LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

STEP 7 1. How is the proses of aging? Biological theories At present, the biological basis of ageing is unknown. Most scientists agree that substantial variability exists in the rates of ageing across different species, and that this to a large extent is genetically based. In model organisms and laboratory settings, researchers have been able to demonstrate that selected alterations in specific genes can extend lifespan (quite substantially in nematodes, less so in fruit flies, and less again in mice)[citation needed]. Even in the relatively simple and short-lived organisms, the mechanism of ageing remain to be elucidated. Less is known about mammalian ageing, in part due to the much longer lives in even small mammals such as the mouse (around 3 years). The US National Institute on Aging currently funds an intervention testing program, whereby investigators nominate compounds (based on specific molecular ageing theories) to have evaluated with respect to their effects on lifespan and age-related biomarkers in outbred mice.[36] Previous age-related testing in mammals has proved largely irreproducible, because of small numbers of animals, and lax mouse husbandry conditions. The intervention testing program aims to address this by conducting parallel experiments at three internationally recognised mouse ageing-centres, theBarshop Institute at UTHSCSA, the University of Michigan at Ann Arbor and the Jackson Laboratory. Many have argued that life-span, like other phenotypes, is selected.

Evolutionary Theories: Enquiry into the evolution of ageing aims to explain why almost all living things weaken and die with age. Exceptions such as rockfish, turtles, and naked molerat are highly informative.[citation needed] Telomere Theory: Telomeres (structures at the ends of chromosomes) have experimentally been shown to shorten with each successive cell division.[37] Shortened telomeres activate a mechanism that prevents further cell multiplication[citation needed]. This may be particularly limit in tissues such as bone marrow and the arterial lining where cell division occurs repeatedly throughout life[citation needed]. Importantly though, mice lacking telomerase enzyme do not show a dramatically reduced lifespan[citation needed], invalidating at least simple versions of the telomere theory of ageing. Mice may be an exception for the theory, as they have long hypervariable telomeres,[38] prolonging the period after which telomere shortening would affect life-span. But wild mouse strains do not, and telomere length in these breeds is unrelated to lifespan [39] Reproductive-Cell Cycle Theory: The idea that ageing is regulated by reproductive hormones that act in an antagonistic pleiotropic manner via cell cycle signalling, promoting growth and development early in life in order to achieve reproduction, but later in life, in a futile attempt to maintain reproduction, become dysregulated and drive senescence (dyosis).[1][40]

Some theories suggest that ageing is a disease. Two examples are

DNA Damage Theory of Ageing: Known causes of cancer (radiation, chemical and viral) account for about 30% of the total cancer burden and for about 30% of the total DNA damage. DNA damage causes the cells to stop dividing or induce apoptosis, often affecting stem cell pools and hence hindering regeneration. DNA damage is thought to be the common pathway causing both cancer and ageing. It seems unlikely that the estimates of the DNA damage due to radiation and chemical causes has been significantly underestimated. Viral infection would appear to be the most likely cause of the other 70%

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

of DNA damage especially in cells that are not exposed to smoking and sun light. It has been argued, too, that intrinsic causes of DNA damage are more important drivers of ageing. [41][42] Autoimmune Theory: The idea that ageing results from an increase in autoantibodies that attack the body's tissues. A number of diseases associated with ageing, such as atrophic gastritis andHashimoto's thyroiditis, are probably autoimmune in this way. While inflammation is very much evident in old mammals, even SCID mice in SPF colonies still experience senescence.

Genetic theories Many theories suggest that ageing results from the accumulation of damage to DNA in the cell, or organ. Since DNA is the formative basis of cell structure and function, damage to the DNA molecule, or genes, can lead to its loss of integrity and early cell death. Examples include:

Accumulative-Waste Theory: The biological theory of ageing that points to a buildup of cells of waste products that presumably interferes with metabolism. Wear-and-Tear Theory: The very general idea that changes associated with ageing are the result of chance damage that accumulates over time. Somatic Mutation Theory: The biological theory that ageing results from damage to the genetic integrity of the bodys cells. Error Accumulation Theory: The idea that ageing results from chance events that escape proof reading mechanisms, which gradually damages the genetic code.

Some have argued that ageing is programmed: that an internal clock detects a time to end investing in the organism, leading to death. This ageing-Clock Theory suggests, as in a clock, an ageing sequence is built into the operation of the nervous or endocrine system of the body. In rapidly dividing cells the shortening of the telomeres would provide such a clock. This idea is in contradiction with the evolutionary based theory of ageing.[citation needed]

Cross-Linkage Theory: The idea that ageing results from accumulation of cross-linked compounds that interfere with normal cell function.[citation needed] Free-Radical Theory: The idea that free radicals (unstable and highly reactive organic molecules), or more generally reactive oxygen species or oxidative stress create damage that gives rise to symptoms we recognise as ageing.[citation needed] Reliability theory of ageing and longevity: A general theory about systems failure. It allows researchers to predict the age-related failure kinetics for a system of given architecture (reliability structure) and given reliability of its components. Reliability theory predicts that even those systems that are entirely composed of non-ageing elements (with a constant failure rate) will nevertheless deteriorate (fail more often) with age, if these systems are redundant in irreplaceable elements. Ageing, therefore, is a direct consequence of systems redundancy. Reliability theory also predicts the late-life mortality deceleration with subsequent levelling-off, as well as the late-life mortality plateaus, as an inevitable consequence of redundancy exhaustion at extreme old ages. The theory explains why mortality rates increase exponentially with age (the Gompertz law) in many species, by taking into account the initial flaws (defects) in newly formed systems. It also explains why organisms "prefer" to die according to the Gompertz law, while technical devices usually fail according to the Weibull (power) law. Reliability theory allows to specify conditions when organisms die according to the Weibull distribution: organisms should be relatively free of initial flaws and defects. The theory makes it possible to find a general failure law applicable to all adult and extreme old ages, where the Gompertz and the Weibull laws are just special cases of this more general failure law. The theory explains why relative differences

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

in mortality rates of compared populations (within a given species) vanish with age (compensation law of mortality), and mortality convergence is observed due to the exhaustion of initial differences in redundancy levels. Mitohormesis: It has been known since the 1930s that restricting calories while maintaining adequate amounts of other nutrients can extend lifespan in laboratory animals. Recently, Michael Ristow's group has provided evidence for the theory that this effect is due to increased formation of free radicals within the mitochondria causing a secondary induction of increasedantioxidant defence capacity.[43] Misrepair-Accumulation Theory: Wang et al.[44] suggest that ageing is the result of the accumulation of "Misrepair". Important in this theory is to distinguish among "damage" which means a newly emerging defect BEFORE any reparation has taken place, and "Misrepair" which describes the remaining defective structure AFTER (incorrect) repair. The key points in this theory are: 1. There is no original damage left unrepaired in a living being. If damage was left unrepaired a life threatening condition (such as bleeding, infection, or organ failure) would develop. 2. Misrepair, the repair with less accuracy, does not happen accidentally. It is a necessary measure of the reparation system to achieve sufficiently quick reparation in situations of serious or repeated damage, to maintain the integrity and basic function of a structure, which is important for the survival of the living being. 3. Hence the appearance of Misrepair increases the chance for the survival of individual, by which the individual can live at least up to the reproduction age, which is critically important for the survival of species. Therefore the Misrepair mechanism was selected by nature due to its evolutionary advantage. 4. However, since Misrepair as a defective structure is invisible for the reparation system, it accumulates with time and causes gradually the disorganisation of a structure (tissue, cell, or molecule); this is the actual source of ageing. 5. Ageing hence is the side-effect for survival, but important for species survival. Thus Misrepair might represent the mechanism by which organisms are not programmed to die but to survive (as long as possible), and ageing is just the price to be paid.

2. Why her skin looked more saggy/slacker espesially around the eye? With aging, the outer skin layer (epidermis) thins even though the number of cell layers remains unchanged. The number of pigment-containing cells (melanocytes) decreases, but the remaining melanocytes increase in size. Aging skin thus appears thinner, more translucent. Age spots or liver spots may appear in sun-exposed areas. Changes in the connective tissue reduce the skin's strength and elasticity. This is known as elastosis and is especially pronounced in sun-exposed areas. http://adam.about.net/encyclopedia/Changes-in-face-with-age_1.htm http://seniorliving.about.com/od/healthnutrition/a/aging101part1.htm

Aging changes in skin Definition

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

Aging changes in the skin are a group of common conditions and developments that occur as people grow older. Alternative Names Wrinkles - aging changes; Thinning of skin Information Skin changes are among the most visible signs of aging. Evidence of increasing age includes wrinkles and sagging skin. Whitening or graying of the hair is another obvious sign of aging. Your skin does many things. It protects you from the environment, helps control your body temperature and fluid and electrolyte balance, and contains nerve receptors that allow you to feel sensations such as touch, pain, and pressure. Although skin has many layers, it can be generally divided into three main parts: The outer part (epidermis) contains skin cells, pigment, and proteins. The middle part (dermis) contains blood vessels, nerves, hair follicles, and oil glands. The dermis provides nutrients to the epidermis. The inner layer under the dermis (the subcutaneous layer) contains sweat glands, some hair follicles, blood vessels, and fat. Each layer also contains connective tissue with collagen fibers to give support and elastin fibers to provide flexibility and strength. Skin changes are related to environmental factors, genetic makeup, nutrition, and other factors. The greatest single factor, though, is sun exposure. This can be seen by comparing areas of your body that have regular sun exposure with areas that are protected from sunlight. Natural pigments seem to provide some protection against sun-induced skin damage. Blue-eyed, fairskinned people show more aging skin changes than people with darker, more heavily pigmented skin.

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

3. Why her weight decrease and the body shapes is tinner? Regulation of food intake changes with increasing age, leading to what has been called a physiological anorexia of aging. The amount of circulating cholecystokinin, a satiating hormone, increases in the circulation. Other substances are also thought to cause satiety. The interplay between the brain and the gut is gaining increasing attention as a mechanism of anorexia and subsequent weight loss. A highly complex process involving taste sensation, neural and humoral signals from the gastrointestinal tract, and neurotransmitters and peptides in the hypothalamus or other brain regions regulates food intake and, consequently, energy homeostasis. Psychosocial and spiritual distress can also influence the sensation of hunger, appetite, or satiety. Loss of lean body mass is common in older people. Advancing age is also associated with a decrease in the basal metabolic rate as well as with changes in the senses of taste and smell. Overly restricted diets, such as those that are low in fat and salt, may cause decreased intake; therefore, a special or restricted diet (low in cholesterol, salt, or concentrated sweets) often reduces food intake without significantly improving the clinical status. The role of inflammatory cytokines, including tumor necrosis factor (TNF, formerly cachectin), interleukin-1 (IL-1), and interleukin-6, has also been postulated. Physiological changes in the regulation of food intake take place, even in the presence of the increased body fat and the increased rates of obesity that occur with age, some of which can be explained by altered patterns of physical activity. Generally speaking, individuals aged 65 years and older experience a mild loss of weight, a near doubling of adiposity, and a significant non-fat mass loss of 5% to 15%.

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

Sarcopenia, the loss of skeletal muscle massand thus leading to a loss of proteinmay play an important role in IWL. Muscle loss can be the result of negative nitrogen balance that occurs with normal aging and with inadequate protein intake, which is commonly observed among the elderly. Agerelated changes in anabolic hormones may contribute to nonfat mass loss. Low testosterone levels in men correlate with the loss of lean body mass, and loss of estrogen during menopause is associated with non-fat mass loss in women. Growth hormone appears to play an important role in body composition; growth hormone levels may decrease by 14% per decade. It has been found that replacement of growth hormone in older people results in increased lean body mass and reduced fat mass. 4. Why her visions was getting blurred? Normal Changes in the Aging Eye What We All Can Expect Losing Focus The most common age-related vision change presbyopia happens to almost everyone beginning between the ages of 40 and 50. A natural result of aging, the lens begins to lose elasticity, making it harder to focus vision up close for such activities as reading. But presbyopia can be corrected easily with reading glasses or glasses with bifocal, trifocal or progressive (no-line) lenses. Declining Sensitivity The lens of the eye also becomes increasingly dense and more yellow with age. These changes may affect color perception and contrast sensitivity. For instance, the color blue may appear darker and harder to distinguish from black. And it may become difficult to tell where an object ends and its background begins, making it difficult to see curbs or steps, for example. Needing More Light As the eye ages, the pupil gets smaller, resulting in the need for more light to see well, along with more time to adjust to changing levels of illumination (going from daylight into a dark theater or dimly lit restaurant, for example). 5. Why did her hearing began to decline? HEARING

With aging, ear structures deteriorate. The eardrum often thickens and the inner ear bones and other structures are affected.

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

Your ears have two jobs. One is hearing and the other is maintaining balance. Hearing occurs after vibrations cross the eardrum to the inner ear. They are changed into nerve impulses and carried to the brain by the auditory nerve. Balance (equilibrium) is controlled in a portion of the inner ear. Fluid and small hairs in the semicircular canal (labyrinth) stimulate the nerve that helps the brain maintain balance. As you age, your ear structures deteriorate. The eardrum often thickens and the bones of the middle ear and other structures are affected. It often becomes increasingly difficult to maintain balance. Hearing may decline slightly, especially that of high-frequency sounds, particularly in people who have been exposed to a lot of noise when younger. This age-related hearing loss is called presbycusis. Some hearing loss is almost inevitable. It is estimated that 30% of all people over 65 have significant hearing impairment. The sharpness (acuity) of hearing may decline slightly beginning about age 50, possibly caused by changes in the auditory nerve. In addition, the brain may have a slightly decreased ability to process or translate sounds into meaningful information. Impacted ear wax is another cause of trouble hearing and is more common with increasing age. Impacted ear wax may be removed in your doctor's office. Sensorineural hearing loss involves damage to the inner ear, auditory nerve, or the brain. This type of hearing loss may or may not respond to treatment, but function can be helped by hearing aids. Conductive hearing loss occurs when sound has problems getting through the outer and middle ear to the inner ear. Surgery or a hearing aid may be helpful for this type of hearing loss, depending on the specific cause. Persistent, abnormal ear noise (tinnitus) is another fairly common hearing problem, especially for older adults. It is usually a result of mild hearing loss. 6. Why did she hasnt got menstruation anymore? Menopause Definition Menopause is the transition period in a woman's life when her ovaries stop producing eggs, her body produces less estrogen and progesterone, and menstruation becomes less frequent, eventually stopping altogether. Alternative Names Perimenopause; Postmenopause Causes Menopause is a natural event that normally occurs between the ages of 45 and 55. Once menopause is complete (called postmenopause) and you have not had a period for 1 year, you are no longer at risk of becoming pregnant. The symptoms of menopause are caused by changes in estrogen and progesterone levels. The ovaries make less of these hormones over time. The specific symptoms and how significant (mild, moderate, or severe) they are varies from woman to woman. A gradual decrease of estrogen generally allows your body to slowly adjust to the hormonal changes. Hot flashes and sweats are at their worst for the first 1 - 2 years. Menopause may last 5 or more years. Estrogen levels may drop suddenly after some medical treatments, as is seen when the ovaries are removed surgically (called surgical menopause). Chemotherapy and anti-estrogen treatment for breast cancer are other examples. Symptoms can be more severe and start more suddenly in these circumstances. As a result of the fall in hormone levels, changes occur in the entire female reproductive system. The vaginal walls become less elastic and thinner. The vagina becomes shorter. Lubricating secretions from the vagina become watery. The outside genital tissue thins. This is called atrophy of the labia.

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

7. What is charatheristics of healthy aging proses? The concept of successful ageing can be traced back to the 1950s, and popularised in the 1980s. Previous research into ageing exaggerated the extent to which health disabilities, such as diabetesor osteoporosis, could be attributed exclusively to age, and research in gerontology exaggerated the homogeneity of samples of elderly people.[32][33] Successful ageing consists of three components:[34] 1. Low probability of disease or disability; 2. High cognitive and physical function capacity; 3. Active engagement with life. A greater number of people self-report successful ageing than those that strictly meet these criteria.[32] Successful ageing may be viewed an interdisciplinary concept, spanning both psychology and sociology, where it is seen as the transaction between society and individuals across the life span with specific focus on the later years of life.[35] The terms "healthy ageing"[32] "optimal ageing" have been proposed as alternatives to successful ageing. Six suggested dimensions of successful ageing include:[19] 1. 2. 3. 4. 5. 6. No physical disability over the age of 75 as rated by a physician; Good subjective health assessment (i.e. good self-ratings of one's health); Length of undisabled life; Good mental health; Objective social support; Self-rated life satisfaction in eight domains, namely marriage, income-related work, children, friendship and social contacts, hobbies, community service activities, religion and recreation/sports.

8. Is the process could be posponed ? how to posponed to the aging process? You can't change genetics, but you can make healthy lifestyle choices to delay aging or reduce the opportunity for ill health. Avoid tobacco products and alcohol abuse. Choose to eat healthy and nutritious foods and stay fit. Drink lots of water to maintain healthy skin. Use moisturizers and sunscreen. Visit the foot doctor (podiatrist) regularly to assure good foot care. After all, you use your feet all day to get around in this world. Keep your heart active by doing aerobic exercises. Aerobic exercises keep the heart working, which keeps the blood pumping, which brings oxygen to the lungs, which makes breathing easier, which makes a person feel more energetic. It reduces the risk of stroke, heart disease and CHF. As Martha Stewart says, "Its a good thing." See your doctor before starting any aerobic activities. Stay physically active throughout the age span. Work to maintain strength in muscles and lungs to promote deep breathing and getting oxygen to the blood. The result will be an increase in energy and vigor, feeling better about life, and a greater ability to do preferred activities. Avoid smoking, being near smokers and polluted environments. Take slow deep breathes regularly. Wake up and smell the roses.

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

Regular physical exercise throughout the lifespan helps reduce the negative effects of age related changes. So, the best tip is to stay physically active. Work on maintaining muscle strength and joint and muscle flexibility. Tai Chi is an excellent resource. To prevent constipation, drink lots of water. Water really does help. Remember to try to drink at least 5-6 eight ounce glasses of water a day. To keep healthy bones, it is important to stay active. Weight bearing activities that make the muscles and joints move around can help to maintain healthy bones. Take a look at calcium supplements. All boomers and people 65 or older should see a doctor for medical advice before starting an exercise program. Eat lots of greens and orange foods such as spinach, asparagus, and carrots. Pay attention to declining driving skills, because unsafe driving is a skill that can kill. More of the same, stay active, eat small amounts of food throughout the day to maintain an energetic metabolic system, and drink lots of water.

http://ist-socrates.berkeley.edu/~aging/ModuleProcess.html#anchor157481
Dr. Vanessa M. Dazio, OTD, OTR SAFE Aging, Inc. 2006 9330 Regency Park Blvd. Suite C, Port Richey, FL 34668 727-848-

9. How to goods for the healthy life style for a health aging process? 10. Why she felt so dizzy and got balance disorders? The semicircular canals, found within the vestibular apparatus, let us know when we are in a rotary (circular) motion. The semicircular canals are fluid-filled. Motion of the fluid tells us if we are moving. The vestibule is the region of the inner ear where the semicircular canals converge, close to the cochlea (the hearing organ). The vestibular system works with the visual system to keep objects in focus when the head is moving. This is called the vestibulo-ocular reflex (VOR). Movement of fluid in the semicircular canals signals the brain about the direction and speed of rotation of the head - for example, whether we are nodding our head up and down or looking from right to left. Each semicircular canal has a bulbed end, or enlarged portion, that contains hair cells. Rotation of the head causes a flow of fluid, which in turn causes displacement of the top portion of the hair cells that are embedded in the jelly-like cupula. Two other organs that are part of the vestibular system are the utricle and saccule. These are called the otolithic organs and are responsible for detecting linear acceleration, or movement in a straight line. The hair cells of the otolithic organs are blanketed with a jelly-like layer studded with tiny calcium stones called otoconia. When the head is tilted or the body position is changed with respect to gravity, the displacement of the stones causes the hair cells to bend. The balance system works with the visual and skeletal systems (the muscles and joints and their sensors) to maintain orientation or balance. For example, visual signals are sent to the brain about the body's position in relation to its surroundings. These signals are processed by the brain, and compared to information from the vestibular, visual and the skeletal systems. When balance is impaired, an individual has difficulty maintaining upright orientation. For example, an individual may not be able to walk without staggering, or may not even be able to stand. They may have falls or near-falls. When symptoms exist, they may include:

A sensation of dizziness or vertigo. Lightheadedness or feeling woozy. Problems reading and difficulty seeing. Disorientation.

Some individuals may also experience nausea and vomiting, diarrhea, faintness, changes in heart rate and blood pressure, fear, anxiety, or panic. Some reactions to the symptoms are fatigue, depression, and

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

decreased concentration. The symptoms may appear and disappear over short time periods or may last for a longer period. Cognitive dysfunction (disorientation) may occur with vestibular disorders. Cognitive deficits are not just spatial in nature, but also include non-spatial functions such as object recognition memory. Vestibular dysfunction has been shown to adversely affect processes of attention and increased demands of attention can worsen the postural sway associated with vestibular disorders. Recent MRI studies also show that humans with bilateral vestibular damage undergo atrophy of the hippocampus which correlates with their degree of impairment on spatial memory tasks. 11. Why did she began feel to anxious to enter this age? Generalized anxiety disorder (GAD) is a common chronic disorder characterized by long-lasting anxiety that is not focused on any one object or situation. Those suffering from generalized anxiety experience nonspecific persistent fear and worry and become overly concerned with everyday matters. Generalized anxiety disorder is the most common anxiety disorder to affect older adults. Anxiety can be a symptom of a medical or substance abuse problem, and medical professionals must be aware of this. A diagnosis of GAD is made when a person has been excessively worried about an everyday problem for six months or more. A person may find they have problems making daily decisions and remembering commitments as a result of lack of concentration/preoccupation with worry. Appearance looks strained, with increased sweating from the hands, feet and axillae. May be tearful which can suggest depression. Before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and medical causes.

12. Why she was to easy fall of is spesially when she just got up from sitting to standing straight running? AGING CHANGES Bone mass or density is lost as people age, especially in women after menopause. The bones lose calcium and other minerals. The spine is made up of bones called vertebrae. Between each bone is a gel-like cushion (intervertebral disk). The trunk becomes shorter as the disks gradually lose fluid and become thinner. In addition, vertebrae lose some of their mineral content, making each bone thinner. The spinal column becomes curved and compressed (packed together). Bone spurs, caused by aging and overall use of the spine, may also form on the vertebrae. The foot arches become less pronounced, contributing to a slight loss of height. The long bones of the arms and legs, although more brittle because of mineral loss, do not change length. This makes the arms and legs look longer when compared with the shortened trunk. The joints become stiffer and less flexible. Fluid in the joints may decrease, and the cartilage may begin to rub together and erode. Minerals may deposit in and around some joints (calcification). This is common in the shoulder. Hip and knee joints may begin to lose joint cartilage (degenerative changes). The finger joints lose cartilage and the bones thicken slightly. Finger joint changes are more common in women and may be hereditary. Some joints, such as the ankle, typically change very little with aging. Lean body mass decreases, caused in part by loss of muscle tissue (atrophy). The rate and extent of muscle changes seem to be genetically determined. Muscle changes often begin in the 20s in men and the 40s in women.

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

Lipofuscin (an age-related pigment) and fat are deposited in muscle tissue. The muscle fibers shrink. Muscle tissue is replaced more slowly, and lost muscle tissue may be replaced with a tough fibrous tissue. This is most noticeable in the hands, which may appear thin and bony. Changes in the muscle tissue, combined with normal aging changes in the nervous system, cause muscles to have less tone and ability to contract. Muscles may become rigid with age and may lose tone, even with regular exercise. EFFECT OF CHANGES Bones become more brittle and may break more easily. Overall height decreases, mainly because of shortening of the trunk and spine. Inflammation, pain, stiffness, and deformity may result from breakdown of the joint structures. Almost all elderly people are affected by joint changes, ranging from minor stiffness to severearthritis. The posture may become more stooped (bent) and the knees and hips more flexed. The neck may become tilted, and the shoulders may narrow while the pelvis becomes wider. Movement slows and may become limited. The walking pattern (gait) becomes slower and shorter. Walking may become unsteady, and there is less arm swinging. Older people become tired more easily, and have less energy. Strength and endurance change. Loss of muscle mass reduces strength. However, endurance may be enhanced somewhat by changes in the muscle fibers. Aging athletes with healthy hearts and lungs may find that performance improves in events that require endurance, and decreases in events that require short bursts of high-speed performance. COMMON PROBLEMS Osteoporosis is a common problem, especially for older women. Bones break more easily, and compression fractures of the vertebrae can cause pain and reduce mobility. Muscle weakness contributes to fatigue, weakness, and reduced activity tolerance. Joint problems are extremely common. This may be anything from mild stiffness to debilitating arthritis (see osteoarthritis). The risk of injury increases because gait changes, instability, and loss of balance may lead to falls. Some elderly people have reduced reflexes. This is most often caused by changes in the muscles and tendons, rather than changes in the nerves. Decreased knee jerk or ankle jerk can occur. Some changes, such as a positive Babinski's reflex, are not a normal part of aging. Involuntary movements (muscle tremors and fine movements called fasciculations) are more common in the elderly. Inactive or immobile elderly people may experience weakness or abnormal sensations (paresthesias). Muscle contractures may occur in people who are unable to move on their own or have their muscles stretched through exercise. PREVENTION Exercise is one of the best ways to slow or prevent problems with the muscles, joints, and bones. A moderate exercise program can help you maintain strength and flexibility. Exercise helps the bones stay strong. Consult with your health care provider before beginning a new exercise program. A well-balanced diet with adequate amounts of calcium is important. Women need to be especially careful to get enough calcium and vitamin D as they age. Postmenopausal women, and men over age 65, need 1,200 - 1,500 mg of calcium and 400 - 800 international units of vitamin D per day. If you have osteoporosis, talk to your doctor about prescription treatments. References Minaker KL. Common clinical sequelae of aging. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 23. 13. Risk factor?

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

The word aging implies change as a result of the passage of time. It is a common mistake to disregard the mechanisms of aging and to place the main emphasis on the factor of time alone. The aging process does not result solely from chronological age. Instead, the critical factor is the length of time during which events occur that are injurious to the body and its cells. Whereas there are many mechanisms by which aging occurs (some of which are not fully understood), scientists have a basic understanding of the general categories of factors that initiate cell damage resulting in aging. Let us examine these factors, some of which are impossible to prevent, but others of which can be prevented with a bit of knowledge and effort. High-Frequency Radiation Radiation in this context refers to the emanations of particles or electromagnetic energy from radioactive decay or from man-made processes such as x-ray photography of the human body. In non-massive amounts, such radiation damages individual cells. Damaged cells may be impaired in their function (such as a muscle cells losing their ability to contract). As time passes and the number of impaired cells increases, the entire muscle (in this example), which is composed of a very large number of individual cells, becomes impaired in its general functioning. If the cells in question are that of an organ, as time passes, that organ will become decreasingly able to perform its function, and other organs will, in turn, be affected. Eventually, when the proportion of these damaged cells throughout the body reaches a certain degree, the organs cannot fulfill their functions. The individual cannot survive the resulting avalanche effect and dies. The damaging effects of radiation occur cell by cell and are a substantial part of the aging process. Another effect is that cells that are damaged by radiation may lose their ability to reproduce, and, therefore, healing of injuries is increasingly limited as the number of such damaged cells increases. Or, the cell damaged by radiation may still retain the ability to reproduce but generates defective copies, or, it reproduces excessively, causing a tumor to be formed. Last, consider a reproductive cell such as a sperm in the male or an egg in the female. If this cell becomes damaged or has originated from other damaged cells and takes part in sexual reproduction, the resulting offspring can be seriously deformed. The effect on offspring is probabilistic; namely, the greater the amount of radiation, the larger the proportion of damaged genetic cells. Consequently, the probability that the offspring will be defective increases with exposure to radiation. In experiments with animals exposed to radiation, the damage to cells is proportional to the radiation exposure. This proportionality holds for amounts of radiation so low that they are barely measurable. There appears to be no threshold of radiation below which there is no damage.1 Ways in Which We Are Exposed to Radiation Some radiation is unavoidable because it comes from outer space and from natural objects such as rocks. Other radiation results from nuclear explosions or from the venting of radioactive materials into the air, which occurs either accidentally or routinely in nuclear power plants. Still other radiation is received from medical x-rays. By eliminating all medical radiation other than that which is crucial (e.g., x-rays for a broken bone), we can cut the harmful effects of radiation approximately in half. It should be noted that dental xrays constitute a very low exposure compared to chest x-rays. Also, x-rays to the extremities are not as bad

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

as those to the trunk of the body, wherein lie the organs. X-rays to the genital area are especially to be avoided if one expects to conceive offspring. There is reason to suspect that chest x-rays may contribute to breast cancer. Low-Frequency Radiation Presently there is a growing concern among scientists that the electromagnetic radiation from power lines, television sets, computer monitors, electric stoves and heaters, etc. causes damage to cells. The extent of this danger is presently unknown, but it is best to play safe and minimize such exposure. A recent report in Macworld Magazine on the emission ranges of monitors regularly used with Macintosh computers explains some of the risks.2 Free Radicals Free radicals are molecules that are ingested or produced within the body that combine haphazardly with the molecules of living cells. Free radicals damage the cells of all the bodily organs especially the heart and arteries. Free radicals are formed in foods during processing, storage, or cooking. Fats, especially unsaturated ones, are subject to free-radical formation when they are exposed to heat, light, or oxygen. To avoid the introduction of free radicals into the body, you should avoid damaged fats. Damaged fats include not only foods fried in vegetable oil but bottled oils, most of which have been exposed to processing, heat, light, and oxygen. Since fats are essential to health, one should eat a moderate amount of fats that occur in raw, whole seeds and nuts or in steamed or baked cold-water fish. Such foods are rich in undamaged essential fatty acids. The undesirable fats should be avoided. An excellent book on fats and oils by Udo Erasmus 3 is essential reading. Once free radicals have been introduced into the body, they are removed and their damaging effect is offset by substances called anti-oxidants. Vitamin C, vitamin E, zinc, and selenium are examples of antioxidants. It is ironic that the very oils which produce the free radicals have had the vitamin E removed in the refining process. Moreover, white flour, the staple of the American diet, has had all of the zinc and vitamin E removed, as well as other vital nutrients. When the natural anti-oxidants are unavailable, the body utilizes cholesterol to clean out the free radicals. To attempt to reduce blood cholesterol levels by removing cholesterol from the diet does not address the problem of free radicals and may place an additional burden on the body to manufacture its own cholesterol. The answer is to lower intake of free radicals and increase the intake of antioxidants. Nutrition Another manner in which cells are damaged is by not receiving the nutrients required for their functioning, repair, or reproduction. Every cell in our body requires a supply of oxygen, vitamins, minerals, amino acids, sugar, etc. Every cell also requires that waste products such as carbon dioxide be eliminated from it. It is not sufficient to eat a well-balanced diet. The food must be digested, absorbed into the bloodstream, and routed to the appropriate cells. Optimal digestion and absorption are unlikely when foodstuffs are haphazardly consumed without regard to their mode of digestion and the effect of one upon the digestion of the other. Full discussion of this topic is beyond the scope of this book but can be found in Herbert Sheltons excellent book on combining foods.4

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

Unfortunately, most foods lack essential vitamins and minerals. This lack results from forcing foods to grow in impoverished soil, from losing vitamins and minerals during processing, or from purposely removing nutrients. For example, wheat products such as bread, pasta, cake, cookies, crackers, and cereals are made almost exclusively from white flour rather than whole-wheat flour. Even bread labeled made from 100% whole-wheat flour is often made primarily from white flour and some 100% whole -wheat flour, as can be verified by reading the list of ingredients. White flour is whole wheat, from which is removed most of the magnesium, zinc, iron, selenium, chromium, vitamin E, and B vitamins. Then iron (in a less assimilable form) plus three B vitamins are added as a token gesture (enriching). In addition to our being deprived of essential nutrients, we are subjected to the stresses discussed next, some of which increase our requirements for vitamins and minerals. Gary Price Todd 5 has written a valuable book that clarifies the role of supplements. Repeated Cellular Reproductive Demand Widespread or repeated damage to cells requires many cell divisions for the repair of the damage. The greater the number of reproductions that occurs, the greater the probability that errors will be made. Such errors can result in (a) tissue that is unable to perform its specialized function, (b) an inability to reproduce past a certain point, and (c) cancerous growth. Excessive or Insufficient Sunlight Health consequences stem from exposure to too much or too little sunlight (see article on sunlight). Insufficient Sleep There are many important restorative effects that occur during sleep. During the day, our body is under the constant pull of gravity in a vertical direction. Gravity compresses the spine and requires the heart and vascular system to pump blood against its pull. When sleeping, which is usually done lying down, the heart and vascular system can rest, and the spine can regenerate. Of course, merely lying down will give similar benefits, but there are other benefits that only occur during sleep. For example, certain hormones such as growth hormone and cortisol are secreted only during sleep. Also, the brain and nervous system go into a state that does not occur while awake. Many of the benefits of sleep occur during meditation, and those who meditate regularly often require much less sleep. Stimulants such as coffee, tea, and chocolate cause difficulty in falling asleep, and then, the minimal sleep that occurs is not deep. Stimulants also lead to overdrawing ones energy account, which is never adequately paid back. Also, work schedules and alarm clocks also cause many people to incur a sleep deficit. Excessive Sexual Activity For the male, excess sexual activity is not without a cost. Sperm requires energy and nutrients for its production, and engaging in excessive sexual activity tends to stimulate a larger than normal production of sperm. Moreover, the production of seminal fluid requires nutrients that are lacking in the diets of many. For example, the secretion of the prostate contains relatively large amounts of zinc, and unless one eats a diet primarily consisting of natural foods or takes mineral supplements, that mineral is not easy to get. The main staple of the American diet, white flour, has had essentially all of its vitamins and minerals removed in the refining process. Whole-wheat flour, from which white flour is made, is rich in many nutrients, especially zinc.

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

On the other hand, excessively abstaining from sexual activity is probably a bad idea. At the very least, large amounts of mental energy are required for abstinence. Moderation is, of course, the answer. Poisons A poison is any substance that has an adverse physiological relationship to the growth and nutrition of the cells of the body. There are a multitude of poisons that harm us and are, consequently, to be avoided. Among these poisons are artificial flavors, artificial colors, preservatives, polluted air, polluted water, damaged fats, alcohol, caffeine, mercury-amalgam dental fillings, inoculations, most pharmaceuticals, and products of putrefaction in the gut. Whenever a poison enters the body, it is transported to all of the cells of the body via the blood. Cells that are bathed in these poisons are altered deleteriously in function. Aside from the physical damage caused by poisons, there is an addictive effect. The addictive effect stems from the fact that as the poison is eliminated, the cells must resume their original function. However, by now, some of the essential constituents of the cell may have been released and are no longer available. Thus, it may be easier for the body to adapt to the elimination of a poison by the introduction of more of that poison. This adaptation is experienced as a craving for the poison that was eliminated and explains addiction. Therefore, it is imperative that poisons be avoided.

14. What are the manifestation in other process?

Organ/Function Abnormal Growth Arteries Ageing Symptoms Cancers, hyperplasia, and macromolecular aggregates become common. Cholesterol and calcium buildup, walls thicken, arteries harden, high blood pressure, risk of heart attack. Connective tissue weaken, lower capacity to store urine, and reduced efficiency of emptying content. White blood cell and red blood cell count decrease. Weight declines between age 55 and 75, due mostly to loss of lean tissue, muscle mass, water, and bone. Loss of bone cells accelerates at about age 35, bones become porous and brittle in the demineralizing process. Osteoporosis is common in women. Gradual loss of brain tissue ( 5-10% by age 90), slow reaction, faltering memory, insomnia. Mammary (milk secreting) glands reduce in size, as does the breast. Gradual loss of the ability to hear higher frequencies, starting around age 30; hair grows in auditory canal.

Bladder (65) Blood Body Weight

Bones (35) Brain (20) Breast (35) Ear (55)

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

Eye (40) Face Fat Hair (30) Heart (40) Hormones Immunity Joints More far-sighted, problem with focusing, difficulty in adjusting to light intensity, perception of hues altered. Wrinkles, facial hair, bags under the eyes, double chin, longer ears, thinning cheek. Fat content and distribution change, storage increases Graying, thinning, balding. Thickening of heart wall, gradual lose of effectiveness as a pumping machine. The level of several hormones, e.g., GH, DHEA, IGF, ... falls with age, may be a major cause on ageing. Body's power to combat infection declines; auto-immune responses increase. Cartilage becomes cracks and frays, cushioning fluid gets thinner, tendons and ligaments are less resilient. Weight & volume of the kidneys shrink, marked reduction in the cleansing of impurities from the blood. The ageing process does not affect adversely the liver. Lose elasticity and capacity (40% between ages 20 and 80), increasing difficulty to oxygenate blood. Ability to metabolize sugar decreases with age, reduction of food intake may prolong life. Loss of muscular mass, partly due to un-use, other causes include loss of blood flow and energy supply. Demyelination - loss of myelin covering of nerve fibers, which is characteristic of neurological disorders. Ability to smell declines after age 65, amount of reduction varies widely between individuals. Reduction in semen making after 60, enlargement in size may cause difficulty to urinate. Mental and physical responses to specific stimuli become slower. Women go through menopause at ages of 45 - 50, reduced level of estrogen affects the whole body. Men's reproductive change with age is more like a reduction than a cessation. Wrinkles (related to decreased mitochondrial function), dryness, dark spots.

Kidneys (50) Liver (70) Lungs (20) Metabolism (55) Muscles (30)

Nerve Nose (60) Prostate (50) Reaction Time Reproductive System (35) Skin (25)

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

Teeth (40) Thermoregulation Tongue (60) Voice (65) Teeth gum recession Response to changes in environmental temperature becomes impaired. Sense of taste loses only gradually with age, with equal reduction of all flavors. Voice becomes weak and muffled

Table 01 Ageing Symptoms

16. What are the dissease to occure the aging process?

1. Vision changes/Cataracts, glaucoma and macular degeneration

Before an individual turns 50, his eyes have begun to change. As they age, the eyes become less able to produce tears, the retinas thin, and the lenses gradually turn yellow and become less clear. As aging progresses, the iris (the colored portion of the eye) stiffens, turns less responsive and it is more difficult to adapt to different light levels. The three most common ailments related to aging eyes are cataracts, glaucoma and macular degeneration. A cataract is a clouding of the lens that affects vision. Most cataracts are related to aging. In a patient with the eye disease glaucoma the normal fluid pressure inside the eyes slowly rises, which can lead to vision loss or blindness if not treated. Age-related macular degeneration causes no pain but gradually robs an individual of his/her clear, central vision. AMD is the leading cause of vision loss in people over 60.
2. Hearing loss

One in three people older than 60, and half of those older than 85 have hearing loss, according to the National Institute on Deafness and Other Communication Disorders. Gradual hearing loss that occurs from aging is called presbycusis and is thought to run in families. NIDCD reports that hearing loss can also be caused by a virus or bacteria, heart condition or stroke, head injury, tumors and certain medications. Hearing loss hinders or prevents vital communication with family, friends and caregivers, banishing an individual to virtual isolation. This can cause frustration, anger and depression.
3. Arthritis

This chronic disease is an inflammation of the joints. The most common type is osteoarthritis, and although it can occur in any joint, it most often affects the hands, knees, hips or spine. The exact cause is not known. Although it occurs after considerable wear and tear on the joints (in older people and athletes, for instance), heavy "wear and tear" alone cannot cause it to occur. It is believed the disease runs in families.
4. Sleep changes/disorders

By the time an adult is 65 or older, their sleep-wake cycle does not work as well. Typical changes an older person experiences include getting sleepy earlier than usual, trouble falling asleep, not sleeping soundly and waking early. Alcohol, caffeine and smoking can wreak havoc on the sleep cycle, as can illness, pain or certain medications. The elderly are especially vulnerable to insomnia, a disorder that prevents sleep, sometimes night after night, which can lead to sleep deprivation. Sleep disorders such as sleep apnea (can cause daytime sleepiness and worsen high blood pressure and

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

heart disease), restless leg syndrome (may prevent falling asleep) and periodic limb movement disorder (can interrupt sleep and result in daytime sleepiness), affect older people and are treatable.
5. Osteoporosis

This silent disease is more common in women than in men, because they have less bone mass to begin with, tend to live longer and take less calcium and need estrogen to keep their bones strong. However, if men live long enough, they too are at risk. As many as half of all women and a quarter of men older than 50 will break a bone due to osteoporosis, according to the National Institutes of Health. Risk factors for the disease include aging, a thin body and small bone frame, a family history of osteoporosis, taking certain medications, being a Caucasian or Asian woman and low bone mass. An individual with osteoporosis is often unaware she has the disease until she suffers a broken bone, low back pain or develops a hunched back. The disease can cause the vertebrae to collapse, so the person may also get shorter over time. There is no cure, so those afflicted must learn to manage the disease with nutrition, exercise and medication.
6. Cardiovascular disease and stroke

With age the heart becomes less efficient and must work harder to circulate blood throughout the body. Blood vessels lose their elasticity. The loss of elasticity, along with atherosclerosis (caused by hardened fatty deposits on the arterial walls), makes the arteries inflexible, which forces the heart to work harder. This process leads to high blood pressure. High blood pressure, along with atherosclerosis and uncontrolled diabetes (see below) are two major risk factors for stroke. A stroke can occur without warning and cause temporary or permanent brain damage and related loss of bodily function(s), depending on the area of the brain where the blockage occurs. "One in three people older than 60, and half of those older than 85 have hearing loss. " National Institute on Deafness and Other Communication Disorders Thought at one time to be part of the normal aging process, cardiovascular disease and stroke are two disease processes that are now known to be influenced by lifestyle. Smokers, those who eat a lot of meat and fat and have high cholesterol levels are at high risk for this condition.
7. Diabetes

Nearly 17 million people have diabetes in the U.S. today, according to the American Academy of Family Physicians (AAFP). The blood sugar levels of a person with diabetes are too high. The disease prevents the body from producing any insulin (Type 1); or, the body does not produce enough insulin or the cells ignore the insulin (Type 2). As a result, the glucose/sugar builds up and stays in the blood instead of being distributed to the cells. Nearly 95% of people with diabetes have Type 2, according to AAFP. There is no cure, but people with diabetes can live a healthy life by controlling their glucose levels. This can be accomplished with good nutrition, exercise, maintaining a healthy weight and taking oral medications or insulin. Untreated, diabetes can lead to blindness, heart disease, nerve and blood vessel damage and kidney damage.
8. Cancer

This disease evokes universal fear when mentioned, and while it strikes people of all ages, adults are more

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

likely to get cancer as they age (even if no one in your family has had it). According to the National Institute on Aging, cancer begins when cells in one part of the body become abnormal and begin multiplying. These extra cells form a mass of tissue called a tumor; as it gets larger it can harm nearby tissue and organs. The cancer can break away and spread to other parts of the body. People over 50 should have tests on a regular basis to screen for specific cancers: breast cancer (clinical breast exam and mammogram); cervical and other cancers (pap test and pelvic exam); colorectal cancer (fecal occult blood test, sigmoidoscopy and colonoscopy); mouth and throat cancers (oral exams); prostate cancer (digital rectal exam and Prostate Specific Antigen (PSA)); and skin cancer (skin exams) 17. What is the pshycological changes for the aging process? Understanding about the psychological changes of the elderly will help those who are caring for elderly patients to be better prepared as caregivers. As people get older bodily function decreases so some of the main functions that changes are in vision, hearing, touch, skin, endoctrine, renal, and musculoskeletal. Health management for older adults consists of determining the reasons for loss of independence in the elderly, some symptoms include the high incidence of dementia caused by psychological changes such as in the decline of mental and physical abilities, the diminishing mental health and cognitive functions leads many adults to seek assistance from family members or institutions. Physiological effects of Social Change Studies have been conducted that show how the social changes in aging causes physiological effects for the elderly simply from the standpoint of how men and woman think of aging differently. Some social characteristics facing woman as they age is that they usually live longer and face the loss of family members and friends. This results in the need for emotional healing and elimination of stress. Elderly mens changing roles of social status allows them to create coping skills requiring more social involvement as well as the continuous process of learning ways to strengthen their mental abilities. Physical health conditions caring for elderly Some of the most common health conditions among the aging elderly are

Alzheimers Parkinsons diabetes heart disease vision and eye disease osteoporosis arthritis cancer

LBM 5 TUMBUH KEMBANG & GERIATRI Miranti

incontinence mental health hearing and sleep disorders. Aging is a process where over time individuals experience a decline in performance, productivity and health. Age related regenerative diseases are different from person to person due to genetics, lifestyle and the change between biological and physiological age. The breakthroughs in clinical medicine will help in the connection between age and disease.

National Institutes of Health and the U.S. National Library of Medicine http://www.nlm.nih.gov/medlineplus/seniorshealth.html http://hubpages.com/hub/Elderly-Nutrition http://hubpages.com/hub/Caring-Elderly-Parent-Guide