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physiotherapy thtrough the life > Age Related Changes > Flashcards

Age Related Changes Flashcards

1
Q

Define aging

A

Progressive deterioration of functional properties of the body at the cellular, tissue and organ levels.

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2
Q

Why is it important to understand the physiological changes caused by age?

A
  • to promote healthy aging
  • to develop effective healthcare plans
  • to improve quality of life
  • to reduce the cost of healthcare
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3
Q

What are the three types of muscle fibers

A

Type I aerobic, slow twitch
Type IIa aerobic, fast twtich
Type IIb anaerobic, fast twitch

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4
Q

What is the main change in body composition due to aging ?

A

Muscle mass loss starting at the 4th decade

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5
Q

What is the percentage of muscle mass loss per year from 40 ?

A

0,5%

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6
Q

What is the percentage of muscle mass loss per year from 50?

A

1% to 2%

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7
Q

What is the muscle mass loss percentage per year from 60?

A

3%

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8
Q

Why is there a loss of muscle mass and strength with aging ?

A

Due to:
- decreased size and number of muscle fibers (mainly type II fibers)
- decreased neural activation

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9
Q

What are the different categories of older adults ?

A

Young-old from 65 to 74
Mid-old from 75 to 84
Old-old older than 85

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10
Q

What is the average life expectancy in Europe ?

A

75 years old

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11
Q

What are the visible signs of aging

A
  • grey hair
  • postural changes (flexion)
  • muscle mass loss
  • wrinkles
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12
Q

What are the signs of atrophy ?

A
  • diminution in type II (fast twitch) muscle fibers
  • increase in fat deposit around the muscle tissue
  • increase in connective tissues around the muscle tissue
    (Fat + connective-tissue being non-contractile tissues)
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13
Q

What is the result of type II muscle fibers loss ?

A
  • reduction of muscle mass
  • reduction of strength and velocity of muscle contraction
  • reduction of aerobic capacity
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14
Q

What is the result of the increase of fat deposit around the muscle tissue?

A
  • less toned muscles
  • reduction of muscle cross sectional area
  • loss of strength
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15
Q

What is the result of the increase of non-contractile structures (define) ?

A

Non contractile structures: fat and connective tissue
Result: decrease in muscle cross sectional area; reduction of potential strength

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16
Q

Which body parts decline faster due to aging ? Give an example

A

Lower limbs > Upper limbs
Extensors > Flexors
Ex: isometric knee extension between 55% and 76%

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17
Q

What causes decline in gait velocity in elderly people?

A

Decline in knee isometric extension

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18
Q

What are the effects of aging on connective tissue (define)

A

Connective tissue= fascia, cartilage, ligaments and tendons
Effects= increased number of cross-links in collagen fibers
—> makes them less extensible causing a decrease in AROM an PROM
—> as well as tendon stiffness
—> and reduced maximal force production
—> and slower transmission of forces.

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19
Q

What are the effects of aging on the cartilage ?

A
  • reduced number of proteoglycans
  • remaining proteoglycans become shorter and lose their ability to hold water

These factors cause a degeneration, thinning/ damage and loss of water content in the cartilage and leads to OA

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20
Q

What are the effects of aging on the MSK system ?

A
  • decrease in bone density
  • increase in cross links between collagen fibers
    Both causing a higher risk of bone fracture
  • cartilage becomes less hydrated and thinner
    This leads to possible degeneration

Risk of fall is an aggravating factor

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21
Q

What are the roles of the hypothalamus and pituitary gland complex ?

A

Command center of the endocrine system which secretes several hormones, some producing responses on targeted tissues, others regulating the synthesis and secretion of hormones of other glands.

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22
Q

What is the role of the pituitary gland ?

A

Controls other glands through release of hormones: growth hormone, prolactin, luteinizing hormone.

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23
Q

What is the role of the pineal gland?

A

Production of melatonin

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24
Q

What is the role of the thyroid gland ?

A

Controls metabolism through thyroid hormone

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25
Q

What is the role of the parathyroid ?

A

Controls calcium levels in blood

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26
Q

What is the role of the adrenal gland ?

A

Production of epinephrine, corticosteroids, aldosterone

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27
Q

What is the role (hormonal) of pancreas ?

A

Producing insulin and glucagon

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28
Q

What is the role of ovaries ? (Hormonal)

A

Production of estrogen

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29
Q

What is the role (hormonal) of testes ?

A

Production of testosterone which increases muscle protein synthesis

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30
Q

What are the effects of aging on the pituitary gland ?

A

It produces less growth hormone, reducing muscle mass and increasing deposition of adipose tissue.

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31
Q

What are the effects of aging on the pineal gland ?

A

It produces less melatonin, reducing the time of sleep and altering its pattern

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32
Q

What are the effects of aging on the parathyroid gland ?

A

It produces less parathyroid hormone leading to increased osteoclast activity and therefore a diminution in bone density.

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33
Q

What are the effects of aging on the pancreas ?

A

Its function decreases causing insulin resistance and increasing glucose levels in the blood.

34
Q

What are the effects of aging on the adrenal cortex gland ?

A

It produces less aldosterone, reducing the regulation capacity of postural hypotension

35
Q

What is the effect of aging on ovaries ?

A

They decrease in size, reducing the production of estrogen and progesterone causing the inability to reproduce, a risk of osteoporosis, atherosclerosis and hyperlipidemia.

36
Q

What are the key points of endocrine system’s aging ?

A
  • build up of body fat
  • diminution in bone density
  • sleep disturbances
  • risk of insomnia
  • risk of fractures
  • risk of type II diabetes
  • cognitive changes
37
Q

What are the 3 effects of aging on the digestive system ?

A
  • increase of dysphagia: causes malnutrition, aspiration and pneumonia
  • reduction of the production of hydrochloric acid in the stomach causing nutritional deficiencies (iron, protein) and a decreased solubility of medications
  • slower peristalsis, increasing the duration of transit and causing constipation
38
Q

Why does eating become less interesting in elderlies ?

A

Taste and smell change:
- loss of taste
- salt detection decline
- bitter is exaggerated
- saliva glands produce less saliva

39
Q

What are the effects of aging on the urinary system?

A
  • reduction of renal blood flow: reducing the filtration rate
  • reduction of the kidney size and of the number of functional glomeruli: reduction of the filtration rate of blood and reduced ability of excretion
  • reduction of elasticity and muscle strength of the bladder and urethra tissue, make it harder to fully empty the bladder, increasing the frequency of urination
40
Q

What are the effects of aging on the anatomy of the kidney ?

A
  • decrease in cortical volume
  • reduction in renal mass
  • decrease in cortical/medullary ratio
  • reduction in number of glomeruli
  • increase in surface roughness
  • increase in number and size of cysts
  • tubular atrophy and fibrosis
  • global glomerular and vascular sclerosis
41
Q

How is the renal function affected due to aging ?

A

Decline in glomerular filtration rate such that blood is not filtered properly

42
Q

What are the effects of aging on the bladder ?

A
  • fibrosis on the wall of the bladder
  • reduced bladder capacity (increased frequency of urination)
  • decreased urinary flow rate
  • sphincter function decreases
  • overall reduction of bladder compliance
43
Q

What is caused by the prostate gland enlargement ?

A
  • difficulty to start micturition
  • urinary frequency
  • difficulty to fully empty the bladder
44
Q

Define cognitive decline

A

Observed around 60 yo.
Memory issues, the processing speed of information is slowed down, sensory losses are observed.

45
Q

Why do we observe memory, learning and intelligence changes in elderly?

A

Due to the reduction of the production of central neurotransmitters such as catecholin, serotonin, acetylcholine, a decrease in memory, a decline in perceptual motor skills (times tasks).

Due to neurons’ atrophy and decreased number of connections among them.

Due to a shrinking of the brain (starting at 40 yo)

Due to a decrease in blood flow in the brain.

46
Q

How does aging affect the nervous system ?

A
  • decrease in number of motor neurons : causing a reduction of strength and muscles’ force as well as a reduction in muscle innervation (impacting perception of touch, pain, temperature and vibration)
  • decreased action potential speed : reduction of fine motor control, slower reaction time, and slower initiation of movement
  • decrease in axon/dendrite branches: reduces fine motor control
47
Q

What is potentially caused by slower reaction time ?

A
  • development of gait abnormalities
  • increased risk of falls
48
Q

What are the effects of aging on cognition ?

A
  • Memory: decreased retrieval ability
  • Decreased cognitive speed (slower understanding and reaction to inputs)
  • Decreased cognitive flexibility (ability to adapt to new situations)
49
Q

What are the effects of aging on peripheral nervous system ?

A
  • motor, sensory and autonomic fibers are lost
  • reduced both afferent and efferent conduction velocity
  • reduced number of innervated muscle cells causing muscle atrophy and denervation
50
Q

What are the effects of aging on the autonomic nervous system ?

A

Increased activity of the sympathetic nervous system leading to an increase in systemic vascular resistance and an increased arterial blood pressure.

51
Q

What are the effects of aging on the sight (eye)

A

Vision is impaired
- presbyopia
- decline in glare tolerance
- decline in colour discrimination
- decline in attention visual field

52
Q

What is caused by the sight impairement?

A
  • driving is impacted
  • reading is impacted
  • balance is impacted
  • incidence of falls is increased
  • risk of depression is higher
  • risk of social isolation is higher
  • risk of dependency is higher
53
Q

What are the effects of aging on the eye ?

A
  • Thickening of cell layers reducing the transparency of cornea and causing loss of clear vision
  • Thickening of lens causing difficulty in focusing on near objects and cataracts
  • Reduction of the pupil diameter : requires more light to read, slow adaptation to dark environment (—> falls at night)
54
Q

What are the effects of aging on the hear ?

A
  • decline of the semicircular canal function
  • reduction of the number of neurons in the semicircular canals

Both causing a vestibular system dysfunction = impaired detection of gravity, changes in speed and rotation thus increasing the risk of falls

55
Q

What are the effects of aging on skin ?

A
  • reduction of skin thickness
  • reduction of elastin
  • increase of collagen cross-links

All three factors leading to a loss of padding, and elasticity of the skin

  • reduction of the number of capillaries causing a loss of blood supply, reducing sensitivity to touch, pain and temperature.
56
Q

What are the risks of skin aging ?

A
  • patients are prone to cuts and bruises
  • patients are predisposed to pressure sores
  • patients report less pain
  • the healing process is slower
  • bruises appear under the skin following minor trauma
57
Q

What are the effects of aging on thermoregulation ?

A
  • loss of thermoregulation = hypothermia/hyperthermia
  • decrease in number of sweat glands = overheating
  • decreased blood flow to surface of the skin = overheating
  • thinning of the skin = loss of insulation
  • decrease in muscle mass, and production of internal heat (less shivering)
58
Q

How does old age impact physiotherapy treatment?

A

-Additional time may be required for assessment (slower pace of gait, reactions..etc)
-Speak slowly and clearly, using a lower pitch voice
-Consider slower healing time and progression
-Use a larger font handout for home exercise if applicable

59
Q

What are the main factors leading to fracture in elderly ?

A

Aging => reduced muscle mass/ sarcopenia => reduced muscle strength => balance impairment => fracture;

Aging => reduced bone mass/ osteoporosis => reduced bone strength => fracture

60
Q

Define sarcopenia

A

Geriatric condition/indicator of development of fragility/ powerful predictor of late-life disability.
Sarcopenia is a syndrome characterized by the reduction in skeletal muscle mass, and strength due to aging. It is correlated with a physical disability, poor quality of life, and death. Stronger findings in men compared to women.

61
Q

What are the factors influencing the maintenance of skeletal muscle strength and mass in aging ?

A
  • increased inflammation
  • diminished activity
  • mal nutrition
  • reduction of motor neurons
  • age-related molecular change
  • hormonal change
62
Q

What are the contributing factors of sarcopenia ?

A
  • poor nutrition
  • physical inactivity
  • comorbidities
  • genetics
  • trauma
  • neuromuscular dysfunction
63
Q

At which age starts sarcopenia in women ?

A

40 yo

64
Q

At which age starts sarcopenia in men?

A

60 yo

65
Q

What are the clinical signs of sarcopenia ?

A
  • noted decline in function, strength and «health status»
  • self-reported mobility difficulties
  • history of recurrent falls
  • recent unintentional weight loss (>5%)
  • post hospitalization
  • other chronic conditions such as type 2 diabetes, chronic heart failure, COPD, chronic kidney disease, rheumatoid arthritis, cancer)
66
Q

Which patient is at risk of sarcopenia ?

A
  • no ambulatory or need assistance to rise from a chair
  • 4 meter walk test is > 1m /s (then proceed to additional tests)
67
Q

How to reduce the effects of sarcopenia ?

A
  • Start early!
  • reduce sedentary time (<6h per day or 6000-10000 steps daily)
  • exercise = mix resistance and aerobic
  • have protein intake of 1-1,2 g/kg/day (new researches: 1,6-1,8g/kg/day depending on health statute)
  • take at least 5g leucine per meal (ex: parmesan, soybeans, meat, nuts, fish, seafood, beans or supplement)
  • when taking protein supplement, use high-quality, fast digestive protein (whey)
  • avoid negative energy balance
68
Q

How can physiotherapy help patient with sarcopenia ?

A

By improving functional tasks and quality of life

69
Q

What are the two components of bone ? Which one is most affected by aging ?

A
  • cortical bone
  • cancellous (spongy) bone

Greater loss of cancellous bone > loss of cortical bone

70
Q

What is the WHO definition of osteoporosis ?

A

A systemic skeletal disease characterized by low bone density and micro architectural deterioration of bone tissue with a consequent increase in bone fragility.

71
Q

What is the incidence of osteoporosis ?

A

Most common in females from 55 yo.

72
Q

How to diagnose osteoporosis ?

A

Bone mineral density is described as a T score :
A T-score of - 2,5 SD or less at the femoral neck or spine

73
Q

What is osteopenia ?

A

Bone densitometry : T score from -1 to - 2,5
Midway point to osteoporosis

74
Q

At which age is the peak bone mass reached ?

A

30yo

75
Q

What concomitant condition aggravates osteoporosis in women ?

A

Menopause

76
Q

What are the non-modifiable risk factors of osteoporosis ?

A
  • age > 50 yo
  • caucasian/ Asian
  • Northern European ancestry
  • menopausal
  • family history of osteoporosis
  • personal history of fragility fracture
  • long periods of inactivity, immobilization, long-term care
  • lactose intolerance
77
Q

What are the modifiable risk factors of osteoporosis ?

A
  • inactivity/ sedentary lifestyle
  • excessive intake of : alcohol, tobacco, caffein (>3 per day)
  • estrogen deficiency/ testosterone deficiency
  • some medications (ei: corticosteroids, immunosuppressants, anticoagulants, some antibiotics, chemotherapy, etc)
  • low BMI
  • diet and nutrition (ie: vit D, vit C, calcium, magnesium deficiency), eating disorders, excessive sugars, repeated crash dieting, high fat dieting
78
Q

What are fragility fractures ?

A

Fractures secondary to falls (low energy trauma), most common being hip, spine and forearm

79
Q

Which type of exercise is recommended to manage osteoporosis ?

A

Résistance training

80
Q

What are the main guidelines to manage osteoporosis ?

A

Mainly lifestyle and dietary measures :
- regular weight-bearing exercise
- vitamin D, calcium supplementation and dietary protein
- pharmacological intervention - medication

physiotherapy thtrough the life (6 decks)

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