Immune System

Question 1

When does the immune system usually start to change in aging adults?

Answer 1

After the 6th decade of life but can begin prematurely in some clinical conditions such as rhuematoid arthritis and with chronic organ diseases like COPD or CKD

Question 2

What is immunosenescence? what is it a combination of?

Answer 2

the gradual decay of the immune system

combo of declining protective immunity and increasing incidence of inflammatory disease

Question 3

What are the cardinal features of immune system aging?

Answer 3

• weakened antimicrobial immunity (susceptibility to respiratory infections and reactivation of chronic viral infections like shingles)
• impaired anti-vaccine responses
• insufficient protection against malignancies
• predisposition for unopposed tissue inflammation (i.e atherosclerotic disease, OA, nuerodegenerative disease)
• failing wound repair mechanisms

Question 4

What may occur because of the shift of bodily fat from peripheral to the abdomen along with the general increase in overall intra-abdominal fat with age, which acts as an inflammatory organ?

Answer 4

Increased systemic inflammation such as increased proinflammaotry cytokines, C-reactive protein, and tumor necrosis factors

Question 5

What is the result of increased systemic inflammation due to immune system changes?

Answer 5

muscle wasting, loss of physical function, and it is an underlying factor in development of age-related diseases like Alzheimer’s, atherosclerosis, cancer, and diabetes

Question 6

What is the result of reduction in lymphocyte development as a person ages?

Answer 6

• decreased efficiency of response to novel or previously encountered antigens (i.e increased vulnerability to influenza in those older than 70)
• decreased responsiveness to vaccines (except for shingles vaccine)

Question 7

What is the best approach to address total body inflammation that PTs can effect?

Answer 7

Exercise

• just one bout of exercise results in significant decrease in inflammatory markers
• results in wider window of homeostasis
• enhances systemic ‘reserve’
• decreases risk for disease
• delays functional decline

Question 8

What are the characteristics of infectious disease in aging adults?

Answer 8

• it accounts for 1/3 of all deaths in people older tan 65
• Early detection is difficult due to lack of typical signs and symptoms such as fever or leukocytes
• Most often the first sign of illness is change in mental status, decline in function, falls, weight loss/anorexia, or vague symptoms such as nausea, vomiting, and decreased urinary output

Question 9

What are the two most common infectious diseases in aging adults?
What other conditions may resent atypically in older adults?
What is the common thread in all of the conditions?

Answer 9

Bacterial Pneumonia and UTIs

heart failure-confusion, agitation, anorexia, and fatigue
acute bowel obstruction- acute confusion, minimal or absent abdominal pain and tenderness
biliary or liver disorders-nonspecific mental and physical deterioration, no jaundice or abdominal pain

cognitive dysfunction or confusion

Question 10

What therapy implications should be taken into consideration when treating aging adult patients with infectious diseases?

Answer 10

• Be sensitive to descriptions of unusual changes and observant of subtle changes with older patients in every setting but esp. OP settings
• Be prepared to treat pts. in the hospital with a diagnosis of infectious disease for deconditioning
• Prepare for functional setbacks after your older pts. sustain acute illness
• Prepare for some exacerbation of previously compensated system deficits after an acute illness