Academic Geriatric Resource Center
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AT A GLANCE

Glossary

0. Introduction
1. Demography And Epidemiology
1.1 The Changing Face of Aging: Objectives
1.2 Local and Regional Variations Among Older Adults in the United States
1.3 Implications of an Aging Society for Health Care Needs and Resources
1.4 Common Chronic Conditions Associated with Advanced Age
1.5 Post Test
2. Biology and Physiology of Aging
2.1 Introduction and Background
2.2 Theories of Aging
2.3 Physiological Changes with Aging
2.3.1 Loss of Homeostatic Reserve--Hyperthermia
2.3.2 Loss of Homeostatic Reserve--Hypothermia
2.3.3 Vulnerability of Older Adults to Hypothermia
2.3.4 Clinical Importance of Vulnerability to Hypothermia
2.3.5 Loss of Homeostatic Reserve--Other Examples and Clinical Implications
2.3.6 Clinically Important Age-Related Changes in Organ Systems
2.3.7 Clinically Important Age-Related Changes in the Renal System
2.3.8 Clinical Significance of Age-Related Changes in Renal System
2.3.9 Clinically Important Age-Related Changes in the Cardiovascular System
2.3.10 Clinical Significance of Age-Related Changes in the Cardiovascular System
2.3.11 Clinically Important Age-Related Changes in the Pulmonary System
2.3.12 Clinical Significance of Age-Related Changes in the Pulmonary System
2.3.13 Age-Related Changes in the Neurologic System
2.3.14 Clinical Significance of Age-Related Changes in the Neurologic System (I)
2.3.15 Clinical Significance of Age-Related Changes in the Neurologic System (II)
2.3.16 Clinically Important Age-Related Changes in the Gastrointestinal System
2.3.17 Clinical Significance of Age-Related Changes in the Gastrointestinal System (I)
2.3.18 Clinical Significance of Age-Related Changes in the Gastrointestinal System (II)
2.3.19 Clinically Important Age-Related Changes in the Immune System
2.3.20 Clinical Significance of Age-Related Changes in the Immune System
2.3.21 Clinically Important Age-Related Changes in the Endocrine System (I)
2.3.22 Clinically Important Age-Related Changes in the Endocrine System (II)
2.3.23 Clinical Significance of Age-Related Changes in the Endocrine System
2.3.24 Clinically Important Age-Related Changes in the Musculoskeletal System
2.3.25 Clinical Significance of Age-Related Changes in the Musculoskeletal System (I)
2.3.26 Clinical Significance of Age-Related Changes in the Musculoskeletal System (II)
2.3.27 Clinically Important Age-Related Changes in the Genitourinary System (I)
2.3.28 Clinically Important Age-Related Changes in the Genitourinary System (II)
2.3.29 Clinical Significance of Age-Related Changes in the Genitourinary System
2.3.30 Clinically Important Age-Related Changes in the Sensory Systems
2.3.31 Clinical Significance of Age-Related Changes in the Sensory Systems (I)
2.3.32 Clinical Significance of Age-Related Changes in the Sensory Systems (II)
2.3.33 Clinically Important Age-Related Changes in the Integument
2.3.34 Clinical Significance of Age-Related Changes in the Integument
2.4 Pharmacologic Considerations
2.5 Post Test
3. Socio-cultural And Psychologicial…
3.1 Module Objectives
3.2 Social Theories of Aging
3.3 Psychological Development In Late Life
3.4 Ethno-Cultural Issues And Age-Stratified Societies
3.5 Late-Life Transitions
3.6 Dependent Elders: Special Concerns
3.7 Cultural Views of Death
3.8 References
3.9 Post Test
4. Assessment Of The Geriatric…
4.1 Module Objectives
4.2 Domains of Assessment: Functional Assessment
4.2.1 How to Use Information from a Functional Assessment
4.2.2 Vision Impairment
4.2.3 Hearing Impairment (I)
4.2.4 Hearing Impairment (II)
4.2.5 Oral and Dental Health
4.2.6 Introduction to Oral Health Assessment
4.2.7 Oral Health Assessment
4.2.8 Common Oral Conditions in Older Adults: Tooth Loss (I)
4.2.9 Common Oral Conditions in Older Adults: Tooth Loss (II)
4.2.10 Common Oral Conditions in Older Adults: Care of Dentures
4.2.11 Common Oral Conditions in Older Adults: Dental Decay
4.2.12 Common Oral Conditions in Older Adults: Periodontal Disease
4.2.13 Common Oral Conditions in Older Adults: Candidiasis Infection
4.2.14 Common Oral Conditions in Older Adults: Leukoplakia and the Risk for Oral Cancer
4.2.15 Guidelines for a Dental Referral
4.2.16 Falls and Gait Assessment
4.2.17 Assessing for Falls
4.2.18 Techniques for Gait Assessment
4.2.19 Gait Assessments and Falls Interventions
4.2.20 Risk Factors for Falls and Targeted Interventions
4.2.21 Modification of Risk Factors: Ability to Get Up After a Fall
4.2.22 Modification of Risk Factors: Fracture Risk
4.2.23 Modification of Risk Factors: Anticoagulation
4.2.24 Incontinence
4.2.25 Skin Breakdown: Pressure Ulcers
4.2.26 Cognition/Dementia
4.2.27 Benefits of Early Detection of Dementia
4.2.28 Screening Techniques for Dementia
4.2.29 Decision-Making about Dementia Screening
4.2.30 Nutrition
4.2.31 Alcohol Use and Alcoholism
4.2.32 Medication and Complementary Therapies
4.2.33 Case Example: Mr. Singh
4.2.34 Mr. Singh--Use of Herbal Medicines
4.2.35 Mr. Singh--Possible Interventions
4.2.36 Mr. Singh--Concerns about Marathon Running at 92?
4.2.37 Mr. Singh--Considerations for Patient/Family Well-Being
4.2.38 Assessing for Polypharmacy (I)
4.2.39 Assessing for Polypharmacy (II)
4.3 Domains Of Assessment: Psychosocial Health And Functioning
4.4 Special Considerations In Assessment
4.5 Post Test
5. Health Care Policies
5.1 Module Objectives
5.2 The Policy-Making Process
5.3 Financing Health & Long Term Care
5.4 Quality Of Care Issues In Long Term Care
5.5 Need And Access Across The Spectrum Of Care
5.6 References
5.7 Post Test
6. Exploring Age-Related Body…
6.1 Cardiovascular System
6.2 Endocrine System
6.3 Immune System
6.4 Musculo-Skeletal System
6.5 Neurological System
6.6 Renal System
6.7 Post Test

Module 6: Exploring Age-Related Body Systems Changes

6.3: Immune System



6.3.13: What Happens to Specific Immunity With Age?

Data are somewhat conflicting on whether the total number of T & B cells change (at least in peripheral blood), but it is felt that these cells may not be as functionally competent in older persons as in younger persons. What is currently supported most strongly is that cellular immunity is affected to a greater extent than humoral immunity. Yet, because they are so inter-related, the changes in cellular immunity impact the functioning of the humoral system.

One reason given for the change in cellular immunity is thymic involution—that is, it keeps getting smaller and smaller after birth so that it almost disappears by age 60. Because thyosin is generally considered important to the maturation of T-cells, a decrease in its levels could be important. However, it is still controversial regarding whether this is the most important factor in the decline in cellular immunity and more data are certainly needed.

General changes in humoral and cellular immunity are presented below.

Age Changes in Select Components of Specific Immunity1, 2

                           
Immune System     Component of Immune System     Age Related Change    

Humoral Immunity
B-Cells
Plasma Cells
Antibodies (IgG, IgM, IgA, IgE)

        B-Cells

        Bone Marrow

        Less reserve

 

        Circulating #s and %

No or minimal change but altered repertoire which affects type/amount of antibody produced

        Production of antibodies

        Decreased

        Auto-antibodies

        Increased

        Anti-idiotype antibodies

        Increased
suppression of Antibody production

        Memory phenotype

        ? Decreased

        Cellular Immunity
T-Cells
T-Helper (CD4+), Cytotoxic (CD8+)

        T-Cells

        Thymus

        Involutes starting after puberty

 

        Circulating #s and %

        Some decrease or no change but altered functional capacity

        Memory phenotype

        Increases

Delayed type hypersensitivity Reaction (DTH)

        Decreased; delayed

        Cytotoxicity (lytic capacity of CD8(+) cells)

 

        Diminished

        Proliferative response

Decreased

        Response to IL-1 (from APCs)

        Diminished

        Cytokines: Variable changes (data are still limited and often contradictory but data suggest there may be a subtle shift in T-cell repertoire to more Th2 cytokine dominance with age)

 

IL-2 (from Th1 T-cells; proinflammatory)

 

        ?  Decreased & have less feedback T-cell proliferatory capacity

IL-4 & IL-6 (from Th2 T-cells & other cells; proimmune/B-cell stimulation effect)

 

        ?  Increased

        IL-10 (from Th2 T-cells; proimmune)

 

        ?  Decreased or no change

IFN-gamma
(from Th1 T-cells, CTL, & NK cells; proinflammatory)

        Increased, decreased or no change

1 Components included represent a number of key aspects of the immune system but are far from inclusive; as this is an expanding area, understanding about components and how they change are continuing to evolve.

2  Adapted from: Boon, et al, 2002; Breitbart, et al, 2002; Groer, 2001; Murasko & Bernstein, 1999; Sandmand, et al., 2002; Weksler, 2000.           

 


Module 6: Exploring Age-Related Body Systems Changes
6.3.12 Specific Immunity
6.3.14 The Immune Response