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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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