glycogenesis
8.3. Citric acid Cycle
8.4. Fatty acid synthesis (lipogenesis)
8.5. Protein synthesis
9. Metabolic pathways in fasted state
9.1. Glycogenolysis
9.2. Gluconeogenesis
9.3. Fatty acid degradation
9.4. Ketogenesis
9.5. Protein degradation
9.6. Glycolysis
10. Nutritional deficiency in elderly
10.1. Causes
10.1.1. Dental problems
10.1.2. Social & economic barriers
10.1.3. Dementia
10.1.4. Lack of sun exposure
10.1.5. Less nutrients absorption due to medications side effects
10.2. Need of healthy nutritional diet plan
11. Psychology problems
11.1. Treatments
11.1.1. Pharmacological therapy
11.1.2. Electroconvulsive therapy
11.1.3. Transcranial magnetic stimulation
11.1.4. Psychological therapy
11.2. Most common
11.2.1. Depression
11.2.2. Anxiety
12. Functional abilities
12.1. Activities of daily living
12.1.1. Bathing
12.1.2. Feeding
12.1.3. Using the bathroom independently
12.2. Instrumental activities of daily living
12.2.1. Preparing meals
12.2.2. Managing finances
12.3. Could be assisted by asking elderly individual, caregiver, number of screening tests as timed up and go test ( balance) ,snelled chart ( vision) & , whispered voice test or audioscope (hearing ) .
13. Healthy routine lifestyle
13.1. Decreasing smoking
13.2. Dental care
13.3. Frequent check ups
13.4. Adequate sleep
13.5. Good hygiene
13.6. Social activities
14. Supportive roles
14.1. Family
14.1.1. Frequent visits
14.1.2. Engagement to surrounding life
14.1.3. Being patient and understandable
14.1.4. Encouragement to participate in social activities
14.2. Public services in Qatar
14.2.1. Ehsan
14.2.1.1. Financial support
14.2.1.2. Psychological support