1. GERIATRIC MEDICINE

5. SELECTED PHYSIOLOGIC AGE-RELATED CHANGES Changes in drug levels  Strength Tendency toward dehydration  Lean body mass  Muscular mass  Creatinine production  Skeletal mass  Total body water  Percentage adipose tissue (until age 60, then .until death) Body composition Clinical Manifestations Physiologic Change Affected Organ or System

6.  Cancer risk DNA damage and  DNA repair capacity  Oxidative capacity Accelerated cell senescence  Fibrosis Lipofuscin accumulation Cells Clinical Manifestations Physiologic Change Affected Organ or System

7.  Ability to recognize speech Loss of high-frequency hearing EARS Tendency to parkinsonian symptoms (eg,  muscle tone,  arm swing)  Number of dopamine receptors  alpha-Adrenergic responses  Muscarinic parasympathetic responses CNS Clinical Manifestations Physiologic Change Affected Organ or System

8.  Muscle mass  Bone mass  Fracture risk Vaginal dryness Changes in skin Water intoxication Menopause,  estrogen and progesterone secretion  Testosterone secretion  Growth hormone secretion  Vitamin D absorption and activation  Incidence of thyroid abnormalities  Incidence of diabetes (  insulin sensitivity or  insulin resistance)  Bone mineral loss  Secretion of ADH in response to osmolar stimuli Endocrine system Clinical Manifestations Physiologic Change Affected Organ or System

9. Tendency toward constipation and diarrhea  Splanchnic blood flow  Transit time GI TRACT Presbyopia  Glare and difficulty adjusting to changes in lighting  Visual acuity  Lens flexibility  Time for pupillary reflexes (constriction, dilation)  Incidence of cataracts EYES Clinical Manifestations Physiologic Change Affected Organ or System

10. Tendency toward syncope  Ejection fraction  Intrinsic heart rate and maximal heart rate Blunted baroreflex Cardiac acceleration  Diastolic relaxation  Atrioventricular conduction time  Atrial and ventricular ectopy HEART Clinical Manifestations Physiologic Change Affected Organ or System

11. Tendency toward some infections and possibly cancer  Antibody response to immunization or infection but  Autoantibodies  T-cell function  B-cell function IMMUNE SYSTEM Clinical Manifestations Physiologic Change Affected Organ or System

12. Changes in drug levels with  risk of adverse drug effects Tendency toward dehydration  Renal blood flow  Renal mass  Glomerular filtration  Renal tubular secretion and reabsorption  Ability to excrete a free-water load KIDNEYS Tightening of joints Tendency toward osteoarthritis Degeneration of cartilaginous tissues Fibrosis  Elasticity JOINTS Clinical Manifestations Physiologic Change Affected Organ or System

13.  Taste and consequent  appetite  Likelihood (slightly) of Nosebleeds  Smell NOSE Changes in drug levels  Hepatic mass  Hepatic blood flow  Activity of P-450 enzyme system LIVER Clinical Manifestations Physiologic Change Affected Organ or System

14. Tendency toward syncope  Response to beta-blockers Exaggerated response to anticholinergic drugs  Baroreflex responses  beta-Adrenergic responsiveness and number of receptors  Signal transduction  Muscarinic parasympathetic responses Preserved alpha-adrenergic responses PERIPHERAL NERVOUS SYSTEM Clinical Manifestations Physiologic Change Affected Organ or System

15.  Likelihood of shortness of breath during vigorous exercise if people are normally sedentary or if exercise is done at high altitudes  Risk of death due to pneumonia  Risk of serious complications for patients with a pulmonary disorder  Vital capacity  Lung elasticity (compliance)  Residual volume  FEV1  V/Q mismatch PULMONARY SYSTEM Clinical Manifestations Physiologic Change Affected Organ or System

16. Tendency toward hypertension  Endothelin-dependent vasodilation  Peripheral resistance VASCULATURE Clinical Manifestations Physiologic Change Affected Organ or System

37. Ánandamaya Kôùa Vijòanánmaya Kôùa PERFECT HEALTH Manômaya Kôùa Annamaya Kosa Pranamaya Kosa ÁDHIJA VYÁDHIS YOGA Panchakosa concept