Aging Changes in Muscles and Bones PDF

 Aging changes (Msculoskeletal) BY MOHIE ALDEEN ABD ALZAHER KHALIFA PROFF OF RESPIROLOGY Our Objective Speci fic Lear By the successful completion of this presentation, you are expected to: ning Aging changes in the bones - muscles - joints Outc omes ...

 Aging changes (Msculoskeletal) BY MOHIE ALDEEN ABD ALZAHER KHALIFA PROFF OF RESPIROLOGY Our Objective Speci fic Lear By the successful completion of this presentation, you are expected to: ning Aging changes in the bones - muscles - joints Outc omes  Alternative Names  Osteoporosis and aging  Muscle weakness associated with aging  Osteoarthritis  Posture and Gait  Changes in posture and gait (walking pattern) are common with aging.  Aging changes of posture and movement  The posture may become more stooped (bent). The knees and hips may become more flexed. The neck may tilt, and the shoulders may narrow while the pelvis becomes wider.  Movement slows and may become limited. The walking pattern (gait) becomes slower and shorter. Walking may become unsteady, and there is less arm swinging.  The skeleton  The skeleton provides support and structure to the body.  Joints are the areas where bones come together.  They allow the skeleton to be flexible for movement.  In a joint, bones do not directly contact each other. Instead, they are cushioned by cartilage in the joint, synovial membranes around the joint, and fluid.  Muscles  Muscles provide the force and strength to move the body.  Coordination is directed by the brain, but is affected by changes in the muscles and joints.  Changes in the muscles, joints, and bones affect the posture and walk, and lead to weakness and slowed movement.  Aging changes of bone Bones become more brittle and may break more easily. Overall height decreases, mainly because the trunk and spine shorten. Breakdown of the joints may lead to inflammation, pain, stiffness, and deformity. Joint changes affect almost all older people. These changes range from minor stiffness to severe arthritis.  Aging changes of bone  lose bone mass or density with aging, especially women after menopause.  The bones lose calcium and other minerals.  The spine is made up of bones called vertebrae. Between each bone is a gel-like cushion (called a disk).  With aging, the spine becomes shorter as the disks gradually lose fluid and become thinner.  Aging changes of spine  Vertebrae also lose some of their mineral content, making each bone thinner.  The spinal column becomes curved and compressed. (Senile kyphosis)  Aging changes of bone  The foot arches become less pronounced, contributing to a slight loss of height.  The long bones of the arms and legs are more brittle because of mineral loss, but they do not change length.  This makes the arms and legs look longer when compared with the shortened trunk.  Aging changes of joints  The joints become stiffer and less flexible. Fluid in the joints may decrease.  The cartilage may begin to rub together and wear away. Minerals may deposit in and around some joints (calcification).  This is common around the shoulder.  Hip and knee joints may begin to lose cartilage (degenerative changes).  The finger joints lose cartilage and the bones thicken slightly.  Finger joint changes, most often bony swelling called osteophytes, are more common in women. These changes may be inherited.  Aging changes of muscles  Lean body mass decreases. This decrease is partly caused by a loss of muscle tissue (atrophy).  The speed and amount of muscle changes seem to be caused by genes.  Muscle changes often begin in the 20s in men and in the 40s in women.  Lipofuscin (an age-related pigment) and fat are deposited in muscle tissue.  Aging changes of muscles  The muscle fibers shrink. Lost muscle tissue may be replaced with a tough fibrous tissue. This is most noticeable in the hands, which may look thin and bony.  Muscles are less toned and less able to contract because of changes in the muscle tissue and normal aging changes in the nervous system.  Muscles may become rigid with age and may lose tone, even with regular exercise.  Aging changes of muscles  Older people get tired more easily and have less energy.  Strength and endurance change. Loss of muscle mass reduces strength.  COMMON PROBLEMS  Osteoporosis is a common problem, especially for older women.  Bones break more easily. Compression fractures of the vertebrae can cause pain and reduce mobility.  Muscle weakness contributes to fatigue, weakness, and reduced activity tolerance.  Joint problems ranging from mild stiffness to debilitating arthritis (osteoarthritis) are very common.  COMMON PROBLEMS  The risk of injury increases because gait changes, instability, and loss of balance may lead to falls.  Some older people have reduced reflexes. This is most often caused by changes in the muscles and tendons, rather than changes in the nerves.  Decreased knee jerk or ankle jerk reflexes can occur. Some changes, such as a positive Babinski reflex, are not a normal part of aging.  COMMON PROBLEMS  Involuntary movements (muscle tremors and fine movements called (fasciculation) are more common in the older people.  Older people who are not active may have weakness or abnormal sensations (paresthesia).  People who are unable to move on their own, or who do not stretch their muscles with exercise, may get muscle contractures.  Aging and Muscle Loss As a normal part of the aging process, individuals experience a loss of skeletal muscle. This loss of muscle has been well documented in individuals over the age of 50. This loss of muscle tissue, with an associated loss of strength and mass, is referred to as sarcopenia.  Aging and Muscle Loss Sarcopenia can begin as early as the fourth decade of life. However, by the seventh and eighth decades of life, a decrease in the maximal contractile strength on the order of 20-40% for both men and women is observed. The weakness associated with sarcopenia has been shown to be associated with difficulty in rising from a chair and getting out of bed. Decreases in muscle quality may also be a contributing factor in increased fracture risk in older individuals. Also associated with a decrease in muscle mass and muscle strength is a decrease in the rate of force development in the muscles of elderly individuals.  Aging and Muscle Loss  Aging is associated with oxidative stress and subsequent local inflammation in skeletal muscle.  Oxidative stress, by way of increased free radical generation, causes oxidative modification and damage to protein, lipid, and DNA in skeletal muscle.  This invariably leads to cellular dysfunction and muscle protein degradation, as well as a decline in muscle mass and function.  Sarcopenia  Involuntary loss of skeletal muscle mass, strength, and function.  Part of the normal aging process.  Enhanced by morbidity, chronic malnutrition, a sedentary lifestyle, and smoking.  Limits Functional Capacity  Increases the risk for incapacitation, falls, fractures, and a dependent lifestyle.  Consequences of Sarcopenia  Decreased resting energy expenditure  Decreased insulin sensitivity  Decreased muscle mass and strength  Increased risk of physical disability  Increased risk of falls  Increased risk of mortality  Sarcopenia is a Multi-Factorial Disorder  Decreased levels of sex hormones (testosterone )  Decreased levels of growth hormone and insulin-like growth factor 1 (IGF-1)  Increased cytokine production (i.e., IL-1, IL-6, TNF-α, etc.)  Neuromuscular changes  Smoking  Physical inactivity  Malnutrition (especially protein deficiency)  As a result of this loss of muscle mass and strength, older individuals experience a decreased quality of life.  The lack of physical exercise is one of the most important predictors of disability in elders.  Low Protein + Low Exercise = Sarcopenia  Sarcopenia starts to set in around age 45, when muscle mass begins to decline at a rate of about 1 percent per year.  This gradual loss has been tied to protein deficiency, lack of exercise, and increased frailty among the elderly.  The human body reacts to protein deficiency by taking amino acids (the building blocks of proteins) away from muscle tissue and other areas of the body.  Low Protein + Low Exercise = Sarcopenia  The process, in which the body basically metabolizes itself, is called catabolism and leads to muscle loss and weakness.  Currently, the recommended daily intake is 0.8 grams per kilogram of body weight (established by the ADA), or 56 grams for a 154-pound person.  However, very active older individuals might instead benefit from about 1.2 grams per kilogram body weight.  Aging Effects on Skeletal Muscle  Strength training remains highly effective in maintaining muscular strength throughout life.  However, after about age 60, strength levels fall more rapidly, independent of training.  This is probably influenced by changes in hormones such as testosterone and growth hormone, which appear to decline more dramatically after age 60.  Reduction in the circulating concentration of these hormones will result in a shift in the balance between muscle protein synthesis (anabolism) and protein breakdown (catabolism).  The decreased strength is due to atrophy of muscle fibers. Benefits of Weight Training for Older Adults  Better control of symptoms of diabetes, arthritis, osteoporosis, back pain, and depression.  Prevents falls due to restoration of balance.  Improved posture and stability.  Increased flexibility and range of motion.  Strengthens the bones and reduces risk of fractures.  Improves muscle strength and endurance.  Healthy, independent, and functional life. Benefits of Weight Training for Older Adults It is never too late to start on a muscle conditioning and weight training program.  Weight training is especially important to slow the process of sarcopenia (age-related skeletal muscle loss).  Regular weight training has shown to: Reduce blood pressure Improve blood cholesterol levels Improve insulin sensitivity Speed-up gastrointestinal transit Increase bone mineral density Alleviate low-back pain Ease arthritic discomfort Improve cardiovascular function Relieve depression Reduce body fat Improve functional abilities  PREVENTION  Exercise is one of the best ways to slow or prevent problems with the muscles, joints, and bones.  A moderate exercise program can help to maintain strength, balance, and flexibility.  Exercise helps the bones stay strong.  PREVENTION  It is important to eat a well-balanced diet with plenty of calcium.  Women need to be particularly careful to get enough calcium and vitamin D as they age.  Postmenopausal women and men over age 70 should take in 1,200 mg of calcium per day. Women and men over age 70 should get 800 international units (IU) of vitamin D daily.  PREVENTION  Regular exercise.  Eat a healthy diet that includes fruits and vegetables, whole grains, and the right amounts of healthy fats.  Limit alcohol use.  Avoid tobacco products and illicit drugs.