Test1 Flashcards
Functional training
Overload the activity of interest to challenge the entire neuromuscular system
Simple -> Complex Slower -> Quicker (or vice versa) Stable-> Unstable Eyes open -> Eyes Closed Form -> Intensity BOS -> outside BOS
True strengthening: 6-8 weeks
Motor learning: random and repetitive practice
Joint- normal aging
Connective tissue
(Ligament, capsule, cartilage)
Decreased activity of osteoblasts and chondroblasts
Increased activity of osteoclasts and chondroclasts
Decreased response to growth factors (hormones, cytokines) - Alters repair of tissues
Altered response to loading
Decreased ability to retain water (Decreased glycoconjugates that maintain fluid content.)
Fragmenting of collagen strands and decreased rate of turnover
Increased cross linking between collagen molecules (increase stiffness and decrease ability to absorb energy)
Calcification of articular cartilage (IV discs, nucleus becomes more fibrous, annulus less organized; decreased water content)
Chair rise: 30 seconds no hands
< 8 reps
Frail
Cane
Appropriate for…
Patients who need balance and stability assistance with minimal WB support (up to 25%)
Coordination needed to use effectively
May not be appropriate for older patients with cognitive or coordination impairments
Exercise:
Defibrillators
Therapist needs to know rate at which generator becomes activated
Goals of therapy to determine safe activities and proper resistance/workload for exercise to allow for high enough HR for health benefit but not too high to activate ICD
If HR Riss above present rate, pt should sit down and be instructed to cough or perform Valsalva to cause Vagal stimulation and decrease HR/prevent ICD shock
Inform physician if defibrillator delivers shock during session
80% w/ ICD have significant psychological effects: depression and anxiety
Cardiopulmonary and CV examination-
Tests/Measures more specific to pulmonary and cardiac patients
Vital signs during testing
Walk and step tests
Graded exercise
Self-reported Measures
Use of Angina, Dyspnea, Claudication scalers; RPE
Mini-Cog
3 item recall: memory
Clock drawing test (CDT) : executive function
draw time as: 10 after 11
3 minutes to administer
Scoring:
0-2 positive screen for dementia
3-5 negative screen for dementia
Fall Risk-
Physical exam and functional assessment :
Functional balance and gait
Lots of measures- skill is selecting correct assessment for patient
Gait speed, TUG, Tinetti-POMA, MiniBest, Functional reach, Functional gait, 4 step square, Berg balance, DGI, Short physical performance battery
Increased systemic inflammation due to immune system changes with age-
Results in
Muscle wasting
Loss of physical function
Underlying factor in development of age-related diseases like Alzheimer’s, atherosclerosis, cancer, diabetes
Normal aging: Cardiopulmonary
Other (outside lung and thorax) - functional
Decreased autonomic control =
Decreased responsiveness to hypoxia and hypercapnea
Decreased muscular ATP reserves =
Increased possibility of respiratory fatigue/failure
Decreased immune function =
Predisposition to pneumonia and other respiratory disease
Decreased protective reflexes (ie gag, cough) = increased aspiration risk
Successful aging
Avoid disease and disability
Maintain high physical and cognitive function
Sustained engagement in social and productive activities
PTs impact successful aging when working with teen and young adult clients
Common medications that reduce urethra pressure
Antihypertensives
Neuroleptics
Benzodiazepines
Gerontologists focus on those ____+ years old.
Federal government considers ___.
Researchers use subgroups….
Gerontologists: 60+
Government: 65
Researchers:
65-75 “younger old”
75-85 “older old”
85+ “oldest old”
SAIL: Stay Active and Independent for Life
Community program
Exercises for strength, balance and fitness
3x week for 1 hour
Functional UI
Normal bladder/urethral function, but have difficulty getting to toilet before urination occurs
Common with impaired mobility or cognitive issues
Normal aging gait-
Toe clearance
Small toe clearance
Muscle- normal aging
Whole muscle and fiber atrophy
Muscle is ~50% of total body weight in a young adult
Reduced to 25% by age 75-80
Type II atrophy > Type I
Denervation and reinnervation of alpha motor neurons
Decreased muscle activation - less agonist, more coactivation of antagonist
Decreased muscle strength and power
Functional implications with CNS changes
Delayed recall- if given time, then able
Rote memory decreases
Altered gait, balance, and fine motor control
Diminished motor learning
Decreased activity level
Skin tear treatments
Non-adherent dressings
Hydrocolloid/films NOT recommended bc risk of further damage on removal.
ISTAP- skin tear tool kit
Normal diastolic
70-90 mmHg
Diastolic >115
Exercise
Contraindication to initiating activity/exercise
Refer to physician
Multifactorial fall risk assessment
Focused history
Physical exam
Functional assessment
Environmental assessment
Best predictor of falls
- Activities-specific Balance Confidence (ABC) Scale
- Fear of Falling Avoidance Behavior Questionnaire
- Timed Up and Go (TUG)
Claudication Scale
1- Definite discomfort or pain, but only at initial or modest levels (established, but minimal)
2- Moderate discomfort or pain from which pt attention Chan be diverted (ex by conversation)
3- intense pain (short of grade 4) from which pt’s attention cannot be diverted
4/ Excruciating and unbearable pain
6MWT
200-299 m
Frail
Crutches
Appropriate for…
Permits more WB shift (50% or more) than a cane
Less stable than walker
Requires good balance and upper body strength
Inappropriate use can lead to brachial plexus injuries
Loftstrand crutches permit hand use and reaching
Decreased IV and bone height
___ loss over lifetime
Decreased ability to ….
2” loss over lifetime
Decreased ability to withstand compression, tension and shear
Thus more load bearing on neural arch- osteoarthritis and osteophyte formation
Thinning trabeculae of bone- increased risk for spinal deformities and fractures
Spinal stenosis - result of…
OA
Disc degeneration
Spinal ligament hypertrophy
Street crossing m/s
0.21-0.88 m/s
Average 0.49 m/s to meet traffic light timing
Gait exam - older adult
Ideal combo of measures
Speed (TUG; gait speed)
Endurance (6MWT; 2MWT)
Balance (Berg, Tinetti, 4 square step)
Postural stability
(Dual Task: TUGognitive; TUGmanual)
(Multiple Task: DGI; FGA)
Pathological gait-
Ankle-Foot
Large toe clearance OR Tripping
OR both
Forefoot or foot-flat contact during IC
Excess PF or DF
Fall Risk-
Physical exam and functional assessment :
Neuromuscular
Strength:
MMT, 5x sit>stand, 30 sec chair stand
ROM and flexibility:
Ankle, knee, hip, trunk, c-spine
Fall Risk Management-
Interventions
Assessment drives intervention
Body structure and function
Activity
Participation
Maximize independence and functioning
Prevent falls
Reduce risk
Angina Scale
1- mild, barely noticeable
2- moderate, bothersome
3- moderately severe, very uncomfortable
4- most severe or intense pain ever experienced
Skeletal- Normal aging
Decline in bone mineral
Increased osteoclast activity,
Decreased osteoblast activity
Osteopenia- leads to increased risk of osteoporosis
Load absorption decreases
Decreased load dispersion to other parts of the joint
Results in increased bone loading, results in increased risk for fracture
PNS-
Sensory changes with aging-
Smell and Taste
Ability to detect smell and identify odors decreases with age
Has been linked to 3 types of dementia
High prevalence of hyposmia (decreased smell) and anosmia (loss of smell)
Can create safety risk
Impaired ability to taste food
Thirst sensation declines
Dementia- intervention
Maximize function
Prevent or slow decline (muscle strength, ROM, balance, mobility, etc)
Environmental recommendations
Exercise:
Aerobic- improved cognition
Task specific - dancing, walking, stationary bike, etc
Resistance
CNS changes with aging
Neuron loss - decreased gray matter
Myelin loss - decreased white matter
Results in decreased brain weight
Nerve cell shrinking
Delayed impulse conduction and conduction velocity
Reduction and altered balance of neurotransmitters
Decreased size of cerebellar hemispheres
Vestibular changes- decreased hair cells and receptor ganglion cells
Decreased cerebral blood flow
Decreased glucose metabolism
Normal aging gait-
Step width
Ave 1-4 inches
Dementia- PT Strategies
Use stimulus for teaching and performing (sound, scent) - Use lots of cues (tactile, sense based, non-verbal)
Simple, one step commands Minimize distractions Use positive reinforcement Repeat, repeat, repeat Provide feedback after task Minimize variation - Consistency is key Functional, meaningful, pleasant
Go slow, be patient, avoid debate/conflict
6 most common chronic health conditions
- Arthritis/MSK issues
- Heart/Circulation issues
- Vision/Hearing issues
- Fractures/Joint issues
- Diabetes
- Mental illness
Immune changes with age
Generally begins -6th decade
“Immunosenescence”
Can begin prematurely in conditions such as RA and chronic organ diseases (COPD, CKD..)
Combo of declining protective immunity and increasing incidence of inflammatory disease
Normal aging- CV
Blood vessels
Functional significance
Decreased:
Blood flow to oxygenate tissue
Cardiac output
Venous return
Increased: Risk of clots in venous circulation Risk of myocardial ischemia/infarction CVA, PVD and renal failure Resting BP
Pathological gait-
Speed
Significant decrease in free velocity (<0.85 m/s)
With loss of ability to voluntarily increase speed from self-selected
Matter of Balance
Community program
2 hour week, 8 weeks
Coping strategies to reduce fear of falling, prevention strategies, and exercise
Normal aging: Cardiopulmonary
Lung - functional
Impaired gas exchange
Air trapping
Decreased inspiratory and expiratory reserve volumes
Increased resistance to airflow in small airways
Decreased pulmonary artery pressure
Decreased pulmonary capillary network
Decreased mucous clearance
Systolic <100
Exercise
No action if asymptomatic
Refer to physician if symptomatic
Fall Risk-
Physical exam and functional assessment :
Aerobic
6MWT
2MWT
2 min step test
Increased systemic inflammation due to immune system changes with age
Increased:
Pro inflammatory cytokines
C-reactive protein (CRF)
Tumor necrosis factor
May occur bc of:
Shift in fat mass from periphery-> abdomen
Along w/ overall increase in intra-abdominal fat w/ age
Abdominal fat is metabolically active and serves as inflammatory organ
Increase inflammatory cytokines assoc w/ metabolic syndrome and decrease organ system function
Dementia- Caregiver challenges
Psychological health - increased depression and anxiety common
Discuss realistic goals Teach ADL strategies Teach behavioral modification strategies Encourage self-care Community support groups Respite care
Gait speed <0.6 m/sec
Dependent in ADLs and IADLs
More likely to be hospitalized
Disability
Restrict use of this term only with long-term overall functional decline
Reflects the sum of interactions between: Health condition Environment Personal factors Impairments Activity limitations Participation restrictions
Activity limitations and participation restrictions in older adults change over time… and these are subject to change with intervention
“Fun” Gait speed? 6MWT? Chair rise (30 sec no hands)? Climb 10 stairs? Floor-stand?
Gait speed: 0.9-1.4 m/sec
6MWT : 300-500 m
Chair rise (30 sec no hands): 8-14 reps
Climb 10 stairs: 9-30 sec (with or without rails)
Floor-stand: 11-30 sec (with or without assistance)
PNS motor changes with aging
Axonal degeneration
Greater internodal length
Slower conduction velocity
Decreased ability to adapt to environmental or visceral changes
Decreased neurons per muscle fiber (fiber grouping)
Decrease in Ruffini’s, Pacinian, and Golgi tendon-like receptors
Increased sympathetic activity
Decreased cerebral blood flow
PT interventions- UI
PFM exercises:
Quick contractions
Sustained contractions
Contractions during functional activity
Biofeedback:
Surface EMG (internal)
Palpation
Electrical stimulation (lacks evidence)
PNS-
Sensory changes with aging-
Vision
Begins to decrease in 3rd decade
Neuron loss in visual cortex
Presbyopia : Decreased flexibility of lens to accommodate far to near
Decreased elasticity of lens Decreased recovery from glare Decreased tear production Decreased acuity Decreased visual fields
Common medications that impact full bladder emptying
Anticholinergics
Beta blockers
Fall Risk Factors -
Intrinsic
Medical and neuropsychiatric conditions
Impaired hearing and vision
Age-related changes in NM function, gait and postural reflexes
Bowel incontinence - causes
Age-related loss of strength and changes in tissue elasticity decrease anal resting tone (esp women) Loss of anal sensation Fecal impaction Psychological/Behavioral problems Neoplasms (rare) Loss of normal continence mechanisms: Local neuronal damage (ex pudendal nerve) Impaired neurologic control Anorectal trauma/sphincter disruption
4-Stage balance test
Assess static balance
4 standing positions that get progressively harder to maintain
Should NOT use AD and should keep eyes open.
Describe and demo position
Stand next to patient, hold their arm and help assume the position
When patient steady, let go and time how long can hold (but remain ready to assist if they lose balance)
If patient can hold for 10 sec without moving feet or needing support, move to next position
If not, STOP test
Feet together side-by-side-> instep of 1 foot touches big toe of other-> tandem -> 1 foot
Home assessment
More than just…
making sure patient has a clear path through the home
Rearranging obstacles and removing barriers
Looking at flooring surfaces
Is environment functional at current level of mobility?
What recommendations would make it functional or help pt achieve function required to live in home?
Understanding big picture- Mobility, needs, medical issues, social support, safety
Key history questions with older adults..
Polypharmacy Basic ADL assistance Physical activity Falls/Fear of falling and imbalance AD use Home environment Vision CV Continence Pain Depression Skin
6MWT
300-500 m
Function
Pathological gait-
Step width
> 4 inches OR <1 inch
Or too much/too little step width variability
Normal aging gait-
Pelvis
5* forward rotation during WA
5* backward rotation at TSt/PSw
Iliac crest on reference limb >= iliac crest on opposite during MSt
Pathological gait-
Knee
Limited or excessive flexion, wobbling, extension thrust
Weight bearing increases valgus or varus moments
PNS sensory innervation changes with aging
Decreased number and density of myelinated peripheral nerve fibers
Decreased thickness of remaining fibers
Decreased nerve conduction velocity and AP
Increased H-reflex latency
PT with the depressed aging adult
Timeline may need to be longer to accomplish goals
May need to focus on ADL training as these tasks require more energy and may be more difficult for the patient
Matter of fact approach is better than overly cheery approach
Discourage negative self-perception and emphasize achievement
Demonstrate a genuine and respectful regard for the patient
Realize these pt aren’t “fun” at times bc they appear unmotivated, but they aren’t lazy. It just takes s lot of energy to accomplish simple tasks.
Joint ROM aging changes:
Shoulder
Flexion and ER
Thoracic kyphosis May also impact
Flexibility exercise
60 seconds needed for those 65 years and older to achieve long term muscle lengthening
4 reps
5-7 days a week
Muscles to consider in aging adults:
Suboccipital, pec minor, downward rotators, protractors, lumbar extensors, hip flexors and external rotators, ankle PFs
Many other CVP changes common in aging adults due to ___ factors, not ____
Many other CVP changes COMMON in aging adults due to MODIFIABLE factors, not necessarily aging
Orthostatic hypotension-
Interventions
Ankle pumps/marching/hand clenching prior to standing
Counting to 5 before walking away from chair
Slow positional change
Pressure stockings
Cardinal features of immune system aging
Weakened antimicrobial immunity
Susceptibility to respiratory infections
Deactivation of chronic viral infections (shingles)
Impaired anti-vaccine responses
Insufficient protection against malignancies
Predisposition for unopposed tissue inflammation (ie atherosclerotic disease, OA, neurodegenerative disease)
Failing wound repair mechanisms
8 gait observations that may signify neurological problems (TUG)
- Slow tentative pace
- Loss of balance
- Short strides
- Little or no arm swing
- Steadying self on walls
- Shuffling
- En bloc turning
- Not using AD properly
Osteoporosis
Systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture
Anterior vertebral body (can be asymptomatic)
Caution: ADLs in trunk flexed position
Normal integumentary aging
Thin, less elastic skin Thinner dermis Decreased dermal vascularity Flattening of rete pegs Decreased fibroblasts Loss of subcutaneous fat
Decreased:
Langerhans- 50% by age 80 (altered immunity)
Melanocytes- 8-20% every 10 years after age 30
Blood vessels become thinner/fragile
Decreased oil/sweat gland activity
Critical speed for crossing street
1.14 m/s
Aerobic exercise-
Absolute Contraindications
- Unstable angina
- Uncontrolled cardiac dysrhythmias causing symptoms of hemodynamic compromise
- Uncontrolled symptomatic HF
- Acute or suspected major CV event (severe aortic stenosis, pulmonary embolus or infarction, myocarditis, pericarditis, or dissecting aneurysm)
- Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands
Orthostatic hypotension
Decrease in autonomic regulation of BP
Combined with physiological issues contributing to hypovolemia such as GI bleed, diarrhea and dehydration
Combined with common meds like antihypertensives, antipsychotics, antiparkinsonian
Increased inactivity
Contributes to high fall risk
PNS-
Sensory changes with aging-
Hearing-
Suggestions
Ask what works. Eat for patient Use a lower tone Face the person when possible Slow rate of speech appropriately Keep background noise to minimum
Avoid “elderspeak”
Avoid jumping from one idea/topic to another quickly
Systolic with exercise/activity
Increases in proportion to workload
> 250 is indication to stop exercise
Alzheimer’s - clinical presentation
Memory impairment Lapse in judgement Personality changes Depression possible Language problems Difficulty with ADLs Visual spatial problems Short tempered, hostile Loss of motor function (swallowing, bowel/bladder)
Pathological gait-
Trunk
Forward, backward or sideways lean
5 most common causes of death
- Heart disease
- Malignant neoplasms
- Cerebrovascular disease
- Chronic lower respiratory diseases
- Pneumonia/Influenza
Joint ROM aging changes:
Ankle
DF decreases
Strengthening exercise considerations
“Underutilized and undermanaged”
Proper form
Watch for breath holding
Otago exercise program
Community program
17 strength and balance exercises
30 min day, 3x week
Walking program
30 min day, 3x week
Great for preparing to enter a community program or as a starter community program
Aerobic exercise-
Relative Contraindications
- Known significant cardiac disease (L main coronary stenosis, moderate stenosis valvular disease, hypertrophic cardiomyopathy, high-degree AV block, ventricular aneurysm)
- Severe arterial HTN (systolic >200 or diastolic >110) at rest
- Tachycardia or Bradycardia
- Electrolyte abnormalities
- Chronic infections disease
- Mental or physical impairment leading to inability to exercise safety
Frailty
3 out of 5 = frail
1 or 2 = pre-frail
- Unintentional weight loss >10 lbs in past year
- Self-reported exhaustion 3 or more days per week
- Muscle weakness: grip strength <23 women, <32 men
- Walking speed <0.8 m/sec
- Low level of activity: sitting quietly or lying down majority of day
Functional impact of sensory loss on balance and function
Errors in proprioception have a bigger effect on balance than errors in vision in older adults
With vision available, oldest older adults need accurate proprioception to maintain balance
Impairment associated with increased fall risk and functional decline
PTs need to provide older adults with sensory strategies to increase sensory information
Normal aging: Cardiopulmonary
Thorax - structure changes
Calcification of bronchial and costal cartilages
Increased stiffness of costovertebral joints
Increased A-P diameter
Increased wasting of respiratory muscles
Structural changes in thoracic cage and spine
Stair climbing
Commonly feared environmental obstacle
Successful negotiation requires greater ROM and muscle strength than level ground
Older Adult self-efficacy relates to speed
And safety precautions
May serve as significant barrier to home mobility and safety
Don’t forget about curbs and ramps
Normal cognitive changes
Loss of synaptic connections
Creates memory impairment (slowed but intact)
Evidence of mild decline in executive function
In general it is agreed that aging has contributions from..
General whole body inflammatory response
Genetics
Consequences of lifestyle- primarily decline in physical activity
Slippery slope of aging
Fun: what you want, when you want, for as long as you want
Function: choices made based on decreased physical capacity
Have mobility disability or at risk for
Frailty: require help for ADLs and IADLs
Failure: completely dependent
Diastolic with exercise/activity
Remains similar to resting or may drop slightly
Increase >115 is indication to stop exercise
SpO2 86-89%
Exercise
Consider adding or increasing supplemental oxygen
Refer to physician if previously undiagnosed
HR >150
Exercise
Contraindication to initiating activity/exercise
Refer to physician immediately
Immune system changes with age-
Approaches to address total-body inflammation
Anti-inflammatory drugs
Antioxidants
Caloric restriction
Exercise
Systolic >200
Exercise
Contraindication to initiating activity/exercise
Refer to physician
Hip fractures
300k+ hospitalized each year for hip fractures
Greater than 80% caused by falling- usually sideways
Chances breaking hip increase w/ age
Normal aging gait-
Trunk
Erect
Normal aging gait-
Speed
Decreased self-selected speed and fast speed
Ability remains to voluntarily increase speed from self-selected to fast speed
Increased gait variability
Floor-stand
Under 10 seconds, No assistance
Fun
Falls among older adults are…
Common; 1 in 4 each year
Cost $50 billion annually
Preventable- clinicians can use STEADI to prevent falls and reduce cost
Cycle of fear of falling
Fear of falling->
Restricts activity->
Physical capabilities reduced (moves slower; avoids movement) ->
Restricts more activities->
More impaired physical capabilities (becomes deconditioned; decreased strength and endurance) ->
Fear of falling
Fall Risk-
Environmental (home) Assessment
Often overlooked
Key for safety and prevention of falls at home
Consider all areas of living environment: Physical environment, level of assistance, support, adaptations using and needed
Include other family members living in home and caregivers/caretakers present in home.
HR <60
Exercise
No action if asymptomatic and normal ECG
Refer to physician if symptomatic, or of no ECG available and no history of dysrhythmia or chronotropic medication use
Osteoarthritis (OA)
Failure of articular cartilage
Load bearing joints UE: hands LE: hips, knees, feet Spine: cervical and lumbar (Can compromise diameter of canal...spinal stenosis)
Joint destruction
May lead to need for total joint arthroplasty
Multi-factorial impairment-based interventions
Flexibility
Change what you can, adapt/compensate what you can’t
Address obvious structural limitations caused by pathology or surgical procedures
Functional implications with PNS changes
Increased recruitment of motor units- more work to do a task
Increased co-contraction at the ankle
Altered motor control and postural stability
Decreased LE proprioception, vibration, discriminative touch, and balance
Increased risk of falls
Resting BP rises with age
Delayed response to pain
Joint ROM aging changes:
Hip
Extension decreases
Decreased walking speed
SpO2 normal
=>90%
Physical stress theory
Too much stress
>100% max
Injury or tissue death
Sufficient overload
60-100% max
Strengthening
Usual stress
40-60% max
No change in tissues
Too little or no stress
0-40% maximum
Atrophy and loss of ability to adapt
“Frail” Gait speed? 6MWT? Chair rise (30 sec no hands)? Climb 10 stairs? Floor-stand?
Gait speed: 0.3-0.8 m/sec
6MWT : 200-299 m
Chair rise (30 sec no hands): <8 reps
Climb 10 stairs: 31-50 sec (with rails)
Floor-stand: >30 sec (with assistance)
Age-Related changes affecting sexuality-
Men
Decreased testosterone->delayed and less firm erection, more stimulation required to attain erection/orgasm
Shorter ejaculation time
Rapid loss of erection
Increased refractory period between ejaculations (12-48 hours)
NOT synonymous with ED
“Fun” Gait speed? 6MWT? Chair rise (30 sec no hands)? Climb 10 stairs? Floor-stand?
Gait speed: >1.5 m/sec
6MWT: >500 m
Chair rise (30 sec no hands): >15 reps
Climb 10 stairs: under 10 sec, no rails
Floor-stand: under 10 sec, no assistance
Vascular dementia
2nd most common type of dementia
Risk factors: HTN Smoking Hypercholesteremia Diabetes CV disease Cerebrovascular disease
Deterioration may be select with other functions left completely intact
Delirium- treatment focuses on
Increased time OOB
Walking
Managing hydration, hypoxia, and nutrition
MSK conditions impacting aging adults
Osteoporosis (fractures)
Osteoarthritis (joint arthroplasty)
Spinal stenosis
Frailty
Relative contraindications for stopping exercise (7)
- Drop in systolic >10 from baseline despite increased workload in absence of other evidence of ischemia
- Increasing chest pain
- Hypertensive response (systolic >250 or diastolic >115)
- Fatigue, SOB, wheezing, leg cramps, claudication
- ST or QRS changes such as excessive ST depression (>2 mm)
- Arrhythmias other than sustained ventricular tachycardia
- Development of bundle-block or intraventricular conduction delay that cannot be distinguished from ventricular tachycardia
Normal aging- CV
Blood
Functional significance
Decreased total body water =
Decreased blood volume
Decreased speed of RBC production =
Decreased response to blood loss and anemia
Decreased neutrophils =
Decreased immune response/infection resistance
Fall risk-
Considerations for every space
Surface: Concrete, wood, tile, carpet, gravel, grass, dirt, throw rugs, rugs, runners…
Lighting: Adequate, dim, bright, glare…
Steps/Stairs (handrails, number, height, condition)
Door widths and direction of open/close
Thresholds
Objects: clutter, cords, furniture…
Phone- accessible
Posture Changes- Cause
Besides habitual posture, age related changes in bone, disc, cartilage, muscle etc…
Decreased IV and bone height
Decreased elastin in ligaments of spine
MMSE
Must purchase
Mini mental state exam
11 questions to assess:
Orientation, registration, attention, calculation, recall, language, and visual construct
Scoring:
0-17 = severe impairment
18-24 = mild impairment
24-30 = no impairment
Factors contributing to aging gait changes-
Physiological
System changes: MSK changes Higher level neural processing Sensory and perceptual changes Individual sensory systems
Others:
Specific and individual pathologies
Adaptive and anticipatory mechanisms
Intricately related to balance responses
Dementia is development of multiple cognitive deficits including
Memory and at least one other:
Aphasia
Apraxia
Disturbance of executive function
Look beyond the reason for referral
- Screen for falls and risk factors for other conditions (DM, osteoporosis, etc) and make appropriate referrals
- Identify characteristics of frailty, depression, abuse/neglect, geriatric syndromes and make proper referrals
- Plan for sustainable outcomes and increase in safe physical activity/participation through education and exercise prescription
- Ascertain the role of social support in their condition or limitation
- Consider their health literacy and education contribution to condition or limitation
PT interventions-
Balance
Progressions
Static -> Dynamic Incorporate head, arm, leg movements Change/advance environment Single task -> Dual Task Surface changes Add resistance Change speed
Climb 10 stairs
9-30 seconds, with or without rails
Function
Posture- aging
Changes are not inevitable- but are common
Habitual postures often lead to…
FHP- forward head posture
Thoracic kyphosis
Increases >40 y/o; women>men
Associated with osteoporosis and vertebral fractures
Lumbar flattening (reduction of lordosis) Decreased IV space = decreased diameter of IV foramen : impact nerve root integrity
TUG
Instructions
Identify a line 3 m (10 feet) away. Instruct: When I say “Go” I want you to: 1. Stand up from chair 2. Walk to line at your normal pace. 3. Turn 4. Walk back to chair at normal pace. 5. Sit down again.
> =12 seconds to complete = at risk for fall
(Stay by patient for safety)
Normal aging gait-
Single Limb support
Increased double limb support, but generally equal stance time B LE
Absolute contraindications for stopping exercise (8)
- Drop in systolic >10 from baseline despite increased workload when accompanied by other evidence of ischemia
- Moderately severe angina (>2/4 on scale)
- Increasing nervous system symptoms
- Signs of poor perfusion
- Subject’s desire to stop
- Technical difficulty with monitoring equipment
- Sustained ventricular tachycardia
- ST elevation (+1.0) in leads without diagnostic Q waves
Pathological gait-
Hip
Limited flexion or extension
“Past retract” (visible forward then backward movement of thigh during TSw)
Excessive ABD or ADD
Excessive or limited IR or ER
Community ambulation
More than typically quoted goal of 150 ft
Falls screening
Determine if low, moderate or high fall risk
“Stay independent” brochure OR 3 key questions: 1. Have you fallen in past 12 months? 2. Do you feel unsteady when standing or walking? 3. Do you worry about falling?
> 4 on “Stay independent” OR if “yes” to any of the 3 questions above
= should receive full assessment
Age-Related Genitourinary Changes
Males
During middle age, prostate enlarges (BPH: benign prostatic hypertrophy)
->
Growth of prostatic tissue encroaches on prostatic urethra
Dual task training
Motor
Multidirectional
Balancing (dynamic weight shifts, perturbations)
External cueing (speed, stride length, timing)
Carrying/picking up/teaching for objects
Normal aging gait-
Step/Stride length
Smaller steps and stride length, but symmetrical
Fall Risk-
Physical exam and functional assessment :
Perceived functional ability and fear of falling
Falls efficacy scale,
Activity specific balance scale,
Fear of falling,
Avoidance behavior questionnaire
Seated step test
Stage 1: alternate placement of feet onto step/bar at 6 inch., rate = 1/sec
Stage 2: 12 inches
Stage 3: 18 inches
Stage 4: 18 inch step and add alternating arms
HR, BP monitored; at 2 min below 75% HRmax continue for 5 minutes
After 5 minutes, if <75% the progress to next stage
Multi-factorial impairment-based interventions
Focus/Incorporate
Focus on:
Reduce deviations
Improve gait efficiency and safety
Increasing endurance
Incorporate:
Specificity, Task-oriented, Dual-tasking, Task and environmental constraints
Rehab ALL components
Pathological gait-
Step/Stride length
Significant decrease in step and stride length and/or non-symmetric steps
Delirium, clinically may see ____.
Shouting and resisting Refusal to cooperate with medical care Potential to be injured falling Combative Pulling of lines and tubes
RPE
0= nothing 1 = very light 2 = fairly light 3 = moderate 4 = somewhat hard 5 = hard 7= very hard 10 = very, very hard
Vascular dementia- clinical presentation
Impairments May include: Memory Abstract thinking Judgement Impulse control Personality changes
Characterized by more abrupt onset, step by step deterioration, fluctuating course, and emotional lability
Speed requirements by population density
Rural : 0.5 m/s
Urban: 1.375 m/s
Gait speed
D/C to SNF
<= 0.1 m/sec
Screening for UI
Do you leak urine with laughing, coughing, sneezing, lifting or exercise?
Do you leak urine on the way to the bathroom?
Do you have to strain to empty your bladder?
Do you feel that your bladder is still not empty after you void?
A “yes” to any = refer to PCP or specialist
PT interventions-
Balance
Intensity
50 hours of training over 3-6 months
Decreased elastin in ligaments of spine
Converts into cartilaginous tissue for scarring
Become thickened- spinal stenosis
6MWT
Over 500 m
Fun
Aerobic exercise
Dosing: 60-90% Measured using: Target HR (220-age) X 60% to 90% Karvonen Method RPE: 12-16 = 60-90% on 6-20 scale; 5-8 = on 10 point scale (good for those w/ blunted HR response) Talk test
Joint pain, muscle weakness- May limit
May need strengthening exercise first; Aquatics may also be option
Normal aging- CV
Heart
Functional significance
Decreased: Excitability Max cardiac output (25-30%) Venous return Max HR
Increased:
Cardiac dysrhythmias
No change in RHR
Infectious disease in aging adults-
Therapy implications
Be sensitive to descriptions of unusual changes and observant of subtle changes with older adult patients in every setting- especially OP setting
Be prepared to treat older patients in hospital with medical dx of infectious disease for the effects of deconditioning
Realize may not be able to challenge them- but return to basic function and prevent functional decline remain high priority
Prepare for functional setbacks with acute illness
Prepare for exacerbation of previously compensated system deficits after acute illness
Diastolic BP <70
Exercise
No action if asymptomatic
Refer to physician if symptomatic
Major depressive episode
Depressed mood or loss of pleasure in all activities
AND
At least 5 associated symptoms for at least 2 weeks that impact function, social or occupational endeavors
Associated symptoms: weight loss, insomnia, hypersomnia, decreased or hyperactive motor activity, fatigue, loss of energy, feelings of worthlessness, excessive inappropriate guilt, diminished ability to think/concentrate, recurrent thoughts of death, suicide ideation or attempt
SpO2 with exercise/activity
Should remain =>90%
86-89% relative indication to stop exercise
=<85% absolute indication to stop exercise
Climb 10 stairs
Under 10 seconds, no rails
Fun
“Failure” Gait speed? 6MWT? Chair rise (30 sec no hands)? Climb 10 stairs? Floor-stand?
Gait speed: <0.3 m/sec
6MWT : <200 m
Chair rise (30 sec no hands): unable
Climb 10 stairs: unable
Floor-stand: unable
Medications treating common medical conditions impair sexual function
Anti anxiety:
Change libido, erection problems, delayed orgasms
Antidepressants:
Changes in libido, delayed orgasm
Antihypertensives:
ED, Decreased libido
Ulcer medications:
Decreased libido, ED
Normal aging- CV
Decreased max HR..
Decreased HR max ->
Decreased CO ->
Decreased tissue oxygenation
Resulting in
Progressive decrease in VO2max beginning between ages 20-30, decreases 10%/decade
Normal aging- CV
Baroreceptor sensotivity
Decreased->
increasing incidence of HTN
Gait speed
0.9-1.4 m/second
Function
Muscle-
Metabolic changes-
Normal
Decreased resting metabolic rate
Less lean muscle mass
Insulin resistance (common in older adults) Increased body fat further contributes Regulator of protein metabolism and important for protein gain and muscle growth
Decreased growth hormones
Decreased estrogen and testosterone
Vitamin D deficiency
Integumentary compromise-
General prevention
Nutrition and hydration
Environment:
~40% humidity
Control of comorbidities:
Glycemic control, etc
Skin care:
Moisturize
PT interventions-
Balance
Reactive postural control:
Ankle, hip, knee, stepping strategies
Weight shifts; Perturbations
Anticipatory postural control:
Expected changes and learned experience
Functional and Dynamic activities
Stability limits: Reaching and Functional activities
Sensory orientation: Surface changes, Functional activities, Eyes open/closed
Integumentary- Bathing advice
- Avoid bar soaps
Use gentle, moisturizing liquid soaps - Soft cloths, cooler water temps
- Moisturize after bathing
Within 3 minutes to trap moisture
No fragrance (eucerin, Vaseline, etc) - Don’t over bathe. 10 min daily or 2x week
Climb 10 stairs
31-50 seconds, with rails
Frail
Chronological age is not ___.
Not biologically uniform
The continuum of cognitive
Normal aging->
Mild impairment->
Dementia
Not everyone follows the continuum
Mild impairment and dementia are pathological
Normal aging gait-
Hip
15-20* flexion during WA and 15-20* apparent hyperextension at TSt
Gait speed “community ambulatory”
0.8-1.2 m/sec
Urinary incontinence
Involuntary leakage of urine
Continence requires: neural coordination between bladder, urethra, and pelvic floor muscle muscles (PFMs)
Types: Stress UI Urge UI Overflow UI Functional UI Mixed UI
Dementia-
Motor learning
Practice conditions: Massed, constant, Blocked
(No variety, No random)
Whole vs Part - Depends
(Opposite from normal cognition:)
Specificity- Unable to transfer
Mental practice- NO
Discovery vs Guidance- Guidance
Feedback: Simple, lacking intrinsic, skillfully given
Urge UI
Strong desire to pass urine which is difficult to defer without involuntary leakage (can’t get to toilet in time)
Low bladder compliance
Detrusor over-activity- involuntary bladder contractions: assoc with neuro conditions; pelvic organ prolapse with urethral obstruction in Femalee.
Prostatic enlargement in males
Smoking, hysterectomy, arthritis, impaired mobility
Pathological gait-
Pelvis
Limited or excessive rotation forward or backward
Pelvic drop or hiking
Exercise and immune/inflammation
Just 1 exercise bout results in significant decrease in inflammatory markers
Cumulative exercise sessions further decrease inflammation- enables regular exercisers to resist fatal infections and aggressive pathogens
Results in wider window of homeostasis
Enhances systemic “reserve”
Decreases risk for disease
Delays functional decline
Conditions that may present atypically in older adult:
HF
Confusion Agitation Anorexia Insomnia Fatigue
Gait speed
< 0.3 m/second
Failure
Moving for Better Balance
Community program
2 hour class, 1x week, 12 weeks
Slow, therapeutic Tai Chi movements
Ageism
Prejudice or discrimination against a particular age-group and especially the elderly
Infectious disease in aging adults-
Most common types
Bacterial pneumonia
UTI
Conditions that may present atypically in older adult:
Acute bowel obstruction
Acute confusion
Minimal or absent abdominal pain and tenderness
30-sec chair stand
Instructions
To test leg strength and endurance
Straight back chair, without arm rests, seat 17” high
- Sit in middle of chair
- Place hands on opposite shoulder crossed, at wrists
- Keep feet flat on the floor
- Keep back straight and arms against chest
- On “Go” rise to full standing, then sit back down
- Repeat for 30 seconds
Below average scores = fall Risk
Age 60-64 M: <14 W: <12 …
Age 90-94 M: <7 W: <4
Optimal aging
Modified version of “successful aging”
Not all can avoid the effects of disease and disability
Capacity to function across several domains to one’s satisfaction and in spite of medical conditions
Sarcopenia
Age related loss of skeletal muscle mass and strength
Not completely age related
Decreased physical activity
Co-morbidities
Results in decreased protein reserves
Challenge to meet protein synthesis demands with injury or disease
This even worse sarcopenia
Joint- Normal aging:
Most common changes
Decreased joint space Increased laxity Altered load dispersion Altered joint forces Decreased joint ROM (not uniformly)
Joint ROM aging changes:
Knee
In absence of pathology, knee ROM remains fairly stable
Walkers
Appropriate for…
Provides greater WB shift (50% or more) than a cane but with more stability than crutches
Difficult to maneuver on stairs
Standard offers greater stability but can be difficult for older adults to maneuver
Requires more attentional demand and has greater destabilizing effect compared to RW
RW less stable than std but easier to propel w/upper body weakness; decreased energy cost over std walker (5%)
Rollators have brakes
Platform walkers are heavy- increased energy but permit WB
Pathological gait-
Toe clearance
Either large toe clearance OR Tripping OR Both
Floor-stand
> 30 seconds, With assistance
Frail
Dementia most commonly affects
Memory and language
Multi-factorial impairment-based interventions
Flexibility training
Strength, power, and agility
Cardiovascular
Speed
Lewy body dementia- clinical presentation
Gait and balance issues Visual spatial issues Poor executive functioning Sensitivity to antipsychotics May be depressed
SpO2 =<85%
Exercise
Add or increase supplemental oxygen
Contraindication to initiating activity/exercise
Refer to physician if remains <90%
Altered posture: Altered function
Hyperkyphosis:
Spine extensors lengthened - weakened (Lifting difficultly)
FHP:
Challenges swallowing, breathing, supine/prone position
Decreased lumbar lordosis:
Pain nerve root impingement symptoms, spinal stenosis: standing, walking painful- limits activity
Fall Risk Factors -
Extrinsic
Medications
Improper prescription and/or use of AD for ambulation
Environmental hazards
Ask patients about fluid intake (UI)
If they are reducing to avoid UI, can lead to constipation from dehydration or UTI and further aggravate UI
Fall risk- Focused History
History of falls- need details
Medication review
Review of risk factors for falls- current and past medical history
Living environment- gather info from patient/family/caregiver
Joint ROM aging changes:
Cervical spine
All motions decrease
Greatest reduction in extension and lateral flexion
Delirium
Sudden, rapid change about mental function (often confused with dementia)
Associated with:
Medical illness; recovery from surgery; hospital admission
Usually short-term, temporary
HR 120-150
Exercise
Precaution to initiating activity/exercise
Refer to physician
Major cause of death in >65 years old
Cardiovascular disease
Reversible causes of urinary incontinence
DIAPPERS
D- delirium or other altered mental status
I- infection, UTI, symptomatic
A- Atrophic urethritis or vaginitis
P- Pharmaceuticals
P- Psychological disorders (esp depression)
E- Endocrine disorders (hyper- calcemia or glycemia)
R- Restriction Mobility
S- Stool impaction
Multi-factorial impairment-based interventions
Strength, power and agility training
Achieve mobility with stability prior to emphasizing increased velocity
Target PF, DF, quads, abductors, and extensors
UE strength in lats and triceps when patient using AD
Pre-gait activities can be done to focus on strength and control
Fall Risk-
Modifications to environment
Enhance lighting Remove rugs or secure them Add hand rails Change room layout, furniture Remove clutter, trip hazards.. Change accessibility of food, utensils, clothing.. Widen doors Obtain elevated toilet, shower chair/bench, non-slip surfaces
Age-Related Genitourinary Changes
Both genders
Decreased bladder sensation
Decreased detrusor contraction strength -> Decreased urine flow rate
Increased post-void residual volume
Circadian rhythm changes
Decreased diuretic hormone vasopressin -> nocturia
Other renal system changes:
Loss of renal mass/functional glomeruli
Decreased renal blood flow/glomerular filtration rate
Leads to increased sensitivity to fluid and electrolyte imbalance and decreased drug elimination
Normal aging: Cardiopulmonary
Thorax - functional
Increased resistance to chest wall deformity
Increased choking/aspiration risk
Decreased FEV1 (forced expiratory volume) Decreased FVC (forced vital capacity) Decreased cough force
Alzheimer’s disease
Most common form of dementia Early onset (30-60) Late onset (after 60)
Risk factors: Advancing age Positive family history Women > Men African-American and Hispanic populations
Factors contributing to aging gait changes-
Psychological
Depression Self-efficacy/confidence Appearance Older adults perception of his/her mobility Anxiety/Fear Perceived risks of community mobility Access to or barriers in community
Gait speed
0.3-0.8 m/second
Frail
Stress UI
Occurs with effort or exertion; cough; sneeze; lifting activity; Valsalva
Childbirth Aging changes in muscle/connective tissues Estrogen loss Radical prostatectomy Caucasian Family history Smoking Obesity Chronic cough/respiratory disease Pelvic surgery Chronic constipation Neurologic disorders
Floor-stand
11-30 seconds, With or without assistance
Function
Joint ROM aging changes:
Thoracic and lumbar spine
Extension becomes most limited
No or very little change in rotation
What is a generation?
Cohort born in specific time period (18-22 year increments)
Each generation develops a collective world view based on prevailing cultural influences in first 18 years of life.
6 current: GIs : 1901-21 Veterans/Greatest generation: 1922-45 Boomers: 1946-60 X: 1961-81 Y (millennials): 82-04 Z: 04...
Gait speed “limited community ambulatory”
0.4-0.8 m/sec
Common visual diagnosis and functional implications in old age
Cataracts
AMD (age-related macular degeneration)
Glaucoma
DR (diabetic retinopathy)
Retinal detachment
Dry eyes
Normal aging gait-
Ankle-Foot
Mild decrease in force at push-off and/or
Slight decrease in PF and DF ROM
Geriatric depression scale
30 Q
Yes = 1 point
No = 0 point
> 10 need referral or follow up
0-9 = normal 10-19 = mild depressive 20-30 = severe depressive
Screening tools for dementia
Mini-Cog
MOCA: Montreal cognitive assessment
Mini mental state exam
Fall Risk-
Physical exam and functional assessment :
Movement analysis
Bed mobility, transfers, use of AD and adaptive equipment
The Barthel index
PNS-
Sensory changes with aging-
Hearing
Presbycusis: hearing declines with age
Effects both genders
Men especially lose hearing for higher frequencies
Difficulty tuning out background music
HR with exercise/activity
Increases in proportion to workload
Significant drop is indication to stop exercise
Consequences of falls
Injury and/or death:
Hip, wrist, compression fractures
Head trauma, TBI
Bruises, contusions, lacerations
Psychosocial: Fear of falling Anxiety Isolation Depression
Pathological gait-
Single limb support
Short, shuffling steps
Unequal stance time
Antalgic pattern
Pathological cognitive changes
Certain growth factors in brain are inhibited
Death and loss of neurons
Dementia
MOCA
Montreal cognitive assessment
16 item test
10 minutes
Includes tests for executive function, naming, memory, attention, language, abstraction, delayed recall and orientation
Score >26 = normal
Infectious disease in aging adults
1/3 of all deaths in 65+
Early detection difficult due to absence of typical s/s : Lack of fever, leukocytosis. In UTI, absent/masked clinical manifestations
1st sign of illness is:
Change in mental status or cognitive impairment
Decline in function
Falls
Weight loss/anorexia
Slight increase in respiratory rate
Vague symptoms: nausea, vomiting, decreased urine output
Fall Risk-
Physical exam and functional assessment
Sensory NM Aerobic endurance Movement analysis Functional balance and gait Perceived functional ability and fear of falling Footwear
Strengthening exercise
60-80% of 1RM for strength gains
Determine by:
Select weight think pt will experience fatigue at ~10 reps
Have them perform 1-2 reps and assess RPE
11-15 on 6-20 point scale
“Somewhat hard to hard” = 70-80%
8-12 reps should result in momentary muscle fatigue
Observe for: concentration, slight tremor, mild increase in respiration.
1 vs 3 sets
Normal integumentary aging-
Nerve function
Decreased ability to thermo-regulate
Increased pain threshold
Exercise:
Pacemakers
Mode of pacing programmed into device affects patient’s CV tolerance to exercise
Exercise tolerance dependent on underlying disease, type of pacemaker, and degree to which patient dependent on pacer to maintain CO
Fixed rate pacemakers : cannot elevate HR to accommodate higher demand
Pacemaker set on dual mode can allow HR to vary according to demand
Patient c/o lightheadedness, syncope, Low BP, and decreased activity tolerance should trigger referral back to cardiologist to check pacemaker function
Systolic normal
100-140 mmHg
“Entryway to frailty”
Muscular system
Leg strength - most important factor in subsequent institutionalization
PT key point- must apply appropriate principles of exercise prescription
Gait speed - need intervention to reduce fall risk
<1 m/sec
6 key motor learning concepts
- Need to practice to build experience
- Error is necessary
- Intrinsic vs Extrinsic feedback
- Task analysis- where is the problem
- Does it require reactive or anticipatory postural response
- Consider environment
Chair rise: 30 seconds no hands
8-14 reps
Function
6MWT
<200 m
Failure
Multi-factorial impairment-based interventions
Cardiovascular training
Continue to assess vitals to determine response to training
Remember while AD can increase stability, they can also increase energy demands
Dyspnea scale
1- light, barely noticeable
2- moderate, bothersome
3- moderately severe, very uncomfortable
4- must severe or intense dyspnea ever experienced
CES-D
Center for epidemiological studies depression scale
20 Q
Likely scale questions
> 16 points may need referral
Higher score = more likely depression is an issue
Common pathology of the CNS
CVA
TBI
Parkinson’s
Dementia
Normal aging- Exercise capacity
Aerobic capacity decreases with age (appx 1% per year)
Decreased size and number of mitochondria
Decreased capillary/fiber ratio (decreased blood flow)
Decreased work capacity 20-30%
Decreased O2 uptake and transport
Sedentary individuals have a 2-fold decrease in VO2max.
Depression screening
2 question depression test:
- Over the past 2 weeks, have you ever felt down, depressed or hopeless?
- Have you felt little interest or pleasure in doing things?
Yes to either of these indicates a need to refer or follow up with MD
Conditions that may present atypically in older adult:
Biliary or Liver disorders
Nonspecific mental and physical deterioration
No jaundice or abdominal pain
Clinical symptoms of UTI
Often silent, no fever
Unilateral costovertebral tenderness Flank pain Ipsilateral shoulder pain Fever and chills Skin hypersensitivity Hematuria (RBC in urine) Pyuria (pus or WBC in urine) Bacteriuria Nocturia
Adjustment disorder with depressed mood
Maladaptive reactions to identifiable psychosocial stressors that occur within 3 months of onset of stressors
Impairs social or occupational function or marked distress in excess of normal/expected reaction
Symptoms: depressed mood, tearfulness, and feelings of hopelessness
Age-Related Genitourinary Changes
Females
Decreased estrogen causes changes in lower urinary tract
Decreased arterial flow to vagina ->
Thinning of vaginal mucosa and perineal skin breakdown->
Weakened connective tissue structures supporting bladder neck
Decreased arterial flow to submucosal vasculature and decreased striated muscle fibers ->
Decreased urethral closure pressure (contributes to more frequent UTI)
___ Americans age 65 and older fall each year (less than half tell dr)
__ in every __ falls causes significant injury
Falls are most common cause of __.
25% or 1 in 4 fall annually
20% or 1 in 5 falls causes significant injury
Falls are most common cause of TBI, and leading cause of fatal injury among older adults.
Normal aging: Cardiopulmonary
Lung- structural
Increased alveolar duct and alveoli size
Increased alveolar compliance
Increased mucous glands
Decreased mucous clearance
Increased stiffness of pulmonary vasculature
Decreased bronchial smooth muscle integrity
Decreased lung elasticity
Normal aging gait-
Knee
ROM from 5* flexion during WA to 60* flexion during swing limb advancement
Dual task training
Cognitive
Listening to music or talk-radio
Verbal fluency
Answer autobiographical questions
Subtraction by 3
Visuospatial task of pattern matching
Bladder training
For Urge UI
Gradual increase in time intervals between voids:
Distraction
Deep breathing to relax
PFM contractions to inhibit bladder contractions
Goal is to delay voiding to every 3-4 hours
3 most common types of dementia
Alzheimer
Vascular
Lewy body
Immune system changes with age-
Reduction in lymphocyte development
Decreased:
T- and B- cell development
Quality and composition of lymphocyte pool
Thymic epithelial cells
Results in decreased:
Efficiency of response to novel or previously encountered antigens (ex: increased vulnerability to flu >70)
Responsiveness to vaccines (except shingles vaccine)
Gait speed
Over 1.5 m/second
Fun
Age-Related changes affecting sexuality-
Women
Decreased estrogen levels ->
Delayed/Decreased vaginal lubrication
Decreased extensibility of vaginal tissue
Increased refractory period between orgasms and decreased orgasmic contractions
Bladder and urethra May become irritated during intercourse
Age-Associated Changes Affecting Sexuality :
Cognitive issues
Depression: decreased libido cardinal symptom
Dementia: ranges from hyperarousal/inappropriate demands - to withdrawl
Gait speed “household walker”
<0.4 m/sec
Fall Risk-
Physical exam and functional assessment :
Sensory
Vision: acuity, contrast, depth, visual field
Vestibular
Somatosensory: vibration, proprioception, cutaneous
Sensory integration: interaction between above 3 (mCTSIB and CTSIB)
In 2016, life expectancy at birth ___. (Males ___, Females ___)
Those who love to 65 can expect to live an additional ___ years.
Between now and 2030, the 65+ population is expected to make up close to ___%
At birth:
78.8
Males 76.3
Females 81.2
If live to 65, can expect to live average of 19.1 more years.
Between now and 2030, the 65+ Population is expected to make up close to 20%
Lewy body dementia
Progressive cognitive decline with
- Fluctuations in alertness and attention (may be drowsy or lethargic)
- Visual hallucinations
- Parkinsonian motor symptoms
Overflow UI
Bladder overly distended causing pressure > urethral pressure
From loss of bladder sphincter after surgery or injury
Chair rise: 30 seconds no hands
Over 15 reps
Fun
