Age Related Tissue Change

T/F: no pathology is inevitable with age

TRUE — but age related changes may increase vulnerability to pathology

T/F: physical strength and power tends to decline with age

TRUE — but exercise can counteract + limit amount of loss

Don't need to know telomere length slide

Only ___% of adults 65+ live in nursing homes

2.3%

__% of older people report they are healthy enough to carry out normal daily activities independently

80%

T/F: pain is a part of the natural aging process

FALSE!!

T/F: genetic factors account for up to 84% of variance in human lifespan

FALSE — NON GENETIC

As we age, we have greater (hetero/homo)geneity between AND within individuals

HETERO - we become more different

What study is best to observe age related changes?

Longitudinal (better!)

What study is best to observe age related differences?

Cross-sectional

T/F: presentation of illness can differ in older adults

TRUE — for example may not have chest pain with MI but other symptoms

Major age-related physical change is a decrease in what?

Reserve capacity — means it is harder to recover from stress/illness

Age related changes in bone tissue

Bone absorption (osteoclasts) outpaces bone formation (osteoblasts)

Gradual loss of bone tissue is about __% per year starting around __ years

0.5% // 40

Which has a greater loss with age-related changes: trabecular bone or cortical bone?

Trabecular bone loss

T/F: females have an accelerated rate of annual bone loss (2%) in the first few years following menopause

TRUE

Why do rates of trabecular bone loss exceed rates of cortical bone loss?

Trabecular bone has greater surface area (more space for age-related changes to happen) and is more metabolically active

With age, cortical bone total diameter ___ and the diameter marrow cavity ___ meaning the wall ___

Increases // increases // thins (INCREASED POROSITY!!)

This type of osteoporosis is caused by exacerbated rates of expected age changes

Primary

This type of osteoporosis is caused by medical conditions, medications, immobilization, or malnutrition

Secondary

Factors in which to test BMD (4)

○ Female age 65 years and older

○ Male age 70 years and older

○ Anyone who has broken a bone after age 50 years

○ Anyone over 50 with risk factors present

T/F: hormone imbalances, ethnicity, and family history are all risk factors for osteoporosis

TRUE!!

Most common measurement of bone to soft tissue distinction

DEXA scan

3 legged stool approach to optimize bone mineral density by inhibiting resorption or stimulate formation

1. Nutritional support

2. Hormonal support

3. Mechanical stimulus (exercise!)

Don't need to know names of drugs for BMD

Threshold numbers for suspected vertebral fracture

○ Tragus to wall test >10 cm

○ Occiput to wall test >3 cm

○ Height loss >5 cm

○ Rib-pelvis distance <2cm

Functional implications of osteoporosis? (2)

-increased fx risk

-posture

What are some good supplements for BMD?

-vitamin D3

-calcium

-also: vit C, B12, B6, folic acid

What is the "three legged stool" approach for optimizing BMD?

1. Nutritional support

2. Hormonal support

3. Mechanical stimulus (EXERCISE!!)

2 main categories of hormonal support/medications to optimize BMD

-antiresorptives (inhibit bone resorption)

-anabolic agents (stimulate bone formation)

For osteoporosis, the exercise recommendation is...

Combined impact exercise (jumping) + resistance training

For osteoporosis, in exercise we want to avoid...

Loaded trunk flexion, end range trunk rotation, end range femur rotation, strenuous overhead lifts

For people with osteoporsis, do we want more flexion or extension based exercises?

Extension based (think of kyphosis - compression on vertebral body)

Resistance training for osteoporosis should be ___% 1RM

50-85% 2-3x/week 3-12 months

Examples of impact exercise for osteoporsis

50 jumps 3x/week for 6 months

Statistically significant changes in BMD

● 3-4% at hip

● 4-5% at spine

● 2% at wrist

Implications from kyphotic posture due to osteoporsis (4)

-balance/fall risk

-gait deviation (COM is anterior, can't get foot out as far in front in heel strike)

-decreased shoulder ROM

-breathing mechanics

T/F: a brace is a good long term solution for acute compression fractures in osteoporosis

FALSE — GOOD TEMPORARY SOLUTION TO ALLOW PAIN FREE MOVEMENT BUT NOT TO BE USED LONG TERM

Age-related changes to joints and ligaments causes a (incr/decr) in water content, quantity of elastic fibers, and synovial fluid

Decreased

Age causes joints and ligaments to have a (incr/decr) in cross-linking in collagen

INCREASE

With age-related changes to joint capsules, we would expect a (incr/decr) in joint end range, shock absorption, and height and a (incr/decr) in stiffness

DECREASE // INCREASE

When do individuals begin to start losing height?

~45 years

A height loss greater than __ cm may be a sign of a potential compression fracture

5 cm

With age changes, we would expect a (incr/decr) in cervical extension + sidebending, thoracic extension, lumbar extension + flexion + sidebending

DECREASE

With age changes, we would expect a decrease in ankle (DF/PF)

DF

With age changes, we would expect a decrease in hip (flexion/extension)

Extension

With age changes, we would expect a decrease in what 2 shoulder motions?

Flexion & EROT

A height loss greater than ___ cm may indicate potential compression fracture

5 cm

Why does water content decrease in articular cartilage?

Decreased PG water retention and decreased quantity of GAGs

How does decrease in articular cartilage affect joint surfaces?

Increased resistance to gliding, decreased shock absorption, increased risk of developing OA

T/F: older cartilage is osteoarthritic

FALSE!!! It is only an increase in RISK

T/F: OA is only in the cartilage

FALSE — also changes in subchondral bone, joint capsule, synovial membrane, and ligaments

Self-reported measure to look at primarily knee and hip OA symptoms such as pain, stiffness, and physical function; good reliability and good validity

WOMAC

T/F: imaging correlates with OA function/pain

FALSE - DOES NOT!

OA is a pathological change and inflammatory response to ___

Chrondrocytes

In early stage OA, cortical plate ___ // in late stage OA, cortical plate ___

Thins // thickens

Cortical bone plate thinning and degradation of trabeculae are changes in (early/late) OA

EARLY

Cortical bone plate thickening, sclerosis of trabeculae, neovascular invasion, bone marrow edema, and bone cysts are changes in (early/late) OA

LATE

A higher score on WOMAC means (better/worse)

WORSE!! (Primarily knee + hip)

Due to age-related changes in integumentary system, we expect... (3)

-increased risk of skin tears/cracking

-decreased protection from dehydration

-decreased protection from infections

Age related changes to integumentary system include (incr/decr) in epidermal ridge height, dermal thickness, hydration, immune cells, vasculature, and sweat response

DECREASED

Most widely used scale to determine pressure ulcer risk

Braden scale (lower score = higher risk of pressure ulcer; less than or equal to 16 = high risk!!)

Less than or equal to ___ on Braden scale indicates 100% certainty of pressure ulcer unless action is taken

16

In skeletal muscle we would see (incr/decr) elastin and (incr/decr) collagen

DECREASED // INCREASED == incr stiffness!

In skeletal muscle we would see (incr/decr) oxidative stress and (incr/decr) mitochondrial density

INCR // DECR

What type of muscle fibers do we mainly see a decrease in?

Type II (fast)

In neuromuscular system, we would see (incr/decr) motor units and (incr/decr) size of motor units

DECREASE // INCREASE == less precise movements

Why would we see a greater strength loss versus CSA loss?

Nervous system changes to power generation

In NM system, there is a (incr/decr) in contract/relax time and antagonist co-activation

INCREASE

Degree of change and impact on NM system varies based on these factors

-sex

-muscle group

-nutrition

-physical activity

-hormones

-meds

-comorbidities

-responsiveness to exercise

Progressive muscle failure categorized by decrease in strength, mass, and function; negatively correlated with activity level

Sarcopenia

T/F: a decrease in estrogen/testosterone + increase in inflammation & stress can lead to Sarcopenia

TRUE

If you had a muscle mass at least 2 SDs below health population as shown via MRI/DEXA/CT, you would be diagnosed with ___

Sarcopenia

This is a clinical tool for determining Sarcopenia; a score greater than 4 suggests further assessment; poor sensitivty but high specificity (good a ruling IN)

SARC-F questionnaire

This is a muscle wasting disease that is caused by chronic inflammation, cancer, or chronic illness leading to progressive loss of skeletal muscle and low appetite

Cachexia

Age related changes to CV system include a DECREASE in baroreceptor sensitivity; how might this present?

Orthostatic hypotension

In CV system, we would see (incr/decr) in thickness of capillary basement membrane

INCREASE - leads to decreased oxygen to muscles

What 3 things decrease with a decrease in VO2 MAX?

-MAX HR

-SV

-A-V O2 diff

In CV system, we would see a (incr/decr) IN SA cells, capillary density and myocytes

DECREASE

In CV system, we would see a (incr/decr) in myocardial stiffness, LV fill time, and LV end diastolic volume

INCREASE

Does HR at rest change with aging?

NO, just MAX HR

Can exercise affect max HR?

NO evidence

(Diastolic/systolic) BP INCREASES with age

Systolic —- due to increase in afterload (heart overcoming greater pressure to facilitate forward motion of blood; leads to left ventricle hypertrophy since it is working harder to squeeze against tight blood vessels)

Biological risk factors for CVD (3)

-elevated blood lipids

-DM or elevated blood glucose

-hypertension

T/F: VO2 max can increase even with chronic conditions (DM, HTN) if individuals engage in mod-high intensity training for >20 weeks

TRUE!!!!

Age-related changes to pulmonary system include (incr/decr) elasticity in bronchioles and cilia

DECREASE

Size of alveoli (incr/decr) with age

INCREASE which decreases surface area and decreases gas exchange

Respiratory rate (incr/decr) with age

INCREASES

Age-related changes to lungs include (incr/decr) compliance and mucus layer

INCREASED

This is a pulmonary system pathology that is progressive airflow limitation leading to limited gas exchange & an inflammatory response; includes emphysema + chronic bronchitis

COPD

This is a restrictive lung pathology; unable to take air in

Pulmonary fibrosis

In immune syste, there is a (incr/decr) ability to ID pathology and response to pathology

DECREASED

Why might older adult not run a fever with infections?

Blunted immune response

With age in the nervous system, what happens to ventricular size in brain?

Increased

T/F: exercise can buffer losses in endocrine/metabolic system such as thermoregulation and dehydration

TRUE!!!!!

Should age related changes to the nervous system such as increased reaction time and decreased reflexes impact task completion?

NO!

T/F: age related changed to nervous system include a decrease in short term memory and memory retrieval in things such as proper nouns

TRUE!!

Vestibular sensitivity (incr/decr) with age

Decreases (decreased hair cells + degradation of otoconia)

Age-related vision loss after age 40 that is due to an increase in lens stiffness; risk factors include medical conditions (DM, MS) and medications (antidepressants, antihistamines)

Presbyopia (farsightedness)

How is presbyopia managed?

Reading glasses