Normal/ Pathological Changes with Aging

What is “Inflammaging”

• Inflammation that accelerates the aging phenotype - more inflammation that we have, the worse everything gets

What are programmed theories ?

• non- stochastic

• genetically controlled, cellular senescence 

• DNA - biological timetable 

• hormonally regulated 

• continuation of the theory that regulates childhood growth and development 

• basically you grow up, things happen, then you die 

What are damage or error theories ?

• stochastic

• epigenetic: changes of gene expression via lifestyle and environment

• DNA mutations, mitochondrial DNA, DNA repair

• Oxidative stress theory, wear and tear theory

Give 2 examples of age-related connective tissue changes:

• loss of water from the matrix

• increased # of collagen cross-links

• loss of elastic fibers

Give 2 consequences of age related connective tissue changes:

• decreased ability for shock absorption

• reduced ROM 

• More effort required to move 

• loss of end range motion 

• saggy skin 

Give 2 examples of age related changes in muscle

• Type II muscle atrophy

• Type I atrophy (LE affected more than UE)

• affects force, velocity, strength, power

• fiber necrosis

• chronic inflammation causes pathological remodeling

• slower rate of activation

• increase in fat, decrease muscle mass and BMR

• more fat can cause increase in inflammation

T/F: Physical therapy can reverse cachexia but not sarcopenia

False - PT can reverse sarcopenia but not cachexia

Name 2 modifiable factors contributing to bone mass

• diet (calcium, vitamin D, protein)

• low BMI

• inactivity, immobilization 

• medications 

T/F: Decline in bone mass is faster in men than women 

False - decline happens faster after menopause with drop in estrogen 

What is a t-score ?

• t-score is how close your bone health is based on your age

  • the further from 0 your t-score is the worse

• Osteopenia (t-score -1 to -2.5)

• Osteoporosis ( t-score < -2.5)

What are 3 components for screening for compression fractures ?

• Historic Height Loss (HHL)

  • max height - current height

  • MD referral: HHL > 6cm (>60yrs) or >4cm (<60yrs)

• Rib Pelvis Distance (RPD)

  • PT behind pt, palpates mid axillary line 

  • MD referral: RPD<2 fingers or <3.6cm 

• Wall Occiput Distance (WOD) 

  • distance btwn occipital prominence to wall

  • MD referral: WOD >6cm 

If suspecting osteoporotic fx, how would you screen ? 

Is it:

• low level trauma 

• fall from a standing height or less 

• adults > 50yo

Need bone mineral density (BMD) scan to identify

Typical sites: spine, hip, distal radius, proximal humerus

Name 2 joint changes that occur with aging

• decrease joint spaces

• increase laxity

• altered distribution load

• decreased ROM

What is a possible cause for postural changes in older adults

• decrease in intervertebral disc height - begins at 30 yo

• decrease bone density

• hypokinesis

• muscle imbalance and weakness

Name 3 common postural changes in older adults

• forward head 

• rounded shoulders 

• kyphosis 

• flatter lumbar spine 

• hips, knees increased flexion 

• arms and legs look longer

• foot arches become less pronounced 

What is Dowager’s Hump 

• hyperkyphosis 

• abnormal outward curvature of thoracic vertebrae 

What is the atherosclerosis vs arteriosclerosis ?

• Arteriosclerosis is hardening of artery walls

• Atherosclerosis is plaque build up in the arteries

Name 3 age related cardiovascular changes 

• decline in max HR 

• decline in VO2 max 

• less compliant vascular tissues 

• reduced contractility of vascular walls 

Common causes for varicose veins 

• family hx 

• age

• sex (esp pregnancy)

• obesity 

• prolonged standing 

What are 3 age related integumentary changes ?

• decreased collagen → weak skin 

• decreased elastin → wrinkles 

• dry skin 

• decrease function of nerve endings 

• slower wound healing 

T/F: Increase in systemic inflammation is the underlying factor for the Four Horsemen: Alzheimer’s, ASD, cancer, DM 

True 

What are some benefits of exercise on the immune system changes ?

• one bout of exercise increases BDNF - protein that is correlated with brain health

• further reduces chronic inflammation

What are 3 functional changes that occur due to endocrine changes ? 

• loss of muscle and bone 

• body temp regulation

• fluid regulation 

• fatigue 

• comorbidities: DM, CVD, visceral fat

What are the three components of “successful aging”

• Avoid diseases

  • lifestyle, daily walks, regular check ups, nutrition

• Physical and Cognitive Function

  • memory, attention, decision making

• Social and Productive Activity

  • cooking, gardening, shopping, ADLs/IADLs

What is “Optimal Aging” ? 

• the capacity to function across many domains to one’s satisfaction and in spite of one’s medical conditions 

What is frailty?

• aging- associated decline

• risk of poor physical health, hospitalization. nursing home care and mortality 

• coexist with disability and comorbidity 

What are the 5 factors that determine frailty ?

• if you have 3/5 or more you are frail LOL

  • unintentional weight loss > 10lbs or 5% in one year

  • exhaustion, low energy

  • low physical activity

  • slow gait speed (<0.8m/s)

  • weakness (grip strength)

What is the most successful type of physical activity for frail patients?

• strength and balance training