AGING PROCESS

RA TUTY KUSWARDHANI
IGP SUKA ARYANA


GERIATRIC DIVISION, INTERNAL MEDICINE OF UDAYANA
UNIVERSITY/SANGLAH HOSPITAL, DENPASAR
MARIA ESTHER HEREDIA DE CAPOVILLA ,116 Y.O
EKUADOR (GUINNESS BOOK DEC 2005)
NAMA: dr IGP SUKA ARYANA, SpPD
STAF PENGAJAR DIVISI GERIATRI,
BAGIAN/SMF ILMU PENYAKIT DALAM FK UNUD DENPASAR, RSUP
SANGLAH

Pendidikan
Dokter umum: FK Unud 1997
Spesialis Penyakit Dalam: FK Unud 2005
Visiting research fellow Kobe Jepang 2002
Penghargaan:
Nominator the Best Young Investigator Award AFES Singapura 2003
Nominator the Best Young Investigator Award AFES Manila 2005
The Best Mustafa-Varon Award for the Best Free Paper On shock and Critical Care
2005
The Best Young Investigator Award, ASMIHA Surabaya 2005
KURIKULUM VITAE
TOPICS
INTRODUCTION
GERIATRIC DEFINITION
DEMOGRAPHIC POPULATION
AGING DEFINITION
AGING AND SENESCENCE
THEORIES OF AGING
INTRODUCTION
GERONTOLOGY : GERONTOS AND LOGOS
GERIATRY SCIENCE :A SCIENCE WHICH LEARNS THE
ELDERLY AND THE TREATMENT
GEROS = ELDERLY
IATRY = TO TREAT
THE TERM : IGNAS LEO VASCHER (1909)
PROGRESSIVE DEVELOPMENT :
DR. MARJORI WARREN
(THE PIONEER OF GERIATRY IN THE WORLD)

ELDERLY POPULATION
INDONESIA : 60 Y.O
W H O : 60 Y.O
DEVELOPED COUNTRY : 60 Y.O
ELDERLY PATIENT : 60 Y.O +
MULTIPLE DISEASE/ COMPLEXITY


CHINA 198. 343
INDIA 107.713
INDONESIA 24.816
BRAZIL 21.945
UK 12.912
MEXICO 12.829
NIGERIA 9.115

THE PREDICTION OF THE ELDERLY
POPULATION 2020

INDONESIA DEMOGRAPHY
YEARS BALITA (< 5 yrs) ELDERLY(> 60 yrs)

1971 19,1 mil (16,1 %) 5,3 mil(4,5 %)
1980 21,2 mil (14,4 %) 8,0 mil (5,5 %)
1985 21,6 mil (13,4 %) 9,4 mil (5,8 %)
1990 21,0 mil (11,7 %) 11,2 mil (6,3 %)
1995 21,6 mil (11,0 %) 13,6 mil (6,9 %)
2000 21,2 mil (10,1 %) 15,9 mil (7,6 %)
2005 21,1 mil ( 9,5 %) 18,3 mil (8,2 %)
2015 18,8 mil ( 7,6 %) 24,4 mil (10,0 %)
The importance of genetics in the regulation of
biologic aging is demonstrated by the
characteristic longevity of each animal species.
Several theories of aging have been promulgated
and recently reviewed (Goldstein, 1989; Abrass,
1991).
These theories fall into two general categories:
accumulation of damaged to informational
molecules, or the regulation of specific genes
BIOLOGIC AGING
AGING PROCESS DEFINITION
Aging is a process of the loosing of ability the tissue
slowly to develop it self and to maintain the structure
and the normal function; so it can not stand towards
the trauma to develop the damage. (Constantine 1994)

AGING: A process of gradual and spontaneus change
resulting in maturation through childhood, puberty and
young adulthood and then decline through middle and
late aging



SENESCENCE: The process by which the
capacity for cell division, growth and function is
lost over time, ultimately leading to an
incompatibility with life i.e the process of
senescence terminates in death.

DISEASE vs aging In both aging and
senescence, many physiology function decline but
normal decline is not usually considere the same
as disease. So ??

Progressively the human will loose the defence
of infection & it will accumulate more metabolic
and structural distortion which is called :
DEGENERATIVE DISEASE
WHY DO WE AGE?

WHY DO WE LIVE AS LONG
AS WE DO?

WHY DO WE DIE?
THEORIES OF AGING PROCESS
AGING IS EXTREMELY COMPLEX AND
MULTIFACTORIAL PROCESS

SEVERAL PROCESSES MAY INTERACT
SIMULTANEOUSLY

AGING PROCESS MAY OPERATE AT MANY LEVEL
OF FUNCTIONAL ORGANISM
MAJOR THEORIES ON AGING
(focus on proces)
Theory Mechanisms Manifestations
Accumulation of
damaged to
informational
molecules
(demage and
error)
Spontaneous mutagenesis
Failure in
DNA repair systems
Errors in DNA,
RNA, and protein synthesis
Superoxide radicals and loss of
scavenging enzymes
Copying errors


Error catastrophe

Oxidative cellular
damage
Regulation of
specific genes
(program)
Appearance of specific
protein(s)
Genetically
programmed
senescene
CLASSIFICATION THEORIES OF AGING
(focus on level)
EVOLUTIONARY
MUTATION ACCUMULATION mutation effect healht at older age
DISPOSABLE SOMAafter reproductive somatic cell become disposable
ANTAGONISTIC PLEIOTROPY genes beneficial at younger, deleterious at older
MOLECULAR
GENE REGULATION change regulating development and aging
CODON RESTRICTION inability decode codonimpaired translation mRNA
ERROR CATASTROPHE decline fidelity of gene expresion increased abnormal
protein
SOMATIC MUTATION accumulated molecular demage (DNA/genetic material)
DYSDIFFERENTIATION accumulated molecular demage impairs gene expresion
CELLULAR
CELLULAR SENESCENCE-TELOMERE THEORY
FREE RADICAL
WEAR AND TEAR accumulation of normal injury
APOPTOSISprogrammed cell dead from genetic event /genome crisis
SYSTEM
NEUROENDOCRINE alteration control homeostasis aging related physiological
change
IMMUNOLOGIC decline immune function increased autoimmunity
RATE OF LIVING fixed amount of metabolic potential for every living (live fastdie
young)
AGING PROCESS THEORY
1. GENETIC CLOCK THEORY
In this theory aging has been programmed genetically for
certain species.
Every species has nucleus like a genetic clock which has been
winded according to a certain replication.
This clock will count the mytocys
Mytocys will stop cell replication if it is not winded
PROGRAMMED THEORY
Why on some species get a real different of life
expectation
Figure 1. Record in life span (Eudililin et al, 1993)
Turtle 170 y.o
Elephant 70 y.o
Horse 62 y.o
Gorilla 48 y.o
Bear 47 y.o
Cat 30 y.o
Dog 27 y.o
Theoritically it is possible to rewind this
clock eventhough just for small time, with
external interverences, such as :
Health development
Disease prevention with medicine/ treatment

The theory supported by experiment : nucleus
which determines the replication Aging
Death
2. THE SHORTENING OF TELOMERE THEORY.

The shortening of DNA telomere will cause the death
of the cell.
The DNA replication leads to telomere shortening
because DNA polymerase cannot replicated the very
end of DNA molecule.
Telomerase elongates the chromosome through de
novo sequerell addition.
3. THE DAMAGED BY FREE RADICAL.

Teory was first proposed in 1957, its one of best
teory

All organism live contain free radical (ROS)

For aerobic organism, the free radical is mainly
formulated while respirating (aerob) in mitochondria.
The free radical are : super oxide (O
2
), Hydroxcyl
radical (COH), Hydrogen peroxide (H
2
O
2
).

Free radical is destroyer it can react to DNA
cumulative demage aging and senescence

The body itself is able to prevent free radical with
its enzymes : superoxide dismutase (SOD) : Zn, Cu, Mn


2 O
2
-

+ 2H
+ SOD
H
2
O
2
+ O
2
*Catalase enzyme with Fe element in the haem to burst
hydrogen peroxide become water & oxygen :

CATALASE
2H
2
O
2


2H
2
O

+ O
2


*Glutathion peroxide enzyme with selenium (Se) element
burst peroxide hydrogen through the reaction :

H
2
O
2
+ GSH GSSH +H
2
O

Also can be netralised by vit C, A and E


4. METABOLIC AGING THEORY

From the experiment it get a longer life span caused
by the retriction of the calorie. It is caused by one of
metabolism process increase insulin sensitivity,
neuroendocrine and immune respon

The modification of under exercise to be more active
will cause the longer life span

Calaric retriction delayed growth and failure of
sexual maturation
5. THE DAMAGE OF IMMUNE SYSTEM

The repeated mutation/ the changing protein post translation
decrease the immune system decreased ability of self
recognition

The somatic mutation change antigen in the surface cell
immune system treat the changing cell as a strange cell and
destroy it AUTO IMMUNE PROCESS

All somatic cell will set aging process, except sexual cell & cancer
cell.
6. WEAR-AND-TEAR THEORY
Supports the concept that aging is a programmed
process. each animal-each cell, has a specific amount
of metabolic energy available to it & that the rate at
whish this energy is used determines the animals length
of life.
In addition to the depletion of available energy, wear-
and-tear theories include the effects of the
accumulation of harmful by products of metabolism &
of faulty enzymes due to random errors as contributing
to aging changes
MODEL HEALTHY AGING
Endogenic aging

Cellular Tisue Anatomical Organ




Environment Life Style

Exogenic factor
Healthy aging
(menua sehat)

HEALTY AGING CONCEPT
GERONTOLOGY IS
CONCERNED PRIMARILY
WITH PROBLEM OF
HEALTHY AGING
RATHER THAN THE
PREVENTION OF AGING