Physiological Changes In Aging Flashcards
Understand this model
(We’ve taken this before many times)
Understood👍🏻
What is homeostasis
Physiological process that maintain a stable internal state of the body
What will influence vulnerability to illness and injury ?
Extent to which the body can:
- adapt to physiological stressors
- maintain homeostasis
As we age, what happens to our ability to tolerate stressors ?
Can it be modified ? And how?
DECREASE
Yes it can be modified with lifestyle adaptations
The SUCCESSFUL aging older adult has a __________ capacity to tolerate physiological stressors.
The UNSUCCESSFUL aging older adult has a __________ capacity to tolerate physiological stressors.
HIGH
LOW
What increases tolerance to physiological stressors?
Exercise
Healthy diet
Emotional health
Sleep pattern
Regular physical check ups at doctor
What decreases tolerance to physiological stressors?
Smoking
Sedentary lifestyle
Bad eating habits
Co-morbidities (presence of 2 or more chronic illnesses in patient)
At which point in life does the decline in bone mineral begin?
3rd decade (30 yrs old)
Which gender has a FASTER rate of bone mass loss and when?
Women during menopause
Skeletal tissue can change depending on what?
Day-to-day nutrient intake
Inactivity
Weight bearing
Hormones
Medications
True or false
All risk factors for bone loss are NON-modifiable
False
There are modifiable AND non-modifiable risk factors for bone loss
(NOTE:
Modifiable : CAN be changed by lifestyle
Non-modifiable: CANNOT be changed by lifestyle)
What are some non-modifiable risk factors for bone loss (hint: 7)
Genetics : women with small frame
Age: female > 50 years
Family history of osteoporosis
Premature at birth
LOW estrogen: menopause
Childhood malabsorption dx
Age-related loss of muscle mass
What are some modifiable risk factors for bone loss (hint: 9)
Calcium intake : ≥ 1200 mg/day is required
Alcohol intake
Smoking
Low BMI ( <18.5 ) - may lose skeletal tissue faster
Low estrogen (may take hormonal therapy)
Inactivated, immobilization
Insufficient protein at all ages
Inadequate vitamin D
Hyperthyroidism
What is estrogen
Critical hormone for the maintenance of bone mass in BOTH men and women
True or false
Estrogen is responsible for the maintenance of bone mass in only women
False
Both men and women
Why is exercise crucial for skeletal tissues ?
What jobs involve a lot of inactivity ?
Because inactivity ( ⬇️ muscle contractions ) removes stimulus for osteoblastic activity (bone formation)
Desk/office jobs
What has research concluded about exercise AND hormonal replacement
That either alone or in combination, they can ADD bone mineral density to the osteopenic framework of older men and women.
What is body composition
Body composition is a term used often by doctors and health professionals. It refers to the percentage of fat, bone, and muscle in your body.
What gradual shift in body composition occurs with aging ?
Provide example
⬆️ INCREASE in fat mass
⬇️ DECREASE in lean mass
Example:
- 20 year old man with lean body mass/fat mass ratio of 85/15
- 70 year old man with the SAME WEIGHT as the 20 yr old has a ratio of 70/30
Relationship between intra-abdominal fat and risk for serious illnesses?
The MORE the intra-abdominal fat = the GREATER the risk for heart disease, diabetes, and cancer
Active men and women have LESS:
- fat
- whole-body inflammation
- disease
Does the number on the scale necessarily dictate a person’s health ?
No
Both pictures are of the same weight , however the one on the right has more muscle mass contributing to a good portion of the body weight, while the picture on the right has more fat mass.
What are some changes in cardiovascular tissue that occur as a result of aging ?
(Hint: 3 major changes + examples)
- Decline in maximum HR = lower aerobic capacity
( ex: even though a 90 year old can still run a marathon, he takes a longer time ) - Decline in VO2 max = lower aerobic capacity
( ex: a 70 year old female with VO2 max value of 18 mL O2/kg/min is UNABLE to climb a flight of stairs without resting OR is unable to walk half a kilometer) - The heart and peripheral vessels are stiffer and less compliant = high blood pressure (⬆️BP) and reduced cardiac output (⬇️CO)
For exercise safety, what should you take into consideration when dealing with older patients with cardiovascular changes resulting in high BP and low CO ?
- Physical therapist must watch for unacceptable increase in BP
- Patient must perform WARM-UPS before aerobic exercise
Why must an older patient with cardiovascular changes due to age perform warm ups BEFORE aerobic exercises ?
To accommodate for :
- slower arteriovenous oxygen exchange
- stiffer vascular tissues
- reduction in sympathetic nervous system output
- lower aerobic capacity
How to enhance cardiovascular endurance in older patients?
Exercise programs must CHALLENGE older adults, they must NOT be treated like fragile objects !!
The heart, like any muscle, must be ___________ to grow stronger .
Trained
True or false
Walking a patient in the hallway constitutes an acceptable aerobic workload for most people
FALSE
Can be acceptable for UNCONDITIONED patients.
BUT it does NOT constitute as an acceptable workload for most people.
What is required for “training” to occur ?
Elevated HRs that are sustained for 20 minutes or more
5 minute of bike exercise followed by rest and then 5 minutes of alternating normal/brisk gait is an example of :
Accumulating aerobic exercise
Changes in the nervous system (NS) that occur due to aging
- Slowing of NS which causes :
- LESS nerve conduction velocity
- HIGH movement time
- HIGH reaction time
- HIGH risk of falling - Loss of neurons = LESS muscle mass (loss of innervation)
- Altered balance of SNS and PNS which causes:
- LESS gastric mobility
- bladder control issues
- hypertension or hypotension
- inadequate response to heat or cold - LESS deep sensation (joint position sense and vibratory sense)
How can reaction time in older adults be measured
Induced fall
External perturbation
Simulated driving
(NOTE: external perturbation forces the patient to react to the external force and maintain postural stability to not fall)
True or false
Exercise has LITTLE effect on improving reaction time
True
( even if it improved, it has little impact on function !)
How is nerve conduction velocity basically measured?
They stimulate the nerve and record the latency response of the muscle
What are some visual changes that can occur due to aging
What is a consequence of these changes?
LOW contrast sensitivity
NO depth perception
Consequence: falling
Common visual problems in the elderly
Changes in postural alignment that occur with aging
Malalignment of joint
Center of mass is shifted ANTERIORLY
True or false
Center of mass shifts POSTERIORLY with aging
False
Shifts ANTERIORLY
What is sarcopnia ?
Loss of muscle mass
Loss of muscle mass in older adults can lead to:
- LESS muscle strength and power
- LESS function
- Frailty and risk of falling ( when combined with LOW balance and endurance )
- increased intramuscular fat
- larger subcutaneous fat
- decreased cortical bone mass
Loss of muscle mass in older adults may be exacerbated by ______________________.
Sedentary lifestyle
Application of Nagi Model regarding the loss of muscle mass in older adults
Muscle mass can be measured by :
Manual muscle testing MMT
Isokinetic and hand-held dynamometers
Many articles addressed the value of grip strength as a predictor of important outcomes. Due to its predictive validation and simplicity, grip strength should be considered as a VITAL SIGN useful for screening in adults.
What is LOW grip strength associated with:
- Functional limitations
- Disability
- Premature death
- An increased risk of complications/prolonged stay after hospitalization or surgery
Treatment of loss of muscle mass
- nutrition
- strength-training exercises
What is the minimum time required to achieve a true strengthening response in muscle tissue ?
6 weeks minimum
Is power training better than regular resistance training ?
A study concluded that power training is feasible for older adults AND has a small advantage over strength training for functional outcomes
What is Cachexia ?
- can it be treated the same way as regular loss of muscle mass?
- what is it associated with ?
- when is it typically seen?
Severe weakness and wasting of the body due to severe chronic illness (loss of muscle mass due to severe illness)
- CANNOT be treated with nutrition and strength training ❌
- Associated with :
- End-stage cancer
- AIDS
- Tuberculosis - cachexia of old age typical precedes DEATH and is the FINAL STAGE of COPD and chronic HF
What is joint mobility?
The capacity of a joint to move PASSIVELY taking into account the surrounding tissues
Joint mobility is DIRECTLY influenced by:
Changes in muscles, bones, tendons, ligaments, cartilage, and capsules
________________________ tissues hold us together while still permitting freedom of movement in all directions
Collagenous
Characteristics of impaired joint mobility
Impaired joint mobility: what does the decrease in water content in intervertebral discs cause?
Body shrinking or Height loss
Impaired joint mobility: what does the decrease in water content in articular cartilage cause?
Osteoarthritis
(More prone to breakdown)
Clinically, loss of water content in joints can be seen as :
How to treat impaired joint mobility ?
What is the influence of impaired joint mobility on activity and participation?
Joint mobility is assessed by:
Joint mobility is treated by:
True or false
Physically active older adults will not go through age-related changes in joint function .
False
They will also go through these changes
Joint mobility is treated by remediation, compensation, and prevention. What do physically active older adults require more?
Compensation & prevention > remediation
Impaired joint mobility can be treated by remediation, which involves:
Remediation: what is the benefit of therapeutic exercises?
Can reverse age-related decline in joint mobility
Remediation: what is the primary mode of exercise targeting impaired joint mobility
Stretching exercises
Remediation: what does muscle strengthening exercises contribute to?
Joint loading and control of motion
Remediation: manual joint mobilization for impaired joint mobility should be done with _________________.
Caution
What is the optimal stretching time and number of repetition for an adult > 65 years?
According to a study, what are the SLR stretch durations that were found most effective when increasing hip flexion and knee extension in older adults?
15 , 30 , or 60 seconds
Relationship between stretch duration and ROM benefit
The longer the hold of the stretch (60 sec) = the greater the ROM benefit
Young adults VS older adults in static standing.
Does swaying increase or decrease as we age ?
Swaying increases as we age
What factors increase swaying with age?
Muscle weakness
Proprioception
Vertigo
Diabetes ( sensation )
Impaired vision
Etc.
Older adults rely on _____________ to balance themselves
Vision
Older adults have longer reaction time, which can lead to:
- Longer reaction time
⬇️
- Longer time to activate muscles
⬇️
- Increase possibility of falling
⬇️
- Longer time to recover from fall
Functional mobility may include:
Sit to stand
Transfer from bed to chair
Walking
Stair climbing
What is one definition of “mobility disability” ?
Inability to walk 1/4 mile or climb a flight of stairs without assistance
____________ is a unique human skill that requires multiple systems to work in a correct manner.
Walking
What systems are involved in walking?
Neurologic
Musculoskeletal
Cardiopulmonary
Cognition
Age-related changes of gait?
True or false
Older adult gait is simply a slower version of younger adults gait.
False
Older adults display a more conservative gait pattern in an effort to be safer and stable.
Does the base of support increase or decrease as we get older?
Increase BOS
How to assess functional mobility?
____________________ is a reliable, valid, sensitive, and specific measure of functional ability.
Gait speed
Gait speed is the _______ vital sign
6th
Importance of gait speed.
Just get a good understanding of this diagram that basically shows how gait speed can predict an individual’s health status etc.
Ok 👍🏻
Gait speed rule of thumb
Impaired functional mobility is treated by?
What is our goal?
Our goal is to ensure that the patient is able to ambulate safely and independently in different environments
You can read this, but she said don’t worry about it
Ok 👍🏻
List some low impact exercises to try at home
