PT 742 Geri Lecture 2 normal / pathological changes with aging +successful aging and frailty

Describe a programmed theory on aging

non-stochanstic

Genetically controlled, cellular senescence

DNA: biological timetable

hormonally regulated

continuation of the theory that regulates childhood growth and development

describe a non-programmed theory of aging

damage or error theories: stochastic

epigenetics: changes of gene expression, via lifestyle and environmet

DNA mutations

oxidative stress

wear and tear theory

free radical theory

differentiate between normal aging and pathologic aging

normal: age related changes that occur due to passage of time (muli organ related changes seen in all elderly)

pathological aging: age related pathologic conditions that occur in most older adults (alzheimer’s)

What are age related changes related to connective tissue (msk system) in older adults?

loss of water from matrix

increase # collagen cross links

loss of elastic fibers

clinical consequence > stiffness

What are age related changes to the muscle in older adults?

increase in fat mass, decrease muscle mass (fiber necrosis), decrease BMR

true or false: PT can reverse cachexia but not sarcopenia

FALSE; it can reverse sarcopenia but NOT cachexia

In regards to stretching, how is it different for older adults?

Spend more time actively in their end ranges and use it more

True or false: LE are more affected than UE in terms of type II muscle atrophy

true

Which are these are non-modifiable factors contributing to bone mass:

a. family hx of osteroporosis

b. hormones

c. low birth weight

d. inactivity

e. medications 

a. family hx of osteroporosis

b. hormones

c. low birth weight

true or false: there is a greater loss of cortical bone than trabecular as you age

false: trabecular > cortical (1% yr vs 0.5 % yr)

What type of training should those with low bone mass according to the LiftMor Trial?

a. low intensity aerobic

b. high intensity aerobic

c. high intensity resistance

d. low intensity aerobic

What classifies an osteoporotic fracture?

low level trauma

fall from standing height or less

adults over age 50

what are common major sites of osteoporotic fractures?

hip, spine, distal radius, proximal humerus

What are changes that occur at the joint level in older adults?

decreased joint space, increase laxity, altered distribution of load, decreased ROM

What is the avg height loss per decade?

1-2 cm, up to 12 cm ; postural changes begin at 40 yrs old greater at 60

What complications can occur from hyperkyphosis (Dowager’s Hump)?

pain, difficulty sleeping, difficulty breathing, fall

What are vascular changes that occur in older adults?

high bp common

thicker walls in arteries

veins thicker more dilated 

valves stiffer

What areas are common to find varicose veins? (enlarged, twisted dilated veins)

the lower extremities

causes = family hx, age, sex, obesity, prolonged standing

what are common areas to find spider veins? (small, dilated veins near surface)

face (skin, nose, cheeks), legs (thigh below knee ankle)

causes = heredity, age, females more affected

what is a common cardiac change in older adults?

a. ventricular hypertrophy

b. spider veins

c. varicose veins

d. decrease VO2 max

a. ventricular hypertrophy

A common cardiac change in older adults includes a ____(increase/decrease) in SBP and _____ (increase/decrease) in DBP 

increase SBP, decrease in DBP

How do you expect the cardiac output to change in the geriatric population?

it was decrease with age since SV and HRmax decrease with age

What are respiratory changes you expect to see in older adults?

decreased height of T/S vertebrae (kyphosis), calcification of the rib cage (decreased expansion), diaphragm placed a mechanical disadvantage, increased x links in costal sternal cartilage

True or false: as you age, your residual volume decreases with leads to air trapping and higher risks of infection

FALSE, the residual volume INCREASES

Match the respiratory changes with the best description

__decrease in elastic recoil of lungs, mismatched ventilation/perfusion

__ loss of muscular pharyngeal support, respiratory effort in response to airway occulsion

__can occur due to poor oral hygiene and decreased saliva flow

__protective mechanisms, coughing, swallowing

a. aspiration

b. pneumonia

c. atelectasis

d. upper airway obstruction

---

c. atelectasis - decrease in elastic recoil of lungs, mismatched ventilation/perfusion

b. pneumonia-loss of muscular pharyngeal support, respiratory effort in response to airway occulsion

b. pneumonia-can occur due to poor oral hygiene and decreased saliva flow

a. aspiration _ protective mechanisms, coughing, swallowing

A decrease in these types of cells play a role in the reduction of immune function

a. t cells

b. white blood cells

c. red blood cells

e. langerhans cells

e. langerhans cells

What contributes toward geriatrics skin darkening, decreased protection from UV, and increased risk of skin CA

melanocyte senescence

In regards to nervous system, what changes do you expect to see in the CNS and PNS with aging?

CNS: neuronal atrophy

PNS: loss of myelin sheath, slower nerve conduction velocity

What are endocrine changes you may see in regards to the thyroid?

hypo-reduced metabolism: weakness, fatigue, weight gain

hyper-increase cardiac arrhythmias and weight loss 

What are functional changes relevant to the endocrine system in older adults?

loss of muscle, bone; body temp regulation, fluid regulation, fatigue, comorbidities: DM, CVD, visceral 

Which of these fall under the category of multicomplexity? (5M’s) choose all

a. social determinants of health

b. safety and fall risk

c. declining function

d. advanced illness

e. fraility

f. recurrent hospital hospitalization

a. social determinants of health

b. safety and fall risk (mobility)

c. declining function (mobility)

d. advanced illness

e. fraility

f. recurrent hospital hospitalization

decribe “successful aging” based on this chart

successful aging = higher tolerance/threshold for maintaining homeostasis during stressful experiences (disease, trauma, illness)

what are the 3 main categories for successful aging?

avoid disease

physical and cognitive function

social and productive activity

what is the significance of the hormonal axis in males vs females?

females: decrease ovarian estradiol output: menopause

men: slow decrease in testosterone (andropause)

loss of sex hormones=loss of muscle strength and bone

what is frailty? choose the best answer

a. weakness due to aging

b. decline across multiple physiologic systems due to aging

c. decline in physical and cognitive function leading to disability

d. being unable to perform tasks you used to due to old age

b. decline across multiple physiologic systems due to aging

What determines frailty? 5 things

a. unintentional weight loss

b. exhaustion, low energy

c. low physical activity

d. slow gait speed (<0.8 m/s)

e. weakness (grip strength: men <28.6 =, women: 16.4)