geriatrics????

two theories of aging

extrinsic theory-- aging is a result of cumulative damage (exposure, error in protein synthesis)

intrinsic theory-- aging is pre-programmed (genetically programmed cell death)

how does the sensory system change with age?

vision, vestibular, and proprioception decreases

a decrease in peripheral visual field with age is due to? what are some accommodations?

decrease in periphery is due to decreased pupil size, therefore decreased light. older adults lose vision above head height due to relaxation of upper eyelid.

accommodation-- improve lateral awareness and educate patient to look up

what is acuity? why does it change with age?

ability of the eye to discriminate fine details in the visual field. with age, the lens thickens and decreases in elasticity.

what causes visual glare in older adults? what are some accommodations?

glare results form diffuse light scattering on retina due to increased opacity of the lens, which diffuses the light.

accommodation-- non waxy floor, lamp shades, curtains.

old people can't see in the dark???

smaller pupils require 2-4x more light to see since they don't dialate

what causes poor depth perception in older adults? what are some accommodations?

impaired color discrimination results in a flat visual effect

accommodation- use different colors of tape on stairs to differentiate changes in height or flooring

what causes colored vision loss in older adults? what are some accommodations?

lens thickens and is less sensitive to colors with short wavelenghts (green, blue, purple)

accommodation-- use bright/warm colors and avoid pastels

cause of conductive hearing loss? accommodations?

transmission to inner ear is lost because the signal is not sufficient. due to ear wax, fluid in ear, otosclerosis.

accommodation-- adjust sound of smoke detectors, alarms, etc

cause of sensorineural hearing loss? accommodations?

dysfunction in sound conversion by the inner ear OR dysfunction of cranial nerve

accommodation-- reduce background noise and use rugs to absorb sound in home

what is the cause of decreased touch sensation in elderly?

decreased nerve endings

decreased nerve transmission rate

reduced blood floww

which is impacted more with age-- taste or smell?

smell

bone loss rates and ages

0.5-1% loss per year after 30

2% per year after menopause

why is osteoporosis more common in women?

lower peak bone mass and hormonal changes post menopause

osteopenia v osteoporosis diagnostic criteria

less than 2.5 SD from norm = osteopenia

over 2.5 SD from norm = osteoporosis

the heck is piezo 1

mechanosensitive ion channel that opens in response to mechanical force to help regulate bone density.

basically-- loading is needed for bone growth

major age related changes in collagen tissue

loss of water (shrinkage of cartilage and decreased shock absorption)

increase in collagen cross links (stiff tissue, more effort to move)

loss of elasticity (less give to tendons and more saggy skin)

how does connective tissue change on the cellular level (fibroblastsssss)

fibroblasts decrease in proliferation and alter the ability for repair and maintenance of tissue

hormones and cytokines decrease in release and are less responsive to loading adaptations

what are glycoconjugates? what happens to them as they age?

carbs bonded to other compounds such as proteins and lipids. critical for maintaining fluid content in tissue.

with age, there is an increase in degradation and synthesis, leading to a decrease in fluid in tissue and decrease in pliability of tissue

what happens to collagen with age?

collagen increases in stiffness and fragments with age. decreased energy absorption and more injury.

primary function of chondroid structures

to disperse loads between segments. structures can include cartilage, menisci or cartilaginous discs

what kind of load is good for chondroid structures? what kind are bad?

moderate intermittend loads promote cartilage health

excessive compression and torsion create damage

metastatic calcification v dystrophic calcification v calcinosis

metastatic- calcification of normal tissue; increased calcium or phosphorus

dystrophic- calcification of damaged or necrotic tissue (atherosclerosis)

calcinosis- hypo vascularity or hypoxia related, either local or widespread

what is the effect of calcification on cartilage

load absorbing capacity of cartilage is compromised

how do discs change with age?

nucleus of disc becomes fibrous due to less water content. loss of disc height can lead to stenosis

how does thoracic spine change with age? what muscles change as kyphosis increases?

increased thoracic flexion which increases the lever arm

traps and pec minor become tight

neck flexors and serratus anterior are weak

the aging heart is capable of reaching ___% of max HR

70-80%

decline in max HR!!!

describe the change in cardiovascular tissue with age

vascular system is less compliant due to collagen and BP increases due to the stiffness. increases flow-mediated dilation

nitric oxide causes vasodilation

body comp changes (fat) with age and its effect on metabolism

increase in fat mass which can contribute to inflammation and predisposes elevated lipids and prediabetes

fat is a highly active metabolic organ

adipose tissue secretes hormones, and metabolites that regulate appetite and inflammation

how does muscle contractility and force change with age?

reduced cross bridging

increased tendon compliance

decreased calcium storage in ST

more protein catabolism than anabolism

reduction in satellite cells (that have more than 1 nuclei so they can split into sarcomeres)

how do muscle fibers change with age? II v I

type II atrophy faster than type I due to satellite cell reduction

fat also infiltrates fibers

how does fat infiltration decrease muscle contractility?

alter muscle fibers, inhibit central activation, inflame tissues and inhibit force

half of muscle mass decline with age from ____ loss

axonal loss (loss of innervation)

what happens to resting metabolic rate with age?

progressively declines along with IGF1, estrogen and test, vitamin D, and parathyroid hormone

how does muscle relate to insulin resistance

decrease in muscle mass increases ab fat which increases insulin resistance

benevolent ageism vs hostile ageism

benevolent-- good and bad. old people are sweet but can't drive

hostile-- old people are a waste of space and need to croak

what is the transtheoretical model of change

A model used to determine a patient's willingness to change

stages of the transtheoretical model of change

1. Precontemplation, currently not considering change. (40%)

2. Contemplation, Ambivalent about change (40%)

3. Preparation, Planning to change (20%)

4. Action, Practicing new behaviour

5. Maintenance, Commitment to maintaining change/new behaiours

6. Termination, no desire to return to prior behavior

four key principles of motivational interviewing

empathy

develop discrepancy

roll with resistance

support self-efficacy

what is OARS?

Open ended questions

Affirmations

Reflections

Summaries

steps to habit formation

repetition

situational

insensitive to outcome