12. dr. sahala - lecture penurunan imunitas pada geriatri nov2013

7/25/2019 12. Dr. Sahala - Lecture Penurunan Imunitas Pada Geriatri Nov2013

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Dr. dr. Sahala Panggabean, SpPD-KGH

Madical FacultyChristian University ! "ndnesia


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IntroductionGeriatrics is the assessment and treatment

of disease in a person who is 65 years or

older.How fast one ages is a function of genetics,

lifestyle, and attitude.

The process of aging is gradual and startsmuch earlier than most people realize.


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GENE!" !#$E%T# &'I(()NENE#%EN%E

The immune system undergoes profound age*related changes, collecti+ely termedimmunosenescence

This process aects +arious cell typesincluding hematopoietic stem cells -H#%s,

lymphoid progenitor cells in the /one marrowand in the thymus, the thymus itself, maturelymphocytes in peripheral /lood andsecondary lymphatic organs and also

elements of the innate immune system


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Genetics of !ging

#ging is nt a passiveactivity,But an acti+ely regulated

meta/olic process

Speci$c genes identi$edthat regulate aging,!ging and "onge+ity are only partially under

genetic in0uenceest of Gain is from Nutrition


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%hanges in the 1ody

The aging process is accompanied /ychanges in physiologic function.

!ll tissues in the /ody undergo aging.The decrease in the functional capacity of

+arious organ systems is normal /ut can aectthe way in which a patient responds to illness.


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"%%une syste%

structures


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#HI'T &' I(()NE #T!T)# INE"2E"3

2ecrease num/er of H"! class I

and II antigenic sites onlymphocytes

2ecreased proportion of T, 1, cells

N4 cells increased density per cell

2ecreased num/er of monocytes

2ecreased a/ility of dendriticcells to stimulate T*cell secretion

of I'N*and I"

'unctional impairment ofmacrophages and granulocytes

(acrophages produce less I'N*


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I(()NE #T!T)# &' E"2E"31*%E""# ')N%TI&N

2ecreased num/er of circulating

and peripheral /lood 1 cells

2ecreased generation of

primary and secondary memory

1 cells

General decline in lympho*

proliferati+e capacity

General decrease in humoral

responsi+eness

2ecline in high a7nity

protecti+e anti/ody productionof

Germinal center*site of 1 lymphocytes pr


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I(()NE #T!T)# &' E"2E"3T*%E""# ')N%TI&N

General decline in cell

mediated immunity

T*cell population /ecome

hyporesponsi+e

2ecline in new T*cell production

Increase in proportion of

memory T*cells

2ecrease in new T*cellsproduction

2iminished functional capacity

of new T*cells T cytoto8ic cells attac9ing canc


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&hree 'ilgical De!ense Mechanis%s&hat Prtect the 'dy

'irst line of defense -anatomic:/iochemical /arrier#9in and mucous mem/ranes

#econd line of defense -mechanical clearance

#9in sloughing, respiratory cilia, and urination

Third line of defense -immune response

"ong*lasting and sometimes permanent protection

#tructuresThymus

ed /one marrow

#pleen

"ymph nodes, +essels, and tissues

#9in


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(ultiple 'actors !ect the Indi+idual;sImmune #ystem

"nternal characteristics ()ternal!actrs "ntensity ande*ectiveness

(odi


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Three %haracteristics )ni=ue to

the Immune #ystem#elf*regulation

#peci


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#elf*egulation

The immune system dierentiates /etweennormal and a/normal constituents

!ntigens -!gNonself su/stances that stimulate an immune

response"ocated on surfaces of li+ing cells or en+ironmental

su/stances

#elf*!ntigens

Histocompati/ility antigens or human leu9ocyte antigens-H"!

2o not stimulate an immune response

2ierent in all people

Genetically identical twins will /e the same


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#peci


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(emoryImmune response de+elops long*lasting

protection

esidual set of cells that are speci


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Integumentary #ystem %hanges

$roduction of new s9incells decreases

&il and #weat glands/ecome less acti+e

%irculation decreases

Hair losses color, andhair loss occurs

#9in /ecomes lesselastic > dryItching is common

2ar9 yellow or /rowncolored spots appear#enile lentigines -li+er

spots'atty tissue layer of s9in

diminishes

"ines and wrin9lesappear

Nails /ecome thic9,tough, and /rittle

Increased sensiti+ity totemperature


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Ner+ous #ystem %hanges

1lood 0ow to /rain decreases > there is aprogressi+e loss of /rain cells * * Interferes with

Thin9ing * eacting

Interpreting * emem/ering#enses of taste, smell, +ision, > hearing are

diminished

Ner+e endings less sensiti+e

2ecreased a/ility to respond to pain and otherstimuli

2ecrease in taste> smell fre=uently aectsappetite


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Changes in visin

$ro/lems readingsmall print

#eeing o/?ects at adistance

2ecrease inperipheral +ision

2ecrease in night+ision

Increased sensiti+ityto glare

%ataracts

Glaucoma

Changes in hearing

Hearing loss usuallygradual

$erson may spea9louder than usual

!s9 for words to /erepeated

Not hear highfre=uency sounds

(ay not hear well incrowded places


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2ecreased sensation to pain > other stimuli @more suscepti/le

1urns

'rost/ite%uts

'ractures

(uscle strain and other in?uries


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2igesti+e %hanges

'ewer digesti+e ?uices and enzymes produced(uscle action /ecomes slower > peristalsisdecreases

Teeth are lost

"i+er function decreases

2ecrease peristalsis

Increase 0atulence -gas

%onstipation

2ecrease sensation of taste

$oor appetite

$oor diet


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)rinary %hanges

4idneys decrease in size > /ecome less e7cient1ladder /ecomes less e7cient(ay not hold as much(ay not empty completely

Incontinence

Urinary Care

Increase 0uid inta9e2ecrease /efore /edtime

egular trips to /athroom

Easy to remo+e clothing

!/sor/ent pads


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Endocrine %hanges

Increased production of some hormones anddecreased of others

Immune system less eecti+e

1( decreases

Intolerance to glucose

(ndcrine Care$roper e8ercise

!de=uate rest(edical care for illness

1alanced diet

Healthy lifestyle


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eproducti+e #ystem

%hanges2ecrease of estrogen :progesterone in femaleThinning of +aginal

wall

2ecrease +aginalsecretions

In0ammation of +aginacommon

Aea9ness in

supporting tissue )terus sags downward -)terine prolapse

1reasts sag when fatredistri/uted

2ecrease in Testosterone#low production of

spermesponse to se8ual

stimuli slowerTestes smaller less


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12. dr. sahala - lecture penurunan imunitas pada geriatri nov2013

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