System | Age-related changes | Clinical implications | Strategies |
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? |
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) |
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 |
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 |
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 |
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 |
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? |
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 |
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 | |
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 |
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 | |
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) |
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 | |
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 |