The effect of aging on the cutaneous microvasculature

• Age related changes in the microcirculation lead to reduced reserve during stress.
• Age related changes include decreased density, lack of organization and impaired reactivity.
• Current approaches to improve the microcirculation focus on optimizing vascular reactivity.
• Future directions will need a multifactorial approach to improve microvascular function.

Aging is associated with a progressive loss of function in all organs. Under normal conditions the physiologic compensation for age-related deficits is sufficient, but during times of stress the limitations of this reserve become evident. Explanations for this reduction in reserve include the changes in the microcirculation that occur during the normal aging process. The microcirculation is defined as the blood flow through arterioles, capillaries and venules, which are the smallest vessels in the vasculature and are embedded within organs and tissues. Optimal strategies to maintain the microvasculature following surgery and other stressors must use multifactorial approaches. Using skin as the model organ, we will review the anatomical and functional changes in the microcirculation with aging, and some of the available clinical strategies to potentially mitigate the effect of these changes on important clinical outcomes.