2. Index
Definitions and postulates.
Myths and facts about ageing.
Consequences of ageing.
Mechanism of ageing.
Why do we age.
Theories of ageing.
Hall marks of ageing.
Structural changes aassociated with brain ageing.
Neurochemical changes with ageing in brain.
Mental health and personality.
Ageing and coping.
Theoratical aspect of ageism.
Succesful ageing.
3. Definition
Aging is characterized by a progressive loss of physiological integrity, leading to
impaired function and increased vulnerability to death.
It is cumulative, processes that interfere with the function of the body.
López-Otín, C., Blasco, M. A., Partridge, L., Serrano, M., & Kroemer, G. (2013). The hallmarks of aging. Cell, 153(6), 1194–1217. https://doi.org/10.1016/j.cell.2013.05.039
4. Definitions.
Primary ageing: aka normal ageing refers to maximum life span of species,
unaffected by smoking , drinking, diet etc.
Secondary ageing : is defined as life expectancy of an individual , affected by
genetics and environmental factors.
young-old (65-74 years)
old-old (≥ 75 years),
old age (75-84 years),
old-old age (85-94 years)
oldest-old age (≥ 95 years).
López-Otín, C., Blasco, M. A., Partridge, L., Serrano, M., & Kroemer, G. (2013). The hallmarks of aging. Cell, 153(6), 1194–
1217. https://doi.org/10.1016/j.cell.2013.05.039
5. Epdemiology
• Between 2015 and 2050, the proportion of the world's population over 60
years will nearly double from 12% to 22%.
• By 2020, the number of people aged 60 years and older will outnumber
children younger than 5 years.
• In 2050, 80% of older people will be living in low- and middle-income
countries.
• The pace of population ageing is much faster than in the past.
• All countries face major challenges to ensure that their health and social
systems are ready to make the most of this demographic shift.
(2010). Some macroeconomic aspects of global population aging. Demography, vol. 7, pp.151-172.
6. Strehler, a very well-known American gerontologist,
defines ageing by means of four postulates
Ageing is universal
Ageing must be intrinsic
Ageing must be progressive
Ageing must be deleterious
López-Otín, C., Blasco, M. A., Partridge, L., Serrano, M., & Kroemer, G. (2013). The hallmarks
of aging. Cell, 153(6), 1194–1217. https://doi.org/10.1016/j.cell.2013.05.03
7. Myths and facts about ageing
1.Depression and loneliness are normal in older adults
2. The older I get, the less sleep I need.
3. Older adults can’t learn new things.
4. It is inevitable that older people will get dementia.
5. Older adults should take it easy and avoid exercise so they don’t get injured.
6. If a family member has Alzheimer’s disease, I will have it, too.
7. Now that I am older, I will have to give up driving.
8. Only women need to worry about osteoporosis.
9. I’m “too old” to quit smoking.
10. My blood pressure has lowered or returned to normal, so I can stop taking my
medication
Mulley G. (2007). Myths of ageing. Clinical medicine (London, England), 7(1), 68–72.
https://doi.org/10.7861/clinmedicine.7-1-68
9. Mechanisms of ageing
Aging begins with biochemical
changes at the molecular level
Deficits in functional capacity lead to
loss of physiologic reserve.
Decreased homeostatic control and
increased morbidity and mortality.
Cefalu C. A. (2011). Theories and mechanisms of aging. Clinics in geriatric medicine, 27(4), 491–
506. https://doi.org/10.1016/j.cger.2011.07.001
10. Why do we age?
Currently, there are two main evolutionary
theories of aging:
Mutation accumulation theory
Antagonistic pleiotropy theory
11. Mutation
accumulation
theory
In this theory, older post-reproductive age
organisms expressing a mutation (which
has minimal effects on fitness) are under
little selective pressure.
These mutations accumulate over time
and yield the altered physiology that gives
rise to the aging phenotype.
Cefalu C. A. (2011). Theories and mechanisms of aging. Clinics in geriatric medicine, 27(4), 491–
506. https://doi.org/10.1016/j.cger.2011.07.001
12. Antagonistic
pleiotropy
theory of
aging
Genes that are favored by natural
selection have beneficial effects on early
fitness components in the young.
These genes may have harmful effects on
late in life fitness components, but the
force of natural selection lessens with
increasing age such that these genes
remain expressed in the population
Cefalu C. A. (2011). Theories and mechanisms of aging. Clinics in geriatric medicine, 27(4),
491–506. https://doi.org/10.1016/j.cger.2011.07.001
13. HALL MARKS OF AGEING
Three categories:
Primary hallmarks: This is the case of DNA damage (initiating triggers )
Antagonistic hallmarks: At low levels, they mediate beneficial effects, but at high levels,
they become deleterious (promotor or accelerator).
Integrative hallmarks: Stem cell exhaustion and altered intercellular communication.
López-Otín, C., Blasco, M. A., Partridge, L., Serrano, M., & Kroemer, G. (2013). The
hallmarks of aging. Cell, 153(6), 1194–1217. https://doi.org/10.1016/j.cell.2013.05.039
14. Brief description of
main theories of
aging
Evolutionary
Mutation accumulation* Mutations that affect health at older ages are not selected against.
Disposable soma* Somatic cells are maintained only to ensure continued reproductive
success; after reproduction, soma becomes disposable.
Antagonistic pleiotropy* Genes beneficial at younger age become deleterious at older ages.
15. Theories of ageing.
Molecular
Gene regulation* Aging is caused by changes in the expression of genes regulating both
development and aging.
Codon restriction Fidelity/accuracy of mRNA translation is impaired due to inability to
decode codons in mRNA.
Error catastrophe Decline in fidelity of gene expression with aging results in increased
fraction of abnormal proteins.
Somatic mutation Molecular damage accumulates, primarily to DNA/genetic material
Dysdifferentiation Gradual accumulation of random molecular damage impairs regulation of
gene expression
16. Cellular
Cellular senescence-Telomere theory* Phenotypes of aging are caused by an increase in
frequency of senescent cells. Senescence may
result from telomere loss (replicative senescence)
or cell stress (cellular senescence).
Free radical* Oxidative metabolism produces highly reactive
free radicals that subsequently damage lipids,
protein and DNA.
Wear-and-tear Accumulation of normal injury
Apoptosis Programmed cell death from genetic events or
genome crisis.
17. System
Neuroendocrine* Alterations in neuroendocrine control of homeostasis
results in aging-related physiological changes.
Immunologic* Decline of immune function with aging results in
decreased incidence of infectious diseases but increased
incidence of autoimmunity.
Rate-of-living Assumes a fixed amount of metabolic potential for every
living organism (live fast, die young).
18. Stress and ageing (allostatic load)
Predictors
Age (squared)
High perceived stress
Little physical activity
Smoking, Alcohol consumption
Caregiving
Job strain (effort-rewardimbalance,
low work safety, low decision latitude,
low job control)
Lower education Lower socio-
economic position
Allostatic load
BP, BMI, fasting insulin, GLC,
HDL and LDL cholesterol,
triglycerides, CRP, IL-6
BP, PR; HbA1c, total cholesterol,
HDL cholesterol, Predictors WHR;
CRP, serum albumin
BP, HR; GLC, insulin, BMI, WHR; 24-
h urine cortisol; HDL cholesterol,
cholesterol, triglycerides; serum uric
acid and GGT; CRP fibrinogen,
triglyceride, HDL and LDL, cholesterol
and cholesterolHDL ratio, HbA1c,
CRP, IL-6, BMI, SBP, and DBP
Allostatic load Outcomes
General cognitive
ability (Factor G) Non-
verbal reasoning Verbal
declarative memory
Knowledge Processing
speed
Total brain volume
White matter volume
Hippocampal volume
(inv.)
20. Important
Questions
Regarding Brain
Aging
Should benchmarks or reference ages be used to
calibrate the extent of age-related changes?
Are there biomarkers of chronological age?
Is brain aging a steadily progressive process or
does it accelerate?
How can “normal” aging be distinguished from
disease-related changes?
Are some brain pathological changes inevitable?
What factors are associated with more or less
severe age-associated brain changes?
Are some brain regions more susceptible to age-
related changes than others?
Do plasticity and cognitive reserve attenuate the
loss of function associated with brain aging?
21. Thresholds of
Pathology, Clinical
Disorders, and
Cognitive Reserve
Subthreshold changes related to aging
may increase vulnerability to pathology
For example: In Alzheimer.
Similarly, age-related decreases in the
strength of norepinephrine or dopamine
circuits.
Finally, brain aging may increase
someone’s vulnerability to develop
adverse cognitive side effects and develop
delirium .
Ctp 10th edition.
22. MECHANISMS IMPLICATED IN BRAIN AGING
1.Oxidative stress—damage to DNA, proteins, lipids
2. Mitochondrial damage
3. Protein misfolding and aggregation
4. Decreased endocrine support (e.g., estrogen and testosterone)
5. Decreased neurotrophic factor support
6. Impaired axonal transport
7. Impaired neurogenesis
Ctp 10th edition.
23. STRUCTURAL
CHANGES
ASSOCIATED
WITH BRAIN
AGING
Brain atrophy accompanies aging
1.Decline of brain weight
2. Neuron loss
3. Neuronal atrophy
4. Synaptic loss
5. Pruning of dendritic trees
6. Nucleolar atrophy
7. White matter changes
8. Gliosis
Ctp 10 th edition.
24. Lesions That Accumulate in the Brain with Age
1.Lipofuscin
2. Corpora amylacea
3. Neuromelanin
4. Amyloid deposits, including senile plaques
5. Vascular amyloid
6. Neurofibrillary tangles and argyrophilic grains
7. Lewy bodies
8. Aggregates of TDP43 and hippocampal sclerosis
9. Vascular (ischemic) lesions
Ctp 10th edition
25. NEUROCHEMICAL CHANGES IN
AGING
Dopamine and acetylcholine (cognitive and affective function).
PET imaging has been used to Study that there are age-associated declines in
levels of the dopamine transporter, dopamine D2 receptors, 5HT2 receptors,
and 5HT1a receptors.
Dopamine transporters and D2 receptors show a linear decline with age, but
serotonin 5HT2 receptors decline rapidly during the fifth decade of life
Ctp 10th edition.
26. Brain
Performance
Measures
That Worsen
with Aging
Cognition –
Mental speed
Fluid reasoning
Executive function
Retrieval
Episodic memory
Free recall worse than recognition
Movement –
Gait slowing
Simple reaction time slowing
Upward gaze
Balance changes (vestibular, sensory, motor, and brain)
New otp 3rd edition.
28. PROSPECTS FOR HEALTHY BRAIN
AGING
1. Control hypertension
2. Treat diabetes and vascular risk factors
3. Regular physical activity
4. Mental activity, e.g., cognitively demanding pastimes
5. Social activity, e.g., friend, family, and community interactions
6. Diet: similar components to a heart-healthy diet, e.g., a diet rich in
antioxidants and low in saturated fat, or a Mediterranean-type diet
Ctp 10th edition.
29. MENTAL HEALTH AND PERSONALITY
Early personality theorists proposed that development was completed by the
end of childhood or adolescence.
Erikson believed that development proceeded through a series of psychosocial
stages
Erikson termed the crisis of the last epoch of life integrity versus despair and
believed that successful resolution of this crisis involved a process of life
review and achieving a sense of peace and wisdom through coming to terms
with how one’s life was lived.
Ctp 10th edition.
31. Differences in Coping Strategies and Coping
Effectiveness.
“Coping” is a general term that refers to strategies that individuals use to manage stressful
life situations that involve perceived or actual threats.
Eg : distraction, passive avoidance, and positive reappraisal, and strategies designed to
solve the problem, such as direct action, confrontation, and information-seeking.
Older adults are more passive in their coping style.
The effectiveness of a coping strategy is defined by its outcome.
Ctp 10th edition.
32. Not all stress is bad: potentials
for resilience and the slowing of ageing
Mild or moderately aversive conditions during
childhood can shape an individual to be
optimally adapted to similar conditions later in
life
Stress mindset, the extent to which an individual
thinks a stressor is debilitating or enhancing is
said to be instrumental in the manifestation of
the stress response and the acceleration of
biological ageing
Otp 3rd edition.
33. Role Transitions
Transitions present the individual with the
challenge of having to redefine identity and to
create new roles to replace those that have been
lost.
Ctp 10th edition.
35. Spousal Bereavement.
Older adults might be less able to cope with the loss of a spouse than younger
adults, due to declining physical capabilities and subsequent decrements in the
ability to manage stress.
Ctp 10th edition.
36. Resilience of the Aging Self
Defined as the process of both maintaining adaptive behavior and positive
emotions when presented with stress as well as recovery from adversity.
Maintaining a strong sense of self-worth in the face of accumulating losses
may be an important part of resilience in aging.
Otp 3rd edition.
37. Summary of Age Effects on the Major Cognitive
Domains
Attentional Processes
Language Functions and Verbal Abilities
Visuoperceptual and Visuoconstructive Abilities
In visuoconstructive
Learning and Memory
Processing Speed
Executive Functions
Ctp 10th edition.
38. SUCCESSFUL AGING
Studies have found that high education, absence of alcohol abuse and
cigarette smoking, absence of depression, maintaining appropriate weight,
regular exercise, and social support are all significant predictors of
successful aging.
Intrinsic psychological factors such as resilience, spirituality, and optimism
have also been associated with successful aging.
Ctp 10th edition.
39. Developmental Tasks of Late Adulthood (that lead
to mental health)
To maintain the body image and physical integrity
To conduct the life review
To maintain sexual interests and activities
To deal with the death of significant loved ones
To accept the implications of retirement
To accept the genetically programmed failure of organ systems
To divest oneself of the attachment to possessions
To accept changes in the relationship with grandchildren
Kaplans Synopsis 12th edition.
40. IMPLICATIONS FOR CLINICAL PRACTICE
The clinician working with older adults should not expect that age itself is a
risk factor for poor outcomes.
41. Neuropsychological Evaluation
Neuropsychological assessment can be invaluable in geriatric mental health
care settings
Differential diagnosis among neuropsychiatric and neuropathological
conditions, and determination of long-term functional needs for treatment
and care planning.
Ctp 10th edition.
42. Rating scales in old age
psychiatry
There are five major clinical
domains that are relevant to
the old age psychiatrist:
mood; behaviour;
functioning; cognition; and
quality of life and carer
burden.
DEPRESSION DEMENTIA: COGNITIVE
IMPAIRMENT
BEHAVIOURAL AND
PSYCHOLOGICAL
SYMPTOMS
Geriatric Depression Scale Mini-Mental State
Examination
BEHAVE—AD
Brief Assessment Schedule
Depression Cards
Mental Test Score and
Abbreviated Mental Test
Score
MOUSEPAD
Cornell Scale for Depression
in Dementia
Clock drawing test Cohen-Mansfield Agitation
Inventory
Geriatric Mental State
Schedule
Seven-minute
neurocognitive screening
battery
Revised Memory and
Behaviour Problems
Checklist
Hamilton Rating Scale for
Depression
Alzheimer's Disease
Assessment Scale
Burns, A., Lawlor, B., & Craig, S. (2002). Rating scales in old age psychiatry. British Journal of
Psychiatry, 180(2), 161-167. doi:10.1192/bjp.180.2.161
43. Brain reserve in ageing
The brain retains plasticity and is able to adapt to damage by reorganization
and recruitment of alternative circuits for impaired tasks
This Hemispheric Asymmetry Reduction in Old Adults (HAROLD) model has
support in the domains of episodic, semantic, and working memory,
perception, and inhibitory control.
Ctp 10th edition.
44. PREVENTION.
Slowing brain ageing with physical exercise, which has been shown in
animal models to have beneficial effects on neurogenesis and
cerebrovascular health
Cognitive exercise is another preventive strategy that is thought to increase
resilience to age-related brain changes
Several pharmacological studies are also under way that target some of the
molecular pathways of ageing, such as the TOR or IGF-1 pathways, using
repurposed drugs that have already been approved for treatment of other
diseases, for example the diabetes drugs metformin and pioglitazone.
Otp 3rd edition.
45. Changes in sleep with age
Health issues and aging can hinder older adults’ sleep patterns
They also wake frequently during the night, fragmenting sleep and
deregulating the circadian clock.
With age, the body spends more time in the lighter stages of sleep, meaning
more total rest time is needed to fully recharge
Light therapy and exercise can help, as well as healthy sleep habits.
Changes in sleep patterns are a normal part of aging
Floyd, J. A., Medler, S. M., Ager, J. W., & Janisse, J. J. (2000). Age-related changes in initiation and maintenance of sleep: a meta-
analysis. Research in nursing & health, 23(2), 106–117. https://doi.org/10.1002/(sici)1098-240x(200004)23:2<106::aid-
nur3>3.0.co;2-a
46. Theoretical Perspectives on Aging
What roles do individual senior citizens play in your life?
Wadensten B. (2006). An analysis of psychosocial theories of ageing and their relevance to practical gerontological nursing in
Sweden. Scandinavian journal of caring sciences, 20(3), 347–354. https://doi.org/10.1111/j.1471-6712.2006.00414.x
47. Functionalism
Functionalists analyze how the parts of society work together.
Three social theories were developed to explain how older people might
deal with later-life experiences
Disengagement theory
Activity theory
Continuity theory
48. Conflict Perspective
There are three classic theories of aging within the
conflict perspective.
Modernization theory
Age stratification theorists
Exchange theory
49. Ageing
biomarkers and
longevity.
1. LDL-P
2. Ratio of triglyceride to HDL cholesterol
3. Lp(a)
4. Fasting glucose
5. C-reactive protein (CRP)
6. Coronary artery calcium (CAC) score
7. Insulin-like growth factor (IGF)
8. BRCA1 and BRCA2 genes
9. MSH2 and PMS1 genes: (Lynch Syndrome)
10. APOE gene
50. Opportunities
for organoids
as new models
of aging
An organoid is a miniature, simplified organ that
recreates physiological 3D tissue structure and
cellular composition in vitro.
Aultured tissue fragments, tissues reconstituted from
cultured cells, and tissues grown from stem cells,
usually in the presence of ECM protein.
Hu, J. L., Todhunter, M. E., LaBarge, M. A., & Gartner, Z. J. (2018). Opportunities for organoids as new models of
aging. The Journal of cell biology, 217(1), 39–50. https://doi.org/10.1083/jcb.201709054
51. Scope of geriatric
psychiatry.
Include those diseases indicative of some degree of “brain failure:
Lewy Body Dementia, Fronto-temporal Dementia, Vascular
Dementia
Complex and severe Depression
Late-onset Psychotic Disorders
Complex presentations of Delirium
Psychiatric complications of Cerebrovascular Accidents
Late-onset Depression
Behavioral and Psychological Symptoms of Dementia (BPSD)
52. Challenges in geriatric psychiatry.
All elderly patients have atypical presentations of common diseases, have a complex
interplay of structural and neurochemical brain changes, physiological and immunological
reactions, personality structure, stressful life events, and early psychological development.
Most have multiple chronic and concurrent medical and psychiatric conditions.
Also includes family dynamic issues, exhausted caregivers, lack of insight, stigma of old
age and mental illness, social isolation, and challenging environments such as long term
care homes requiring sharing of confined spaces.
53. Prescribing in older people.
Adherence to the following principles will reduce drug-related morbidity and
mortality:
■ Use drugs only when absolutely necessary.
■ Avoid drugs that block α1 adrenoceptors, have anticholinergic adverse effects, are
very sedative, have a long half-life or are potent inhibitors of hepatic metabolising
enzymes.
■ Start with a low dose and increase slowly but do not undertreat.
■ Try not to treat the adverse effects of one drug with another drug.
■ Keep therapy simple; that is, once daily administration whenever possible.
54. Emotional changes in elderly
Denial
Guilt
Loneliness
Sense of helplessness
Extremely critical and suspicious behavior
Stubbornness
Selective memory
Regression
Recollecting past experiences or events / reminiscence
Anger / rage
Depression and anxiety
Grief
56. Concept of
ageism.
Negative discriminatory practices against
old people
Implicit ageism
Government ageism
Stereotyping
Prejudice: (cognitive process of
stereotyping)
Digital ageism
Visual ageism
Discrimination
57. Ageing and sexuality.
High proportion of men and women remain sexually active well into later
life.
In men, greater physical stimulation is required to attain and maintain
erections, and orgasms are less intense.
In women, menopause terminates fertility and produces changes stemming
from estrogen deficiency.
The extent to which aging affects sexual function depends largely on
psychological, pharmacological, and illness-related factors
58. Ageing in men and women
In general, women live longer than men, consistent with lower biological ages as
assessed by molecular biomarkers (Jylhävä et al., 2017), but there is a paradox. Women
are frailer and have worse health at the end of life. While men still perform better on
physical function examinations (Austad and Fischer, 2016; Gordon et al., 2017), women
outlive men
Reason
Sex-chromosomal linked mechanisms
Sex-hormonal effects
59. REFRENCES:
López-Otín, C., Blasco, M. A., Partridge, L., Serrano, M., & Kroemer, G. (2013). The hallmarks of
aging. Cell, 153(6), 1194–1217. https://doi.org/10.1016/j.cell.2013.05.039]
KAPLAN AND SADOCK’S CTP 10TH EDITION
NEW OXFORD TEXTBOOK OF PSYCHIATRY 3RD EDITION
KAPLAN AND SADOCK’S SYNOPSIS OF PSYCHIATRY 12TH EDITION.
THE MAUDSLEY PRESCRIBING GUIDELINES IN PSYCHIATRY 14TH EDITION.
Liguori, I., Russo, G., Curcio, F., Bulli, G., Aran, L., Della-Morte, D., Gargiulo, G., Testa, G., Cacciatore, F.,
Bonaduce, D., & Abete, P. (2018). Oxidative stress, aging, and diseases. Clinical interventions in aging, 13, 757–
772. https://doi.org/10.2147/CIA.S158513
Pomatto, L., & Davies, K. (2018). Adaptive homeostasis and the free radical theory of ageing. Free radical
biology & medicine, 124, 420–430. https://doi.org/10.1016/j.freeradbiomed.2018.06.016
Viña, J., Borrás, C., & Miquel, J. (2007). Theories of ageing. IUBMB life, 59(4-5), 249–254.
https://doi.org/10.1080/15216540601178067
Cefalu C. A. (2011). Theories and mechanisms of aging. Clinics in geriatric medicine, 27(4), 491–506.
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