Musculoskeletal Changes with Aging and Interventions to Prevent Falls

Question 1

Most common age-related changes in neuroskeletal and movement function

Answer 1

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

Question 2

Physically elite older adults

Answer 2

Sports competition
High risk and power sports

Question 3

Physically fit older adults

Answer 3

Participate in moderate physical work
Participate in endurance sports, games, and regular exercise

Question 4

Physically independent older adults

Answer 4

Participates in very light physical work and can perform all IADLs

Question 5

Physically frail older adults

Answer 5

Can perform some IADLs and all BADLs

Question 6

Physically dependent older adults

Answer 6

Can’t complete some or all BADLs
Need full-time home or institutional care

Question 7

Age-related changes in the nervous system

Answer 7

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

Question 8

Causes of changes in the nervous system

Answer 8

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

Question 9

Sarcopenia

Answer 9

Loss of muscle mass associated with aging
Is a main determinant of movement and performance of almost every ADL

Question 10

Impact of skeletal muscle weakness

Answer 10

Can lead to impaired mobility and functional performance
Decreased walking speed
Loss of independence
Poor balance
Increased risk of falls, hospitalization, and mortality

Question 11

Importance of skeletal functions

Answer 11

Reservoir for calcium homeostasis
Site for red blood cell production
Traps toxic minerals

Question 12

When does bone mass begin to decline

Answer 12

30s

Question 13

Rapid decline of bone density in women

Answer 13

Menopause

Question 14

Bone and cartilage changes

Answer 14

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

Question 15

Postural changes

Answer 15

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

Question 16

Gait changes

Answer 16

Decreased step length
Decreased stride length
Slower walking velocity
Decreased cadence
Decreased ankle range and push-off
Fewer automatic movements

Question 17

Intervention for age-related musculoskeletal changes

Answer 17

Strength and resistance exercises
Trunk strengthening (hyperextension) and abdominal strengthening along with weight bearing activities
Utilize functional daily tasks in exercise program

Question 18

Osteoporosis

Answer 18

Decrease in bone mass that causes disruption in bone architecture and an increased risk for fractures

Question 19

What percentage of older adults die within a year after a hip fracture?

Answer 19

21%

Question 20

What percentage of older adults who sustain a fracture receive intervention for osteoporosis?

Answer 20

20-30%

Question 21

Risk factors for fractures that you cannot changes

Answer 21

Women
Older
Smaller/thinner
Caucasian/Asian
Family history

Question 22

Risk factors for fractures that you can change

Answer 22

Low estrogen and testosterone levels
Anorexia/poor eating habits
Low vitamin D intake
Long term glucocorticoids and anticonvulsants
Sedentary lifestyle
Cigarette use
Alcohol intake

Question 23

Fear of falling

Answer 23

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

Question 24

Interventions to decrease fall risk

Answer 24

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

Question 25

Multicomponent interventions

Answer 25

Set of interventions offered to address more than one intervention (often in long term care)

Question 26

Multifactorial interventions

Answer 26

Set of interventions that target identified risk factors (often within community dwelling setting)

Question 27

What type of intervention is fall education?

Answer 27

Multifactorial intervention that is tailored to the individual

Question 28

Education on falls

Answer 28

Teach protective behaviors (being practical, avoiding, unsafe situations, protective mobility, and pacing self)
Environmental adapations

Question 29

Environmental adaptations to decrease fall risk

Answer 29

Removing clutter
Bathroom and kitchen modifications
Improving lighting
Seat heights and seat stability changes
Room arrangement with necessary items within reach
Decreasing stairs