Lifespan- Musculoskeletal Changes with Aging

movement

what promotes a gene that is good for you

time

movement extends

sarcopenia

some decline in function is due to

sarcopenia

aging muscle loss

aging and tissue function

what do you need to understand to develop a wellness plan

decrease in strength, power, and function

what are the age related physiological changes in muscle

22-33

what percent of community dwelling older adults have sarcopenia

activity, hormones, medications , and weight bearing

bones respond to

20-30 years

bone loss occurs slowly after the age of

lean mass decreases, fat mass increases, decrease in resting metabolic rate, gain of weight without change in caloric intake

what are the age related physiological changes in body composition

decreased water content in connective tissue with aging, increased collagen crosslinks, increased stiffness and loss of ROM

what are the age related physiological changes in connective tissue

less shock absorption

increased stiffness and loss of ROM leads to

mobility disability

why are musculoskeletal changes important with aging?

weight gain, cardiovascular disease, cancer, falls and associated injuries, diabetes, worsening osteoarthritis, worsening pain

what are physical health impacts of musculoskeletal changes with aging

poor cognitive function, depression, anxiety, social isolation

what are psychosocial impacts of musculoskeletal changes with aging

declining ADLs and IADLs, loss of employment, institutionalization, hospitalization, morality

what are quality of life impacts of musculoskeletal changes with aging

cartilage, tendons and ligaments, muscle strength, skeletal loss

what structures are common locations of changes with aging

cartilage

surface becomes rougher especially on joint surfaces with stress

reduced flexibility and cushioning with water content decreases, cartilage of spinal disks become less flexible and compressible

what are the age related physiological changes in body cartilage

dehydrates cartilage, becomes stiffer, thins, reduces chondritin sulfate which decreases cartilage fluid

what are changes in cartilage

chondroblasts

blood flow in adjacent bones and synovial fluid provide nutrient to the

fluid in cartilage

concentration of glycoprotiens in the matrix determines

supply

cartilage has no direct

tendons and ligaments

loose strength and loose water content

muscle strength

declines due to loss of motor units and exercise can help prevent loss

muscle cramps

are common due to vascular supply, dehydration, diabetes, or irritable spinal nerves

nutrients

what enters the matrix of cartilage only when compressive forces are absent

compression and unloading forces

movement of substances in and out of cartilage occur with alternating

metabolites

what remains in cartilage in the absence of compression

fibrocartilage

with inactivity hyaline cartilage is converted to

hyaluronic acid

synovial joints produces what by chondroblasts which lubricates the interface of cartilage; forms viscous layers over cartilage

compression

what facilitates production of hyaluronic acid form the viscous layer covering the hyaline cartilage

hylauronic acid

what decreases with aging reducing joint gliding

not reversible

degenerative changes in cartilage are

weight bearing activities

what are essential for cartilage health

osteoarthritis

advanced stages of cartilage degeneration is

collagen changes

why am I getting so stiff?

increased stiffness in intramuscular connective tissue, intraarticular changes in joint structure, increased stiffness in joint periarticular connective tissue

what are the biological causes of loss of flexibility

increased stiffness, reduced ability to absorb energy, more brittle

what are the connective tissue changes to collagen

increased cross-links reduces ability of tissues to return to original shape after deformation

what are the connective tissue changes to elastin

glycoconjugates

molecules that assist in cell to cell communication, cross-linkages between proteins, maintaining fluid content of tissue (water binds to it)

retain water

increased degradation , reduced synthesis of glycoconjugate as we age results in the reduced ability for connective tissue to

articular cartilage

calcification of what is normal response to aging

reduces in thickness and density

what changes occur to subchondral bone

reduced joint space, altered dispersion of loads, altered joint movements of forces, reduced range of motion

what are whole joint changes

decreased in physical activity, increased time spent sitting

what are functional causes of loss of flexibility

hip and knee flexors and hip rotators

tightness is most often seen in what ROMs

both AROM and PROM decrease over time, ROM changes are different at different joints in absence of pathology

what are the changes of ROM as we age

AROM

what decreases more? AROM or PROM

joints of upper extremities

what joints tend to remain more flexible? joints of the upper extremity or joints of the lower extremity

extension and lateral flexion

what ROM is lost in the cervical spine as we age

flexion and external rotation

what ROM is lost in the shoulder as we age

no age associated declines

what ROM is lost in the elbow/wrist as we age

extension

what ROM is lost in the thoracic spine as we age

extension

what ROM is lost in the lumbar spine as we age

extension

what ROM is lost in the hip as we age

ROM remains relatively stable as we age

what ROM is lost in the knee as we age

dorsiflexion

what ROM is lost in the ankle as we age

less health care costs

older adults that participate in exercise programs once per week have

impact of mechanical forces, circulating hormones including estrogen, testosterone, calcitonin, parathyroid hormone

what are factors affecting bone remodeling

development of maximal peak bone mass in early adulthood, rate of bone loss in later years

bone health is dependent upon

genetics, mechanical loading, nutrition, hormones

bone health is determined by

osteoporosis

metabolic bone disorder with decline in bone mass and micro deterioration of bony tissue with preservation of skeletal mineralization, leading to enhanced bone fragility and increased in fracture risk

pain, immobility, increased spine kyphosis, risk of fracture present for older adults with balance and gait

osteoporosis may lead to

genetic factors, metabolic disorder, sedentary lifestyle, decreased hormonal levels, smoking, alcohol use, steroid use, decreased circulation

what are some causes of osteoporosis

osteoporosis

occurs when bone reabsorption occurs too quickly too quickly and replacement occurs too slowly

type 1 and type 2

what are the different types of osteoporosis

type 1

occurs mostly in post menopausal women, influencing trabecular bone more than cortical bone; manifested frequently by vertebral compression fractures and distal fadius fractures

vertebral compression fractures and distal radius fractures

type 1 osteoporosis is frequently manifested by

type 2

occurs in men and women in old age, affecting trabecular and cortical bone; often manifested by hip or humeral fractures

hip or humeral fractures

type 2 osteoporosis us often manifested by

vertebral fracture

if the anterior height is 20% lower than the posterior height of the same vertebrae or of the adjacent ones, it is called a

osteoporosis medication

if the anterior height is 20% lower than the posterior height of the same vertebrae or of the adjacent ones, it is called a fracture and the patient is treated with an

+1 to -1

what is considered the value for normal bone density

-1 to -2.5

what is considered the bone density for osteopenia

-2.5 to -4.0

what is considered the bone density for osteoporosis

pagets disease

disorder of bone remodeling characterized by both increased bone resorption and increased formation- resulting in abnormal and disorganized collagen deposits; looks like "woven bones"; rapid remodeling of bone makes it weaker and misshapen and may lead to fractures or arthritic joints

older adults, genetic link, european males> females

who is commonly diagnosed with pagets disease

bone pain in leg, pelvis, or spine and is worse lying down; persistent joint pain; compressed nerves cause numbness, tingling; scoliosis; skull problems can lead to hearing loss, vertigo, headaches and tinnitus

what are symptoms of pagets disease

blood tests and scans, high levels of serum phosphates or bone specific alkaline phosphatase, x-rays, bone scans isotope

how is pagets disease diagnosed

bisphosphonates- calm bone activity; pain medications, vitamin D and calcium, surgery for fracture or arthroplasty for arthritis

what are medical treatments for pagets disease

movement, reduce weight on affected bones, braces, walking devices, strength exercises, pain e-stim modalities

what are physical therapy treatments for pagets disease

degenerative joint disease/osteoarthrits, rheumatoid arthritis

what are pathological causes of muskuloskeletal dysfynction-stiffness

degenerative joint disease/osteoarthritis

inflammation within joint space causing pain, decreased mobility, and joint deformity

hands, knee, hips, lumbar, cervical spine

what are the most affected joints affected by degenerative joint disease/osteoarthritis

rheumatoid arthritis

autoimmune, systemic disease in which the synovial membrane becomes inflamed resulting in the release of proteolytic enzymes which perpetuate inflammation and joint damage; not limited to geriatric age; abrupt onset of symmetrical joint swelling, erythema, and pain

pannus

destructive vascular granulation tissue; is developed in the joint space, which contains inflammatory cells that destroy cartilage, bone, and periarticular tissues leading to joint instability, deformity, and ankylosis

small joints of hands and feet, wrists, shoulders, elbows, hips, knees, and ankles

what joints are involved in rheumatoid arthritis

mobility and basic ADLs

joint deformities caused by rheumatoid arthritis affect

after age 70

greatest decline in muscle occurs when

4-6%

what percent of muscle mass is lost per decade

decreased protein in diet

what is a risk for muscle loss/weakness

base metabolic rate, gait speed, balance

loss of muscle leads to declines in

genetics, sarcopenia, endocrine system changes, diseases with muscle loss as a primary impairment

what are biological causes for loss of strength

36-65%

what percent of muscle strength can be explained by heredity

sarcopenia

age related loss of muscle mass; results in loss of strength, rate of force development, power, functional capacity

increased risk of falls, frailty, development of comorbid conditions

sarcopenia leads to

reduced muscle mass that is replaced by fat mass; reduced muscle strength; slowing of muscle contractile properties and rate of force development

what are whole muscle changes caused by sarcopenia

type 2

which muscle fibers atrophy more with sarcopenia

decrease in the gross number of motor fibers and size of individual motor fibers

what are muscle fiber changes caused by sarcopenia