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• Global average life expectancy at 60 years is 20 years, but may be less in the Philippines
• Biology and neurobiology of aging affect individuals differently

Geriatric Age Ranges

• 65-75 years: Considered "old geriatric population"

• 85 years: Considered "oldest old"

• 90 years: Considered nonagenarian

• Octogenarian: 80s
• Centenarian: 100s
• Increase in the number of people who are aging results in more people experiencing symptoms

Body Changes in Aging

• Musculoskeletal, neurologic, cardiovascular, pulmonary, gastrointestinal, genitourinary, endocrine, medication metabolism, and gait

Musculoskeletal Changes

• Muscle loss with fat loss results in biglaang pagpayat (sudden weight loss)
• Sarcopenia: Loss of muscle mass and strength, increased fat mass, and abdominal girth

Muscle Changes

• Loss of muscle fibers reduces fiber size and quality, decreasing force per unit area
• There is a disproportionate loss of type II (fast twitch) fibers
• Loss of motor units occurs, which are the parts where the motor neuron meets the muscle
• Decline in the ability of the muscle to generate force
• Cachexia: Attributable to an underlying disease, resulting in loss of both muscle and fat mass

Bone Changes

• Insufficient load-bearing leads to demineralization
• Bones need stress to stimulate bone growth and produce cells needed for growth
• Without stress, there is an increase in osteoclastic activity
• Affected by changes in the endocrine system, especially significant in women after menopause
• Women's hormones affect calcium and phosphorus activity
• Increased osteoclastic activity may be due to Vitamin D deficiency, causing osteopenia/osteoporosis
• Vitamin D, or cholecalciferol, helps with calcium absorption in the intestines
• The body produces Vitamin D under the sun
• Bedridden patients are often given Vitamin D to aid nutrient absorption

Neurologic Changes

• Decreased brain volume, frontal gray matter loss, and decreased cerebral blood flow
• Frontal gray matter affects cognitive functions
• Cortical thinning also affects higher functions
• Cognitive changes include dementia
• Alzheimer's: decline in episodic memory
• Syndrome; there are different types of dementia like Alzheimer's disease
• Decline in episodic memory affects recalling past events
• Decline in vision results from retinal aging
• Lens aging may lead to cataracts
• Lumalabo mata (blurred vision)
• Age-related hearing loss (AHL) can be intrinsic (genetics, cochlear aging, higher disposition) or extrinsic (noise exposure, ototoxic drugs, medications)

Cardiovascular Changes

• MHR decreases by 6-10 bpm/decade after age 25
• VO2max decreases by 5-15%/decade after age 25
• VO2max indicates maximum oxygen consumption
• Increased VO2max = increased endurance
• Decreased VO2max = decreased endurance which leads to increased fatigue
• Decreased arterial compliance means arteries are less compliant
• Increased BP results in BP diameter to BP because blood vessel has blood flowing inside, and increased blood flow accommodation of blood vessels
• Blood vessels dilate to accommodate, avoiding increased BP, but this isn't the case in older patients
• Increased SBP due to loss of patency of arteries
• Left ventricular hypertrophy with impaired filling
• Decreased beta-adrenergic receptor stimulation response
• Decrease SA node automaticity where SA node can make its own action potential to stimulate the heart
• Heart predicts 60 beats per minute
• Fight or flight response will decrease
• Decreased myocytes lead to muscle weakness
• Exercise-induced adaptations are less available to elderly individuals
• Decreased sensitivity to catecholamines and impaired vasoconstrictive responses
• Commonly seen in vasoconstrictive responses in the lower extremities
• Lower extremity vessels need to contract continuously, sending the blood back to the heart, preventing hypotension
• Factors that we can avoid to reduce the chances of AHL
• Olfaction, light touch sensation, vibration, proprioception
• Sense of smell is lost, so will loss of taste

Pulmonary Changes

• Impaired pulmonary gas exchange and V/Q mismatch
• Loss of elastic recoil and lung stiffening
• Increased lung compliance and decreased thoracic wall mobility
• Decreased strength of respiratory muscles
• Affects diaphragm and accessory muscles
• Leads to increase in Residual Volume and Functional Residual Capacity
• Residual capacity is the air that is left that is not part of the gas exchange

Gastrointestinal Changes

• Decreased appetite and energy intake malnutrition
• Smell and taste sensation may decrease loss of enjoyment from eating
• Decreased gastric compliance
• Decreased ability of the stomach to expand
• Early satiety, prolonged postprandial fullness result
• Hypochlorhydria leads to decreased production of stomach acid
• Can lead to bacterial overgrowth in small intestine (SI)
• Impaired absorption of vit. B12, calcium, iron, zinc, folic acid
• Increase in cholecystokinin and leptin which suppresses appetite

Genitourinary Changes

• Decrease in renal mass
• There is a level of concentration in the tissue that should be maintained.
• Whether the fluid should be absorbed or retained.

Endocrine Changes

• Reduced hormone secretion and tissue responsiveness
• Decreased testosterone, hGH, insulin-like growth factor (anabolic hormones) impairs muscle fiber protein synthesis
• Insulin-like - all anabolic hormones
• To produce other cells
• Can lead to sarcopenia
• Decreased glucose tolerance
• Decreased estrogen collagen loss & thinning of skin
• Bone loss osteopenia & osteoporosis e.g. in menopausal women
• Lead to changes in skin

Skin Changes

• Caused by normal aging and environmental factors
• Thinning of epidermis
• Decreased cell replacement
• Impaired immune response and wound healing
• Decreased moisture content, elasticity, blood supply, sensory sensitivity
• More prone to wounds
• Increased risk of skin disorders and injury because of these physiologic changes in geriatric patients

Medication and Metabolism

• Reactions to drugs will not always the same as in younger age groups and may be more severe
• Increased adipose tissue causes larger volume of distribution for fat-soluble drugs prolonged biologic half-life
• More diffused in the body more fat stored in the body

Gait

• Decreased speed, increased double limb support, shorter stride length
• Increased double limb support - both feet at floor
• Affected by vision, cognition, motor control, balance, peripheral sensation, strength, joint health, and metabolic demands
• Sensation of joints, movement, and position sense
• Gait speed: predictor of survival, possibly a biomarker of health status in older adults
• If able to walk faster more chances of survival
• If slower than normal poor prognosis
• Indicators of gait speed: 6-minute walk test (6MWT), etc.
• 1.0 m/sec relatively good function
• 0.8m/sec predicting median life expectancy for age & sex
• Median life: middle of their life

Frailty

• Age and disease-related loss of adaptation
• Clinical Syndrome should have 3 or more of the following:
• Unintentional weight loss of at least 10 lb over thepast year
• Self-reported-exhaustion
• Weakness (grip strength)
• Slow walking speed
• Low physical activity
• Can be attributable to aging, diseases, and comorbidity
• Category of patients at risk for adverse outcomes

Disuse and Immobilization

• Exacerbates decline in body systems
• Combination of inactivity and lack of mechanical loading lead to negative effects of bed rest
• Nasa kama lang > more effects to the body
• Encourage them to perform more physical activity and walking
• Loss of muscle mass
• Loss of strength and power • Increased muscle insulin resistance • Increased bone loss

Prevention

• Exercise and fall prevention in healthcare

Falls

• Major cause of morbidity and fractures
• Falls increase placement in skilled nursing facility
• High fall risk include patients with physical or cognitive impairments

Osteoarthritis

• Common among older adults and affects hands and knees
• Disc desiccation leads to spinal stenosis, causing nerve root impingement

Osteopenia and Osteoporosis

• Low bone density
• Increased risk for fractures leading to pain
• Osteopenia: bone mineral density score -01.0 and 2
• 5 or less
• Males may still have osteoporosis
• Risk factors: increasing age, family hx, glucocorticoid therapy, smoking

Hip Fractures

• More common in older adult and increases cost and disability
• Rehabilitation for goals of pain control & early loading while avoiding fracture dislocation & implant failure

Stroke

• Leading cause of acute neurologic admissions to hospitals and death
• Rehab begins in the acute setting

Dementia

• Group of symptoms that affect the patient's daily function
• Executive cognitive dysfunction, memory impairment, mood, personality, and behavior changes
• Early identification is critical

Delirium

• Acute neurocognitive disorder, transient, and reversible
• More prevalent among elderly and disturbances in attention

Normal Pressure Hydrocephalus

• Related to previous meningitis or subarachnoid (SA) hemorrhage
• Trademark signs; gait dementia, gait disturbance, urinary incontinence along with ventriculomegaly with normal CSF pressures

Parkinson's Disease

• Progressive neurodegenerative disorder
• Ataxia, bradykinesia, tremor, cog-wheel rigidity
• May have dementia

Amputation

• Attributable to vascular disease, shorter life expectancy
• Prognosis influenced by number and type of comorbidities

Cancer

• More prevalent among those >65 y/o
• Multiple comorbidities increase the likelihood of death for non-cancer related causes

Polypharmacy

• Use of multiple drugs
• Adverse drug reactions from multiple drug regimens

Management Issues

• Limited medication and relieving pain control
• Physical exercise