JOKO WIBOWO S (012116424)

1.

Why does her skin looks more saggy/slacker, especially around the eyes?
Observed Skin Changes - Epidermis:
The number of epidermal cells decreases by 10% per

decade and they divide more slowly making the skin less able to repair itself quickly. Epidermal cells become thinner making the skin look noticeably thinner. Changes in the epidermis allows more fluid to escape the skin.

In Between:
The rete-ridges of the dermal-epidermal junction flatten out making the skin more fragile and making it easier for the skin to shear. This process also decreases the amount of nutrients available to the epidermis by decreasing the surface area in contact with the dermis. = slower repair/turnover

Observed Skin Changes Dermis:

These changes cause the skin to wrinkle and sag. The dermal layer thins Less collagen is produced The elastin fibers that provide elasticity wear out. -------- function of sebaceous & sweat glands contribute to dry skin

Observed Skin Changes SubQ:

The fat cells get smaller This leads to more noticeable wrinkles and sagging

A Note about Sun Worshipers:

Solar elastosisrough, leathery looking skin with wrinkles,

irregular pigmentation, plaques, broken blood vessels & actinic keratosis

Due to repeated overdoses of sun exposure.

Physical Changes with Aging; Racquel Daley-Placide, MD, Clinical Assistant Professor Division of Geriatrics, The University of North Carolina.

2.

Why does she was lost her weight and her body shape seems small?
Observed System: Changes in the Musculoskeletal

Muscles: Sarcopenia ( muscle mass & contractile force) occurs with age. Some of this muscle-wasting is due to diminished growth hormone production (NEJM 323: 1, 1990), but exactly how much is due to aging versus disuse is unclear. Sarcopenia is associated with increased fatigue & risk of falling (so may compromise ADLs). Sarcopenia affects all muscles including, for example, the respiratory muscles ( efficiency of breathing) & GI tract (constipation).

 Bone/Tendons/Ligaments:
Gradual loss of bone mass (bone resorption > bone

formation) starting around age 30s. Decreased water content in cartilage the wear-&-tear theory regarding cartilage destruction & activity doesnt hold up as osteoarthritis is also frequently seen in sedentary elders. Decreased water in the cartilage of the intervertebral discs results in a in compressibility and flexibility. This may be one reason for loss of height. There is also some decrease in water content of tendons & ligaments contributing to mobility.

Physical Changes with Aging; Racquel Daley-Placide, MD, Clinical Assistant Professor Division of Geriatrics, The University of North Carolina.

3.

Why does she hasnt got her period since 5 years ago?
Age-related changes in the reproductive system:
Women The climacteric occurs (defined as the period during with reproductive capacity decreases (ie, ovarian failure) then finally stops = loss of estrogen & progesterone; FSH & LH ). this is also described as the transition from perimenopause (~age 40s) to menopause. Thinning & graying of pubic hair Loss of subq fat in external genitalia giving them a shrunken appearance Ovaries & uterus decreases in size & weight Skin is less elastic + loss of glandular tissue gives breasts a sagging appearance Other physical changes may include hot flashes (can cause sleep deprivation if they occur at night), sweats, irritability, depression, headaches, myalgias. Sexual desire is variable. The symptoms are typically present for about 5 years Atrophy of vaginal tissues due to low estrogen levels = thinning & dryness occurs; agglutination of labia majora & minora may occur.

 Men Testosterone decreases, testes become softer & smaller Erections are less firm & often require direct stimulation to retain rigidity Though fewer viable sperm are produced & their motility decreases, men continue to produce enough viable sperm to fertilize ova well into older age. Less seminal fluid may be ejaculated they may not experience orgasms every time they have sex the prostate gland enlarges; this often results in compression of the urethra which may inhibit the flow of urine.

Physical Changes with Aging; Racquel Daley-Placide, MD, Clinical Assistant Professor Division of Geriatrics, The University of North Carolina.

4.

Why does she suffers from blurred vision, hearing loss, esy to fall especially sitting to standing and feels so dizzy and imbalance? Blurred vision:
More skeris shaped cornea. Pupillary sphincter arise sclerosis and loss of response to

light. More bleak lens (lens opacities). Increased threshold ray observations: the power of adaptation to darkness more slowly, difficulty seeing in dark light. The loss of power of accommodation. Decreased wide visual field of view and reduced. The reduced power distinguish blue or green color on a scale.

Depkes RI. 2003. Pedoman Pengelolaan Kegiatan Kesehatan di Kelompok Lanjut Usia. Depkes :Jakarta.

Hearing loss:
Presbiakusis (hearing impaired): The loss of the ability (power) loss in the inner ear, especially the sound of a voice, among other high-tone tone, the sound is not clear, it is difficult to understand words, 50% occurred at the age above 65 years old.

Become

atrophic tympanic membrane causes otosclerosis. The occurrence of wax collection, can harden due to increased creatine.

Depkes RI. 2003. Pedoman Pengelolaan Kegiatan Kesehatan di Kelompok Lanjut Usia. Depkes :Jakarta.

Easy to fall, feels so dizzy and imbalance:

According to (suhartono, 2005), postural balance mechanism requires the cooperation and interaction of 3 components: 1. Visual system:
Visual disturbances that may increase the risk of falling,

such as cataracts. In elderly commonly have changes in eye structure. One of them is atrophy and hyalinization of the ciliary muscle to increase the amplitude of accommodation.
2. Vestibular: Disorders of vestibular function, for example: vertigo. Predisposing factors of the emergence of vestibular function disorders include hearing infections, ear surgery, aminoglyosides, quinidine, and furosemide.

3. Proprioceptive: Peripheral neuropathy and cervical degenerative disease. This arrangement of proprioceptive gives information to the CNS about the body position of the condition of the surrounding (external) and the position of the body segments of the agency itself (internal) through receptors in the joints, tendons, muscles, ligaments and skin all over the body, especially that of the vertebral column and limbs.

5. Physiologiy of aging process?

Physiology of Aging, Brent C. Williams, MD, MPH, Associate Professor of Medicine, University of Michigan

Overview of Aging Physiology: Skin Body Composition Vision Special Senses Nervous System Musculoskeletal System Renal GI Cardiovascular
Physiology of Aging, Brent C. Williams, MD, MPH, Associate Professor of Medicine, University of Michigan

Skin:

Physiology of Aging, Brent C. Williams, MD, MPH, Associate Professor of Medicine, University of Michigan

Body Composition:

Physiology of Aging, Brent C. Williams, MD, MPH, Associate Professor of Medicine, University of Michigan

Vision:
Visual acuity (cataracts, macular degeneration)
Dark adaptation Peripheral vision (glaucoma) Contrast sensitivity

Physiology of Aging, Brent C. Williams, MD, MPH, Associate Professor of Medicine, University of Michigan

Special Senses:
Auditory and Vestibular Presbycusis: high frequency hearing loss Vestibular dysfunction
Smell Oral/Dental Teeth: 40% of elderly are edentulous Taste Salivary function

Physiology of Aging, Brent C. Williams, MD, MPH, Associate Professor of Medicine, University of Michigan

Nervous system:
CNS: decrease in nerve cell number
Basal ganglia atrophy Dopamine and muscular rigidity Step height Reaction time PNS: decreased vibratory sensation

Physiology of aging, brent c. Williams, MD, MPH, associate professor of medicine, university of michigan

Musculoskeletal System:
30% loss in muscle mass 3rd to 8th decade - sarcopenia.
Osteoarthritis
weight bearing (spine/knees/1st metatarsophalangeals)

strain (distal interphalanges/1st carpometacarpals) Osteopenia/-porosis (80% women >65 y/o osteopenia) decreased activity, dietary calcium, estrogen withdrawal. Physiology of aging, brent c. Williams, MD, MPH, associate professor of medicine, university of michigan

repeated

Renal:
GFR 30-46%
Tubular function Renal plasma flow ~50%

CrCl = [(140 - age) x (BW)]/[72 x SrCr ]

Multiply x 0.85 for females BW in kg (LBW or IBW with edema or obesity)

Physiology of aging, brent c. Williams, MD, MPH, associate professor of medicine, university of michigan

GI:
GI absorptive cells
GI motility or normal Sphincter activity

GI blood flow
Gastric acid secretion Active transport
Physiology of aging, brent c. Williams, MD, MPH, associate professor of medicine, university of michigan

Cardiovascular:
Afterload: Vascular Changes: Vascular Smooth Muscle Increased thickness of intima and media Matrix
Collagen deposition, increased fibronectin, crosslinking (AGEs) Fragmentation of elastin, calcium deposition

Net result is increased vascular stiffness.

Physiology of aging, brent c. Williams, MD, MPH, associate professor of medicine, university of michigan

Summary: Age-associated cardiovascular physiology:

changes

in

Maintenance of resting left ventricular function. Decreased ability to compensate for stress or

impaired LV function. Blunted heart rate response to exercise requires a compensatory increase in stroke volume to increase cardiac output.
Physiology of aging, brent c. Williams, MD, MPH, associate professor of medicine, university of michigan

6. What is the factor of aging process?

Endogenic aging, starting with cellular aging through anatomical tissue aging and the aging process toward organ. The process is like a clock that keeps spinning. Exogenic factor, divided into environmental causes (environtment) where a person lives and the socio-economic, socio-cultural, or most appropriately called lifestyle (life style). Exogenic factor of aging earlier, now better known as "risk factors".

(Boedhi-Darmojo, 1994)

7.

The quality of the socio-economic environment in which individuals live throughout the life cycle is the major determinant of health status. (Kaplan 1997, Marmat 1996). It is not just low income, poor diet and so on that impact on health, but the impact these have on a sense of wellbeing and subjective experience of quality of life. Social support and integration are key: unemployment, job insecurity and lack of social support are associated with high rates of physical and mental morbidity and mortality even when material factors are controlled for (Cooper et al 1999, Bartley 1994, Uhtera et al 1997, Marmot et al 1998, Brown and Harris 1978, Blaxter 1990, Oakley et al 1994, Mathiesen et al 1990, McIntyre et al 1993).

What is the correlation healthy lifestyle, social life and her condition?

8.

What is the methode to adopting a healthy lifestyle?

10 needs of the elderly: 1. Sufficient and healthy food (healthy food) 2. Clothing and completeness (cloth and common accessories) 3. Housing / shelter / shelter (homes, place to stay) 4. And supervision of health care (health care and facilities) 5. Daily practical technical assistance law (technical, judicial ass.) 6. Public transport for the elderly (facilities for public Transportations, etc) 7. Visits / interlocutor / information (visits, companies, informations, etc) 8. Recreation and other wholesome entertainment (recreational activities, picnics, etc) 9. Sense of security and peace (feeling of safety) 10. Help sensory devices (glasses, hearing aids) (other assistance / aids). Continuity of funding and facilities (continuetion of Subsidies and facilities) At a minimum, is very important: Get enough attention ("in-the-right") (= Regarded as still existing in the community) R. Boedhi-Darmojo.Buku Ajar Geriatri.edisi 3. 2006

9. What is disorder?
1. 2.

kind

of

elderly

Joint and bone diseases, such as rheumatism, and osteoporosis. Cardiovascular diseases, such as hypertension, kholesterolemia, angina, cardiac attack, stroke, high triglycerides, anemia, and CHD. 3. Digestive diseases such as gastritis, and ulcers pepticum. 4. Urogenital diseases, such as Urinary Tract Infection (UTI), Renal Failure Acute / Chronic, and benign prostate hyperplasia. 5. Diseases Metabolic / Endocrine, such as diabetes mellitus, and obesity. 6. Respiratory diseases, such as asthma, and pulmonary tuberculosis. 7. Malignancy disease, such as carcinoma or cancer. 8. Other diseases, such as senile / dementia / dementia, Alzheimer, and Parkinson's. Darmojo, Boedhi. 2010. Buku Ajar Geriatri. Jakarta : Balai penerbit FKUI

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