Musculoskeletal Changes with Aging and Interventions to Prevent Falls Flashcards
Most common age-related changes in neuroskeletal and movement function
Decreased muscle strength, power, and mass
Decreased percentage of type II (fast twitch) fibers and functional motor units
Changes in bone, cartilage, balance, gait, balance, and posture
Decreased maximal speed of movement and initiation of responses
Increased threshold for vibration sensation and decreased proprioception
Physically elite older adults
Sports competition
High risk and power sports
Physically fit older adults
Participate in moderate physical work
Participate in endurance sports, games, and regular exercise
Physically independent older adults
Participates in very light physical work and can perform all IADLs
Physically frail older adults
Can perform some IADLs and all BADLs
Physically dependent older adults
Can’t complete some or all BADLs
Need full-time home or institutional care
Age-related changes in the nervous system
Cerebral atrophy
Increased cerebral spinal space
Decreased effectiveness of neurotransmitter systems
Reduced cerebral blood flow
Diminished glucose utilization
Loss of motor nerve fibers
Slowing of nerve conduction velocities
Increased plaques and neurofibrillary tangles in selective brain regions
Causes of changes in the nervous system
Biochemical and morphological changes in neurons
Loss of neurons
Defects in neuronal transport mechanisms
Defect in protein synthesis
Cumulative trauma
Oxidative stress and vascular changes
Sarcopenia
Loss of muscle mass associated with aging
Is a main determinant of movement and performance of almost every ADL
Impact of skeletal muscle weakness
Can lead to impaired mobility and functional performance
Decreased walking speed
Loss of independence
Poor balance
Increased risk of falls, hospitalization, and mortality
Importance of skeletal functions
Reservoir for calcium homeostasis
Site for red blood cell production
Traps toxic minerals
When does bone mass begin to decline
30s
Rapid decline of bone density in women
Menopause
Bone and cartilage changes
Collagen become more stiff and dense
Elastin decreases
Decreased production and release of glycoproteins which leads to increased friction in tissues
Smaller proteoglycans found in articular cartilage result in increased joint compression
Postural changes
Forward head position and rounded shoulders creates difficulty looking anteriorly
Hyper or hypolordosis of lumbar spine causes lower back pain
Hyperkyphosis causes pain secondary to stretching of ligaments and muscles
Increased knee flexion angle
More posterior hip position
Gait changes
Decreased step length
Decreased stride length
Slower walking velocity
Decreased cadence
Decreased ankle range and push-off
Fewer automatic movements
Intervention for age-related musculoskeletal changes
Strength and resistance exercises
Trunk strengthening (hyperextension) and abdominal strengthening along with weight bearing activities
Utilize functional daily tasks in exercise program
Osteoporosis
Decrease in bone mass that causes disruption in bone architecture and an increased risk for fractures
What percentage of older adults die within a year after a hip fracture?
21%
What percentage of older adults who sustain a fracture receive intervention for osteoporosis?
20-30%
Risk factors for fractures that you cannot changes
Women
Older
Smaller/thinner
Caucasian/Asian
Family history
Risk factors for fractures that you can change
Low estrogen and testosterone levels
Anorexia/poor eating habits
Low vitamin D intake
Long term glucocorticoids and anticonvulsants
Sedentary lifestyle
Cigarette use
Alcohol intake
Fear of falling
Lack of self-efficacy and avoiding doing activities they are capable of performing due to fear of falling
Inactivity leads to weakening of legs and increased risk for falls
Leads to feelings of isolation and depression
Interventions to decrease fall risk
Strong evidence for home modifications
Strong evidence for exercise
Withdrawing or minimizing psychoactive medication
Fair evidence for management of postural hypotension and management of foot problems and footwear
Multicomponent interventions
Set of interventions offered to address more than one intervention (often in long term care)
Multifactorial interventions
Set of interventions that target identified risk factors (often within community dwelling setting)
What type of intervention is fall education?
Multifactorial intervention that is tailored to the individual
Education on falls
Teach protective behaviors (being practical, avoiding, unsafe situations, protective mobility, and pacing self)
Environmental adapations
Environmental adaptations to decrease fall risk
Removing clutter
Bathroom and kitchen modifications
Improving lighting
Seat heights and seat stability changes
Room arrangement with necessary items within reach
Decreasing stairs
