Geriatrics: Age related changes

Question 1

define gerontology

Answer 1

the study of aging

Question 2

define geriatrics

Answer 2

medical treatment of aging people

Question 3

List and briefly describe several theories of aging

Answer 3

1. Progressive Decline model → wear and tear
2. Biological Time Clock → finite number of cell replications
3. Free Radical Theory → O2 radicals contribute to pathophysiological changes
4. Cross-linkage Theory → chemical reactions cause irreparable damage to DNA
5. Immune Theory → breakdown in immune system leads to greater risk of disease and cancer
6. Error Catastrophe Theory → errors in cellular RNA transcription lead to faulty structures, especially proteins

Question 4

General trends in disease and disability

Answer 4

1. 79% of people 70 and older have one or more of 7 chronic conditions
   
   1. arthritis
   2. high BP
   3. diabetes
   4. lung disease
   5. stroke
   6. cancer
2. in those 65 and older, 30% have 3 or more chronic conditions (medically complex pts)
3. dementia adds to complexity

Question 5

what should rehab be directed towards in geriatrics?

Answer 5

1. stabilizing primary problems
2. preventing secondary complications (bed sores, contractures, pneumonia)
3. restoring lost functions
   
   1. reducing inflammation
   2. maintaining joint mobility/joint protection
   3. maintaining proper nutrition (including proper admin of meds)
   4. having social/psych support

Question 6

evaluation considerations in geriatrics

Answer 6

1. endurance may be limited, both physical and mental
2. determine cog status immediately to guide direction of interview questions and physical exam
3. use appropriate pain scale
4. understand the dif between depression and dementia and how they may present together
5. keep function at the forefront of clinical assessment/decisions

Question 7

what constitutes successful aging?

Answer 7

1. high capacity to tolerate stressors
2. exercise causes robust, positive changes
3. wider homeostatic window = greater physical resilience

Question 8

what constitutes unsuccessful aging?

Answer 8

1. low tolerance: susceptible to illness
2. positive changes occur but a smaller magnitude
3. narrow homeostatic window = reduced adaptation to even low stress

Question 9

List some age related changes to the MSK system

Answer 9

1. Bone loss
2. Sarcopenia
3. Cachexia
4. decreased height
5. joint stiffness and reduced shock absorption
6. saggy, wrinkled skin

Question 10

what causes bone loss with aging?

Answer 10

advancing age favors bone catabolism rather than bone anabolism

1. women → bone loss accelerated by menopause
2. men → loss accelerated after age 75
3. osteoporosis
   
   1. T-score between -1.0 and -2.5 in lumbar spine, total hip, and femoral neck and increased risk using FRAX

Question 11

what is sarcopenia?

Answer 11

age-related decline in muscle mass

1. dynapenia = age related decline in strength
2. loss of Type II fibers affect strength and power → STS
3. loss of LBM and gain of fat mass = decreased resting metabolic rate of 1% to 2% per decade after 20 years old

Question 12

what is cachexia?

Answer 12

decline in muscle/body wasting that does not respond to nutritional support

• occurs before death, associated with cancer, COPD, end-stage disease
• most likely caused by massive increase in inflammatory cytokines

Question 13

exercise considerations for MSK changes with aging

Answer 13

1. higher-intensity exercise leads to greater strength gains and LBM
2. exercise plays a crucial role in controlling intra-abdominal fat
3. achieving end-range prevents age related ROM losses
4. connective tissue stiffness increases muscular effort required for movement → leads to reduced muscle endurance
5. high-impact exercise may not be appropriate in presence of bone loss and dried out connective tissue

Question 14

List anatomical/physiological changes to the cardiovascular system with aging and the clinical consequences of each

Answer 14

1. decline in HRmax → smaller aerobic workload
2. decline in VO2max → smaller aerobic workload
3. stiffer, less compliant vascular tissue → higher BP, slower ventricular filling time, reduced CO
4. loss of SA node cells → lower HR max
5. reduced contractility of vascular walls → slower HR, lower VO2 max, smaller aerobic workload
6. thickened capillary basement membrane → reduced arteriovenous O2 uptake

Question 15

list anatomic/physiologic changes to the nervous system with aging and the clinical consequence of each

Answer 15

1. sloughing/loss of myelin → slowed nerve conduction
2. axonal loss → fewer muscle fibers, loss of fine sensation
3. autonomic NS dysfunction → slower systemic function (CV, GI) with altered sensory input
4. loss of sensory neurons → reduced ability to discern hot/cold, pain
5. slowed response time (reaction speed) → increased fall risk

Question 16

List some changes to the sensory system with aging

Answer 16

1. peripheral sensory systems
   
   1. vision → loss of acuity, visual field, contrast sensitivity
   2. hearing → presbycusis
   3. losses → depression, poor QOL, cog decline, mortality
2. multisensory impairment common with 66% having 2+ deficits

Question 17

Age related changes to immune system

Answer 17

1. increase in systemic inflammation
2. increased inflammatory markers
3. associated muscle wasting, obesity, and loss of physical function
4. diminished organ function → reduces physiologic reserve

Question 18

what is the impact of exercise on inflammation?

Answer 18

1. sig reduces inflammatory markers
2. creates a wider window of homeostasis
3. exercise reduces visceral fat which secretes inflammatory markers

Question 19

Age related changes to the endocrine system

Answer 19

1. altered gland function, decreased hormone production, decreased tissue responsiveness
2. negative effect on muscle mass, bone density, adipose accumulation, insulin sensitivity, LDL metabolism, libido, congition
3. hormone therapy still an evolving science

Question 20

What is “successful” aging?

Answer 20

1. adding life to the years → achieving QOL
2. it is an outcome and a process
3. includes subjective health → individual’s values and perceptions of their aging
4. includes objective health → physical and cognitive health, physical function
5. adaptation and resilience play a role
6. managing expectations is important

Question 21

how do we motivate pts to achieve their desired outcomes?

Answer 21

1. motivation
   
   1. make it personal
   2. make pt centered goals
   3. reduce unpleasant sensations as much as possible
2. compliance
3. engagement
   
   1. use social supports
4. empowerment
   
   1. edu pt on disease/condition and benefits of exercise/activity

Question 22

List several life transitions that can play a key role in aging

Answer 22

1. Retirement or loss of job
   
   1. work often provides purpose and identity
   2. loss can lead to decreased financial status, depression
   3. recognize how this transition affects pts
2. parent to grandparent
   
   1. emotional and financial strain of raising grandchildren
   2. integrate parent’s context into PT POC
3. relocation
   
   1. moving to another city to be closer to grown children
   2. moving into more supportive environment
   3. loss of independence, social support, autonomy

Question 23

5 guiding principles to trauma informed care

Answer 23

1. safety
2. trustworthiness
3. choice
4. collaboration
5. empowerment

Question 24

what is TIC?

Answer 24

Trauma Informed Care → understanding neurologic, biological, psychological, and social effects of trauma on an individual