Aging Changes
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| Skeletal | -Cartilage (decr H2O, stiffer, erodes) -Bones mass decreases (peaks 40 yrs old; calcium and bone marrow decreases) -intervertebral discs (flatter, less resilient) -postural changes (incr kyphosis, decreased lordosis) | weight bearing is important for cartilage/joint health/mobility; increased risk of falls/fractures | -postural exercises
-weight bearing exercises (gravity loading)
-nutritional, hormonal, medical therapy
-education re falls prevention?
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| Neurological | -Atrophy of nerve cells in cerebral cortex/loss of mass -changes in: morphology, synaptic transmission, spinal cord & peripheral nerves; -age-related tremors | -affect movement (decr speed/coordination, loss of strength, incr reaction & mvmt time, incr caution -slowing of processing (may affect learning/memory) -homeostatic regulation difficulties | -correct medical problems
-improve diet, quit smoking
-increase physical activity
-strategies to improve motor learning & control (incr reaction/mvmt time; avoid long mvmt sequences; explain adequately/demonstrate; repetitive mvmt)
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| Sensory: Vision | -genl decline in acuity -Presbyopia -sensitivity to light/glare -decr adaptation to dark/light -decr color discrim (esp blue/green) -decr pupillary responses -decr corneal reflex -decr oculomotor responses | -assess vision -maximize function | -allow extra time for visual discrim
-work in adequate light
-magnifying glasses
-large, high contrast print
-eye patch (diplopia)
-stand in front of indiv
-use warm colors
-use other sensory cues
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| Sensory: Hearing | -hearing loss (as early as 40s; 23% aged 65-74; 40% aged 75+) -build up of wax in outer ear -bony jt degeneration in middle ear -changes in understanding speech, sound sensitivity, equilibrium in inner ear. -types: conductive, sensorineural, presbycus | -Assess hearing: acuity, speech discrim, tinnitus, dizziness, vertigo, pain -assess for hearing aids | -minimize auditory distractions
-speak slowly/clearly (low over high tone)
-nonverbal communication to reinforce
-written/demonstrated activities
-orient to topics
-assistive devices (vibrating /flashing smoke detectors, telephones, doorbells, clocks
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| Sensory: Vestibular | -degeneration of utricle/saccule -loss of hair-cell receptors -decreased vestibular neurons -reduced fnxn of VOR (vestibular ocular reflex) | -delayed reaction times/diminished acuity -decreased retinal stability -altered sensory organization (incr dependence on somatosensory input) -disorganized postural reponse (incr postural sway & hip torque, decr ankle torque) -increased falls | -falls prevention strategies
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| Sensory: Somatosensory | -decr sensitivity of touch (decline of periph receptors & atrophy of afferent fibers) -proprioceptive losses -loss of joint receptor sensitivity (LE & cervical jts - contrib to loss of balance) -cutaneous pain thresholds increase | -assess thresholds to stim/sensory losses | -extra time for response
-use touch to communicate
-augment sensory feedback (eg kitchen utensils w/wide textured grip)
-protective compensatory strategies for decr sensation
-assistive devices (fall prevention)
-biofeedback
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| Sensory: Taste and Smell | -gradual decrease in taste sensitivity -decreased smell sensitivity | -assess for odor/taste/temp/touch identification -decreased taste, food enjoyment (leads to poor diet/nutrition) -increased use of taste enhancers (salt, sugar) -decreased home safety (gas leaks, smoke) | education?
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| Cognitive | -no uniform decline -perceptual speed impaired by age 39 -numeric abilities peak mid-40s and maintained until 60s -ST memory impaired/LT fine -Learning affected by: incr caution, anxiety, sensory deficits, slower pace; prior learning - | -older adults use strategies to counteract memory decline: context-based v. memorization (young adults) | -improve health (address med probs, reevaluate drugs used, reduce smoking/alcohol, improve nutrition)
-incr physical activity
-incr mental activity (puzzles, social activities, etc.)
-sensory cues (visual demonstrations, written instr)
-reduce stress
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| Cardiovascular | -due to inactivity/disease over aging -degeneration of heart muscle -decr coronary blood flow -cardiac valves/ blood vessels thicken & stiffen -decr pace maker cells (SA Node) -BP rise -decr blood volume -incr blood coagulation -decr neurohumoral | -resting BP incr, tho changes at rest are minor -response during exercise: blunted, decr HR accel, reduced exer capacity -decr stroke volume -max HR declines - decr cardiac output -orthostatic hypotension incr -incr fatigue -murmor -ECG changes |
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| Pulmonary | -chest wall stiffness -decr strength in respiratory muscles -long of elasticity of lungs -alveoli enlarge/thin/fewer capillaries -decline in lung capacity -air flow (forced expiratory volume) decr -altered gas exchg -decr homestatic/autoimmune reps | -response to exercise: at higher intensities, incr ventilatory cost, greater blood acidosis, incr SOB, incr perceived exertion -signs of hypoxia are blunted -cough mechanism impaired -gag reflex decr -prolonged recovery from respiratory illness | -cardiopulmonary assessment prior to exercise pgm (submaximal testing...no standardized batteries for older adults)
-individualized exercise pgm based on fitness, disease, limitations, goals
-aerobic training pgms
-incr daily activity level
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| Integumentary | -changes in skin composition: loss of elastin, decr vascularity, decr sebaseous activity, & dry, wrinkled, yellowed, spotted appearance; thinning/graying of hair; nails thicken, become brittle, and grow more slowly | -skin becomes less effective as a barrier: grows/heals more slowly; less able to resist infection; decr touch/pain/temp sensitivity and resultant incr risk of injury; decr sweat production/loss of temp regulation |
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| Gastrointestinal | -decr salivation/taste/smell & inadequate chewing (tooth loss/dentures)/poor swallowing reflex | esophagus: decr motility & control of esophageal sphincter -> acid reflux/heartburn/hiatal hernia -stomach: reduced motility, delayed gastric emptying; decr digestive enzymes ->decr absorption/digestion (indigestion common) | -decreased intestinal motility (constipation common)
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| Renal/Urogenital | Kidneys: loss of weight/mass & decr renal blood flow/decr filtration -bladder: muscle weakness/decr capacity/difficulty emptying & incr retention | -blood urea rises decreased excretory and reabsorptive capacities -urinary incontinence -incr likelihood of urinary tract infections |
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| Muscular | Loss of muscle strength, power, mass, endurance. Changes in muscle fiber composition (loss o fast twitch/Type II,increase in Type I). Collagen becomes denser, irregular, less elastic. | -Slower movement -increased fatigue -connective tissue stiffer/denser (inc sprains, strains, tears; loss of ROM, incr. adhesions/ contractures) -decr mobility -unsteady gait | -improve health
-improve health (address med probs, nutrition, substance abuse)
-increase physical activity gradually (be sensitive to pace, warming up)
-strength training
-flexibility/ROM exercise
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