Physiological Changes and Adaptation in the Older Adult

Question 1

Muscle strength

Answer 1

Peaks at 30

Constant loss after 50 (20-40% by age 65 in the nonexercising adult)

Question 2

Changes in muscle fiber composition

Answer 2

loss of type II fast twitch and increase in proportion of type I fibers

Question 3

Collagen changes

Answer 3

Denser, irregular due to cross linkages, loss of water content and elasticity - affects tendons, bone, cartilage

Question 4

CT becomes

Answer 4

denser and stiffer
leads to inc risk of sprains, strains, tendon tears
Loss ROM
inc risk of adhesions and contractures

Question 5

Gait changes

Answer 5

Dec amp and speed, slower cadence

Shorter steps, wider stride, inc DS, dec trunk rotation and arm swing

Question 6

Cartilage changes

Answer 6

Dec water content
becomes stiffer, fragments, erodes
by age 60 more than 60% of adults have degenerative changes and cartilage abnormalities

Question 7

Bone mass

Answer 7

Peak bone mass at 40
Dec between 45 and 70
Loss of Ca, dec bone marrow RBC production

Question 8

IVD changes

Answer 8

flatten, less resilient due to loss of water content (30% loss by age 65) and loss of collagen elasticity, trunk length and overall height dec

Question 9

Postural changes

Answer 9

Forward head
Kyphosis of thoracic
Flattening of lumbar
Hip and knee flexion contractures with prolonged sitting

Question 10

Clinical implications - Skeletal changes

Answer 10

Maintenance of WB is important

Question 11

Nerve cells

Answer 11

Atrophy of them in cerebral cortex
overall loss of brain weight 6-11% between ages of 20 and 90
Accelerating loss after age 70

Question 12

Brain morphology

Answer 12

Gyral atrophy
Ventricular dilation
Loss in cortex (esp frontal and temporal)
Presence of lipfuscins, senile, or neuritis plaques and neurofibrillary tangles (NFT)
More selective loss in BG

Question 13

Changes in SC and peripheral nerves

Answer 13

Neuronal loss and atrophy - 30-50% loss of anterior horn cells
30% loss of posterior roots/sensory fibers by age 90

Question 14

Vision changes

Answer 14

Rapid decline between ages 60 and 90

visual loss high as 80% by age 90

Question 15

Presbyopia

Answer 15

visual loss in middle and older ages characterized by inability to focus properly and blurred images due to loss of accommodation, elasticity of lens

Question 16

Cataracts

Answer 16

Opacity, clouding of lens due to changes in lens proteins

results in gradual loss of vision - central first, then peripheral

Question 17

Glaucoma

Answer 17

increase intraocular pressure with degeneration of optic disc, atrophy of optic nerve
results in early loss of peripheral vision (tunnel vision) - progressing to total blindness

Question 18

Senile macular degeneration

Answer 18

Loss of central vision associated with age related degeneration of the macular
dec blood supply or abnormal growth of blood vessels underneath the retina

Question 19

Diabetic retinopathy

Answer 19

damage to retinal capillaries, growth of abnormal blood vessels and hemorrhage leads to retinal scarring and finally retinal detachment
central vision impairment - complete blindness is rare

Question 20

CVA - homonymous hemianopsia

Answer 20

Loss of half of visual field in each eye (nasal half of one and temporal half of the other)

Question 21

Hearing changes

Answer 21

Occur as early as fourth decade

Question 22

Conductive hearing loss

Answer 22

mechanical hearing loss from damage to external auditory canal, tympanic membrane, or middle ear ossicles
Results in hearing loss, tinnitus might be present too

Question 23

Sensorineural hearing loss

Answer 23

central or neural hearing loss from multiple factors (noise damage, trauma, disease, drugs, arteriosclerosis)

Question 24

Presbycusis

Answer 24

Sensorineural hearing loss associated with middle and older ages
characterized by hearing loss, esp at high frequencies at first then all freq.
poor auditory discrimination and comprehension esp with background noise
tinnitus

Question 25

Changes in vestibular/balance system

Answer 25

Degenerative chnages in otoconia of utricle and saccule
Loss of vestibular hair cell receptors
dec number of vest neurons
VOR gain dec
begins at age 30 and acc decline between 55 and 60

Question 26

Menieres disease

Answer 26

Episodic attacks characterized by tinnitus, dizziness, and a sensation of fullness or pressure in the ears
may also experience sensorineural hearing loss

Question 27

BPPV

Answer 27

Brief episodes of vertigo (less than 1 min) associated with position change
result of degeneration of the utricular otoconia that settle on the cupula of the post semicircular canal

Question 28

Somatosensory changes

Answer 28

Dec sensitivity of touch associated with decline of peripheral receptors
atrophy of afferent fibers
LE more affected than UE

Question 29

Propriocetive changes

Answer 29

Loss
Inc threshold to vibratory sensibility - beginning around age 50 - greater in LE and UE and greater in distal vs. proximal extremities

Question 30

Age related cog changes - what age

Answer 30

Not until mid-60s

significant decline impacting everyday life not until early 80s

Question 31

Heart mm changes

Answer 31

degeneration with accumulation of lipfuscins
mild cardiac hypertrophy (LV wall)
Cardiac valves thicken and stiffen

Question 32

Coronary blood flow

Answer 32

dec

Question 33

Changes in BVs

Answer 33

arteries thicken and are less distensible
slowed exchange through capillary walls
inc peripheral resistance

Question 34

Resting BP

Answer 34

rises

sys greater than dias

Question 35

Stroke volume

Answer 35

dec due to dec contractility

Question 36

Pulmonary - chest wall and lungs

Answer 36

Chest wall stiffness
loss of lung elastic recoil
dec lung compliance

Question 37

Lung parenchyma

Answer 37

alveoli enlarge, become thinner, fewer capillaries for delivery of blood

Question 38

Pulmonary BV changes

Answer 38

thicken and are less distensible

Question 39

Total lung capacity

Answer 39

dec
resdual lung vlume inc
vital capacity dec

Question 40

FEV

Answer 40

dec