Age-related changes

Question 1

Characteristics of successful aging vs unsuccessful aging?

Answer 1

1: Successful Aging​

2: Unsuccessful Aging​

1. High capacity to tolerate stressors​
2. Low tolerance: susceptible to illness​
3. Exercise causes robust, positive changes​
4. Positive changes occur but at smaller magnitude​
5. Wider homeostatic window = greater physical resilience​
6. Narrow homeostatic window = reduced adaptation to even low stress​

Question 2

True or false: too much physical stress and not enough physical stress can both cause illness and overwhelm homeostasis

Answer 2

true

Question 3

What is the difference in the stress diagram between unsuccessful and successful aging?

Answer 3

The maintenance range of homeostasis is wider

Question 4

What are some notable changes to the MSK system due to age?

Answer 4

-Bone loss
bone catabolism> anabolism

women bone loss acceleration after menopause
men bone loss acceleration after 75

-Sarcopenia
dynapenia- age related decline in strength

-Loss of type 2 muscle fibers

-Loss of lean body mass and gain of fat mass
decreased resting metabolic rate by 1 to 2% after 20 years old

Question 5

What is cachexia?

Answer 5

decline in muscle/body wasting that does not respond to nutritional support and typically occurs prior to death. Typically muscle mass and weight loss due to disease

Most likely caused by massive increase in inflammatory cytokines (associated with cancer, COPD, end-stage disease)

Question 6

True or false: Older individuals with sarcopenia cannot add muscle mass

Answer 6

False

Question 7

What are some age-related changes in collagenous tissues and what are the consequences?

Answer 7

-Loss of water from matrix: this leads to shrinkage of articular cartilage, reduced shock absorption, loss of ROM.

-Increase in number of collagen cross-links: this leads to stiffer tissues (greater passive tension within tissues), more effort required to move, loss of end range of motion.

-Loss of elastic fibers: this leads to sagging skins and organs, less “give” to tendons, ligaments, and fascia

Question 8

What are some PT considerations for age related changes in MSK system?

Answer 8

Higher-intensity exercise leads to greater strength gains and LBM​

Exercise plays a crucial role in controlling intra-abdominal fat​

Achieving end-range prevents age related ROM losses​

Connective tissue stiffness increases muscular effort required for movement  leads to reduced muscle endurance​

High-impact exercise may not be appropriate in presence of bone loss and dried out connective tissue

Question 9

Age-related cardiovascular changes and consequences of each?

Answer 9

Decreased vO2 max: smaller aerobic workload

Decreased max HR: smaller aerobic workload

Stiffer, less compliant vascular tissue: Higher BP, slower ventricular filling time, reduced CO

Loss of SA node cells: Lower max HR

Reduced contractility of vascular walls: Slower HR, lower VO2Max, smaller aerobic workload

Thickened capillary basement membrane: reduced arteriovenous O2 uptake

Question 10

What type of exercise has been shown as an advantage to older people but is often underprescribed for this population?

Answer 10

HIIT or just higher intensity training in general

it can improve lean mass and decrease fat mass

Some studies have shown larger reduction in BP than moderate intensity exercise

Question 11

What is the common protocol for HIIT prescription in older adults?

Answer 11

“4 x 4” protocol: 4 bouts of 4-min intervals interspersed with 3-min rest—usually 3×/week for at least 4 weeks​

“10 × 1” protocol: alternating 1-min high intensity and 1-min rest for 10–12 intervals

can be any type of aerobic exercise

Question 12

Changes in the nervous system with age-related changes?

Answer 12

sloughing/loss of myelin: reduced nerve conduction velocity

axonal loss: fewer muscle fibers, loss of sensation

Autonomic NS dysfunction: Slower systemic function (CV, GI) with altered sensory input

Loss of sensory neurons: reduced ability to discern hot/cold

slowed response time (reaction speed): increased fall risk

Question 13

PT considerations for changes in the nervous system?

Answer 13

Age-related muscle weakness not entirely explained by muscle atrophy but rather that the communication between the brain and skeletal muscles is impaired with advancing age​

Decreased motor strength, slowed reaction time, and diminished reflexes contribute to balance difficulty ​

These changes may increase the risk of falling​

Falls may lead to fear of falling, which perpetuates falls

Question 14

What are the implications for altered somatosensory input in the older adult?

Answer 14

Complex and poorly understood phenomena with aging is altered somatic sensory input​

Vague symptoms of pain in one area of the body to represent a totally unrelated event

Makes a good differential diagnoses more important in the case of serious conditions that are referring pain elsewhere.

Question 15

Changes in sensory system as you age?

Answer 15

Peripheral sensory systems: visual, proprioception, auditory, tactile, and vestibular​

Vision: loss of acuity, visual field, contrast sensitivity​

Hearing: presbycusis​

Losses = depression, poor QOL, cognitive decline, mortality​

Multisensory impairment common with 66% having 2+ deficits

Question 16

Changes in immune system as you age?

Answer 16

Advancing age leads to increase systemic inflammation​

Increased IL-1, IL-6, IL-10, C-reactive protein, TNF-alpha​

Associated with muscle wasting, obesity, and loss of physical function​

Also diminish the function of other organ systemsreduces physiologic reserve​

Increase in inflammatory cytokines is also associated with metabolic syndrome, which is a major risk factor for CVD​

Increase in systemic inflammation is also an underlying factor in the development of age-related diseases such as Alzheimer disease, atherosclerosis, cancer, and diabetes

Question 17

PT considerations for changes in immune system?

Answer 17

Ways to manage inflammation: medications, diet, calorie restriction, and exercise​

Exercise significantly reduces inflammatory markers​

Habitual exercise results in less systemic inflammation versus being sedentary  creates wider window of homeostasis​

Visceral fat secretes inflammatory markers– exercise reduces it​

A prospective study with 19,000 participants found that higher midlife fitness levels were associated with lower hazards of developing all-cause dementia later in life (70 to 85 years old)

Question 18

Changes on endocrine function as we age?

Answer 18

Altered gland function, decreased hormone production, decreased tissue responsiveness​

Aging hypothalamic-pituitary-gonadal axis: ​

Women: reduced estrogen output  menopause​

Men: low total and free testosterone​

Negative effect on muscle mass, bone density, adipose accumulation, insulin sensitivity, LDL metabolism, libido, cognition​

Loss of sex hormones has been determined to be a contributor to the reduction in muscle mass and, in particular, muscle strength

Question 19

How do we motivate patients to achieve desired outcomes?

Answer 19

motivation…compliance…engagement…empowerment​

Make it personal​

Use social supports​

Make patient-centered goals​

Reduce unpleasant sensations as much as possible (pain, fear)​

Educate patient on disease/condition and benefits of exercise/activity

Question 20

How do we personalize care?

Answer 20

Individualized care includes:​

recognizing individual differences and needs​

using kindness and humor ​

empowering older adults to take an active part in their care ​

providing gentle verbal persuasion to perform an activity ​

using positive reinforcement after performance of an activity​

Providing written instructions and reevaluating progress are critical components​

Demonstrate care: attention, concern, respect, and support​

Set guidelines and explain the purpose for activities to gain “buy-in”

Question 21

Social support

Answer 21

Social support networks including family, friends, peers, and health care providers are important determinants of behavior​

Motivation to exercise has been found to be influenced by the social support ​

Influence of social support can be positive or negative​

Social supports can directly serve as powerful external motivators by (1) providing encouragement, (2) helping the older adult feel cared for and cared about, and (3) helping to establish goals such as regaining self-care abilities and being able to return home alone

Question 22

Patient-centered goals

Answer 22

The ability to develop personal goals and evaluate one’s performance toward that goal can influence motivation to engage in a given behavior​

Patients involved in structured goal setting experience greater autonomy and perceived relevance than those whose goals were set by the therapist​

For individuals who are cognitively impaired and cannot articulate goals, it is useful to review old records and speak with families, friends, and caregivers who have known the individual previously​

Goals are most effective when they are (1) related to a specific behavior, (2) challenging but realistically attainable, and (3) achievable in the near future

Question 23

Personality

Answer 23

Personality, self-determination, and resilience have an important influence on motivation​

Older adults are a heterogeneous group with very rich and diverse life experiences​

Factors that facilitate motivation in one may not work as effectively for another individual​

Interventions can be developed to specifically address identified areas that may be negatively influencing the individual’s motivation to engage in a certain activity