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Lecture to 2nd year medical students on 4th March 2000 at the Kulliyah of Medicine, International Islamic University, Kuantan by Professor Omar Hasan Kasule Sr.
OUTLINE
1.0 DEFINITION and CHARACTERISTICS OF OLD AGE, AGE 60-130
A. Definition:
B. Demographic Change:
C. Qur'anic Terms For Old Age:
D. Human Life-Span:
E. Human Desire For Long Life:
2.0 PHYSICAL DECLINE
A. Types Of Cells And Their Replicative Ability
B. Errors In Cell Division:
C. Cellular Ageing:
D. Nature Of Aging:
3.0 SOCIAL AND PSYCHOLOGICAL ASPECTS
A. Aging Is Psychological:
B. Aging Is Unpleasant
C. Rights Of The Elderly
D. Good Treatment Of The Elderly
E. Abuse Of The Elderly
4.0 RESEARCH ON AGING
A. Prevention Of Aging:
B. Good Physical Health In Old Age
5.0 DISORDERS OF OLD AGE
1.0 DEFINITION and CHARACTERISTICS OF OLD AGE, AGE 60-130
A. DEFINITION:
BIOLOGICAL DEFINITION
It is difficult to define ageing exactly. Ageing is a natural process. It is a long and variable process with much individual variation. Genetic, social, dietary, and disease factors determine the rate and extent of ageing. Old age has physical, social, and religious dimensions. Old age is associated with degeneration and decreased or deranged physiological function. It is not true that old age is illness. The changes seen are part of a natural process. A practical definition of disease in the elderly must take this into consideration.
SOCIAL DEFINITION
On the social level, old age also represents the close of the family cycle with the old generation bowing out to be replaced by the new one in the reproductive process. It is also the period of maximum wisdom after internalizing a lot of experiences in life.
START OF OLD AGE:
The age of 60 has a special meaning (KS p. 402). The age of 60 is generally taken to be the start of old age. By this time a person is expected to have passed through many experiences and to have attained wisdom. Allah does not excuse any sins above 60 years of age (MB # 2095 p 982).
B. DEMOGRAPHIC CHANGE:
The proportion of the elderly in most human populations is increasing. General socio-economic improvement and medical technology have caused this demographic shift in three ways: (a) control of infectious disease and better nutrition have decreased infant mortality, a major determinant of life expectancy. (b) availability of effective contraceptives and the desire for smaller families have decreased fertility rates such that there are fewer young people and more older people. (c) medical technology has caused a decrease of late life mortality so that the elderly now live longer than before.
C. QUR'ANIC TERMS FOR OLD AGE:
The Qur'an has decribed old age, shaykhukha, using the word sheikh in the adjective form (3:40, 11:72, 12:78, 16:70, 19:4, 22:5, 26:171, 28:23, 30:54, 37:135, 40:67, 51:29). The terms kibr and kabir have been used to indicate growing older (2:266, 3;40, 4:6, 12:78, 14:39, 15:54, 17:23, 19:8, 28:23).
D. HUMAN LIFE-SPAN:
Each animal or plant species has a typical life span that varies with environmental conditions. Within humans and animals, the female lifespan is generally higher than the male. Typical lifespan also varies by ethnic group, geographical location, and other socio-demographic variables. A hereditary component is also involved since parental longevity in humans has been observed to affect the longevity of the offspring. The life-span of each individual is fixed by Allah (Muslim #6438, 6440). No human effort or endeavor will alter the span. When the appointed hour arrives death ensues. From the historical record and also from study of living communities we know that the maximum human life span does not go much above 100 years. Life beyond the age of 100 years is rare (MB #368, MB # 96 p 101). The age of 100 is however not the upper ceiling and the possibility of longer life-spans is possible. The Qur'an tells us about 2 exceptions to the average lifespan mentioned above. The Prophet Nuh (PBUH) lived over 900 years. The Prophet Isa (PBUH) who was carried alive to heaven is now aged over 2000 years. The observation of increasing life expectancy at birth in all communities where socio-economic and health conditions have improved is another indication that the lifespan can change. There are gender and ethnic differences in longevity. All these indicate the possibility of lifespan variation upwards or downwards. The steadily increasing life expectancy has given hope of increasing human longevity by controlling causes of aging. Research at the cellular, clinical, and epidemiological levels is being undertaken on aging with this purpose in mind.
E. HUMAN DESIRE FOR LONG LIFE:
Longevity has always been a desirable objective of humans of all ages and all places. The desire for long life is very strong in most individual humans (2:90, KS 106). The primary motivation for prevention and cure of disease is to achieve longevity. Humans of all ages have desired youth and looked for the elixir of permanent youthfulness. Thus attempts to find the causes of aging in order to delay and if possible prevent it serve to perpetuate human kind as much as possible. Longer life has advantages. There is more to contribute to society, to do good deeds to expiate for past failures. However the physical disabilities of old age reach a point when they outweigh the psychological and social advantages. This is the point of life that the Prophet (PBUH) referred to as ardhal al 'umr.
2.0 PHYSICAL DECLINE
A. TYPES OF CELLS AND THEIR REPLICATIVE ABILITY: (BOWMAN P 4.7)
Cell biology can explain many phenomena of aging. Cells can be classified according to their replication properties. (a) Cells that are continuously renewed: epithelial cells, spermatozoa, blood cells. (b) cells with the potential to proliferate: liver, kidney tubules, exocrine glands, endocrine glands, connective tissue (c) cells not renewed or replaced: myocardium, somatic muscle cells, nerve cells, and retinal cells.
The capacity for cell division declines with age. Embryonic cells can divide up to a total of 50 times thus one embryonic cell can over its life-span produce 10E15 cells. Mature cells are capable of fewer divisions; the older they are they less divisions they can make. The reasons for this loss of division capacity is not known but it seems to be part of genetic programming.
Cells can increase in number by mitotic division (hyperplasia) or may increase in size without increase in number (hypertrophy). They can also undergo meiotic division. With age the number of irreplaceable cells decreases through the normal process of tear and wear.
B. ERRORS IN CELL DIVISION:
Let us start by clarifying the term error. Nothing can be an error in the function of the cell. All is deliberate plan by Allah and all is pre-designed. With age the following phenomena increase and their cumulative effects lead to ageing or death of the cell: the cumulation of somatic mutations, error rates in protein synthesi, and failure of error-correcting mechanisms. The increase in these phenomena is due to cumulative environmental insults.
C. CELLULAR AGEING:
Aging, degeneration, and eventual death can be explained at the cellular level. Aging starts with the cells. Normal cells age and die and others take their place. Cellular function declines gradually with age. There is decline of oxidative phosphorylation, DNA and RNA synthesis, synthesis of proteins and cell receptors. Aging cells have definite morphological changes that distinguish them from the younger cells. The causes of cellular aging are: (a) endogenous molecular program of cell senescence (b) wear and tear is a result of damage by free radicals, post-translational modification of intracellular and extra-cellular proteins, and alterations in the induction of heat-shock proteins. The cells are also damaged by accumulation of adverse changes that may happen randomly or under the influence of environmental insults. Nothing can be an error in the function of the cell. All is deliberate plan by Allah and all is pre-designed. With age the following phenomena increase and their cumulative effects lead to aging or death of the cell: the accumulation of somatic mutations, error rates in protein synthesis, and failure of correcting mechanisms.
D. NATURE OF AGING:
It is difficult to define aging exactly. Aging is a natural process. It is a long and variable process with much individual variation. Factors that affect the rate and extent of aging are: genetic variability, environmental insults, accumulation of changes in somatic cells, mutations and chemical damage (2). Old age is associated with degeneration and decreased or deranged physiological function. It is not true that old age is illness. The changes seen are part of a natural process. A practical definition of disease in the elderly must take this into consideration. The elderly are old and not necessarily sick.
3.0 SOCIAL AND PSYCHOLOGICAL ASPECTS
A. AGING IS PSYCHOLOGICAL:
A person is psychologically as old as he feels. An elderly person may feel young. The prophet mentioned that people stay young in 2 ways: love of the world and long hopes (MB # 2096 p. 982).
B. AGING IS UNPLEASANT
Old age in unpleasant for several reasons. Physical incapacities reduce independence. Accumulated negative life experiences with no hope of returning and doing things again. Prophet prayed not to live to ardhal al umr (MB #1750 p. 846-7).
C. RIGHTS OF THE ELDERLY
Rights of the elderly, haqq al kabir (KS p. 402)
D. GOOD TREATMENT OF THE ELDERLY
Good treatment of the elderly, birr al waalidayn (KS p. 247-248)
E. ABUSE OF THE ELDERLY
4.0 RESEARCH ON AGEING
A. PREVENTION OF AGING:
Research on causes of cellular aging. Research on nutrition.
B. GOOD PHYSICAL HEALTH IN OLD AGE
5.0 DISORDERS OF OLD AGE