Activity & Participation for the Older Adult

posture

• The older adult tends to adopt a kyphotic posture

• Forward head

• Slight crouch (lowers COG)

reasons for posture change

• Lifetime of bad postural habits

◦ Muscles get tight

◦ Limited ROM

• Compensation

• Disease

• Fear - lower COG to BOS 

anklylosing spondylitis

a rheumatic disease that affects joint spaces, causing narrowing and fusion

• So-called dowager’s hump

sensory factors and balance change 

• Three main sensory systems involved in balance

◦ Each of these systems changes with age in a way that impacts balance

vestibular system and balance in the elderly

• Normal role of the vestibular system is:

◦ Promote posture for stability and orientation by registering position and movement of the head

• This is done by receptors in the labyrinth (inner ear) that detect position and movement of the head

◦ Hair cells displaced in fluid

effects of aging on the vestibular system

• Presbyastasis

• 20% decrease in hair cells of macula and 40% in semicircular canals

• Decreased ability to respond to position and movement change

• Effects of drugs

• Effects of disease

  • Meuniere’sdisease

visual system and balance in the edlerly

• Visual system role in balance is to provide orientation to the visual environment

• Helps you sense obstacles/dangers

• Adapts to changes in lighting

• Visual memor

effects of aging on the visual system

◦ Presbyopia

◦ Cataracts

◦ Glaucoma

◦ Macular degeneration

• Pupillary responses decrease…difficulty with low light

presbyastasis 

disequilibiurm, loss of balance

presbyopia

loss of lens elasticity; this is important for near-far accommodation

somatosensory system and balance in the elderly

• Somatosensory system tells you about weight bearing surfaces

• Pairs with information about joint angle and body part alignment from the proprioceptors

effect of aging on somatosensory system 

• Increased reaction time

• Higher threshold for activation

• Decreased nerve conduction time

• Disease

◦ Diabetic neuropathy

vision, postural reference, and postural muscle activity

There is normally a “necessary coupling” between _

nervous system

can re-weight input over various sensory channels when stimulus amplitude is altered over any given channel

• Elderly are much more susceptible…they can react like younger counterparts in the disruption of one sensory inputs, but not two

muscuoloskeletal changes in aging that affect balance

• Change in relationship of body parts/body alignment

• Decrease in Range of Motion

• Decrease in Flexibility

• Decrease in strength

characteristics of balance in the elderly

• Postural Sway is increased

• Limits of stability are decreased

• Anticipatory postural control decreases

• Increased use of hip and stepping strategy as opposed to ankle strategy

• Loss of ability to accommodate to changes in environment (reaction time)

• Increased dependence on visual feedback

falls

• Leading cause of injury related visits to emergency departments in people over 65

• Leading cause of accidental death and nonfatal injuries

• Fear of falling

fall risk and hip fractures

• < 50% will regain prior level of function

• 3x more likely to be functionally dependent

• 4x less likely to return to walking in the community

• Individuals who require re-hospitalization post fxare more likely to:  require assistance for ambulation, require NH placement and die

functional reach assessment

◦ Scores of 10 inches or more=adequate balance

◦ Scores less than 6-7 indicate limited balance

◦ Muir et al 201 found self-report of balance problems, forward reach and single limb support independent predictors of falls

transfers 

change of postural set

sit to stand

Key to functional independence in the elderly

requirements of gait

• Activate lower limb muscles with appropriate force and timing to propel the body forward

• Achieve normal step length

• Keep head and trunk balanced above base of support

• Generate a rhythmical stepping movement to regulate cadence

• Maintain foot clearance — dorsiflexion needed

• Possess sufficient aerobic capactiy

adaptable

gait must be _ 

• Alter gait according to the environment

• Perform secondary tasks

.22 mph

physiological walker

.5 mph

Limited household walker

1.43

Gait speeds less than _ mph suggest poor health and functional status

1.8 mph

community walker

3 mph

normal walking speed older adult

perry 

Adults 20-59

◦ CWS = 80m/min

◦ FWS = 106 m/min

seniors

◦ 60-80

◦ CWS  = 74m/min 

◦ FWS =90 m/minFWS =90 m/min

aging and gait speed

• Slower self selected walking velocity

• Decrease ability to walk fast

• Increase cadence vs. increase stride length

• Decreased plantar flexion at end of stance

• Decreased step height in advancing swing limb

• Decreased dorsiflexion at contact

• Increased base of support and increased toe out

• Increased energy expenditure

• Taking more steps as opposed in increase stride length (because can’t do unilateral stance)

• Increase double support stance period

• More flat foot landing

1-3

People who need help with _ ADLs can be “assisted” in their own home, or apartment, assisted living

>3 (3.75)

People who need help with _ ADLs likely to live in nursing homes, long term care