Geriatrics Flashcards
Demographics for geriatrics
65+ accounts for 13% population 85+ accounts for 4% population by 2050 women live longer than men 2% ages 65-74 in nursing home 20% 85+ in nursing home
Why are women prone to poverty in old age
low wages
fringe benefits
interrupted careers
reduction in benefits when they become widowed
3 most common causes of death in elderly
heart disease
cancer
stroke
Chronic disease statistics
more than 50% males and 70% females over 80 have 2+ chronic conditions
Most common self reported chronic diseases
arthritis HTN diabetes hearing impairments heart disease
Common causes of disability
cardiovascular disease diabetes obesity stroke hip fractures osteoarthritis
Recovery statistics after hip fracture
more recovery of walking/ADL occurred within 6 months.
Poor recovery associated with old age, pre-fracture dependency, longer hospital stay, dementia, etc.
Intense rehab program for stroke pt statistics
improvement in weight shifting, balance, and ADL ability 1 year post stroke.
Psychosocial factors that can modify disability
income smoking social isolation depression education alcohol use
Decline in physical fx caused by
reduced physical activity.
can possibly reversed by exercise
Cardiovascular aging changes
ADL ability to depends on cardio system
physiological capacity and reserve are reduced
Older=closer to maximum limit
Structural changes in myocardium, conduction system, and endocardium
Result in reduction of heart’s pumping capacity
1 degree in L ventricle
Arterial vessels lose elasticity resulting in:
chronic increase in vessel diameter and vessel wall rigidity.
Increased resistance to blood leaving L ventricle=increase afterload
(doesn’t pump as much blood out)
Accumulation of lipids in arteries results in:
impedance of blood flow
Walls of veins become thicker resulting in:
valves become stiff and incompetent
increased risk of phlebitis and thrombus (blood clot) formation
Stroke volume and CO at rest is
unchanged
Maximum heart rate raises or lowers with age?
lowers
Aging on systolic and diastolic BP
Systolic BP tends to increase with age
Diastolic BP increases until ~60 and then stabilizes or falls
Structural changes in skeletal muscle with aging
Muscle mass is reduced mm fiber and size are reduced Type 2 mm fibers reduced (fast twitch) less precise grading/control of mm force (decrease in motor units) Diameter of motor axons reduced
How much reduction in maximal isometric strength by 7th and 8th decade?
20-40%
Loss of extremity strength is greatest in:
LE mm strength loss is greater than loss of arm mm strength
Power
Reduced by 20%
Ability to respond quickly decreases
Two types of immobility
acute/accidental:accident/illness
chronic: long standing problem
Deconditioning
multiple changes in organ system physiology that are induced by inactivity and reversed by activity
Degree of deconditioning depends on
degree of inactivity
prior level of fitness
Acute changes associated with immobility
distortion of time perception decrements in intellectual tests mood changes balance increase resting HR greater increase in HR and BP at submaximal activity levels lower maximal O2 uptake loss of lean body mass accelerated bone erosion decrease in joint ROM constipation
Chronic changes associated with immobility
poor sense of well being balance prolonged reaction time increase resting HR greater increase in HR and BP at submaximal activity (moreso than acute) lower maximal O2 uptake (more than acute does) loss of lean body mass accelerated bone erosion decrease in joint ROM
Why are PROM and AAROM important?
exercise reverses physiological changes of inactivity
Causes for falls
hip weakness
poor balance
postural sway
exercise training is important to prevent falls!
Effects of aerobic exercise
extent of change depends on baseline fitness level
changes occur in both skeletal and cardiac mm
Glucose tolerance improves
Exercise interventions for geriatrics
should contain aerobic and resistance training
Resistance can cause elevated BP, but if proper technique is used it should be minimal
Risk of sudden death
Occurring either during activity or 1 hour after is most serious but least commong.
Risk of Injury
Due to 1 degree of overuse
ankle most likely to be injured
lower rates are associated with low impact exercise
Risk of stimulating arthritis
OA affects 85% of population
inactivity may promote OA
weight bearing may prevent OA by improving mm strength and increasing bone density and reducing obesity
Dietary risks
May need to increase dietary protein than when younger
Changes in periarticular tissue (PCT with age
(Ligaments, joint capsule, aponeurosis, tendon, muscle, and skin)
Increased stiffness of PCT
mobility is severely compromised in tissue
Changes in elastin with age
elastin is designed for mobility
returns to shape after deformation
reduces with age
Predominance of collage with old age
designed for immobility
excellent tolerance to tensile forces
no tolerance to compression forces
INCREASES with age
What is hyaluronic acid
naturally occurs in humans for joint and eye lubrication
decreases with age
What is fibrin?
protein involved in clotting of blood
forms a mesh
increases with age
Aging effects on stretch
loss of elastin= loss of ability to respond over time to prolonged stretch.
Does not respond well to large force
Oscillations are best way to increase ROM
What happens to hyaline cartilage with age?
dehydrates and splits into fragments resulting in decreased ability to tolerate compression and tensile forces
Arthrokinetics for elderly
older joints have subtle decrease in angular velocity and displacement due to structural and sensorimotor changes.
Standing normal ROM of hips (line of gravity)
line of gravity falls just post. to axis for flex/ext.
Is balanced by natural stiffness in the taut iliofemoral ligament
Line of gravity with hip flexion contracture
Line of gravity falls just anterior to the axis for flex/ext.
Must be countered by hip extensor mm
Lumbar spine hyperextension and knee flex. occur to help trunk and pelvis
Senile kyphosis
common in elderly
can cause external gravitational torque on spine with increases intervertebral joint forces
They use increased back extensor mm force to hold head and trunk up
Senile kyphosis can result in:
arthritic changes compression fx disc injury loss of height bony remodeling
Sensorimotor changes in brain
subtle deterioration of executive order fx
Sensory changes in visual acuity
Visual acuity (seeing fine details) decreases gradually before the 6th decade
Increases rapidly from 60-80
Affects ability to read
Presbyopia
Difficulty focusing on near object
Most common vision problem in elderly
Color discrimination in elderly
Difficulty identifying blues and greens
Changes in ocular motor systems
convergence difficulty ptosis (drooping eyelids) decreased smooth pursuit saccades (fast eye movements) optokinetic nystagmus
When is fx impairment to hearing typically seen?
70 years old
Presbycusis
age related decline in auditory fx
gradual loss of bilateral hearing loss
Lose high frequency tones first, then the rest
Presbyastasis
age related disequilibrium when no other pathological condition is seen.
May result in vertigo, nystagmus, and postural imbalance.
Hyposmia
diminished sensitivity to smell
Hypogeusia
diminished sensitivity to tast
What is Somatosensory system?
Multiple systems for reception and processing
Proprioception declines and LE is more affected than upper
Paucity
small movements
hesitant and slow movements
delays
What happens to control of muscular forces output?
less precisely graded
increased cocontraction of paired antagonist muscles
Postural changes that occur due to somatosensory changes
forward head increases
upper thoracic kyphosis increases
overall height decreases (falling arches, reduced intervertebral disc hydration)
Balance
rapid movements=loss of balance
Lateral stability is more affected
healthy elderly can maintain bilateral standing balance for 30 seconds w/open or closed eyes
Gait changes
step length decline Time in double support increases speed decreases ankle motion decreases BOS increases decreased pelvic rotation increased should. extension increased toeing out
How can gait changes be improved?
exercise and physical activity
Aging associated cognitive decline (AACD)
Gradual cognitive decline for at least 6 months
Has to result in one standard deviation below age and education norms
Age-associated memory impairment (AAMI)
Memory loss in elderly not sufficient to warrant diagnosis for dementia
One standard deviation below norms
Benign senescent (age related causes) forgetfulness (BSF)
Term for memory loss associated with normal older person
Not severe enough to interfere with ADLs
Fluid Intelligence
involves capacity to use unique kinds of thinking to solve unfamiliar problems and is believed to decline wit age
Crystal Intelligence
acquired through education and acculturation and remains stable through age 70
What is executive functioning?
Complex behavior comprised of memory, cognitive planning, initiating activity
Effects of aerobic exercise on cognition
aerobic exercise leads to increased cardiorespiratory fitness–>Increased max 02 uptake
Exercise has greatest effects on what?
motor function
auditory attention
memory
Exercise has moderate effects on what?
cognitive speed
visual attention
What is dementia?
Group of disorders characterized by multiple cognitive defects.
Impairment of short/long term memory, abstract thinking, judgement,
Interferes with daily life and relationships
Alzheimer’s type of dementia account for how much?
60% of those with dementia
Diagnosis made post mortem (brain tissue autopsy)
Memory impairment, aphasia, apraxia, disturbance in executive function
Multi-infarct dementia
organic mental disorder
result of infarcts that produce loss of brain tissue
Signs/symptoms of multi-infarct dementia
Problems with memory, abstract thinking, impulse control, personality, emotional lability
Reversible dementia
10-30% of those with dementia can be treated to correct a metabolic or structural condition
Pseudodementia
dementia behavior that is the result of major depressive episode
Psychomotor retardation, disinterest, memory impairment
Anxiety
Common in elderly
can be present in early stage dementia
can be caused by pulmonary embolus, COPD, alcohol withdrawal
Coping behavior
depends on personality
no evidence that coping ability declines with age
Treatment methods
similar to TBI simple commands sensory cues rest breaks stay positive use fx activities rather than exercise programs
