NORMAL AGING                                   Definition of aging, Life                                   expectancy/maxi...
Eos and TithonusEos locked Tithonus in a bedroom cupboard and threw away the key in disgust
Aging Offers No Evolutionary     Advantage   From the evolutionary perspective living past the age of    procreation does...
Is Old Age a Human Achievement  Wrestled From Nature? Most   Qualities of Old Age Are Uniquely Human: -Only human beings ...
Human Beings Have an InbornLonging for Meaning Inold age the question of the ultimate  meaning cannot be postponed any  l...
Facing the Unknown Do not cast me off in old age; when my strength fails do not forsake me                    Psalm 71:9
Facing Memory Loss  “Bodily decay is gloomy in prospect, but of all  human contemplations the most abhorrent is  body with...
G.O.M.E.R—Get Out of My ER
GOMERS –Modern Version ofTithonus Gomers are human beings who have lost what goes into being human beings. They want to d...
Shall we ration medical care of theelderly? The “fair innings” argument Medical ethicist Daniel Callahanwrites:―Is there...
―The Crowning Glory of Old Age‖. Aging   is the goal of life - makes us complete    Freed from the youthful intensity of ...
Carl Jung: Aging with Meaning“A human being would certainly not grow to be seventy or eightyyears old if this longevity ha...
Viktor Frankl: Mans Search for    Meaning   The primary motivational force in man is the striving to find a    meaning. ...
Gene Cohen (1944-2009)      Cohen suggests the development of a “social portfolio”       to enable everyone to cultivate ...
Free to Find Meaning
Harvard Grant Study   Began in 1938 - follows the health, happiness and fortunes of    268 male Harvard students, and goe...
Longitudinal Study of Aging Danish    TwinsGenetics account for 25% of the variation in longevity among twins,and environm...
The Blue Zones         Blue Zones: four different regions around the         world in which the highest percentage of     ...
―Age I must, but I would rather not‖        “Endpoint” John Updike Definition           of Aging: a series of time depend...
What is Old? Young-old  adults: 55-75 y/o Old-old adults: 75-85 y/o Oldest-old adults: 85+ y/o
Life Expectancy vs. Maximum   Lifespan Lifeexpectancy – the average number of years an  individual is expected to live. ...
Life Expectancy - Increasing   The number of people over 65 is growing rapidly.   In 1870 there were 1 million people ov...
Maximum Lifespan - Unchanged Jeanne   Calment (1875-1997)                                 She reportedly                 ...
How We Age? Sophocles, wrote the story of Oedipus when he was 90. Oedipus became king because he solved the famous riddl...
Erikson - Stage Nine of PsychosocialDevelopment                       Joan Erikson:                        -In the ninth ...
Lars Tornstam - Gerotranscendence                   -Becoming less self-occupied                   -Increased feeling and ...
Gerotranscendence ?
Why We Age? Over300 theories, but there is no unified theory of aging. Organismal   and Cellular Aging
Organismal Aging-As we age there is a steadydecline in physiologicreserves-Recovery takes longer-Reduced ability tocompens...
Homeostasis, Homeostenosis   and Reserve Capacity-Reduced capacity to maintain homeostasis during stress-Decompensation un...
Brain Vulnerability and Cognitive      Reserve   Reduced capacity to maintain homeostasis   Vulnerability of elderly for...
Cognitive Reserve A Poet’sViewMy history falls away, like sacks of grain froma careless farmer’s wagon.I begin to forget e...
Cellular Aging   In 1961 Dr. Leonard Hayflick published a    classic paper on cellular aging.   Normal cells could under...
Telomeres - ticking ―cellularclocks‖ Resemble  aglets on the ends of shoelaces Each time a cell divides, its telomeres  ...
Telomerase – lengthen telomeresduring early development                        Telomerase is a protein                    ...
Telomere Shortening and  Increased Telomerase Activity Has been observed in many human diseases, including atherosclerosi...
Telomere Shortening in Schizophrenia   Shortened telomere length in chronic schizophrenia may be contributing to the    p...
Progeria - telomere damage increases    progerin production   Patients with progeria experience premature aging.   Accel...
Rapamycin and Progeria   Sirolimus (Rapamycin) is an immunosuppressant    drug used to prevent rejection in organ    tran...
Fountain of Youth Lucas Cranach the Elder 1546
Is it possible for the cells of our bodies    to become immortal?   The answer is YES, but there is a catch. We have to g...
Aging vs. Cancer    Longevity - the extent to which the cells retain the capacity to    repair damage done to the DNA.S Da...
SIRT 3 Protects Genomic Stability to Combat         Aging and Cancer                                                      ...
―Can’t see, can’t hear, can’twalk, but at least I can drive
Why Is Driving an Issue?   Automobile crashes are the third leading    cause of death and injury in the United States    ...
Crashes by Driver Age       (Source: Cerrelli, 1998)
The Law
AD was added to the list of the    disorders that may make driving    hazardousCalifornia is one of the six states in the ...
California Health and SafetyCode Section 103900   They are specific to physicians and surgeons    per section 103900 of t...
LiabilityPhysicians are considered negligent if they do not informpatients of medications and medical conditions that cani...
Reporting to the local healthauthority2802 AD and related disorders. Means those illnesses that   damage the brain causing...
Normal aging
Normal aging
Normal aging
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Normal aging

  1. 1. NORMAL AGING Definition of aging, Life expectancy/maximum lifespan, cellular and organismal aging, Rapamycin, progeria, telomeres, aging and cancer,Rembrandts self-portrait age 63 elderly driver ADONIS SFERA,MD
  2. 2. Eos and TithonusEos locked Tithonus in a bedroom cupboard and threw away the key in disgust
  3. 3. Aging Offers No Evolutionary Advantage From the evolutionary perspective living past the age of procreation does not make sense.
  4. 4. Is Old Age a Human Achievement Wrestled From Nature? Most Qualities of Old Age Are Uniquely Human: -Only human beings care and honor the oldestmembers of the species. -Only human beings care for and remember theirdead. Harry R. Moody; Aging Concepts and Controversies, 6th ed. Pine Forest Press 2010
  5. 5. Human Beings Have an InbornLonging for Meaning Inold age the question of the ultimate meaning cannot be postponed any longer.
  6. 6. Facing the Unknown Do not cast me off in old age; when my strength fails do not forsake me Psalm 71:9
  7. 7. Facing Memory Loss “Bodily decay is gloomy in prospect, but of all human contemplations the most abhorrent is body without mind” Thomas Jefferson
  8. 8. G.O.M.E.R—Get Out of My ER
  9. 9. GOMERS –Modern Version ofTithonus Gomers are human beings who have lost what goes into being human beings. They want to die, and we will not let them. We’re cruel to the gomers, by saving them, and they are cruel to us, by fighting tooth and nail against our trying to save them. They hurt us, we hurt them. Samuel Shem ―The House of God‖
  10. 10. Shall we ration medical care of theelderly? The “fair innings” argument Medical ethicist Daniel Callahanwrites:―Is there an obligation to keep the elderly alive aslong as possible, regardless of the cost of doingso? Perhaps there is a duty to help young peopleto become old people, but not to help the oldbecome still older indefinitely.‖
  11. 11. ―The Crowning Glory of Old Age‖. Aging is the goal of life - makes us complete Freed from the youthful intensity of physical passions and girded with knowledge and wisdom, the accrued influence is “the crowning glory of old age”. ―Of Old Age‖ Cicero Cicero
  12. 12. Carl Jung: Aging with Meaning“A human being would certainly not grow to be seventy or eightyyears old if this longevity had no meaning for the species. Theafternoon of human life must also have a significance of its own andcannot be merely a pitiful appendage of life’s morning.”
  13. 13. Viktor Frankl: Mans Search for Meaning The primary motivational force in man is the striving to find a meaning. When we are no longer able to change our situation - we are challenged to change ourselves.
  14. 14. Gene Cohen (1944-2009)  Cohen suggests the development of a “social portfolio” to enable everyone to cultivate a sense of meaning, vitality and dignity in later life.  Changed the image of aging from one of senescence and senility to a period of creativity.Marc E. Agronin; “How We Age”A Doctor’s Journey Into the Heart of Growing Old; Da Capo Press 2011
  15. 15. Free to Find Meaning
  16. 16. Harvard Grant Study Began in 1938 - follows the health, happiness and fortunes of 268 male Harvard students, and goes on to this day. Continues to yield a treasure trove of data about how people behave, and change in old age including predictions of strong indicators to a happy life.
  17. 17. Longitudinal Study of Aging Danish TwinsGenetics account for 25% of the variation in longevity among twins,and environmental factors for 50%.With greater longevity (to age 90 or 100), genetic influences becomemore important than environmental factors.
  18. 18. The Blue Zones Blue Zones: four different regions around the world in which the highest percentage of centenarians live. -Sardinia, Italy; -Okinawa, Japan; -Loma Linda, California; and the -Nicoya Peninsula, Costa Rica. Buettner asserts that centenarians live longer and better because of the foods they eat, the social circles they keep, and their outlook on life.
  19. 19. ―Age I must, but I would rather not‖ “Endpoint” John Updike Definition of Aging: a series of time dependent anatomical and physiological changes that reduce physiological reserve and functional capacity (Ahmed and Tollefsbol 2001).
  20. 20. What is Old? Young-old adults: 55-75 y/o Old-old adults: 75-85 y/o Oldest-old adults: 85+ y/o
  21. 21. Life Expectancy vs. Maximum Lifespan Lifeexpectancy – the average number of years an individual is expected to live. Maximum lifespan –the longest a member of each species can survive.
  22. 22. Life Expectancy - Increasing The number of people over 65 is growing rapidly. In 1870 there were 1 million people over 65 in the US In 2000 there were 35 million people over 65.
  23. 23. Maximum Lifespan - Unchanged Jeanne Calment (1875-1997) She reportedly smoked and drank a glass of Port up until the age 117.
  24. 24. How We Age? Sophocles, wrote the story of Oedipus when he was 90. Oedipus became king because he solved the famous riddle of the Sphinx :“What creature walks on four legs in the morning, two legs atnoon, and three legs in the afternoon?”
  25. 25. Erikson - Stage Nine of PsychosocialDevelopment Joan Erikson: -In the ninth stage the old person confronts all previous eight stages again, but this time all stages converge at the same time. -The negative pole now takes the dominant role over the positive. For instance, instead of confronting trust versus mistrust, in the ninth stage the elder confronts mistrust versus trust
  26. 26. Lars Tornstam - Gerotranscendence -Becoming less self-occupied -Increased feeling and attachment with past generations -Decreased interest in superficial or unnecessary social interaction -Taking care of the body without being obsessed about it -Decreased interest in material things -Positive solitude becomes more Important -Decrease in right-wrong duality is accompanied by an increased broadmindedness & sense of tolerance -Fear of death disappears and a new understanding of life & death emerges - Increased feeling of cosmic communion and a redefinition of time, space, life and death.
  27. 27. Gerotranscendence ?
  28. 28. Why We Age? Over300 theories, but there is no unified theory of aging. Organismal and Cellular Aging
  29. 29. Organismal Aging-As we age there is a steadydecline in physiologicreserves-Recovery takes longer-Reduced ability tocompensate for illness orphysiologic demands-Illnesses accumulate innumber and severity-Physiologic decline plusdisease results in excessmorbidity and disability
  30. 30. Homeostasis, Homeostenosis and Reserve Capacity-Reduced capacity to maintain homeostasis during stress-Decompensation under a variety of mild perturbations- homeostenosis. Richard W. Besdine, Dinfu Wu;Aging of the Human Nervous System: What do We Know”;Geriatrics, Vol 91,May 2008
  31. 31. Brain Vulnerability and Cognitive Reserve Reduced capacity to maintain homeostasis Vulnerability of elderly for delirium even with mild illnesses or adverse effects of drugs.
  32. 32. Cognitive Reserve A Poet’sViewMy history falls away, like sacks of grain froma careless farmer’s wagon.I begin to forget everything.Joseph Skibell ―A Blessing On The Moon‖
  33. 33. Cellular Aging In 1961 Dr. Leonard Hayflick published a classic paper on cellular aging. Normal cells could undergo a limited number of divisions. The Hayflick limit specifies that fetal cells can only divide 40-60 times before their death. Telomeres shorten with each division
  34. 34. Telomeres - ticking ―cellularclocks‖ Resemble aglets on the ends of shoelaces Each time a cell divides, its telomeres shorten
  35. 35. Telomerase – lengthen telomeresduring early development Telomerase is a protein that is found in all cells, but in normal cells, it is turned off. In abnormal cells like tumors and germ cells, however, telomerase is active it is capable of producing new telomeres in aging cells.
  36. 36. Telomere Shortening and Increased Telomerase Activity Has been observed in many human diseases, including atherosclerosis, cancer, aging syndromes, Alzheimer disease and schizophrenia.
  37. 37. Telomere Shortening in Schizophrenia Shortened telomere length in chronic schizophrenia may be contributing to the progressive deterioration in treatment-resistant schizophrenia.H-T Kao, R M Cawthon, L E DeLisi, H C Bertisch, F Ji, D Gordon, P Li, M M Benedict, W M Greenberg and B Porton; Rapid telomereerosion in schizophrenia; Molecular Psychiatry (2008) 13, 118–119; doi:10.1038/sj.mp.4002105
  38. 38. Progeria - telomere damage increases progerin production Patients with progeria experience premature aging. Accelerated aging begins at around 16 to 18 months of age, and by the time they are 10, the children look 70-80. Patients on average die of stroke or heart disease complications by the age of 13
  39. 39. Rapamycin and Progeria Sirolimus (Rapamycin) is an immunosuppressant drug used to prevent rejection in organ transplantation. It was recently shown that rapamycin may treat the accelerated aging condition progeria.
  40. 40. Fountain of Youth Lucas Cranach the Elder 1546
  41. 41. Is it possible for the cells of our bodies to become immortal? The answer is YES, but there is a catch. We have to get cancer to do it. Henrietta Lacks He-La cells
  42. 42. Aging vs. Cancer Longevity - the extent to which the cells retain the capacity to repair damage done to the DNA.S Dan Zhang, Yufei Liu, and Danica Chen; SIRT-ain relief from age-inducing stress; AGING, Vol 3, No 2 , pp 158-161
  43. 43. SIRT 3 Protects Genomic Stability to Combat Aging and Cancer Damage to DNA activates "gate-keeping" tumor suppressors like p53, which protect against cancer, but can promote aging. "Care-taking" tumor suppressors like SIRT3 protect against DNA damage, which may result in protection against both aging and cancer.Katharine Brown, Stephanie Xie, Xiaolei Qiu, Mary Mohrin, Jiyung Shin, Yufei Liu, Dan Zhang, David T. Scadden , and DanicaChen ;SIRT3 Reverses Aging-Associated Degeneration; Cell Reports, doi:10.1016/j.celrep.2013.01.005
  44. 44. ―Can’t see, can’t hear, can’twalk, but at least I can drive
  45. 45. Why Is Driving an Issue? Automobile crashes are the third leading cause of death and injury in the United States with 40,000 to 50, 000 people killed in about 2 million accidents per year. In 2001-2002 drivers over the age of 75 had a higher rate of fatal accidents nationwide. This problem is expected to grow because by 2024, one in four U.S. drivers will be over age 65. National Older Driver Research and Training Center
  46. 46. Crashes by Driver Age (Source: Cerrelli, 1998)
  47. 47. The Law
  48. 48. AD was added to the list of the disorders that may make driving hazardousCalifornia is one of the six states in the Nation with mandatory reportingof persons with disorders that may make driving hazardous, includingAlzheimer’s disease.
  49. 49. California Health and SafetyCode Section 103900 They are specific to physicians and surgeons per section 103900 of the Health and Safety Code. The physicians who reports a patient diagnosed with a disorder characterized by lapses of consciousness, according to the Health and Safety code 103900, shall not be civilly or criminally liable to any patient for making the report.
  50. 50. LiabilityPhysicians are considered negligent if they do not informpatients of medications and medical conditions that canimpair driving 1. Physicians may be held liable for civil damages if they clearly failed to report an impaired driver who causes a MVC. 2. Immunity is granted to the physician if the patient is reported prior to a MVC. 3. Document all referrals, recommendations, conversations, and reports (e.g. copy of a driver retirement letter and “do not drive” prescription).
  51. 51. Reporting to the local healthauthority2802 AD and related disorders. Means those illnesses that damage the brain causing irreversible, progressive, confusion, disorientation, loss of memory and judgment.2806 Disorders characterized by lapses of consciousness. Loss of consciousness or a marked reduction of alertness or responsiveness to external stimuli, inability to perform one or more ADLs, the impairment of the sensory motor functions used to operate a motor vehicle California Code of Regulations (CCR) title 17 sub-chapter 2.5― Disorders characterized by lapses of consciousness‖ sections 2800-2812.
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