Aging Introduction: Definitions and Trends PDF

Aging: Definitions, Trends and Physiologic Changes PHTR 627 Ruth Hansen PT, DPT, CCS Outline of Topics • Introduction to Aging • Demographics • Definitions • Physiologic Changes • PT implications to work effectively with older adults Aging: stereotypes and misconceptions • little respect is g...

Aging: Definitions, Trends and Physiologic Changes PHTR 627 Ruth Hansen PT, DPT, CCS Outline of Topics • Introduction to Aging • Demographics • Definitions • Physiologic Changes • PT implications to work effectively with older adults Aging: stereotypes and misconceptions • little respect is given to the experience of a lifetime. • Horse drawn carriage to age of technology • Younger people in this country do not respect the older adults as some cultures do. • Many older adults are active part of today’s society, yet many people hold onto the belief that “You can’t teach an old dog new tricks” • learning & memory diminish with age • not supported by research Aging • part of normal developmental process • all people age • individual process • does not coincide with chronological age • Variability is single most distinguishing factor Definitions • Demography: study of populations • Old Age : 65 years of age • Older adults vs. term elderly • Older adult defined by chronological age but many pathologies of old age can start in 40s or 50s • The “oldest old”: > 85 years of age • Frail elderly • Extremely old Statistics • 52 million (2018) over age 65 • 2060 estimates 95 million www.prb.org • advances in medicine • allow people to live longer • live longer with chronic disease • must be prepared to work with elderly in all settings Factors that affect population demographics • Fertility: Births • Birth rates are decreasing • https://www.nytimes.com/2018/12/19/us/census-population-growth.html • Advances in medicine • Life expectancy • Death rates decreasing • Life expectancy increasing Baby Boomers US Population 1950 US population 2010 US population 2050 Projected Who are these older adults? What do we know about them? More Definitions • Ageism • Stereotyping or discrimination based on age • Often thought of in terms of older adults but you can have ageism with any age • Classification of Ageism • Implicit Ageism – unconscious thoughts feelings or judgements • Stereotyping – consciously categorizing into groups based on charectaristics of group which may or may not be true • Prejudice – emotion linked to stereotyping, expression of negative attitudes More definitions Successful aging •vs. Optimal aging Successful aging • Multidimensional involves 3 elements • Avoiding disease & disability • Maintaining high physical and psychological functioning • Sustaining social interactions and productive activities Optimal Aging Criteria for Frailty Slippery Slope of Aging Normal Aging Process • Normal aging process vs. pathological processes • changes occur in all systems of body • as PTs we do not treat all systems of the body • changes effect the systems we do treat • impact our treatment directly Musculoskeletal System • muscle mass decreases • loss of bone mass • articular cartilage changes Decrease muscle mass • • • • decrease size & number of fibers primarily due to atrophy of type II fibers proximal muscles of LE most affected other changes: • infiltration of fat & connective tissue • denervation • alteration of neuromuscular junction • alteration of sarcoplasmic reticulum Other factors that impact muscle To function optimally muscle tissue must receive: • adequate circulation • adequate nutrition • intact innervation • sufficient circulating hormones strength & coordination decrease with age Overall movements get slower Changes in bone density • bone mass reaches peak between 20-30 • normal progressive loss in bone mass • men 1% per year • women accelerates in first 5 years after menopause, then slows to 1% per year • osteoporosis is not a normal aging process • relationship between bone mass & exercise Changes in articular cartilage Nervous System Changes • Changes have far reaching effect- N.S controls many functions • atrophy of brain & spinal • peripheral nerves • alterations of myelin & motor end platedecrease conduction velocity • Increased central processing time, decreased NCV, and slower reflexes Denervation in aging skeletal muscle: loss of large efferent fibers loss of anterior horn cells atrophy of larger faster conducting nerve fibers that innervate type II muscle Respiratory System • pulmonary function is dependent on: • overall condition of lungs • combined function of chest wall and muscles of respiration • circulation plays a role Respiratory system (continued) • decrease lung compliance • decrease elasticity of alveoli + loss of alveoli • chest wall becomes more rigid • muscles of respiration must work harder to effect ventilation • muscle atrophy, fewer fibers limit ability to generate force decrease in: Overall changes in pulmonary function • FVC • FEV1 • (A-VO2) less O2 extracted from tissues increases in: • Residual Volume (RV) • Closing Volume Cardiovascular system • anatomic changes to heart • elasticity of blood vessels declines yielding higher resting BP • ischemic heart disease, hypertension, dysrhythmia is common affecting ~ 40% of the elderly Cardiovascular System • functional changes • peak HR decreases • maximum cardiac output (Q) decreases (HR x SV) • Contractility decreases • VO2 max decreases with age. For any given workload elderly must work closer to maximum • general slowing of hormonal controls • slower to reach homeostasis (steady state) during exercise Endocrine system • slower to return to baseline • impaired fluid and temperature regulation • physical therapy implications: • adequate warm up and cool down, replenish fluids, avoid overheating and extremes of temp • progressive decline in glomerular filtration rate Genitourinary system • kidney major route of drug elimination • drug elimination is slowed • risk of drug overdose or toxicity • bladder function:  frequency of elimination & residual volume leading to  incidence of incontinence Gastrointestinal system • mastication: tooth or teeth loss • peristaltic motion of esophagus slowed • higher incidence of gastritis & ulcers • constipation • liver function decreases which affects ability to metabolize drugs Functional changes and changes in performance Reaction Speed • gradual slowing after age 30 • all components of a task take longer to execute; delay in: • perception of stimulus, central processing • delay in task execution • delay increases as task complexity/number of tasks increase. Changes in Gait • walking speed (velocity) gradually decreases • Stable to age 70 then decreases 15%/decade for normal walking and 20% for fast walking • Decreased step length • Shorter steps at same rate accounts for decline in gait velocity • Cadence – unchanged • Increased time in double limb support • Greater anterior pelvic tilt, lumbar lordosis and lateral rotation (toe out 5degrees) • Varies greatly in the older adult population • Balance reaction time increases • Takes longer to react to perturbation • Time in single limb stance decreases Balance • Older adults must rely on vision more for balance • Many have visual problems • Bifocals/progressive lenses can interfere Strength isometric strength decreases with age dynamic strength: decrease in strength at higher speeds Endurance Not correlated to age Memory & intellectual function • long term memory unaffected • processing & response time longer • acquire new information at slower rate and difficulty retrieving at later time • intelligence does not decline (one study indicated language skills > in older adults) • learning capacity dependent on other factors • vision, hearing and general health-decline with aging cannot be isolated out of learning process • Short term • recall with little delay 5-30 seconds Types of memory • Recent memory • 1 hour to several days • Remote memory • occurred a long time ago-referred to frequently • Old memory • occurred a long time ago-not referred to frequently Registration • encoding, ability to take in, understand Stages of Memory Retention • storage Recall • ability to retrieve Effect of Aging on Memory • All types of • Encoding and retrieval memory do not defects are the cause decline of memory decline • Age related • No correlation defect in recall between subjective of all types reports of memory loss and tests of • Greater loss in memory. short term and recent memory • + Correlation between depression and tests • Decline is less of memory loss. for rote memory Sensory Systems Vision • loss of visual acuity - universal over age 50 • presbyopia • increase threshold to light stimulation •  ability to accommodate to darkness •  light adaptation • other: • macular degeneration, diabetic retinopathy, cataracts Visual changes: PT implications • wear glasses to therapy • Caution with bifocal/progressive lenses • use high intensity lighting • light colored walls • avoid darkness/drastic changes in lighting • encourage the use of night lights • avoid glare Auditory system • sensitivity ’s : loss of neurons & hair cells • presbycusis • hearing loss usually affects higher frequencies first • related to noise exposure at younger age Touch sensitivity •  touch sensitivity •  temperature sensation •  sharp/dull discrimination • common c/o difficulty with fine detail when using small objects • physical therapy implications: • protective footwear, skin checks, safety hot/cold, difficulty dressing, functional incontinence • Keep directions simple • Break down task to simplest form PT impact: Teaching Strategies in the Clinical Environment • Assign one task at a time • Compensate for sensory losses • visual • auditory • Feedback • Environment • Miscellaneous Vision • use large, bold print • clear instructions-use illustrations • optimum lighting • magnifying glass • if they have glasses encourage use in therapy Hearing • • • • Avoid rapid speech Stay within 10 feet of listener Use low pitch voice Moderate Volume/Do not scream • Allow person to see your mouth and facial expressions • non-conflicting verbal and nonverbal communications • Hearing Aids • Repeat main points Feedback • learning improves when given feedback • constructive • supportive • timely • do not allow to practice wrong technique Environment • learning optimized in familiar environment • natural environment • Transfer of learning not necessary • organized environment fosters learning • physical environment • clinician Miscellaneous • physical comfort • psychological comfort • qualities of teacher • rate of presentation Maintain Respect &Dignity • Avoid referring to clients as honey or dear-ask to use 1st name address as Mr. or Mrs. Unless given permission. • Questions regarding D/C needs, equipment etc. should not be directed to children without consent. • Need to develop goals with client and respect choices • Activity should be functional & meaningful • Give choices during treatment session Summary • Individual attitudes toward aging vary & impact function. Attitudes influenced by: • culture, environment, financial, status, loss of spouse, loneliness etc. • Chronic illness affects aging process • Treatments geared toward younger population may be contraindicated • Variability is most common factor in aging • Older people can be effective learners – with modification • Treat all patients, including older adults with respect & dignity The End • End of Introduction