Anatomy - Falls in older adults Flashcards
What is sarcopenia?
Age-related loss of muscle mass and function
How is sarcopenia defined?
Skeletal muscle mass <2 standard deviations below mean of reference group
What changes occur to slow and fast-twitch muscle with ageing?
Slow-twitch = no change
Fast-twitch = 35% loss
What happens to cardiac output and mitochondrion with ageing?
Quality of both decreases
What are the 4 potential mechanisms that lead to sarcopenia?
- Insufficient protein intake
- Anabolic blunting
- Loss of motor function
- Glucose tolerance
What is anabolic resistance?
Reduced stimulation of synthesis of muscle protein with a given protein intake, leading to reduced muscle mass
What detemrines glucose tolerance?
Balance of insulin secretion and insulin action
How does glucose tolerance lead to sarcopenia in the elderly?
- Beta cell function declines with age
- Insulin secretion remains unchanged
- Insulin resistance occurs in the elderly
- Hyperinsulinaemia is reduced by maintaining physical fitness
What is the role of resistance exercise in sarcopenia?
- Partly reverses sarcopenia
- Increases muscle protein synthesis and satellite cell activation
- Restores muscle insulin sensitivity
- Increases muscle capillarisation and mitochondrial mass
- Reduces muscle fat mass
What other confounding variables can lead to sarcopenia, linked with ageing?
- Sense of taste and smell diminish
- Chewing problems
- Salivary glands shrink and less saliva secreted
- Digestive tract degenerates
- Food choices
- Muscle co-ordination
What changes occur to vision with ageing?
- Farsightedness
- Reduced blood flow - enlarged retinal blind spot - reduced field of vision
- Pupil size and dilation reduced - loss of focussing ability
- Weaker ciliary muscle - less flexible and more opaque lens
- Yellowing of lens
- Clouding of lens (cataracts)
What changes occur to hearing with ageing?
- Presbycusis (hearing loss)
- High frequency sound loss - impaired word discrimination
- Left ear more effected generally by hearing loss
- Tinnitus
What changes occur to touch with ageing?
- Less responsiveness to hot and cold
- Loss of subcutaneous adipose tissue - reduced thermal insulation
- Increased pain threshold - decreased pressure perception
- Danger from reduced ability to feel hot and cold
What changes occur to taste and smell with ageing?
- No change in detecting between sweet, salt, bitter and sour
- Impaired smell so reduced taste
- Reduced appetite
- Increased salt and sugar intake to imporve taste of food
- Risk of food poisoning
- Failure to notice changes in environment (i.e. gas leaks)
What changes occur to the brain with ageing?
- Brain volume decreases
- Slower synaptic speed
- Loss of synaptic plasticity
- Less efficient connections between brain regions
- Reaction time sharply increases after age 60
What changes occur to memory with ageing?
- Impaired recolleciton of everyday events
- Increase in ‘tip-of-the-tongue’ phenomenon
- Slower recognition memory
- Delayed working memory
What are the 4 interventions for the elderly?
- Increasing neuroplasticity
- Psychosocial interventions
- Reminiscence therapy
- Cognitive stimulation therapy
What is involved in increasing neuroplasticity?
- Use transcranial direct current stimulation
- Aids adaptive neuroplasticity
- Reduces cognitive decline from early or insufficient reorganisation of neural networks
What is involved in reminiscence therapy?
- Use memory triggers to provide focus for reminiscence
- Reminiscence rooms
- Maintain person’s identity and assist in social interaction
What are the implications of falls in the elderly?
- Fall
- Fear of falling again
- Less activity
- Decreased muscle strength and balance
- Increased risk of falling
- Fall
What is involved in the multifactorial assessment for falls?
- Home hazard assessment
- History of falls
- Medication review
- Continence assessment
- Neurological function and cognition
- Perceived function and fear of falling
- Gait, balance, mobility and strength assessment
- Osteoporosis risk
- Visual impairment
- Cardiovascular status
What exercises are used prevent falls?
- Strength training
- Balance
- Gait training
- Coordination training
- Multifactorial intervention
- Specialist support
What are the 8 absolute contraindications to exercise in patients with falls?
- New or uncontrolled arrhythmia
- Resting or uncontrolled tachycardia
- Resting SBP > 180mmHg or DBP > 100 mmHg
- Symptomatic hypotension
- Unstable / crescendo angina
- Acute or unstable heart failure
- Unstable diabetes
- Acute febrile illness
What is the effective frequency of exercise to prevent falls?
- At least 2 hours per week
- 3 times per week
- At least 4 month period
- 50 hour total
What are the health benefits of physical activity?
- Reduced hypertension
- Prevents weight gain
- Improved sleep
- Reduces falls risk
- Improves bone health
- Improves cardiorespiratory function
Why is retirement a risk factor for alcoholism?
- More free time
- More financial resources
- Loss of identity
- Frustration with expectations vs reality of retirement
What are the stages of feelings of greif?
- Sadness
- Anger
- Guilt
- Shock
- Numbness
- Yearning
What are the stages of physical sensations of greif?
- Hollowness
- Tightness
- Unreality
- Weakness
What are the stages of cognition of grief?
- Disbelief
- Confusion
- Pre-occupied
- Sense of presence / hallucinations
What are the stages of behaviour of grief?
- Crying
- Poor sleep or excessive sleep
- Loss of appetite
- Withdrawn or overactive
- Dreams
- Searching or avoidance
What are the risk factors for atypical grief?
- Difficult relationship
- Violent or sudden death
- Unusual involvement
- Previous loss issues
What are the 3 themes of grief in the elderly?
- Feelings of isolation
- Sense of loneliness and depression
- Perceived inner representation and development of a dialogue with the deceased
What is the Kubler-Ross stage theory of terminal illness?
D enial
A nger
B argaining
D epression
A cceptance
