Aging Adult (Week 2) Flashcards
What leads to decreased brain weight?
- Neuron loss (dec gray matter)
- Myelin loss (dec white matter)
- Nerve cell Shrinkage
What are some CNS changes with the agin adult?
- delayed impulse conduction and velocity
- reduction/altered balance of neurotransmitters
- decreases hemisphere size
- vestibular changes (decreased hair and gangllion cells)
- decreased cerebral blood flow
- decreased blucose metabolism
What are some functional implications with CNS change?
- Delayed recall (needs time)
- Rote memory decreases
- altered gait, balance, and fine motor control
- diminshed motor learning
- decreasing activity level
What are the top 4 pathologies of the aging adult?
- CVA (stroke)
- TBI
- Parkinsons disease
- Dementia
What are the PNS changes with again?
- Axonal degeneration ( and myelin)
- Greater iternodal length
- slower conduction velocity
- Decreased ability to adap to environment (or visceral changes) - vagus nerve
- decreased neuros per muscle fiber (fiber grouping) - take on fiber from other
- Decrased Ruffini, pacinain, golgi reeptors
- INCREASED Sympathetic Acitivty
- decreased cerebral blood flow
Functioal impliations of PNS changes
- increased recruitment of motor units )more work to do task)
- increase CO-CONTRACTION at ankle
- Altered motor control and postural stability
- Decreased LE proprioception, vibration, discriminative touch and balance
- Increased risk of falls
- resting BP rises with age
- Delayed response to pain
- unaware of pain signals
PNS changes with aging
- Decreased number and dentisy of mylinated nerve fibers
- Decreased thickness of remaning fibers
- decreased nerve conduction velocity and action potentials
- INCREASED H Reflex latency
Vision changes with PNS
- Beings in 3rd decarde
- Neuron los in visual cortex
- presbyopia - decreased flexibility of lens (common)
- Decreased elasticity of lens
- Decreased recovery from glare
- Decreased tear production
- Decreased acuity
- Decreased visual fields
What are cataracts
Disorted vision - environment looks dusty or cloudy (common but not normal)
What is age related macular degeneration (AMD)?
- Central field of vision is impaired, reading and fine motor task are more difficult
What is glaucoma?
Loss of peripheral vision (may lead to tunnel vision or blindness)
What is diabetic retinopathy?
Person with diabetes has blindspots or scotomas, visual skills fluctuate, may be associated with dpressed mood
What is retinal detachment?
- Tearing or separing of retina from underlying tissue caused by trauma
Describe the functioal impact of sensory loss on balance and function?
- Errors in proprioception have BIGGER effect on balance than errors in vision
- Impairement associated with increased fall risk and functional decline
- PTs need to provide older adults with sensory strategies to increase sensory information
What are the sensory changes with Hearing?
Presbycusis - hearing decline with age
BOTH genders but men lose higher frequencies (typical)
- Difficulty turning out background music
Sensory changes with Semll and taste
- Decreases with age - linked to 3 types of dementia
- high prevelanece of hyposmia (deceased smell) + anosmia (loss of smell)
- Impairs taste in food (leads to malnutrition)
- Thirst declines
What are the normal cognitive changes with aging?
Loss of synaptic connections
- creates memory impairment (slow but intact)
- Evidence of mild decline in executive functioning
Exectutive - intiate activty, planing, problem solvingm figuring out consequences
What are the pathological cognitive changes with aging?
- Certain growth factors in brain are inhibited
- death and loss of neurons
- dementia
What are the 3 most common types of dementia
- Dementia is not normal
- alzheimers
- vascular
- lewy body
What are the common affects of dementia?
- memory and language
- aphasia
- apraxia
- disturbance of executive function
What is Alzheimers Diease?
- Common form
- has early onset 30-60 years olf
- late onset
Risk factors include:
- women > men
- family history
- > african american and hispanic population
What is the clinical presentation of an alzheimers patient?
- Memory impairment
- lapse in judgement
- personality changes
- depression possible
- language problems
- Difficulty with aDLs
- Visual spatial problems
- Short tempered, hostile
- Loss of motor function (swallowing, bowel/bladder)
What are the risk factors for Vascular Dementia?
(2nd most common)
- HTN
- smoking
- hypercholestermia
- diabetes
- CV disease
- cerebrovascular diease
How does a vascular dementia patient present?
- Impairments in
- memory
- abstract thining
- judgement
- impulse control
- personality changes
More by abrupt onset, step by step deterioration, flucutating course, and emotional lability
What is Lewy Body dementia?
- Cognitive decline with:
- Fluctuations in alterness and attention (drowsy or lethargic)
- Visual hallucinations
- parkinsonian motor symptoms
Gait and balance issues, visual spatial issues, poor executive functionin, sensitive to antipsychotics, depressed possibly
What is delurium?
Sudden, rapid change in mental function
associated with:
- medical illness
- recovery from surgery
- hospital admission
Short term
Shouting, resisting, refusal to cooperate with emdical care, potential to be injured fallingm combative
What is the mini cog?
- 3 item recall: memory
- clock drawing (10 after 11)
- 3 min
- scoring 0-2 postive dementia
- 3-5 negative
What is the moca test?
16 item test, 10 min
>26 = normal
What is the MMSE?
- 11 questions to assses
- 24-30 no impairment
- 18-24 mild
- 0-17 severe
What are ways to manage depression?
- Pharmacology (SSRI’s, SCA’s) can have hypotensive side effects
- Psychotherapy - less likely to seek this option
- EXERCISE AND ACTIVITY
What is the two question depresison test?
“over the past two weeks have you ever felt down, depressedm or hopeles?
“have you felt little interest or please in doing things?”
YES = follow up with MD or referral
What are 2 depressions screening tools?
- Geriatric depression scale
- 20-30 = severe depression
- CES-D
- >16 questions needs referral
- higher scores = more depressed
What are some differences working with dementia patients?
- Wont perform well with variety and randomness
- Unable to tranfers
- Need guidance
- need simple adnd cuntioanl feed back
- NO MENTAL PRACTICE
- Massed, constant, blocked practice
What is sarcopenia?
Age related loss of skeletal muscle mass and strength
Not completely age related
- decreased PA
- Co-mobiities
Results in decreased protien reserves
- Challenge to meet protien synthesis demands with injury or disease
What is normal muscle aging?
- muscle reduced from 50% to 25% by age 75-80
- Icnreased body fat
- Type II atrophy > Type I (normal)
- Denervation and reinervation of alpha motor neaurs
- decreased muscle activation (less agnoist more coactivation of anatonist
- decreased muscle strength and power
Describe normal metabolic changes with aging?
- Decreased resting metabolic rate
- Less lean muscle mass
- Insulin Resistance (common in older adults)
- increased body fat further contributes
- regulator of protein metabolism and important for protien gain and muscle growth
- Decreased GH
- Decreased Estrogen and testosterone
- Vit D deficiency
What is occuring int he skeletal system with normal aging?
- Decline in bone minreal
- increased osteoCLAST and decreased osteoBLAST
- Osteopenia = increased risk of osteoperosis
- load absorption decreased
- decreased load dispersion
- results in increased bone loading
Describe the connective tissue with aging?
Decreased activity of osteoblasts and chrondroblasts
Increased osteoclasts and chrondoclasts
deceased response to growth factors
- alters repair of tissue
Altered response to tissue loading
Decreased ability to retain water
- decreased glycoconjugates that maintain fluid
Fragment of college sands and decreased turnover
Increased crosslinking between collagen molecues (INC STIFFNESS)
Calficication of articular disk
What is the joint ROM like for the aging adult?
- C spine - all motions decrease
- greatest reduction in ext and lat flex
- Thoracic and lumbar spine
- extension becomes limited
- no or very little change in motion
- Hip
- EXT decreses (Slower walking speed)
- Ankle
- DF decreases
- Shoulder
- Flex and ER (also from kyphosis)
KNEE ROM STABLE!
Describe what habitual postures lead to
- Forward head posture
- Thoracic Kyphosis
- inc >40 years of age Women > Men
- Correlated with increased fall risk
- associated with osteoposos and vertebral fx
- Lumbar flattening (dec lordosis)
- Decreased IV space (nerve root integrity)
What altered function comes from altered posture?
- diffivulty bending, lifting, climbing
- HYPERKyphosos
- spine extensors lengthened
- FHP
- Challenges swallowing, breathing, supine/prone positioning
- Decreased Lumbar lordosis
- pain, nerve root impingement
- spinal stenosis
- standing
What is Osteoporosis?
skeletal decrease low bone mass and microarchitectural deterioration of bone
- INC fx
- Anterior verebral body
- avoid/cautious of ADLs in flexed position
What is OA
- Failure of articular cartilage
- load bearing joints
- can lead to total joint arthroplasty
What are some ways to test/measure postural alignment?
- Plumb line
- Wall Occiput DIstance
- >0 increase liklihood of fx
