The Change of

The Organ’s Function

in Geriatric
Andi Irhamnia Sakinah
Program Studi Pendidikan Dokter
UIN Alauddin Makassar 2019
 LEARNING OBJECTIVES

• To understand physiological changes of organ’s

function in geriatrics
• To differentiate age-related pathological and
physiological changes in organ systems
OVERVIEW
• Makin lanjutnya usia seseorang maka
kemungkinan terjadinya perubahan
anatomik (dan fungsional) atas
organ-organnya makin besar.
• Penurunan anatomi dan fungsi dikaitkan
dengan umur biologik, bukan umur
kronologik.

Source: Hadi-Martono, 2015

 NEUROLOGICAL SYSTEM
Declining Spinal Cord Changes
• Cortical gray matter • Neuronal loss
• Neuronal volume
• Complexity of neuronal
• Demyelination
connections • Reduced reflexes
• Synthesis of • Reduced proprioception
neurotransmitters
• Adrenoreceptor
responsiveness
– Increased concentration of
circulating cathecolamines
Source: Shier et. al. , 2016; Mendelson and McCann, 2016
 SPECIAL SENSES SYSTEM
• Vision
– By age forty loss of elasticity in the lens
– Too few tears, or poor quality tears
– Deposits form in the vitreous humor
– Limitation of pupil dilatation
– The rate of aqueous humor formation exceeds the rate of its removal
– The lens or its capsule slowly becomes cloudy, opaque, and discolored
• Smell
– By the fifties Loss of olfactory receptors
• Taste
– By the fifties Mucosal atrophy
• Hearing
– Damage to the sensitive hair cells

Source: Shier et. al. , 2016

 GASTROINTESTINAL SYSTEM
• Older people sometimes do not chew food thoroughly
because thinning enamel makes teeth more sensitive to
hot and cold foods, gums recede, and teeth may loosen.
• Slowing peristalsis in the digestive tract may cause
heartburn and constipation.
• Aging affects nutrient absorption in the small intestine.
• Accessory organs to digestion also age, but not
necessarily in ways that affect health.
Source: Shier et. al. , 2016
 CARDIOVASCULAR SYSTEM

• Plaque buildup may begin early.

• Fibrous connective tissue and adipose tissue enlarge the
heart by filling in when the number and size of cardiac
muscle cells fall.
• Heart rate and output decline slightly with age.
• Blood pressure increases with age, while resting heart
rate decreases with age.

Source: Shier et. al. , 2016

 RESPIRATION SYSTEM
• Reduced chest wall compliance
– Increased work of breathing
– Reduced maximal minute ventilation
• Reduced respiratory response to hypoxia by 50%
– Due to impaired chemoreceptor function?
• Decreased ciliary function
• Reduced cough and swallowing function
• Reduced partial pressure of oxygen
Source: Shier et. al. , 2016; Mendelson and McCann, 2016
 ENDOCRINOLOGY SYSTEM
• With age, endocrine glands shrink and accumulate brous connective tissue, fat, and lipofuscin, but
hormonal activities usually remain within the normal range.
– GH levels even out, as muscular strength declines.
– ADH levels increase due to slowed breakdown.
– The thyroid shrinks but control of metabolism continues.
– Decreasing levels of calcitonin and increasing levels of parathyroid hormone increase
osteoporosis risk.
– The adrenal glands show aging-related changes, but negative feedback maintains functions.
– Muscle, liver, and fat cells may develop insulin resistance.
– Changes in melatonin secretion affect the body clock.
– Thymosin production declines, hampering resistance to disease.

Source: Shier et. al. , 2016

 HEMATOLOGICAL SYSTEM
• The pattern of blood cell growth is qualitatively unchanged at aging
• Bone marrow actually contains fewer hematopoietic cells with a
slightly decreased response to artificial stimuli.
• The regenerative response to blood loss or treatment of pernicious
anemia is somewhat less than when young.
• The lifespan of red blood cells does not change due to the aging
process.
• Anemia is often found in the elderly because of secondary effect.

Source: Hadi-Martono, 2015

 JOINT OF THE SKELETAL SYSTEM
• Joint stiffness is often the earliest sign of aging.
• Collagen changes cause the feeling of stiffness.
• Regular exercise can lessen the effects.
• Fibrous joints are the first to begin to change and strengthen over a lifetime.
• Synchondroses of the long bones disappear with growth and development.
• Changes in symphysis joints of the vertebral column diminish flexibility and
decrease height.
• Over time, synovial joints lose elasticity.

Source: Shier et. al. , 2016

 UROGENITAL SYSTEM
• Decline in renal blood flow
– 10% per decade after age 50
• Old kidney has difficulty:
– Maintaining circulating blood volume
– With sodium homeostasis
– Removing excess acid
– Adjusting to hypovolemia, hemorrhage, low cardiac output, and
hypotension
• Renal insufficiency may not be appreciated
Source: Shier et. al. , 2016; Mendelson and McCann, 2016
 IMMUNE SYSTEM

• The immune system begins to decline early in life, in

part due to the shrinking thymus.
• Numbers of T cells and B cells do not significantly
change, but activity levels do.
• Proportions of the different antibody classes shift.

Source: Shier et. al. , 2016

 INTEGUMENTARY SYSTEM
• Aging skin affects appearance as “age spots” or “liver spots”
appear and grow, along with wrinkling and sagging.
• Due to changes in the number of sweat glands and shrinking
capillary beds in the skin, elderly people are less able to
tolerate the cold and cannot regulate heat well.
• Older skin has a diminished ability to produce vitamin D, which
is necessary for skeletal health.

Source: Shier et. al. , 2016

 MUSCULOSKELETAL SYSTEM
MUSCLE SYSTEM
• Beginning in one’s forties, supplies of •
ATP, myoglobin, and creatine phosphate
begin to decline.
• By age eighty, muscle mass may be
halved. Re exes slow. Adipose cells and
connective tissue replace some muscle
tissue.
• Exercise is beneficial in maintaining
muscle function.
SKELETAL SYSTEM
Aging-associated changes in the skeleton are
apparent at the cellular and whole-body levels.
– Incremental decrease in height begins at about
age thirty.
– Gradually, bone loss exceeds bone replacement.
• In the first decade following menopause, bone
loss occurs more rapidly in women than in
men or premenopausal women. By age
seventy, both sexes are losing bone at about
the same rate.
• Aging increases risk of bone fractures.
Source: Shier et. al. , 2016
 NORMAL AGING
vs
PATHOLOGY AGING
Source: Mendelson and McCann, 2016
 TAKE HOME MESSAGES

• Long life makes you age

• Life style modification is a must
• Routine medical check-up

Dan barang siapa Kami panjangkan umurnya niscaya Kami kembalikan dia
kepada kejadiannya. Maka apakah mereka tidak memikirkannya?.
[QS. Yaasiin/36:68]
 WASSALAM
TERIMA KASIH