AGING POPULATION
I GUSTI PUTU SUKA ARYANA
CURICULUM VITAE
Dr. dr IGP SUKA ARYANA, SpPD-KGer, FINASIM
(Staf Pengajar Divisi Geriatri, Bag/SMF Ilmu Penyakit Dalam
FK UNUD /RSUP Sanglah Denpasar, Bali)
Pendidikan:
• Dokter umum: FK Unud 1997, Spesialis Penyakit Dalam: FK Unud 2005,
Doktor ilmu kedokteran: FK Unud 2020
• Visiting research fellow Kobe Jepang 2002,Konsultan Geriatri: 2009,
FINASIM 2011, Geriatric emergency course, Singapore 2010
Penghargaan:
• Nominator the Best Young Investigator Award AFES Singapura 2003, and Manila 2005, The Best Mustafa-
Varon Award for the Best Free Paper On shock and Critical Care 2005, The Best Young Investigator
Award, ASMIHA Surabaya 2005, The best Scientific Free paper, TIG 2009, Jakarta
Organisasi/Jabatan:
• Ketua PAPDI Cab. Bali,
• Ketua KOMKORDIK RSUP Sanglah/FK UNUD
• Ketua Bidang Penjaminan Mutu, Kolegium Ilmu Penyakit Dalam, Indonesia
• Instruktur : Perioperatif kolegium Bedah, BT/ACLS 118, Clinical Emergency, Soft Skill for clinical
profesional, Clinical Teacher Training.
INTRODUCTION
• GERONTOLOGY : GERONTOS AND LOGOS
GERIATRY SCIENCE :A SCIENCE WHICH LEARNS THE
ELDERLY AND THE TREATMENT
• GEROS = ELDERLY
IATRY = TO TREAT
THE TERM : IGNAS LEO VASCHER (1909)
• PROGRESSIVE DEVELOPMENT :
DR. MARJORI WARREN
(THE PIONEER OF GERIATRY IN THE WORLD)
THE PREDICTION OF THE ELDERLY POPULATION 2020
CHINA 198. 343
INDIA 107.713
INDONESIA 24.816
BRAZIL 21.945
UK 12.912
MEXICO 12.829
NIGERIA 9.115
ELDERLY POPULATION
• INDONESIA : ≥ 60 Y.O
• WHO : ≥ 60 Y.O
• DEVELOPED COUNTRY : ≥ 60 Y.O
• ELDERLY PATIENT : ≥ 60 Y.O + MULTIPLE DISEASE/ COMPLEXITY
AGEING POPULATION
Pada tahun 2019, hanya sebagian provinsi mengalami penuaan penduduk
Persentase penduduk 60+ berdasarkan provinsi tahun 2019
Sumber: Proyeksi Penduduk Indonesia 2015-2045, Bappenas dan BPS 3
Tahun 2045, 100 tahun Indonesia merdeka, penuaan penduduk akan
mendominasi
Persentase penduduk 60+ berdasarkan provinsi tahun 2045
Sumber: Proyeksi
Penduduk Indonesia 2015-
2045, Bappenas dan BPS
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INDONESIA DEMOGRAPHY
YEARS BALITA (< 5 yrs) ELDERLY(> 60 yrs)
1971 19,1 mil (16,1 %) 5,3 mil(4,5 %)
1980 21,2 mil (14,4 %) 8,0 mil (5,5 %)
1985 21,6 mil (13,4 %) 9,4 mil (5,8 %)
1990 21,0 mil (11,7 %) 11,2 mil (6,3 %)
1995 21,6 mil (11,0 %) 13,6 mil (6,9 %)
2000 21,2 mil (10,1 %) 15,9 mil (7,6 %)
2005 21,1 mil ( 9,5 %) 18,3 mil (8,2 %)
2015 18,8 mil ( 7,6 %) 24,4 mil (10,0 %)
Aging an accumulation of various types of cell and tissue changes that
decline in function and are responsible for increased susceptibility to disease
and risk of death (B. Pedersen, 2006)
Geriatrics → Old age >60 years (WHO)
Elderly in Indonesia : 1990 – 2025
↑ 414 %
Become elderly, a person will have physical, mental, spiritual,
economic and social change, one of them is fundamental: health
problems due to degenerative processes
AGEING PROCESS
THE PROCESS OF CHANGING HEALTHY ADULTS TO BECOME FRAIL / FRAGILE
AGING THEORY
01 FREAE RADICAL
02 THE GLICOSILATION THEORY
03 DNA REPAIR THEORY
ETC (ERROR CATHASTROP, GENETIC CLOCK, CROSS
04 LINKAGE THEORY, CELLULAR GARBAGE THEORY,
AUTOIMUN THEORY)
AGING
Mechanism of growth and
Aging mechanism
development
cell growth
differentiation
maturity
apoptosis
Decreased organ
function
14
regeneration
Healthy & Happy
AGING FACTORS
16
Aryana, Suka et al. (2018). Aging and Sarcopenia
BIOLOGIC AGING
• The importance of genetics in the regulation of
biologic aging is demonstrated by the characteristic
longevity of each animal species.
• Several theories of aging have been promulgated and
recently reviewed (Goldstein, 1989; Abrass, 1991).
• These theories fall into two general categories:
accumulation of damaged to informational molecules,
or the regulation of specific genes
AGING PROCESS DEFINITION
• Aging is a process of the loosing of ability the tissue slowly to develop
it self and to maintain the structure and the normal function; so it can
not stand towards the trauma to develop the damage. (Constantine
1994)
• AGING: A process of gradual and spontaneus change resulting in
maturation through childhood, puberty and young adulthood and
then decline through middle and late aging
• SENESCENCE: The process by which the capacity for cell
division, growth and function is lost over time,
ultimately leading to an incompatibility with life i.e the
process of senescence terminates in death.
• DISEASE vs aging In both aging and senescence,
many physiology function decline but normal decline is
not usually considere the same as disease. So ??
• Progressively the human will loose the defence of
infection & it will accumulate more metabolic and
structural distortion which is called :
“DEGENERATIVE DISEASE”
THEORIES OF AGING PROCESS
• AGING IS EXTREMELY COMPLEX AND MULTIFACTORIAL
PROCESS
• SEVERAL PROCESSES MAY INTERACT SIMULTANEOUSLY
• AGING PROCESS MAY OPERATE AT MANY LEVEL OF
FUNCTIONAL ORGANISM
MAJOR THEORIES ON AGING
(focus on proces)
Theory Mechanisms Manifestations
Accumulation of Spontaneous mutagenesis Copying errors
Failure in
damaged to DNA repair systems
informational Errors in DNA, Error catastrophe
molecules RNA, and protein synthesis
(demage and Superoxide radicals and loss of Oxidative cellular
error) scavenging enzymes damage
Regulation of Appearance of specific Genetically
specific genes protein(s) programmed
(program) senescene
CLASSIFICATION THEORIES OF AGING
(focus on level)
• EVOLUTIONARY
• MUTATION ACCUMULATION mutation effect healht at older age
• DISPOSABLE SOMAafter reproductive somatic cell become disposable
• ANTAGONISTIC PLEIOTROPY genes beneficial at younger, deleterious at older
• MOLECULAR
• GENE REGULATION change regulating development and aging
• CODON RESTRICTION inability decode codonimpaired translation mRNA
• ERROR CATASTROPHE decline fidelity of gene expresion increased abnormal protein
• SOMATIC MUTATION accumulated molecular demage (DNA/genetic material)
• DYSDIFFERENTIATION accumulated molecular demage impairs gene expresion
• CELLULAR
• CELLULAR SENESCENCE-TELOMERE THEORY
• FREE RADICAL
• WEAR AND TEAR accumulation of normal injury
• APOPTOSISprogrammed cell dead from genetic event /genome crisis
• SYSTEM
• NEUROENDOCRINE alteration control homeostasis aging related physiological
change
• IMMUNOLOGIC decline immune function increased autoimmunity
• RATE OF LIVING fixed amount of metabolic potential for every living (live fastdie
young)
AGING PROCESS THEORY
1. GENETIC CLOCK THEORY
• In this theory aging has been programmed genetically for
certain species.
• Every species has nucleus like a genetic clock which has been
winded according to a certain replication.
• This clock will count the mytocys
Mytocys will stop cell replication if it is not winded
• PROGRAMMED THEORY
• Why on some species get a real different of life
expectation
Figure 1. Record in life span (Eudililin et al, 1993)
Turtle 170 y.o
Elephant 70 y.o
Horse 62 y.o
Gorilla 48 y.o
Bear 47 y.o
Cat 30 y.o
Dog 27 y.o
• Theoritically it is possible to rewind this clock
eventhough just for small time, with external
interverences, such as :
Health development
Disease prevention with medicine/ treatment
• The theory supported by experiment : nucleus which
determines the replication Aging Death
2. THE SHORTENING OF TELOMERE THEORY.
• The shortening of DNA telomere will cause the
death of the cell.
• The DNA replication leads to telomere shortening
because DNA polymerase cannot replicated the
very end of DNA molecule.
• Telomerase elongates the chromosome through de
novo sequerell addition.
3. THE DAMAGED BY FREE RADICAL.
• Teory was first proposed in 1957, its one of best
teory
• All organism live contain free radical (ROS)
• For aerobic organism, the free radical is mainly
formulated while respirating (aerob) in
mitochondria.
• The free radical are : super oxide (O2), Hydroxcyl
radical (COH), Hydrogen peroxide (H2 O2).
• Free radical is destroyer it can react to DNA
cumulative demage aging and senescence
• The body itself is able to prevent free radical with
• its enzymes : superoxide dismutase (SOD) : Zn, Cu, Mn
2 O2- + 2H+ SOD
H2 O2 + O2
• *Catalase enzyme with Fe element in the “haem” to burst
hydrogen peroxide become water & oxygen :
CATALASE
2H2 O2 2H2O + O2
• *Glutathion peroxide enzyme with selenium (Se) element
burst peroxide hydrogen through the reaction :
H2O2 + GSH GSSH +H2O
• Also can be netralised by vit C, A and E
4. METABOLIC AGING THEORY
• From the experiment it get a longer life span
caused by the retriction of the calorie. It is caused by
one of metabolism process increase insulin
sensitivity, neuroendocrine and immune respon
• The modification of under exercise to be more active
will cause the longer life span
• Calaric retriction delayed growth and failure of
sexual maturation
5. THE DAMAGE OF IMMUNE SYSTEM
• The repeated mutation/ the changing protein post translation
decrease the immune system decreased ability of self
recognition
• The somatic mutation change antigen in the surface cell
immune system treat the changing cell as a strange cell and
destroy it AUTO IMMUNE PROCESS
• All somatic cell will set aging process, except sexual cell &
cancer cell.
• IMMUNE SYSTEM
Is all mechanism used by the body to keep the unity
of the body as the prevention against the danger
caused by the material in the environment
• IMMUNE RESPON
Interaction of some immune system component of
the body in human
3. METABOLIC AGING THEORY
• From the experiment it get a longer life span
caused by the retriction of the calorie. It is caused by
one of metabolism process the decrease of
hormone excretion will stimulate cell proliferation,
such as insulin
• The modification of under exercise to be more active
will cause the longer life span
Mechanism of Caloric Restriction
• The degree of Caloric Restriction needed to achieve
an anti aging effect is far too severe to be a practical
preventive regimen for more than a tiny fraction of
the human population.
to define the biochemical mechanism by which
Caloric Restriction alters age dependent physiologic
decline is likely to provide the best clues to clinically
useful preventive strategies.
One line of inquiry starts with the set of known,
dramatic changes induced by the Caloric Restriction
protocol & attempts to see whether any of these can
by itself accomplish some or all of the Caloric
Restriction effect.
4. FREE RADICAL THEORY
• The free radical are : super oxide (O2), Hydroxcyl
radical (COH), Hydrogen peroxide (H2 O2).
• Free radical is destroyer it is very reactive it can
react to DNA
• *The body itself is able to prevent free radical with its
enzymes : superoxide dismutase (SOD) : Zn, Cu, Mn
it change superoxide 2O2
2 O2- + 2H+ SOD
H2 O2 + O2
• *Catalase enzyme with Fe element in the “haem” to burst
hydrogen peroxide become water & oxygen :
CATALASE
2H2 O2 2H2O + O2
• *Glutathion peroxide enzyme with selenium (Se) element
burst peroxide hydrogen through the reaction :
H2O2 + GSH GSSH +H2O
5. WEAR-AND-TEAR THEORY
• Supports the concept that aging is a programmed
process. each animal-each cell, has a specific
amount of metabolic energy available to it & that the
rate at whish this energy is used determines the
animal’s length of life.
• In addition to the depletion of available energy, wear-
and-tear theories include the effects of the
accumulation of harmful by products of metabolism &
of faulty enzymes due to random errors as
contributing to aging changes
MODEL HEALTHY AGING
Endogenic aging
Cellular Tisue Anatomical Organ
Healthy aging
(menua sehat)
Environment Life Style
Exogenic factor
HEALTY AGING CONCEPT
• “GERONTOLOGY IS CONCERNED
PRIMARILY WITH PROBLEM OF
HEALTHY AGING
RATHER THAN THE
PREVENTION OF AGING”
What it is
• A participatory, concerted and sustained
global effort, centred around the voices, rights,
abilities and needs of older people
The Decade will build connections and collaboration
Governments
UN and International Org.
Central to every step
Is close engagement with Professionals (health, social
older people themselves care, urban development etc)
Academia
Media
Private sector
Civil society
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Stimulating local actions to make a real difference to lives
The Decade aims to ensure that:
1. We think, feel and act towards age and
ageing in more positive and productive
ways (cross-cutting)
2. Communities become age-friendly by
developing in ways that foster the abilities
of older people
3. Older people have access to person
centred integrated care
4. Older people who need it have access to
long-term care.
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Where it comes from
Global Strategy and
Action Plan on Ageing and Health
Vision
A world in which everyone can live a long and
healthy life.
Goals
1. Evidence-based action to maximize
functional ability that reaches every
person (2016 – 2020).
2. By 2020, establish evidence and
partnerships necessary to support a
Decade of Healthy Ageing 2020 – 2030.
Transformation pathway for the decade of healthy ageing
HEALTHY AGEING CONCEPT
Good Health
Adds Life to Years
What
What is
is Healthy Ageing?
Healthy Ageing?
“Healthy Ageing” “Healthy Ageing”
is the process of developing
is the process of and maintaining the
developing and functional ability
that enables wellbeing in
maintaining the older age.
functional ability
that enables wellbeing in
older age.
Healthy Ageing
“Process of developing and maintaining the
functional ability that enables wellbeing in older age”
Functional Ability (FA)
Combination and interaction of Intrinsic Capacity with
the environment a person inhabits
Intrinsic Capacity (IC)
Combination of all the physical and
mental capacities of an individual
What is Functional Ability?
Pendekatan Kebijakan Stranas Kelanjutusiaan
Strategi Nasional Kelanjutusiaan
Pendekatan Berbasis Hak
(right-based approach):
1
• Lansia memperoleh haknya sebagai Peningkatan Peningkatan
warga negara. Pelindungan Derajat
• Termasuk hak berkontribusi aktif Sosial, Jaminan Kesehatan dan
dalam Pendapatan dan Kualitas
kegiatan ekonomi. Kapasitas Individu. Lanjut Usia. 2
Pendekatan Siklus Hidup (Life Cycle Approach): 5
Lansia Mandiri,
– Berdasarkan keberadaan, karakteristik, dan kebutuhan Penghormatan, Sejahtera, dan
Pembangunan
manusia sejak lahir hingga akhir hayat. Pelindungan dan Bermartabat Masyarakat dan
Pemenuhan Lingkungan Ramah
– Mencegah dan mengurangi risiko kerentanan sejak dini. terhadap Hak Lanjut Usia.
Lanjut Usia
terhadap Hak
Lanjut Usia. Penguatan
Kelembagaan
Pelaksana 3
Program
4 Kelanjutusiaan.
6
TERIMA KASIH
