1. AGING
ONE VIEW
DR.
SHRINIWAS
KASHALIKAR

2. We have to distinguish the handicap or dysfunction that results
from the diseases; and the changes resulting from the natural
process of aging that takes place in the absence of diseases.
We can appreciate that such distinction is quite difficult. Most of
us suffer from ailments such as infections, malignancies, diabetes,
IHD, as well as environmental onslaughts in the form of
ultraviolet radiation, heat, cold, pollution, food additives, allergic
substances, physical and chemical injuries etc apart from
psychological inflictions!
But still the changes, which take place after forty and fifty; in the
absence a history of gross or major diseases or accidents; roughly
represents the true aging and is generally attributed to two basic
facts
1) Genetic program, which decides the range of the longevity of
life for a specific species and determines the time dependent loss
in structure and function characterizing senescence and death and
2) Accumulation of injuries or micro insults:
Since very little is understood in this respect; there are many
theories based on these two tenets meant to explain aging. Since
they focus on a specific change, they are inadequate in isolation;
but together they do give us some insight into the process of
aging.
THEORIES OF AGING:

3. A] The Error Catastrophe Theory:
Random increase in errors of protein synthesis i.e. defects in the
processes involved in protein synthesis called transcription and
translation. But aging processes seem to be posttranslational (i.e.
after the proteins are completely synthesized) modifications.
Further, in senescent cells accumulation of misspelled proteins is
not found and induction of synthesis of erroneous proteins
experimentally does not give rise to ageing. Thus there is
possibility of that errors are not causes but merely coexisting with
aging processes.
B] Somatic mutation theory:
This suggests that there is age associated increase in
chromosomal aberration. This is suggested to give rise to
progressive increase in inefficient cells leading to organ
dysfunction.
C] Free radical theory:
Accumulation of metabolic waste products and radical mediated
cell damage e.g. hydroxy peroxide, aldehydes and ketones,
superoxide radical, singlet oxygen and hydrogen peroxide. If this
were so, we would expect lipid peroxidation at cellular level,
which is not demonstrated in aging. Further, the antioxidants
which we expect to delay aging are not proved to do so!
D] Ionizing radiations and such other environmental factors may
cause cell injury. This could be so; but the cause and effect

4. relationship and the quantitative aspects; are not yet demonstrated
to cause aging by themselves!
E] Cellular dysfunction in tissues such as CNS, endocrine and
immune system; influences other systems and causes aging! Thus
decreased synthesis, increased breakdown, decreased receptor
number, decreased Hormone-Receptor (HR) combination,
decrease in HR internalization etc may be responsible for aging.
These are merely physiological interactions (associated with
aging) amongst tissues; and cannot be called mechanisms or
causes of aging.
F] Sedentary jobs, late night parties, noise, crowding, stress of
highly competitive life, uncertainty of socio-political
surroundings, consistent and protracted denial of the recognition
and appreciation in life, habits such as excessive smoking, lack of
enjoyable job, lack of promotions and incentives in jobs etc. and
the plethora of stressors either not thought of or not given due
importance and hence not mentioned in the text books;
immensely expedite or aggravate (though do not constitute
the basic mechanisms or causes as such) the aging process;
and are described; in my books viz. “Stress: Understanding and
Management” and Conceptual Stress: Understanding and
Management”.
CHANGES DURING AGEING:

5. Overall changes in the body are loss and graying of hair starting
with the temporal hair (side buns), drying and wrinkling of skin,
loss of teeth, decrease in reaction time, decrease in the height,
increase in the length of nose, increase in the length of ears,
decrease in the circumference of neck, decrease in the
circumference of thighs, osteoporosis, bending of the vertebral
column causing kyphotic deformity, reduction in the periorbital
fat causing sinking of the eyes etc. Broadly speaking, maximum
capacity, tolerance, peak performance and reserve are reduced.
The details of the changes can be enumerated as follows.
Matrix:
Collagen becomes stable, more rigid, more insoluble due to
increase in its degradation. In addition there are changes in
proteoglycans and plasma proteins. This is due to damage due
cross linking, less formation of collagen and reduction in the
elastin. Fascia, tendons, ligaments, bones, joints, and peripheral
vascular disease become rigid. Skin becomes dehydrated, devoid
of subcutaneous fact and less elastic thus skin becomes wrinkled,
dry, pale due to reduction in capillary bed, and becomes more
susceptible to injury.
Blood:
Red bone marrow is replaced by yellow bone marrow in the long
bones first, flat bones and then vertebrae. Physiological reserve
capacity for erythropoiesis and leucopoiesis (Formation of red
blood cells and white blood cells); is reduced.

6. Gastrointestinal tract (GIT):
*Enamel, dentin and cement of teeth show decline. There is loss
of teeth due to caries, periodontal infection and reduced
masticatory efficiency.
*Weakness of cricopharyngeus (Muscle of swallowing),
reduction in pressure gradient and inability to relax the lower
esophageal sphincter cause dysphagia (difficulty in swallowing).
*Age related atrophy of inner lining of stomach called mucosa
causing achlorhydria (absence of digestive acid in stomach).
*Pancreatic lipase (fat digesting enzyme secreted by pancreas) is
reduced causing streatorrhoea (presence of fat in the stools).
*Motility of GIT is reduced: Hence there is tendency towards
constipation. In Ayurveda this is categorized under VAATA
VRIDDHI.
*Intestinal lactase activity is reduced and villi are reduced and
absorption is reduced.
*Liver cells reduce in number fibrous tissue increases in the liver
and size of liver cells increases.
Protein synthesis and microsomal mixed oxidase activity required
for metabolism of drugs and steroids; become less. Thus
functions are reduced but since the reserve of liver is great; the
liver function tests are in normal limit.
The immune system:
There is decrease in the T cell activity, Antibody (AB)
production; but increase in the presence of auto anti bodies.

7. The auto-antibodies are increased due to reaction with the
antigens (which were previously recognized as “self” and not
reacted with)! This is called reduced tolerance to “self” antigens.
There is susceptibility to infections.
Since immunological - surveillance is believed to eliminate
neoplastic cells (cancer cells); there is higher incidence of cancer.
Following stress of bereavement; there is steep decline in cell
mediated immunity (T cells) and this is one of the causes of
infections leading to the death that follows the death of spouse or
any other near and dear one.
Reproductive system:
The hormonal secretion reduces and there is stoppage of ova
formation, ovulation in females and there is gradual reduction in
the spermatogenesis (formation of sperms) causing reduction in
the sperm count in males.
Females show a distinct and identifiable change in the form of
menopause; whereas such change is not distinct in males.
There is reduction in sexual performance in terms of number
masturbations and number of intercourses in a given time and
reduction in the functions such erection, ejaculation and the
climax. The infatuation about sex may be increased and provoked

8. by pornographic and or sexually romantic atmosphere even as the
sexual performance is dwindled.
Central nervous system and special senses:
There is atrophy of the brain and neuronal loss associated with
accumulation of lipofuscin and loss of synapses and dendrites.
Cholinergic deficit is demonstrated in Alzheimer's disease and
Dopamine defect is demonstrated in Parkinson's disease. But,
milder form of cholinergic deficit may be responsible for
commoner forms of senile dementia and milder form
dopaminergic deficit may be responsible for milder form of hypo-
kinesia seen in old age.
There is deficit in autonomic responses leading to postural hypo-
tension and impairment of temperature regulation.
There is difficulty in getting sleep as well as there is tendency to
wake up during night and waking up early.
There is development of Presbyopia (age related difficulty in
focusing on the near object), cataract, rise in intraocular pressure;
Presbyacusis (age related difficulty in understanding speech and
localization of sound) decline in perception of smell and taste.
Endocrine system:
There is decrease in the functioning of sympatho-adrenal axis and
there is reduced tolerance to stress. In other words, there is
inappropriate production of adrenaline, noradrenalin, cortisol etc.

9. Cardiovascular system:
Aging is associated with atherosclerosis. But even in those
without atherosclerosis; there is still reduction in the elasticity of
aorta (indicating overall changes in connective tissue); leading to
increase in systolic and pulse pressure; but not in diastolic
pressure. In addition; there is also atherosclerosis, atrophy of
myocardium, accumulation of lipofuscin, fibrosis, deposits of
amyloid, diminish in contractility relaxability, decrease in
ventricular compliance, stenosis of aortic and incompetence of
mitral valves, reduction in pacemaker cells, responses to
sympathetic as well as parasympathetic stimulation also reduce
(this causes postural hypotension).
Maximal Heart Rate during exercise is reduced in aged but
cardiac output is maintained by increasing stroke output.
Respiratory System:
The alveoli (the air pockets in the lungs) become flatter and
narrower and ducts enlarge. Alveolar walls become thin,
capillaries decrease in number causing reduction in diffusion,
surface area decreases by 4 % every decade after the age of 30
and the pulmonary blood vessels show age related increase in
wall thickness.
Functionally there is decrease in total and timed vital capacity,
increase in residual volume, due to reduced elastin lung
compliance increases (degree of expansibility) but compliance of
the total respiratory system decreases due rigidity of chest wall

10. after the age of 60 years. Due to loss of elastic recoil the pressure
which has to be built during expiration from the alveoli; so that
air from alveoli forces open the airways, is decreased. Due to this
there is tendency of the airways to collapse. This tendency to
collapse; increases during expiration when expiration must
become active. The response to hypoxia and hypocapnia (reduced
carbon dioxide) are reduced.
Thus ventilation, diffusion and regulation are all impaired in
elderly individuals.
Muscles:
There is atrophy, reduction in contractility, decrease in tone,
hernia and rupture of inter-vertebral disc etc.
Excretory system:
As a result of aging; the kidneys reduce in size and their blood
flow and rate of formation of urine reduces by 10 % per decade
after 30, nephrons (urine forming tubules) and their secretory and
absorptive functions; reduce and fibrous tissue increases. Kidney
vessels show age related changes irrespective of hypertension
(high blood pressure).
It has been hypothesized that due to high protein diet there may
high solute load on the renal capillaries leading to chronic
dilatation of the capillaries leading to extravasation of
macromolecules in renal glomeruli leading to mesangial reaction
causing renal damage.

11. PSYCHOLOGICAL CHANGES
Frustration, depression, fear, anxiety, insecurity, loneliness,
vacuum, dejection, self pity, sadness; are some of the hallmarks
of old age.
This is because;
1. With aging there is increasing restriction on the kind of
accustomed enjoyments (e.g. sexual); and this can lead to
frustration or depression.
2. The realization of the increased chances of death; (due to
observation of the deaths of the contemporaries); causes alarm,
concern, anxiety and excessive fear of death, diseases and
debility.
3. Due to lack of job after retirement or physical inability there is
always a sense of insecurity.
4. Lack of the children's company due to their being increasingly
independent gives a feeling of unwantedness and loneliness,
especially due to children going abroad or away from home for
their jobs.
5. Since most of the people of younger age groups; have their
own pre-occupations we the elderly are left out.
6. Due to generation gap; the ideas, choice, preferences and other
areas of interests differ and hence the elderly are cut off from
younger generation. This distance gradually increases with
advancing age and leads to vacuum, dejection, self pity and
sadness. Thus overall we tend to become increasingly
melancholic in old age.

12. ECONOMIC CHANGES
The aging almost always associated with reduced income and
increasing economic dependence on the others. The medical
expenses also swell!
SPIRITUAL CHANGES
We begin to visit temples and participate in SATSANG. This is
because we want a certain kind of solace which we do not get
from day to day life and routine activities. This is also to fill the
vacuum created due to retirement, and to get company of those
who sail in the same boat!
When we are aging; we become somewhat disinterested and
indifferent towards life. But this is not detached attitude described
in Geeta. We get detached because; we cannot participate or
oppose the activities of young generation! Thus; this is actually
reluctant acceptance of defeat!
Sometimes we develop ascetic thoughts due to losing interest in
the routine life because we are tired of responsibilities and
dynamism required; for a job or a profession. Even as this
engenders reduction in income; it is not a spiritually oriented
selflessness and sacrifice. It is only fallout of mental apathy.
Sometimes we lose interest in the surroundings due to decreasing
sensory perception and decreased mobility. We become shy about
our deficiency. So we avoid socialization. Gradually we become
increasingly self centered and selfish. We become over-

13. concerned about ourselves and less sensitive to others' problems.
We become more rigid, adamant and at times obstinate; in an
attempt to assert ourselves; and become unreasonable and erratic.
The courage, alertness, enthusiasm and other physical and mental
faculties which are extremely important to undertake spiritual
pursuit i.e. growth of consciousness; are considerably diminished
in old age; unless the spiritual quest has been integral part of life
right from childhood.
Is this a complete picture of aging?
No!
For the complete we have to refer to, “Aging: A holistic view”!