Aging-Lecture 3

Front 1

What are 8 normal aging changes?

Back 1

1) Cardiovascular
2) Pulmonary
3) Musculoskeletal
4) Homeostasis
5) Sensory (taste, smell, hearing, vision, touch)
6) GI
7) Hepatic
8) Kidneys

Front 2

Definition of Eugeric

Back 2

Trying to distinguish between changes related to natural aging processes from changes associated with pathology.

Front 3

Definition of Eugeric Death

Back 3

Progressive decline in function, continuing to the point that it is no longer compatible with life (natural cause of death/wore out)

Front 4

What are 4 aspects of aging successfully?

Back 4

1) Enjoy life
2) Maintain mental function
3) Maintain physical function
4) Avoid diseases

Front 5

What does successful aging come down to?

Back 5

Restoring homeostasis

Front 6

What puts elderly at high risk for mortality?

Back 6

1) weak muscles
2) high amount/rate of muscle loss (sarcopenia)

Front 7

What is the 3rd leading cause of death in the US?

Back 7

Physical inactivity

Front 8

What plays a role in chronic illness of aging?

Back 8

Physical inactivity

Front 9

What can increase immune system function?

Back 9

Moderate exercise

Front 10

What is the most important age related difference?

Back 10

The ability to respond to physical and emotional stressors, then return to pre-stressor levels

Front 11

What is normal aging associated with?

Back 11

Reduction of functional reserve capacity

Front 12

What are some examples of reduction of functional reserve capacity (normal aging)?

Back 12

1) Different max heart rate (declines linearly with age)
2) Kidney function--loss of nephrons
3) Loss of type II fibers--less force

Front 13

What are 2 examples of complete loss of functional reserve capacity?

Back 13

1) Female reproduction
2) Loss of high frequency sounds

Front 14

What are some cardiovascular changes with age?

Back 14

1) Change in fibers/electrolyte balance
2) Decrease in heart response to stress
3) Increase systolic BP
4) Increase peripheral resistance (LV effort)
5) Decrease cardiac output at rest
6) Decrease diastolic fill rate
7) Decrease max heart rate
8) Decrease ventricular compliance
9) Thickening of mitro valves
10) Cardiovagal Baroreflex--decrease sensitivity to barroreceptors
11) Increase norepinephrine
12) Decrease myocardial cell size

Front 15

What do changes in cardiac muscle fibers and electrolytes lead to in older people?

Back 15

Prone to arrhythmias

Front 16

What do you have to be cautious about when an older patient has a decreased heart response to stress?

Back 16

Extend warm-ups and cool-downs to be aware of their homeostasis

Front 17

What do you have to be cautious about when an older patient has decreased diastolic fill rate?

Back 17

Need frequent rests when exercising

Front 18

What are some pulmonary changes with aging? (8)

Back 18

1) Decrease chest wall expansion and lung recoil
2) Increase calcification of ribs
3) Decrease abs and intercostal muscles
4) Changes in spine (kyphosis)
5) Decrease max voluntary ventilation
6) Decrease vital capacity
7) Increase in residual volume
8) Less cilia and cilia strength

Front 19

What must you be cautious about when an older patient has calicified ribs?

Back 19

Special mobilization techniques and be aware of osteoporosis

Front 20

What should you consider when a patient has weak primary and secondary respiratory muscles (i.e. weak abs and intercostal)?

Back 20

May present with low endurance and will fatigue easily

Front 21

What should you consider when a patient has decreased max voluntary ventilation?

Back 21

Slowly progress the patient through exercise program and gradually return them to baseline

Front 22

What do you need to consider when a patient has a reduced vital capacity of their lungs?

Back 22

Patient will not be able to do the same type of exercise they did when they were 20 yo

Front 23

What will changes of lung mechanical properties lead to in an older patient?

Back 23

1) Influences air flow
2) Lung volume is different
3) Alteration in gas exchange
4) Impairment in lung defenses

*Increase work of breathing!

Front 24

Describe how V/Q ratio decreases with age

Back 24

Airway size increases, amount of collapsible small airways increase causing net effect of decrease partial pressure of O2 in blood when breathing room air (O2 sats down)

*VQ mismatch caused by poor ventilation

Front 25

What is osteoarthritis?

Back 25

Deterioration of cartilage

Front 26

What are some musculoskeletal changes with aging?

Back 26

1) Cartilage
2) Muscle
3) Skeletal

Front 27

What changes occur with cartilage as we age?

Back 27

1) Deteriorates
2) Decreased hydration
3) Decreased elasticity
4) Increase fibrous growth around joints

Front 28

What are the effects of dehydration in cartilaginous joints?

Back 28

Amount of glycoproteins in cartilaginous matrix determines the amount of fluid that is drawn into cartilage--no shock absorption

Front 29

How could you influence fluid levels in cartilage?

Back 29

Cyclic loading and unloading a joint with muscle activity to move the synovial fluid in and out of the joint (increase BS and nutrients)

Front 30

What happens to cartilage if there is prolonged physical inactivity?

Back 30

Hyaline cartliage converts into fibral cartilage

*WB exercises important to help with increase in hyaluronic acid to lubricate joints

Front 31

Why do joints look larger as we age?

Back 31

Joints appear larger due to increase fibrous growth and decrease in muscle strength

Front 32

What are the considerations for cartilage deteriorating?

Back 32

Patient will need more strength around joints to decrease stress

Front 33

What are the implications to reduced elasticity in cartilage?

Back 33

May take longer to stretch and need more modalities/mobes for increasing ROM

Front 34

What are the changes to muscle as we age?

Back 34

1) Decrease type II fibers (small increase in # of type I)
2) Decrease in AMN
3) Decrease max strength (force)
4) Decrease in muscle mass

Front 35

What are the therapeutic considerations for decrease in type II fibers?

Back 35

Progressive resistive exercsise (PREs) aimed at specific weakness

Front 36

What are the therapeutic considerations for decline in AMNs?

Back 36

May see faster gains in strength in older patients b/c of neurotrophic influences

Front 37

What are some skeletal changes with aging?

Back 37

1) Decrease calcium--take from bones
2) Decrease vitamin D
3) Decrease bone strength
4) Decrease reserve to quickly accelerate production of RBCs

Front 38

What are the therapeutic considerations for decreased calcium in bones?

Back 38

Patient must take calcium supplements or medication in conjunction with exercise for significant results

Front 39

What are the therapeutic considerations for decreased vitamin D in bones?

Back 39

Patient must get at least 10 minutes of sun exposure 3 x wk or take vitamin D supplements to increase bone strength

Front 40

What can be done with a patient who has decreased bone strength

Back 40

WB, PREs exercises to increase bone strength

Front 41

What causes decreased circulating levels of vitamin D?

Back 41

Imbalance of osteoblasts to osteoclasts activity

Front 42

What must you consider when a patient has decreased reserve to accelerate production of RBCs in bone?

Back 42

Patient may become anemic more easily when stressed and may take longer to respond

Front 43

What characteristics increase chances of having osteoporosis?

Back 43

1) Hypothyroidism
2) Steroid therapies
3) Post-menopausal women (decrease estrogen that influences calcitonin to increase bone resorption)

Front 44

What are normal changes in homeostasis when aging?

Back 44

1) Decrease in hypothalamic thermostat
2) Decrease in BMR
3) Decrease in ANS reactivity
4) Vasomotor less responsive to adjust core temperature
5) Decrease hormone balance
6) Decrease blood flow to brain
7) Decrease nerve cells (PNS)
8) Decrease blood flow to nerve cells (PNS)

Front 45

What controls body core temperature?

Back 45

Hypothalamus

Front 46

What is an example of changes in hypothalamus with aging to consider?

Back 46

Too warm to be outdoors and patient cannot adjust or restore homeostasis (can't sweat)--can lead to death

Front 47

What are the therapeutic considerations to decrease BMR?

Back 47

BWT increases and wt gain is easier

Front 48

What are the therapeutic considerations for decrease in ANS reactivity?

Back 48

Skin hydration and circulation may be slow to respond

Front 49

What are the therapeutic considerations to a less responsive vasomotor system?

Back 49

Older patients may be more prone to hyper-or hypothermia

Front 50

What are the therapeutic considerations for decreased hormonal imbalance?

Back 50

Exercise tolerance will be affected. Older people may be slower to reach homeostasis during exercise and the return to homeostatic state may be prolonged after exercise.

Front 51

What are the precautions for decreased blood flow to the brain?

Back 51

Possible synscope (fainting) when exercising. Monitor vitals.

Front 52

What are the therapeutic considerations for decreased nerve cells (PNS)?

Back 52

Slower reaction times--decrease power, decrease type II

Front 53

What are the therapeutic considerations for decreased blood flow to the nerves (PNS)?

Back 53

Increased activity improves blood flow to nerves, helps with sensation

Front 54

Patient is sensitive to heat, had hip fracture and is white female. How do you adapt your therapy?

Back 54

Short durations of increased intensity with frequent rest breaks to hydrate. Slow warm-up and cool-down. Advise to wear light clothing and bring in fan.

Front 55

What are some changes in touch with aging?

Back 55

1) Decreased sensitivity of receptors and nerve fibers
2) Skin changes (decreased elasticity/vascularity)--thins
3) Decrease # and size of sweat glands--hyperthermia when exercising

Front 56

What do you have to be cautious about when applying modalities to elderly patients?

Back 56

Could easily burn. Add layers of towels and check on them often! They have decrease sensitivity to receptors and nerve fibers.

Front 57

What are some vision changes with age?

Back 57

1) Decrease in muscle tone
2) Decrease in elasticity/orbital fat
3) Decrease in tear production (dry eye)
4) Smaller pupils-can't adapt to light changes
5) Intraocular pressure
6) Increase in lens density
7) Decrease in visual receptors in retina

Front 58

What is a common vision condition that occurs with aging?

Back 58

Presbyopia--can't focus on objects close up due to loss of elasticity of lens

Front 59

What age is common for the lens changes to occur in order to read?

Back 59

40 yo

Front 60

What are the therapeutic considerations of decreased muscle tone in eyes?

Back 60

Less response to eye movements

Front 61

What are the therapeutic considerations of intraocular pressure?

Back 61

Patient is more prone to glaucoma and should get their eyes check every year

Front 62

What are the therapeutic considerations of increased density of the lens?

Back 62

Difficulty distinguishing similar colors

Front 63

What are the therapeutic considerations of loss of visual receptors in the retina or macula?

Back 63

Decreased acuity; HEP should have larger print for ease of reading

Front 64

When the lens opacifies, what does it influence?

Back 64

Color perception

Front 65

What happens to focusing when the lens loses elasticity?

Back 65

When lose elasticity, increases the distance of focusing

Front 66

What is the most common eye surgery for older adults?

Back 66

Cataract surgery (opacity of lens)

Front 67

What can facilitate depth perception in older patients?

Back 67

Increased contrast

Front 68

What is a common eye disease in elderly?

Back 68

Macular degeneration

Front 69

What are some hearing changes that occur with aging?

Back 69

1) sclerotic changes in tympanic membrane (can't hear high freq)
2) coclear osteosclerosis (can't discriminate consonants)
3) decreased corti receptors (can't hear soft sounds)
4) degeneration of auditory nerve (can't localize sound)

Front 70

What are the therapeutic considerations of sclerotic changes in tympanic membrane?

Back 70

Patients may not be able to hear high frequencies--talk in lower tone

Front 71

What are the therapeutic considerations of cochlear oteosclerosis?

Back 71

Patients may not be able to discriminate consonants--speak slowly

Front 72

What are the therapeutic considerations of decreased corti receptors?

Back 72

Patients may not be able to hear softer sounds--speak loudly

Front 73

What are the therapeutic considerations of degeneration of auditory nerve?

Back 73

Patient may have difficulty locating sound--face the person when talking

Front 74

What do you need to do when speaking with elderly patient who has difficulty hearing?

Back 74

Speak in a lower tone, loud voice and slower speed. Make good visual contact to allow patient to read your lips.

Front 75

What are some neural changes that occur with aging?

Back 75

1) Decrease cellular availability for sensory interpretation--don't know where they are in space
2) Decrease in sensory receptors in otoliths/SCC (vestibular)

Front 76

What will a patient with vestibular problems compensate with?

Back 76

Vision

Front 77

What are some neuromuscular changes with aging that increase fall risk?

Back 77

1) Decrease sensory input
2) Decrease nerve speed conduction
3) Decrease AMN
4) Decrease type II fibers
5) Decrease muscle mass

Front 78

What are some CNS changes when aging?

Back 78

Brain mass decreases 6-7% by 80 yo due to post-mitotic cells.

# and efficiency of cells in CNS decrease with age

Front 79

What are the changes to smell and taste as we age?

Back 79

1) Decrease taste buds by 80%
2) Decrease saliva production--increases choking (Xerostomia)
3) Decrease in olfactory bulb cells
4) Chemosensory decrement

Front 80

What are some GI changes due to aging?

Back 80

1) Decrease in motility of esophagus--substernal fullness
2) Decrease in esophageal resting pressure/sphincter--heartburn
3) Decrease motility of stomach (peristalsis)
4) Decrease BS to gut--could cause fecal impaction

Front 81

What are the changes to the liver when we age?

Back 81

1) Decrease BF to detoxify--decrease cytochrome p450 (enzyme breakdown toxins)
2) Decrease liver mass

Front 82

What are renal changes as we age?

Back 82

1) Decrease mass
2) Decrease protein binding of meds (prolonged drug effect)
3) Decrease glomerular filtration
4) Decrease ability to dilute urine
5) Decrease response to sodium changes
6) Decrease response to acid load

Front 83

What are some urinary changes when we age?

Back 83

1) Decrease vascularity
2) Decline in excretory and reabsorptive capacities
3) Decrease urine concentrating abilities--urine less concentrated
4) Increase residual urine--can't fully empty bladder
5) Increased reflux to urters

Front 84

What happens to absorption of meds when we age?

Back 84

Gastric pH is higher (basic) with decreased motility and absorption--can't breakdown the meds

Front 85

What happens to the distribution of fluids when we age?

Back 85

We have reduced total body water, decreased proteins, decreased LBM and higher total body fat

Front 86

What are the 2 fundamental problems of meds and aging?

Back 86

Decreased hepatic/renal function, which decrease metabolization of the drug.

Decreased gastric absorption and changes in pH that reduces the effectiveness of meds into the blood.

Once meds are in, they may be longer lasting.

Front 87

What are some questions to ask when elderly patients are on medications?

Back 87

1) What are your current meds?
2) Do you have any changes to your meds?
3) What time do you take your meds?