A Prelude on the Aging Phenotype - nationalacademies.org

1 JANUARY 13-14, 2014 KECK CENTER - 500 5TH STREET, WASHINGTON, DC HEARING LOSS AND HEALTHY Aging : AN IOM-NRC WORKSHOP A Prelude on the Aging Phenotype Luigi Ferrucci, MD, PhD NIA Scientific Director Aging and Trajectory of Function Aging phenotypes Changes in Body Composition Energy Imbalance Production/Utilization Homeostatic Dysregulation Neurodegeneration Physical and Cognitive FRAILTY Disease Susceptibility Reduced Functional Reserve Reduced Healing Capacity and Stress Resistance Unstable Health failure to thrive geriatric Syndromes Aging Gait Disorders Falls Cognitive Impairment Sleep Disorders Disability Urinary Incontinence Delirium Decubitus Ulcers Comorbidity Aging phenotypes and the Genesis of geriatric Syndromes Ferrucci L, Studenski S. Clinical Problems of Aging . In: Harrison s Principles of Internal Medicine, 18th Ed.

2 Longo, Fauci, Kasper, Hauser, Jameson and Loscalzo. McGraw Hill 2011 (In Press) The Domains of Energy Fitness, Resting Metabolic Rate, and Efficiency Minimum energy to sustain life in good health Repair, recovery & regulation Energy for casual walking Instability, infirmity & inefficiency 3-6 ml O2/kg/min 0-5 ml O2/kg/min 0-5 ml O2/kg/min <0-11 ml O2/kg/min Basal Energy 60-70% of 24 h consumption Reserve energy for sustained or intense activity <0-33 ml O2/kg/min Homeostatic Effort due to Diseases and/or Aging Excess cost of Movement due to Energetic Inefficiency Sources of Energy Waste 20 25 30 35 40 45 Basal Metabolic Rate (kcal/hr/m2) -1 0 1 2 Excessive Mortality High Basal Metabolic Rate Is a Risk Factor for Mortality: The Baltimore Longitudinal Study of Aging Ruggiero C. et al. Journals of Gerontology: Medical Sciences 2008; 63A:698 Aging phenotypes Changes in Body Composition Energy Imbalance Production/Utilization Homeostatic Dysregulation Neurodegeneration Physical and Cognitive FRAILTY Disease Susceptibility Reduced Functional Reserve Reduced Healing Capacity and Stress Resistance Unstable Health failure to thrive geriatric Syndromes Aging Gait Disorders Falls Cognitive Impairment Sleep Disorders Disability Urinary Incontinence Delirium Decubitus Ulcers Comorbidity Aging phenotypes and the Genesis of geriatric Syndromes Ferrucci L, Studenski S.

3 Clinical Problems of Aging . In: Harrison s Principles of Internal Medicine, 18th Ed. Longo, Fauci, Kasper, Hauser, Jameson and Loscalzo. McGraw Hill 2011 (In Press) The Domains of Brain Resources Total Capacity, Resource Allocation, Plasticity, Functional Reserve Functional Reserve Attention Cognitive function Motor Function Balance Metabolic Control Hearing Vision Cardiovascular Control Dual Task creates competition for brain resources In young and healthy individuals, additional resources can be pulled from reserve (plasticity) In older individuals functional resources and plasticity are constrained, leading to dysfunction Conclusion Older age is often associated with a state of brain susceptibility, reduced plasticity and depauperated functional reserve. Additional requests to the brain compete with finite resources, may have functional consequences and increase fragility.

4 Because of the reduced plasticity, effective adaptation is less likely to occur. Hearing loss may have a negative impact on unexpected functional domains.