Aging Adult: Postural Control and Fall Risk Assessment

What are some age-related changes in the visual system that impact postural control?

Normal aging includes no abnormal changes, but vision types such as glare sensitivity increase with age: 75 yo - 3x, 85 yo - 5x, 90 yo - 14x; attentional area increases: 75 yo - 2x, 85 yo - 3x, 90 yo - 9x; depth perception increases: 75 yo - 2x, 85 yo - 5x, 90 yo - 9x; contrast sensitivity increases: 75 yo - 2x, 85 yo - 3x, 90 yo - 5x.

What are some abnormal aging changes in the visual system?

Cataracts (cloudy lens), Glaucoma (fluid buildup causing optic nerve damage), Age-related Macular Degeneration (AMD - protein accumulation damages the macula), and Diabetic neuropathy (fluid accumulation in the macula; microaneurysms).

How does normal aging affect the vestibular system and postural control?

Normal aging leads to faster changes with a sedentary lifestyle, calcification of otolithic membranes, decreased number of vestibular hair cells, decreased size of vestibular adherents, and decreased efficacy of the vestibulo-ocular reflex (VOR), resulting in vestibular HYPOsensitivity.

What is the impact of decreased vestibular inputs on postural control?

Decreased vestibular inputs lead to decreased efficacy of the VOR and decreased efficacy of postural control related to vestibular inputs, resulting in increased reliance on vision and proprioception, decreased gaze stabilization when moving, and difficulty with spatial navigation.

What are the effects of age-related changes in the musculoskeletal (MSK) system on postural control?

Normal aging leads to decreased efficacy of postural control due to decreased size and number of type II muscle fibers (affecting strength, power, endurance), decreased number of motor units, decreased maximal voluntary muscle activation (increasing osteoporosis prevalence), increased axial stiffness (causing postural changes), and decreased soft tissue flexibility (reducing joint ROM, especially in hips and ankles).

What are the age-related changes in the neuromuscular (NM) system affecting postural control?

Normal aging results in decreased coordination, increased sympathetic nervous system (SNS) response to stress, decreased efficacy of postural responses, decreased reaction time, increased difficulty with divided attention, and increased cognitive processing time.

What is the 'Stiffening Strategy' in older adults?

The 'Stiffening Strategy' refers to increased co-contraction of antagonist muscles during voluntary movements, leading to decreased ability to isolate movements.

What are the routine screening questions for older adults regarding falls?

1. Have you fallen in the past 12 months? If yes, how many, context, injury, activity limitations, is your primary care provider aware, and do you use assistive devices? 2. Do you have difficulty with balance or walking?

What is the significance of attentional cost in postural control for older adults?

The attention required for function is greater than the attention required for dual tasks, indicating a higher cognitive load during postural control.

How does aging affect muscle strength and endurance?

Aging leads to a decrease in the size and number of type II muscle fibers, resulting in decreased muscle strength, power, and endurance.

What is the relationship between aging and osteoporosis prevalence?

Decreased maximal voluntary muscle activation associated with aging increases the prevalence of osteoporosis.

How does aging affect soft tissue flexibility?

Aging results in connective tissue changes that decrease soft tissue flexibility, leading to reduced joint range of motion, particularly in the hips and ankles.

What are the effects of decreased vestibular hair cells with aging?

Decreased vestibular hair cells contribute to vestibular HYPOsensitivity, impacting balance and postural control.

What happens to gaze stabilization with aging?

Aging decreases the efficacy of gaze stabilization when moving, increasing the risk of falls.

How does aging affect reaction time and cognitive processing?

Aging is associated with decreased reaction time and increased cognitive processing time, which can affect balance and mobility.

What is the impact of decreased motor units on muscle function in older adults?

A decrease in the number of motor units leads to increased recruitment of type I fibers to achieve peak muscle tension, affecting overall muscle function.

What is the impact of sedentary lifestyle on vestibular function in older adults?

A sedentary lifestyle can lead to faster changes in vestibular function, exacerbating balance issues.

What are the implications of increased reliance on vision and proprioception in older adults?

Increased reliance on vision and proprioception can make older adults more vulnerable to falls, especially when visual or proprioceptive inputs are compromised.

How does aging affect spatial navigation abilities?

Aging can lead to difficulties with spatial navigation due to decreased vestibular input and cognitive processing challenges.

What is the significance of dual-tasking in older adults?

Older adults may struggle with dual-tasking due to increased attentional costs, which can compromise their balance and mobility.

What are the potential consequences of decreased postural responses in older adults?

Decreased efficacy of postural responses can increase the risk of falls and injuries in older adults.

What does a positive screen indicate in fall risk assessment?

A positive screen indicates the need for a multifactorial fall risk assessment.

What are the three screening tools mentioned for assessing fall risk?

BERG, TUG, and POMA.

What are the independent predictors of falls?

Psychoactive drugs, polypharmacy (>/= 4 meds), orthostatic hypotension, and nocturia.

What are common psychoactive drugs that can increase fall risk?

Antianxiety medications, antidepressants, and sleeping pills.

What defines polypharmacy in the context of fall risk?

Polypharmacy is defined as the use of four or more medications.

What is orthostatic hypotension?

A drop in blood pressure with positional changes, specifically a drop in SBP of >/= 20 mmHg or DBP of >/= 10 mmHg, often causing lightheadedness or dizziness.

What is nocturia and how does it relate to fall risk?

Nocturia is the increasing need to use the restroom at night, which can contribute to fall risk.

What are some side effects of psychoactive drugs that can affect fall risk?

Confusion, dizziness/unsteadiness, weakness, decreased response time, decreased coordination, blurred vision, hypotension, and insomnia/restlessness.

What is the cut-score for the Geriatric Depression Scale?

The cut-score is 7 out of 15.

What is the cut-score for further testing for the Mini-Cog?

A score of less than 4 out of 5 indicates the need for further testing.

What questions can be asked to assess pain's impact on balance?

Questions include: Do you avoid certain activities because of pain? Does pain threaten your balance? Do you have any episodes of your lower extremities giving away?

What causes postural hypotension related to beta-blockers and diuretics?

They can decrease blood supply to the brain, leading to syncope.

What question can be used to screen for fear of falling?

Do you worry about falling?

What is the FES-I used for?

The FES-I is used to assess fear of falling when a person answers 'yes' to worrying about falling.

What personal factors can impact fall risk?

Self-perceived health, polypharmacy, positive sensory impairment, poor sleep quality, poor nutritional habits, decreased cognitive stimulation, and decreased group social activity.

How does social support relate to fall risk in older adults?

There is a positive association between social support and leisure time physical activity levels in older adults.

What does it mean if a person is more cautious doing certain activities?

It may indicate a fear of falling, which can impact their overall activity levels.

What is the significance of decreased cognitive stimulation activity?

It is a personal factor that can increase fall risk.

How does poor nutritional habits affect fall risk?

Poor nutritional habits can contribute to overall health decline and increase the risk of falls.

What is the relationship between sleep quality and fall risk?

Poor sleep quality can negatively impact balance and increase the risk of falls.

What percentage of fall-related traumatic brain injuries (TBI) in older adults is caused by alcohol use?

34.8%.

What is the pre-test probability for falls in community-dwelling older adults?

30%.

What are common risk factors for osteoporosis?

Age, female gender, over 50 years old, low estrogen in females, low testosterone in males, and slender build (SLENDER).

What does the acronym SLENDER stand for in relation to osteoporosis risk factors?

S- Slim build; L- Low calcium intake or little exercise; E- Early menopause or irregular periods; N- No pregnancies; D- Dermatologic/ethnic background; E- External factors; R- Relatives with osteoporosis.

What are the T-scores for osteopenia, osteoporosis, and normal bone mineral density (BMD)?

Ideal: > +1.0 SD; Borderline: between +1.0 & -1.0 SD; Osteopenia: between -1.0 & -2.5 SD; Osteoporosis: < -2.5 SD.

What are the negative effects of age-related hyperkyphosis?

Mechanical restriction limits vital capacity, increases difficulty in reaching and manipulating heavy loads, impairs balance, and increases mortality risk when combined with vertebral fractures.

What is the cut-score for hyperkyphosis on the Occiput-to-Wall test?

Hyperkyphosis is indicated by an occiput-to-wall distance (OWD) of greater than 5 cm (2 inches).

What are the gait speed classifications for older adults?

0.4 m/s - 0.8 m/s = limited community ambulator; > 0.8 m/s = community ambulator; 1.2 m/s = SAFE community ambulator; 1.32 m/s = safely cross a U.S. street.

What are the early signs (prodromal markers) of Parkinson's Disease?

REM sleep behavior disorder (RBD), hyposmia, depression, autonomic dysfunction, and mild motor signs.

What are the key symptoms of Parkinson's Disease?

Rigidity, cogwheel and lead pipe rigidity, bradykinesia, and insufficient recruitment of muscle force.

What is the mean kyphotic angle in younger adults compared to adults aged 65 and older?

Mean kyphotic angle is 26.8° in younger adults and 41.9° in adults 65+.

What factors increase the risk of hyperkyphosis in older adults?

Decreased spinal extensor muscle mass/strength, decreased bone mineral density (BMD), increased fragility of connective tissue, and decreased vertebral disc height.

What should be avoided to prevent exacerbating hyperkyphosis?

Loaded or extreme spinal flexion.

What is the impact of decreased trailing-leg extension on running mechanics in older adults?

It leads to decreased stride length and running speed.

What are the effects of aging on running mechanics?

Decreased wing leg hip flexion, increased ground contact time, increased anterior pelvic tilt, and dynamic knee valgus.

What is the significance of the Occiput-to-Wall test in assessing older adults?

It helps evaluate hyperkyphosis, which is associated with increased fall risk.

What are the implications of spinal extensor muscle weakness in older adults?

It contributes to impaired balance and increased risk of falling.

What external factors contribute to osteoporosis risk?

Smoking, excess alcohol consumption, steroids, hyperthyroidism, anti-seizure medications, and aluminum-containing antacids.

How does age affect the risk of falling in older adults with hyperkyphosis?

Older adults with hyperkyphosis are more likely to fall within the next year.

What is the relationship between vertebral compression fractures and osteoporosis?

Vertebral compression fractures are a risk factor for osteoporosis.

What is the significance of the term 'bradykinesia' in Parkinson's Disease?

It refers to slow and gradually decreasing movement.

What is the definition of idiopathic Parkinson's Disease?

A form of Parkinson's Disease with no known cause, often classified by age of onset and symptom dominance.

What are the most characteristic impairments in Parkinson's Disease?

Postural instability and tremor, with 80% of patients exhibiting these symptoms.

Why is Parkinson's Disease commonly misdiagnosed as a central tremor?

Because bradykinesia and postural instability symptoms are often missed.

What type of tremor is most commonly associated with Parkinson's Disease?

Pronation/supination tremor.

How might tremors in Parkinson's Disease respond to treatment?

Tremors may not respond to levodopa but could respond to Deep Brain Stimulation (DBS).

What are some limitations of mobility in Parkinson's Disease?

Rigidity, bradykinesia, coordination issues, reduced kinesthesia, attention required, and freezing of gait.

What should patients be educated about regarding their medication in Parkinson's Disease?

Patients should understand ON/OFF times and fluctuations, and it is advised to take medication early after diagnosis.

Why is it important to refer patients to a movement disorder specialist?

They can make necessary adjustments to treatment and provide specialized care.

What is the purpose of Deep Brain Stimulation (DBS) in Parkinson's Disease?

To deliver high-frequency stimulation to the basal ganglia to override abnormal neuronal activity.

What is the relationship between levodopa response and DBS response?

A good response to levodopa typically indicates a good response to DBS.

What are the potential negative effects of DBS?

Verbal fluency and balance can worsen, and it may not be suitable for everyone.

What are the expected results of DBS in Parkinson's Disease?

Improved tremor, rigidity, slowness, dyskinesias, and less off/on fluctuations.

What are the potential worsened conditions after DBS?

Walking and balance, speech and swallowing, and cognition may worsen.

What are some motor symptoms associated with Parkinson's Disease?

Falls, retropulsion, freezing, choking, aspiration, axial rigidity, drooling, and decreased breath support.

What are some non-motor symptoms associated with Parkinson's Disease?

Dementia, incontinence, skin changes, sexual dysfunction, and pain.

How does the duration of diagnosis affect fall risk in Parkinson's Disease?

Patients diagnosed for more than 15 years are 5 times more likely to fall.

What does the Modified Hoehn & Yahr scale assess?

The severity of Parkinson's Disease, ranging from unilateral involvement to mild to moderate bilateral disease.

What is the BESTest used for in Parkinson's Disease?

To assess balance through anticipatory and reactive activities.

What are the four main categories assessed in the BESTest?

Anticipatory, reactions, sensory, and gait.

What is a common pattern of falling for individuals with Parkinson's Disease?

Falls commonly occur forward and down onto knees due to freezing of feet, or backward when standing.

How does a narrow base of support (BOS) affect fall risk in Parkinson's Disease?

It increases the risk of falling to the side when turning.

What is a significant problem affecting self-initiated movements in Parkinson's Disease?

Slowness and inability to adjust force during movements.

What are some characteristics of continuous gait disorders?

Reduced arm swing, reduced and variable step length, postural deformities, and reduction in gait speed.

What is meant by 'slow turns - en bloc' in gait disorders?

It refers to the inability to turn smoothly, resulting in a rigid, stiff movement when changing direction.

What is freezing of gait (FOG)?

A condition where the feet feel glued to the floor, leading to small shuffling steps and difficulty initiating movement.

What factors can trigger freezing of gait?

Context-dependent triggers such as start hesitation, narrow passages, dual tasking, loss of visual input, and executive function issues.

What is festinating gait?

A tendency to speed up while losing normal amplitude of movement, resulting in rapid, small steps and forward propulsion.

How does postural alignment affect gait in Parkinson's Disease?

Stooped posture reduces limits of stability and makes the individual unstable due to the lever being behind the heel.

What is bradykinesia in the context of Parkinson's Disease?

A condition characterized by increased motor output requiring high effort for larger or faster whole-body movements.

What is the significance of functional power training in Parkinson's Disease?

It focuses on high effort for large amplitude functional movements to improve overall mobility and strength.

What exercises can help with freezing of gait?

Larger stepping, side stepping, activities with a wide base of support, and exercises that increase the force of push through the feet.

What is the role of rigidity in Parkinson's Disease?

Rigidity primarily affects the hip and pelvis, leading to stiffness that can hinder mobility and requires postural flexibility.

How does reduced kinesthesia manifest in Parkinson's Disease?

It is characterized by poor joint position sense and perception, impairing the central interpretation of movement information.

What types of exercises can improve kinesthesia?

Activities that involve a target for the upper or lower extremities, allowing visual feedback of limb movement.

What is the Agility Boot Camp-Cognitive (ABC-C) designed for?

To challenge cognitive mobility skills impaired in Parkinson's Disease through a circuit of various exercises.

What types of stations are included in the Agility Boot Camp-Cognitive?

Stations include gait training, functional skill training, agility obstacle courses, lunges, boxing, and adaptive tai chi.

What is the impact of executive function on freezing of gait?

Executive function is a predictor of freezing of gait, affecting the ability to initiate and control movement.

What is the relationship between anticipatory postural control and freezing of gait?

Poor coupling between anticipatory postural control and stepping can lead to freezing of gait.