682 SECTION XII — MISCELLANEOUS TOPICS

• Blood pressure: Systolic BP increases due to loss of

Changes in musculoskeletal system
elasticity in aorta, but diastolic BP remains un-
changed. Hence, pulse pressure is increased. • Osteoarthritis
• Blood vessels: Loss of elasticity due to deposition of • Degenerative changes of joint, cartilage and
calcium salts and loss of distensibility due to deposi- subchondral bone leading to pain and stiffness
tion of collagen. of joint.
• Senile Osteoporosis: Loss of bone tissue and
Cardiovascular changes bone mass makes bones weak and fragile, that
is increases risk of fracture.
• Degenerative changes in heart • Senile kyphosis: Abnormal convex curvature in
• Decrease in cardiac output various regions of spine.
• Increase in systolic BP and pulse pressure • Decrease in muscle power due to deposition of
• Loss of elasticity and distensibility of blood lipofuscin and degenerative changes
vessels • Postmenopausal osteoporosis

Respiratory changes
• Increase in pulmonary compliance due to decrease in
elasticity.
Renal changes
• Total thoracic compliance is reduced due to calcifi-
cation of costal cartilage. • GFR: Reduced by 30-40% leading to impaired
• Functional changes excretion of some drugs which results in toxicity
• Impaired ventilation, decreased V/P ratio • Tubular function: Impaired
and diffusion • Nocturia
• FRC: Increased • Reduced specific gravity of urine
• RV: Increased
• VC: Decreased
• Impaired mucociliary escalator system.
• Increased tendency of airways to collapse during
expiration due to decrease in elastic recoil of Reproductive changes
thoracic cage
• Benign prostatic hypertrophy (BPH)
• Thinning of pleural space.
• Vaginal mucosal dryness
Respiratory changes

• Increase in pulmonary compliance and reduc-

tion in total thoracic compliance
• Impaired ventilation Changes in GIT
• Increase in FRC, RV and decrease in VC
• Collapse of airways • Mastication: Reduced due to loss of teeth
• Gastric secretion: Reduced after 60 years age
due to mucosal atrophy. This leads to deficiency
Changes in ANS of iron and vitamin B12
• Postural hypotension: Due to impaired barore- • Hepatic changes: Decrease in number of
ceptor mechanism. hepatocytes. So, protein synthesis, hepatic me-
• Impaired thermoregulation: As ANS modulates the tabolism of drugs and steroids is reduced
body response by vasoconstriction/shivering • Small intestine: Villous atrophy, so absorption
(in cold) or vasodilation/sweating (in hot), so is decreased
these mechanisms do not function well in old • Lactase enzyme: Decreased
• Motility of large intestine: Reduced leading to
age. Therefore, old age people face difficulties in Constipation
facing the extremes of temperature.

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 CHAPTER 93 — Ageing 683

even in old age and segmental switch on and

Changes in endocrinal system
off of certain areas occurs, resulting in age re-
• Thyroid hormone: Decreased lated changes.
• Sexual hormones (testosterone, oestrogen,
progesterone): Decreased DAMAGE REPAIR THEORY OF AGEING
• Reduced sensitivity to insulin CONCEPT
• ADH, renin and aldosterone: Decreased
• Vitamin D: Decreased (risk factor for osteopo- As the age progresses there is a balance between
rosis) damage and repair.
• Gonadotrophins: FSH, LH (in males and
• Cross linkage theory: Increased cross linkage of
females) —increased due to negative feedback
effect. collagen and proteins due to non enzymatic com-
bination of glucose with amino groups which alters
the biological and structural properties of pro-
teins.
Changes in blood and immune system
Advanced glycosylation end products are implicat-
• Haematopoietic marrow: Reserve is decreased ed in pathogenesis of atherosclerosis, loss of
gradually as it is replaced with fatty bone marrow functioning of other vital structures and diabe-
• Senile purpura: Due to defect in capillary en-
tes mellitus.
dothelium
• ESR: Increased due to increase in plasma fi- • Free radical damage theory: Superoxide and hy-
brinogen droxyl free radicals produced as a result of oxi-
• Anaemia: Due to iron and vitamin B12 deficiency dation reactions can damage the DNA, proteins
• Cell mediated and humoral immunity: Reduced and cause lipid peroxidation in the membranes.
• Replication theory: Cells have limited replicat-
ing potentials, so ageing occurs at a stage of life
THEORIES OF AGEING when the replication ability of cells is reduced.

Life expectancy is increasing from 45 to 75 years

Applied aspect
due to improved treatment and prevention of in-
fections. 1. Werner’s syndrome
In this syndrome, human ageing occurs at
1. Genetic theories of ageing increased rate. There is a mutation in gene for
a. Random mutation theory DNA helicase, the enzyme, which unwinds the
b. Senescence theory DNA strands during duplication of DNA. Due
2. Damage repair theory of ageing to this defect, there is a rapid accumulation of
a. Cross linkage theory chromosomal damage, which accelerates ageing.
b. Free radical damage theory
c. Replication theory 2. Role of telomeres in ageing
3. Role of telomere in ageing Length of telomeric DNA is important. With
each cell division, 50 out of 2000 base pairs
GENETIC THEORIES OF AGEING are lost. So, telomeric shortening occurs with re-
petitive division. This leads to loss of genes ac-
• Random mutation theory: As the tissue age in- cessibility.
creases, the mutations accumulate in the genome Cell cycle arrest occurs at G1/S phase of DNA syn-
of somatic cells, which lead to cumulative abnor- thesis.
malities. Both of the above mentioned factors are
• Senescence theory: The changes occurring from implicated in ageing.
childhood to adulthood continue to occur

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684 SECTION XII — MISCELLANEOUS TOPICS

HOW TO STAY YOUNG/DELAY AGEING? CHAPTER RECAPITULATION

Ageing means growing old and senescence means decrease
1. Caloric restriction: In animal study, it was proved in biological efficiency due to ageing. So, ageing is progres-
that reduced caloric intake delays ageing. sive decrease in biological activity, that is homeostatic reserve
of each organ is reduced. Time related decrease in physiologi-
Decrease in caloric intake cal activity is necessary for the survival and reproduction.
Gerontology is the science of ageing. Geriatric medicine
↓ is a specialised branch to study the problems of ageing.
Decrease in protein cross links Age-related changes in different organ system includes
↓ changes in skin and hair, changes in ears, eyes, changes
in CNS, ANS, CVS, respiratory system, musculoskeletal sys-
Decrease in free radical formation tem, endocrinal system, reproductive system, renal, GIT
↓ changes, blood and immune system changes. Theories of
Decrease in macromolecular damage and ageing include genetic theories of ageing (random muta-
tion theory, senescence theory), damage repair theory of
increase in protein turnover ageing (cross linkage theory, free radical damage theory,
↓ replication theory), role of telomere in ageing. Life expec-
Delay of ageing tancy is increasing from 45 to 75 years due to improved
treatment and prevention of infections. Ageing is delayed
2. Supplementation: With ageing, the circulating by caloric restriction, supplementation with sex hormones
and growth hormone and exercise.
levels of sex hormones and growth hormone
are decreased. So, hormonal replacement may be
beneficial. RECENTLY ASKED QUESTIONS
3. Exercise: Exercise improves the cardiovascular IN EXAMINATION
and pulmonary performance, which increases • Age-related changes in different body organ systems
work capacity. • Theories of ageing
• How to delay ageing and stay young
• Role of telomeres in ageing
• Werner’s syndrome

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 Body Temperature and 94
Regulation

KNOWLEDGE GOALS
• Body temperature • Fever
• Heat producing and heat loss • Hypothermia
mechanisms

4. Consumption of hot or cold fluids also affects

BODY TEMPERATURE
body temperature especially oral tempera-
Normal human body temperature: ture.
5. Sleep: Core body temperature is lowest during
• Oral temperature: 36.3–37.1°C
sleeping. When the person is awake (but slight-
• Axillary temperature: 35.8–36.5°C
ly relaxed), temperature rises slightly. Further
• Rectal temperature: 36.8–37.6°C
increase in body temperature is observed with
• Scrotal temperature: 32°C (strictly maintained)
engagement in activities.
6. Exercise: Muscle contraction leads to heat
FACTORS AFFECTING BODY TEMPERATURE production with increase in oral temperature
Physiological Variations upto 38.5°C and rectal temperature upto 40°C
1. Sex: In female sex, the body temperature is slightly (104°F). This contributes to maximum in-
low as compared to males because of low BMR crease in heat production by body.
and a thick insulating layer of subcutaneous fat. 7. Emotional excitement: Emotional excitement
Thermogenic effect of progesterone contrib- increases body temperature due to uncon-
utes to increase in basal body temperature at scious tensing of the muscles.
ovulation and in postovulatory phase. 8. Food intake: Food intake increases body tem-
2. Diurnal fluctuation: A circadian fluctuation of perature. Maximum increase of temperature
0.5–0.7 °C is observed in the temperature of occurs with protein rich diet due to high spe-
deeper structures of body. People who sleep cific dynamic action (SDA) of food.
adequately at night and remain awake at day- 9. Hormones: Catecholamines such as epinephrine
time, have lowest body temperature at 6 O’clock in and norepinephrine cause fast and short-lived
morning and highest during evening hours. The rise in body temperature. Thyroid hormones
rhythm gets reversed in those who work in cause slow, but long lasting increase in tem-
night shift. perature.
3. Age: Body temperature of young children is 0.5°C 10. Core and shell body temperature: Core temperature
more than the established temperature for refers to the temperature of intra cranial, in-
adults. Temperature of small children increas- tra thoracic and intra abdominal structures
es with fits of crying and falls with cold bath. of body, that is deeper areas of body. This tem-
Elderly people are not able to tolerate extremes of tem- perature is represented by rectal, vaginal and
perature because of impaired thermoregulation and esophageal temperature. Core body tempera-
compromised circulatory system. Also, the body ture does not exhibit variations and remains
temperature becomes subnormal due to slug- stable. The temperature of skin and the under-
gish activities and reduced BMR. lying structures represent shell body temperature.

685

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686 SECTION XII — MISCELLANEOUS TOPICS

Figure 94-1 Representation of body core and shell temperature concept. (A) Cold. (B) Warmth.

It ­includes extremities and surface layer of trunk. time of exercise, skeletal muscle contraction is
Shell temperature is subjected to change with varia- the major contributor. Thirty-eight percent of
tions in environmental temperature (Fig. 94-1). activity heat is by the respiratory muscles.
2. Basic metabolic processes occurring inside the
Pathological Variations
body increase heat production.
1. Thyroid disorders: Increase in body temperature is 3. Food intake increases heat production due to
seen in hyperthyroidism. Hypothyroid patients SDA of ingested food.
have reduced body temperature with cold in- 4. Emotional excitement.
tolerance. 5. Shivering refers to the rhythmic muscle tremors
2. Constitutional hyperthermia is the chronically in- (10–20/s) occurring in response to cold. Shiv-
crease in body temperature above normal val- ering thermogenesis is involuntary response of
ues. skeletal muscle due to heat production by im-
3. Pituitary disorders: Hypopituitarism leads to hy- pulses from posterior hypothalamus resulting
pothermia and hyperthermia is observed in hyper- in cutaneous vasoconstriction and shivering.
pituitarism. 6. Hormones: Nonshivering thermogenesis or chemical
4. Fever is increase in body temperature as a re- thermogenesis—Increased cellular metabolism
sult of ongoing infection inside body. due to increased sympathetic stimulation and
5. Pontine haemorrhage leads to hypothermia. catecholamine release in response to cold is
6. Damage to hypothalamus is also a reason for hy- non shivering or chemical thermogenesis.
pothermia. Role of brown fat: Increased catecholamine is
directly proportional to amount of brown fat,
HEAT PRODUCING MECHANISMS which is located in interscapular region behind the
sternum, around neck and kidneys, helps in uncou-
1. Muscle contraction: Contraction of skeletal mus- pling reaction and increases heat production.
cle is a major source of heat. The term heat of Brown fat is present in infants (not in adults),
activity is used for the heat production during so increases heat production significantly.
muscular activity. At resting state, unconscious Thyroxine also plays role in chemical thermo-
muscle tensing and tone of the muscles con- genesis, as cold temperature stimulates release
tribute towards heat production, while at the of TRH.

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