VCU DPT - Lifespan 2 (Age Related Tissue Changes Part 1: Intro, Bone, CT, Skin)

power and physical strength ____ with age

declines

although physical strength and power decline as we age, what is something PT can help work on and advocate to limit this

exercise!!!! exercise helps counteract/limit loss of these

do a majority of older adults live in health care home

nope

just a few (2.3%)

a majority of adults __(do/do not)____need to depend on others anymore than they did at other time of life

do NOT

does imapirments seen in adults happen just becuase of aging?

no!

happen only in presence of illness, injury, disease

t/f: pain is a natural part of aging process

FALSE

it is not

tell me if pain is a natural part of aging process

also, tell me how your answer impacts reporting of sx

it is not

it often leads to underreporting and reporting too late

should pain be ignored as we age due to it being normal

no! pain is a sign of illness/injury, and therefore pain should not be ignored

t/f: aging is not a disease, and there is no universally accepted theory of biological aging

true

how do humans present, in terms of variance, with age

increasingly more unique!!

we become less alike the more we age

are some pathologies inevitable with age

no

- NO pathology is inevitable with age

are some people more vulnerable to pathology as we age

YES

- age related changes may increase the vulnerability to pathologies

t/f: you may be more likely to get pathology with age due to tissue changes, but it is not inevitable that pathologies will occur

true

biological aging is ___________ from psychological, social, and environmental factors

inextricable

- this is stating ICF model!!!! all of the factors coincide with each other, all play a role

non-genetic factors account for up to _____% of variance in human lifepsan

84%

so a lot is determined by the life you live

age related CHANGES are shown in ___(longitudinal/cross sectional)____ studies

age related DIFFERENCES are shown in ___(longitudinal/cross sectional)____ studies

changes --> longitudinal (follows one person over time, see changes)

differences --> cross sectional (takes a snapshot of one group and compares them)

as we develop over the lifespan, we have the ability to increase our independence and function through exercise

this represents how our development is _______

plastic

what does it mean by saying our development over the lifespan is plastic

we have the ability to change how our function is as we age

- exercise at ANY point can increase our long term and short term outcomes

is it ever too late to get benefits of exercise

NO

while it is true it is better to start earlier, you still can get a lot of benefit even if you start later

are the illness presentations of older adults similar as we age

NO!!!

heart attacks, pneumonia, and UTIs are some examples of having a wide variety of presentations

the rate of functional change varies across adults as is impacted by pathology, enviornmental factors, and health modifying behaviors

this shows how our change is ________

plastic

what does the aging trait of 'heterogenity' mean

that as we age and progress across the lifespan, we become less alike and present with increased variance

a major age related change:

a) _________ reserve capacity of functional performance

b) EXPLAIN IT TOO

c) can exercise and PT help

a) decreased

- less in tank in terms of capacity if struck with fatigue, illness, etc

b) so as we get older, these things will impact us harder than when we were younger

c) can help us start at a higher point, so we have more room from the functional performance threshold when presented with a setback as we age

with decreased reserve capacity of functional performance, we have _____________ when presented with injury/illness/etc towards a level where we do not meet a functional performance threshold

LESS BUFFER

get closer to a level where we need help, so if we lose some function from an issue we are already at higher risk

t/f: all of the following systems may change with age:

skeletal system

joint capsule/ligaments and connective tissue

neruomuscular system

cardiovascular and pulmonary system

hormone and immune system

nervous system

vision, hearing, taste, smell

TRUE, also- read through them again bc I know i just flipped this card over without reading it

systems impacted include:

- skeletal system

- joint capsules, ligaments, connective tissues

- neuromuscular system

- cardiovascular and pulmonary system

- hormone and immune system

- nervous system

- vision, hearing, taste. smell

bone tissue:

bone is built by ___________

bone is resorbed by ________

osteoblasts (Build = Blast)

osteoclasts

while we grow, bone formation _____ bone resorption

in steady state/middle age, bone formation _____ bone resorption

as we are in older age, bone formation _____ bone resorption

while we grow, bone formation IS GREATER THAN bone resorption

in steady state/middle age, bone formation EQUAL TO bone resorption

as we are in older age, bone formation IS LESS THAN bone resorption

as we get older, bone resorption ______ growth

this leads to ______ frequent and ______ deep resoprtion cavities found along bone

outpaces

more, more

describe the resoprtion cavities found in osteoporotic bone

are more frequent, more deep compared to normal bone

are incompletely replaced by new bone, leading to destructive cycle

may have perforations

normal bone resorption cavities are _________ replaceed by new bone, while osteoporotic bone has cavities that are __________ replaced

what does this lead to

completely

incompletely

places where the bone is thinner and weaker, causing progressively worsening issues

what is the age-related expected change in bones

gradual loss of bone mass

with age related change to bones.....

a) bone resoprtion rates ________ formation rates

b) trabecular bone loss ______ cortical bone loss

c) (T/F) can be impacted by blood calcium levels, decreased growth hormone, meds

d) lose about _____% per year starting around ____ years

a) resorb > form

b) trabecular loss > cortical loss

c) T

d) 0.5% per year, around 40 years

bone mass in later life is related to what TWO THINGS

peak bone mass achieved

rate of loss

- rate of bone loss

- peak bone mass achieved

are related to WHAT

the bone mass present in later life

you will likely have more bone mass present in later life if you have:

a) ____________ rate of bone loss

b) ______ peak bone mass achieved

a) slower

b) higher

when do we typically see peak bone mass

year 30

- genetics

- cellular changes

- hormone levels

- nutrition

- mechanical load/stimulus

- participation in health-modfiying behaviors

ALL play a role in what related to bone

the peak bone mass, and the rate of loss

trabecular/cancellous bone:

a) is the rate of this bone type faster or slower than cortical

b) do females or males lose bone more

c) name a specific time frame in life that might see a higher rate of loss in the population you chose for answer B

a) MORE loss seen

b) females

c) accelerated loss of bone mass in first few years AFTER menopause

cortical/compact bone:

what happens to this bone during the aging process

the total diameter increases, and the diameter of marrow's cavity will increase

- walls get thinner!!!!

- it expands wider but does NOT get thicker as it does so

cortical/compact bone:

as we increased the diameter of haversian canals, we ________ the porosity of bone

increase

________ is a skeletal disease with increased fracture risk

osteoporosis

osteoporosis is signified by an _______ fracture risk

increased

we can measure bone strength by bone __________, to help see the risk one is in

density

what is the clinical marker of osteoporosis

individual has bone density 2.5 std dev lower than mean

what is primary osteoporosis?

secondary?

primary: exacerbated rates of expected age changes

secondary: medical conditions, medications, immobilization, nutrition disorders

exacerbated rates of expected age changes in bone density loss is __(primary/secondary)___ osteoporosis

primary

very high rate of bone density loss brought on via medical conditions, medications, immobilization, nutrition disorders are considered ____(primary/secondary)____ osteoporosis

secondary

there are many risk factors for osteoporsis, but the two main ones are:

the peak bone mass achieved

the rate of bone resorption due to combined loss ofrom factors (both things promoting loss and inhibiting osteoblasts)

name some modifiable risk factors for osteoporosis (4)

low body weight (not putting weight on bone)

nutrition deficit (calcium, vitamin D --> related to bone dz)

low activity/sedentary lifestyles (not putting weight on bones)

health-modifying risk behaviors (smoking, excess alcohol)

name some nonmodifiable risk factors for osteoporosis

age (greater than 65 F, 70 M)

female

family history

ethnicity

certain medications

hormone imbalances

early menopause

chronic diseases (RA, renal fail, malabsorption, DM)

what 4 things signify we should test someone for osteoporosis

a female aged 65 years or older

a male aged 70 years or older

anyone who has broken a bone over 50 years old

anyone over 50 years old that has risk factors present

you are working with a 65 yo F patient who is recovering from breaking her tibia. she asks if you think she should get screened for osteoporosis, what do you say

YES

Female 65 or older

50+ yo with broken bone

you are working with a 65 yo MALE patient who is recovering from breaking his tibia. he asks if you think he should get screened for osteoporosis, what do you say

YES

is NOT a male over 70...

BUT is over 50 with a broken bone

WHAT DO THESE THINGS INDICATE:

a female aged 65 years or older

a male aged 70 years or older

anyone who has broken a bone over 50 years old

anyone over 50 years old that has risk factors present

a patient who should get tested for osteoporosis

what is the most common measurement method for osteoporosis

DEXA, measuring bone density

the W.H.O. states the T-score, which is ___________, needs to be ____ for:

a) osteopenia

b) osteoporosis

the clients bone mineral density compared to that of a younger, same sex adult

a) -1.0 to -2.5

b) -2.5 or lower

the W.H.O. states that _______ women and _____ men should get tested for osteoporosis

post menopausal women

men 50+

what are functional implications of osteoporosis

you have an increased fracture risk

posture can be impacted (PTs want to increase strength to help maximize fn)

for every std dev a patient is lower than a younger counterpart of BMD, the fracture risk is ______x higher

1.5/2

just know it gets worse the higher you are below

what are the most common sites of fracture with osteoporosis

name one that we know fits this bill

high trabecular bone content, with thinner cortical bone

- the trabecular is resorbed up and the cortical is stretched thin

vertebral bodies, femoral necks

what are 2 very common tests we can do that will help screen for osteoporosis

height

- if more than 5 cm it is an issue

occiput to wall test

- if more than 3 cm, issue

for screening osteoporosis, there are some clinical tools to use. name the scores of the following that would indicate a risk

a) tragus to wall test

b) occipiut to wall test

c) height loss

d) rib-pelvis distance

a) more than 10 cm

b) more than 3 cm

c) more than 5 cm

d) less than 2 cm

what are 4 core components of an osteoporosis care plan

fall risk reduction

health related behaviors to optimize BMD

body mechanics

postural support

in a plan of care for osteoporosis, you are setting out to optimize BMD (one of 4 components of the PoC)

what are the three components you need for this

nutritional support

hormonal support

mechanical stimulus (exercise!!!!)

if you have the building blocks present and give the body a stimulus, it will help to inhibit osteoclasts and use osteoblasts

in a plan of care for osteoporosis, you are setting out to optimize BMD (one of 4 components of the PoC)

describe some things you would do for the nutritional support (one of 3 components for optimize BMD)

Vitamin D3

calcium

other vitamins with benefit (vitamin c, folic acid, b12/6)

no smoking

in a plan of care for osteoporosis, you are setting out to optimize BMD (one of 4 components of the PoC)

what are some of the medications you give for hormonal support (one of 3 components for optimize BMD)

antiresorptives (inhibit resorption)

anabolic agents (stimulate formation)

WORK WITH PCP/PHARM

what are the two main hormonal supports a patient with osteoporosis likely needs

antiresorptives

anabolic agents

in a plan of care for osteoporosis, you are setting out to optimize BMD (one of 4 components of the PoC)

with mechanical stimulus (one of 3 components for optimize BMD)...

a) strain = _________

b) the recommendation is WHAT

c) what should you avoid

a) bone growth stimulation

b) combined impact exercise + resistance training

c) loaded trunk flexion, end range rotation of trunk and femur

why might you want to limit loaded trunk flexion for a patient with osteoporosis in the mechanical stimulus

they already are getting a compressive load on the vertebral bodies

- likely in kyphosis already

want to do extension based exercises!!!

in a plan of care for osteoporosis, you are setting out to optimize BMD (one of 4 components of the PoC)

with mechanical stimulus (one of 3 components for optimize BMD)...

name some parameters for impact exercise

- contacts per session

- session per week

- total duration of treatment

50 jumps per session

3+ sessions per week

6+ months

in a plan of care for osteoporosis, you are setting out to optimize BMD (one of 4 components of the PoC)

with mechanical stimulus (one of 3 components for optimize BMD)...

name some parameters for resistance training

- %1RM

- reps per set

- sessions per week

- total duration of treatment

50-85% 1RM

3-12 reps per set

2-3 sessions per week

3-12 months

in a longitudinal study on postmenopausal women, ______________ helped slow the rate of BMD more than control

high impact training group

- this training may help reduce risk of fx and osteoporosis

in a plan of care for osteoporosis, you are doing patient education (one of 4 components of the PoC)

name 3 aspects you want to include

body mechanics

behavioral interventions (exercise!!!!)

explain BMD values, and what they mean

in a plan of care for osteoporosis, you are doing postural support (one of 4 components of the PoC)

some implications of impacted posture include:

a) _______ balance, _______ fall risk

b) gait _________

c) _____ shoulder ROM

d) _________ breathing mechanics

a) decreased, increased

b) deviations

c) decreased

d) imapired

in a plan of care for osteoporosis, you are doing postural support (one of 4 components of the PoC)

you should include:

a) supporting a ______ postural alignment

b) _______ based movement, and core ____________

c) ____ flexibility

d) a brace for _____ compression fracture

- name benefits, drawbacks

a) neutral

b) extension, stability

c) include

d) acute

- allows pain free movement with external stability in early rehab

- it will turn off muscle activity, leaving long term issues

for acute compression fractures, you can use a brace. what is important about the timing of these braces

TEMPORARY

connective tissue changes you see in joints and ligaments include:

a) _______ water content

b) _____ cross linking in collagen (meaning tissue is ________ and less ______)

c) ____quantity of elastic fibers

d) _____ synovial fluid quantity and quality

a) decreased

b) increased (stiffer and less flexible)

c) decreased

d) decreased

as we age, our connective tissue has less water, less synovial fluid, and higher cross linking.

this results in....

a) ______ stiffness/passive tension

b) _______ joint end range

c) _____ shock absorption

d) height _________

a) increased

b) decreased (but still WFL)

c) worse, tissues are stiffer!

d) loss

as we age, in conjunction with tissue changes in ligaments and joints, we see a ________in ROM

decrease

- but still functional!

as we age, the expected height loss is ____ cm but a red flag amount of height loss is _______ cm

2-4 cm

5 or more cm

a height loss of 5 cm or more as we age is a risk factor for _________

potential compression fracture

as we age and our cartialge loses water, what is the impact of this

what does this put us at higher risk of developing

we lose our ability to absorb shock and cushion against compression

OA

why might as we get older we are at higher risk of OA

because our cartilage can not hold water as well, making it not as good at absorbing compression and there is resistance provided to joint gliding

- aka compression distributed worse and in smaller area

t/f: as we get older, our cartilage gets OA

FALSE

at higher risk for OA, but not guaranteed

__________ represents a WBing failure

- articular cartialge degeneration, with changes in subchondral bone + joint capsule + ligaments + etc

OA

t/f: OA is heterogenous, with different etiologies, and different progression rates

t

what is relationship between OA and imaging

imaging does NOT correlate with function and pain

OA pathological changes:

chondrocytes undergo an ________ response, see an abnormal synthesis of _________ (so can not repair matrix), and the AC matrix is now filled with __________, _________, _________

inflammatory

collagen

wrong collagen type, disorganized fibers, proteoglycan depletion

what happens to the cartilage in OA

tldr; perforation and disruption of the cartilage

it degrades, calcifies, inflames, and has bad elasticity

pathological changes in early OA:

cortical bone _______

trabecular bone ________

thins

degrades

pathological changes in late OA:

cortical bone __________

trabecular bone _________

bone marrow _____

bone _______

thickens

scleorosis

swells

cysts

demographics

genetics/family history

weight/metbolic factors

history of joint injury

repetitive/high impact load

insuffecient force attenuation

joint mechanics

these are all ___________

OA risk factors

Ik i just skipped it go read them again

what is a good measure for OA

womac

3 components to OA care plan

focus should be on function and sx management

normalize joint loading

promtoe movement, reduce fear avoidance beahviors

t/f: with OA, it is important to emphasize that movement will help it get better

- also may want to avoid talking about the tissue changes, saying things like bone on bone

Also, focus should be on functional outcomes and symptom reduction

TRUE

is there an FDa drug for OA

no, just use them for sx mngmt

age expected changes related to integumentary system:

_______ risk of skin tears/cracking

_____ protection from dehydration

______ protection from infection

increased

decreased

decreased

a _________ happens with pressure being put on skin over time, causes damage to skin and under/lying tissues

pressure ulcer

cause of pressure ulcer?

unrelieved pressure OR pressure + shear over a bony prominence

some risk factors for pressure wounds or integumentary issues

prolonged bed rest

bad nutrition

moisture

decreased sensation

DM, renal fail, other complications impacting blood flow