3.3 Musculoskeletal Considerations for the Elderly

what are the disc impairments seen in aging adults?

• decreased water in nucleus

• increased fibrosus of annulus

• flatter, less resilient disc

what are the common abnormal postures seen in elderly?

• forward head

• increased thoracic kyphosis 

what are common postural changes seen in elderly pts?

• hip flexion contractures

• knee flexion contractures

• valgus/varus changes

• increased/decreased lumbar lordosis

• loss of height

what is the intervention to correct common postural changes in elderly pts?

• extension

• ex.

  • back bends

  • cervical retraction

  • chest puffing

  • scapular retraction

  • prone on elbows

what are age related changes in relation to strength?

• decreased number and size of muscle fibers

• decreased rapid muscle force exertion

what are the age related changes in relation to pain?

• decreased ability to localize pain

• decreased production/use of enkephalin

• decreased report of pain due to social pressures

what factors affect strength impairments?

• cardiovascular

  • inefficiency leads to poor nutrient exchange 

• neuromuscular junction

  • contract inefficiently 

• swelling, joint distention

• pathology 

  • PD or stroke 

what are interventions we can do to help improve strength?

• increase activity level → increase blood flow to muscles

• exercise has been shown to improve nerve conduction velocity, reaction times and strength 

• modalities and anti-inflammatory meds 

• warm up and cool down periods

• repetition of functional activities 

• circuit training

• strength program with emphasis on spinal alignment 

what are the recommendations for isometric strengthening in elderly pts?

• near max effort

• 6-10 second holds 

• 5-10 reps

• 10 second rest

• 3x/day for 5 weeks

what are the recommendations for isotonic strengthening in elderly pts?

• determine 1RM (reevaluate each week)

• exercise 60-80% 1RM 

• 3 sets of 8-10 reps 

• 1-2 min rest 

• 3x/wk for 8 weeks 

what are common flexibility impairments for elderly pts?

• decrease in elastin and increase in collagen 

• tendons and ligaments become more rigid

• less responsive to length changes

• hypokinesis 

what are interventions we can do to increase flexibility?

• slow, prolonged stretching

• focus on functional range not normal 

• encourage frequent activity 

what are ways we can create effective pain management?

• TENS

• visual imagery 

• relaxation

• coordination with MD (meds)

what is the NIH definition for osteoporosis?

a systemic, skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with a constant increase in bone fragility and susceptibility to fracture

what is the WHO definition of osteopenia?

BMD between 1 and 2.5 standard deviations below adult peak mean without evidence of fractures

what is the WHO definition for osteoporosis?

BMD at least 2.5 standard deviations below adult peak mean without evidence of fractures

what is the WHO definition of severe osteoporosis?

BMD more than 2.5 standard deviations below adult peak mean with history of one or more fractures

what are the osteoporosis risk factors?

• sex

• age

• race

• family history

• tobacco use

• lifetime exposure to estrogen

• steroids, thyroid hormones, heparin

• calcium deficiency

• sedentary lifestyle

• alcoholism

  • depression

what medications are used to treat osteoporosis?

• hormone replacement therapy (estrogen)

• selective estrogen receptor modulators

• bisphosphonates

• calcitonin

what are the side effects of hormone replacement therapy?

increased risk of breast and uterine cancer

how do selective estrogen receptor modulators works?

• synthetic drugs mimic estrogen’s beneficial effects on bone density

• blocks the effect of estrogen on breast and uterine tissues

what is the name of a common selective estrogen receptor modulator?

roloxifene (Evista)

how do bisphosphonates work?

• inhibit bone breakdown/bind permanently to bone surfaces

• limit osteoclast activity

what are common bisphosphonates?

• fosamax

• didronel

• actonel

how does calcitonin work?

• hormone that regulates bone metabolism 

• reduces bone resorption and may slow bone loss

what are essential exercises for pts with osteoporosis?

• postural alignment → extension 

  • reduce the incident of spine fracture reoccurrence 

• strengthening → high impact 

• weight-bearing exercise

what impact does swimming have on BMD?

no impact

what impact does walking have on BMD?

protects against further BMD loss

what impact does weight training or running have on BMD?

increases BMD

how are compression fractures treated?

• pain management

• transitional movements (within a safe range)

• orthosis (lumbosacral)

what are the pain control options for a compression fracture?

• kyphoplasty

• vertebroplasty

what is the PT intervention for compression fracture in the acute phase?

• pain management with modalities

• bedrest possibly 

• therapeutic exercise addressing postural awareness 

what is the PT intervention for compression fracture in sub-acute phase?

• walking program

• strengthen abdominals, back extensors, scapular retractors

• avoid lifting > 10#

• avoid flexion 

what is some education we can provide for elderly pts regarding exercise?

• sit as little as possible

• 2-3x/wk do yard work or house cleaning and strengthening

• 3-5x/wk do aerobic activity and swim/golf/tennis etc. 

• every day, walk more at home, take stairs, park further from store