Lecture 4: Geriatrics

What percentage of the population was over 65 years old in 1970?

10%

How many people over 65 were there in 2000?

35 million (13% of the population)

What is the estimated number of people over 65 by 2040?

70 million (1 in 5 people)

What percentage of males experience a hip fracture by age 90?

16%

What percentage of females experience a fall or hip fracture by age 70?

more than 40%

What is the #5 cause of death in persons over 65 years old according to the CDC?

accidents

What is the #1 cause of death in older adults?

cardiovascular disease

What is the #2 cause of death in older adults?

cancer (CA)

What is the #3 cause of death in older adults?

cerebrovascular accident (CVA/stroke)

What is the #4 cause of death in older adults?

lower respiratory disease

What is the #6 cause of death in older adults?

diabetes mellitus (DM)

What percentage of 65-74 year old are without significant problems or deficits?

90%

What percentage of people are over 85 are without significant problems or deficits?

50%

What percentage of people over 65 fall in a year?

30%

Of those over 65 who fall, what percentage are injured significantly?

10-15%

How much muscle strength is typically lost between ages 20-70?

about 30%

What is the total lifetime loss of muscle strength?

35-45%

How does range of motion change with age?

muscle length decreases progressively with age

How does endurance change in different muscle fiber types?

fast twitch fibers lose endurance faster than slow twitch fibers

What happens to motor units with aging?

loss of motor units: both the neuron and the muscle fibers it innervates are lost

When do bones reach peak mass and strength?

during adolescence

When does bones mass begin a constant decline?

after the 5th decade of life

How much bone mass is typically lost per year after age 30-35?

0.75-1.0% per year

What lifestyle factors influence bone health?

Wolfe’s law (stress strengthens bone), sedentary lifestyle, endocrine state, and dietary deficiencies

What are risk factors for accelerated bone loss?

smoking, excessive caffeine, and alcohol (ETOH) consumption

How does bone strength change with aging?

bone strength decreases due to loss of calcium and less weight bearing activity

How does aging affect fracture risk?

there is an increased susceptibility to fractures

What condition is commonly associated with aging bones?

osteoporosis

What happens to bone mineral density with aging?

bone mineral density decreases over time

What structures are included in periarticular connective tissue (PCT)?

ligaments, tendons, fascia, skin, and joint capsule

What happens to the cellular components of PCT with aging?

they undergo changes that reduce tissue elasticity and repair capacity

What are the functional changes of PCT with aging?

increased stiffness, reduced ROM, altered arthrokinematics and postural changes

How does aging affect the ability of articular cartilage to dissipate forces?

its ability decreases due to loss of elastic properties

What structural change occurs in cartilage with aging?

cracking of cartilage

How does water content in articular cartilage change with age?

it decreases

What happens to collagen organization in cartilage with aging?

collagen fibers become disorganized, reducing cartilage integrity

How can physical activity affect age related muscle changes?

it can reverse some effects of aging through resistance and endurance training

What normal changes in muscles can be prevented or slowed with exercise?

loss of endurance, strength, and muscle atrophy

What types of training are most effective in maintaining muscle function with age?

resistance training for strength and endurance training for stamina

How does the brain change structurally with aging?

decreases in size, loss of some cells, reduced blood flow, and changes in neurotransmitter function

How does cognitive performance change with normal aging?

there may be slower processing, but normal aging typically preserves basic cognitive function

How do sensory systems change with aging?

changes occur in vision, auditory, taste, and smell

How does the vestibular system change with aging?

balance may be reduced due to vestibular decline —> increasing fall risk

How does somatosensation change with normal aging?

sensation may decrease, affecting touch, proprioception, and fine motor control

What are common psychosocial losses that affect older adults?

loss of independence and loss of family or friends

What emotional condition is commonly associated with these losses in aging?

depression

What cardiovascular changes occur in aging adults with immobility?

↑ Orthostatic hypotension, ↑ Workload of the heart, ↑ Thrombus formation

What respiratory changes occur in aging adults with immobility?

↓ Lung movement, ↓ O₂ saturation, ↑ Secretions

What musculoskeletal changes occur in aging adults with immobility?

changes in bone, soft tissue, skin and muscles

What gastrointestinal (GI) changes occur in aging adults with immobility?

↑ Malnutrition, ↑ Constipation, ↑ Impaction

What urinary system changes occur in aging adults with immobility?

↑ Urinary retention, ↑ Kidney stones

What happens to ventilatory responses during submaximal exercise in older adults?

• Minute ventilation (VE): ↑

• CO₂ production: ↑

• Respiratory exchange ratio (RER): ↑

• Blood lactate: ↑

• Ventilatory equivalent for O₂ (VE/VO₂): ↑