6-Normal Physiologic Changes Associated with Aging in Respiratory,cardiovascular musculoskeletal.pdf

Normal Physiologic Changes Associated with Aging in Respiratory,Cardiovascular and Musculoskeletal Systems By Dr. Mona Abdel Khalek Dr. Mina Atef Dr. Ahmed Abdel Haleem Components of the Upper Respiratory Tract Figure 10.2 Components of the Lower Respiratory Tract Figure 10.3 Lower Respirato...

Normal Physiologic Changes Associated with Aging in Respiratory,Cardiovascular and Musculoskeletal Systems By Dr. Mona Abdel Khalek Dr. Mina Atef Dr. Ahmed Abdel Haleem Components of the Upper Respiratory Tract Figure 10.2 Components of the Lower Respiratory Tract Figure 10.3 Lower Respiratory Tract  Functions:  Larynx: maintains an open airway, assists in sound production  Trachea: transports air to and from lungs  Bronchi: branch into lungs  Lungs: transport air to alveoli for gas exchange Four Respiration Processes  Breathing (ventilation): air in to and out of lungs  External respiration: gas exchange between air and blood  Internal respiration: gas exchange between blood and tissues  Cellular respiration: oxygen use to produce ATP, carbon dioxide as waste Age-related changes • Chest wall stiffness. • Declining strength of respiratory muscle results in increased work of breathing. • Loss of lung elastic recoil, decreased lung compliance. • Changes in lung parenchyma: alveoli enlarge, become thinner; fewer capillaries for delivery of blood. Age-related changes • Changes in pulmonary blood vessels: thicken, less distensible. • Decline in total lung capacity: residual volume increases, vital capacity decreases. • Forced expiratory volume (air flow) decrease. Age-related changes • Respiratory muscles become weaker with age. • . Diminished ciliary & macrophage activity • The alveoli in the lungs become thinner and less elastic. • The bronchioles also lose elasticity • Changes in the larynx lead to a higher-pitched and weaker voice Effects of respiratory changes on geriatrics • • • • Decreased cough, deep-clearance. Gag reflex is decreased, increased risk of aspiration. Recovery from respiratory illness is prolonged in the elderly. Significant changes in function with chronic smoking, exposure to environmental toxic inhalants. Effects of respiratory changes on geriatrics • Can develop chronic conditions such as: Emphysema- alveoli lose their elasticity Bronchitis- the bronchioles become inflamed • These changes cause the elderly to experience dyspnea, or difficult breathing. • Breathing becomes more rapid, and have difficulty coughing up secretions from the lungs • More susceptible to respiratory infections 13 Effects of respiratory changes on geriatrics • Combine less functional alveoli with slightly thickened capillaries  decreased surface area available for O2-CO2 exchange  lower O2 to supply vital organs, especially in setting of acute respiratory illness. • Respiratory rate12-24 Effects of respiratory changes on geriatrics • Altered pulmonary function - lower maximal expiratory flow (FEV, FEV1/FVC1 - increased residual volume - reduced vital capacity - unchanged total lung capacity 6000 Volume (ml) IRV IC VC VT TLC ERV FRC RV 0 Primary Lung Volumes Lung Capacities Physical therapy Interventions to slow changes in respiratory system • Alternate activity with periods of rest • Proper body alignment & positioning • Sleep in semi-fowlers position • Use 2 or 3 pillows • Avoid polluted air • Breath deeply & cough frequently • May need continuous oxygen therapy • Using of incentive spirometery. Physical therapy Interventions to slow changes in respiratory system Physical therapy Interventions to slow changes in respiratory system Incentive Spirometery Physical therapy Interventions to slow changes in respiratory system • avoidance of environmental contaminants, smoking cessation • Maintain hydration and mobility Normal Physiologic Changes Associated with Aging in Cardiovascular System Introduction • The cardiovascular system consists of • heart • blood • The network of blood vessels • Sends blood to • Lungs for oxygen • Digestive system for nutrients • CV system also circulates waste products to certain organ systems for removal from the blood. • Our heart beats nearly 100,000 times daily. Valves of the heart:  Tricuspid valve – prevents blood from flowing back into the right atrium when the right ventricle contracts  Bicuspid valve – prevents blood from flowing back into the left atrium when the left ventricle contracts  Pulmonary valve – prevents blood from flowing back into the right ventricle  Aortic valve – prevents blood from flowing back into the left ventricle From body To body To lungs From lungs From lungs Age-related changes. • Changes due more to inactivity and disease than aging. • b. Degeneration of heart muscle with accumulation of lipofuscins (characteristic brown heart);mild cardiac hypertrophy left ventricular wall. • c. Decreased coronary blood flow. Age-related changes • Cardiac valves thicken and stiffen. • Changes in conduction system: loss of pace maker cells in SA node. • Changes in blood vessels: arteries thicken, less distensible; slowed exchange capillary walls; increased peripheral resistance. • Resting blood pressures rise: systolic greater than diastolic. Age-related changes • Decline in neurohumoral control: decreased responsiveness of end-organs to beta-adrenergic stimulation of baroreceptors. • Increased blood coagulability. Effects of Cardiovascular changes on geriatrics • Decreased stroke volume due to decreased myocardial contractility. • d. Maximum heart rate declines with age (HRmax = 220-age). • e. Cardiac output decreases, 1% per year after age 20: due to decreased heart rate and stroke volume. Effects of Cardiovascular changes on geriatrics • Orthostatic hypotension: common problem in elderly due to reduced baroreceptor sensitivity and vascular elasticity. • g. Increased fatigue; anemia common in elderly. • h. Systolic ejection murmur common in elderly. • I. Possible ECG change : loss of normal sinus rhythm; longer PR & QT intervals; wider QRS; increased arrhythmias COMMON PROBLEMS • Angina (chest pain caused by temporarily reduced blood flow to the heart muscle), shortness of breath with exertion, and heart attack can result from coronary artery disease. • Arrhythmias Abnormal heart rhythms. • Arteriosclerosis (hardening of the arteries) is very common. Fatty plaque deposits inside the blood vessels cause them to narrow and can totally block blood vessels. COMMON PROBLEMS • Coronary artery disease is fairly common. It is often a result of arteriosclerosis. • High blood pressure and orthostatic hypotension are more common with older age. • Heart valve diseases are fairly common. Aortic stenosis, is the most common valve disease in the elderly. COMMON PROBLEMS • Congestive heart failure is also very common in the elderly. congestive heart failure occurs 10 times more often than in younger adults. • Transient ischemic attacks (TIA) or strokes can occur if blood flow to the brain is disrupted. Physical Therapy Interventions to slow changes in cardiovascular system . • Complete cardiopulmonary examination prior to commencing an exercise program is essential in older adults due the high incidence of cardiopulmonary pathologies. Assessment of cardiovascular system in geriatric • Assess BP (lying, sitting, standing) • Cardiac assessment: rate/rhythm/heart sounds • Palpate cartoid artery, peripheral pulses for symmetry • Monitor heart rate and rhythm, note irregularity, ECG • Assess for dyspnea with exertion, exercise intolerance • Assess for Orthostatic Hypotension(OH) Orthostatic Hypotension(OH) • Definition: OH is a decrease of 20 mmHg (or more) in systolic pressure • Testing: • OH is tested at the bedside by BP of the patients while they are in supine position • Recheck BP after standing or sitting for 3minutes • OH is defined as a fall of SBP by >20 mm Hg • OH is tested in the laboratory using a tilt table,patient lie on a table that is moved from a horizontal to an upright position. What are the symptoms of orthostatic hypotension? • The main symptom of orthostatic hypotension is feeling dizzy or lightheaded when you stand up. In some cases, people with orthostatic hypotension may even faint. • • • • • • • blurred vision nausea disorientation or confusion feeling weak fatigue falling chest pain Management of Orthostatic Hypotension • It is essential to educate patients, their family, and caregivers to reduce falls occurring because of OH. • In patients with mild OH, non-pharmacological methods like avoiding sudden standing after prolonged rest in the supine position might be enough. • Elderly Parkinson's disease PD patients should be advised not to pass urine while standing. • Alcohol and medicines might worsen OH; therefore, it is important to check all medicines they are taking. • They should avoid foods rich in carbohydrates. • It is helpful to increase the head end of bed by 20° while sleeping Management of Orthostatic Hypotension • Taking small meals at frequent intervals will avoid postprandial OH. • Patients with OH should take 5 g of common salt divided through the day. • Exercising the calf muscles by walking or cycling can help to prevent BP falls. • In the presence of severe OH, calf muscle exercises using a reclining bicycle can be helpful. Elastic stockings are helpful but could be uncomfortable in warm weather. • - Rise slowly from lying or sitting position -Wait 1-2 minutes after position change to stand or transfer -Monitor for every signs of hypotension: change in mental status, dizziness, orthostasis Summary Slide Aging Effects on the Heart 1. Structural changes at the cellular level 2. Decrease in SA cells and autonomic nerve function 3. Thickening and calcification of heart and vessels 4. Myocardial stiffness 5. Decreased elasticity of vessels 6. Decreased venous return 7. Decreased maximum heart rate 8. Changes in cardiac output,stroke volume and blood pressure What Happens When You Exercise ? Maximum Oxygen Consumption (VO2 max) • VO2max is the maximum amount of oxygen that the heart can pump and the muscles can use in a given period of time. • VO2max is the product of maximum cardiac output and maximum systemic arteriovenous O2 difference. • The Maximum Oxygen Consumption (VO2 max) is considered an indicator of cardiovascular fitness. Maximum Aerobic Power (Aerobic Capacity) • Aerobic Capacity declines 1% per year in adults when measured by VO2max. • The measurement of VO2max is dependent on agerelated changes in: • Maximum heart rate • Cardiac output • Decreased muscle mass • Decreased skeletal muscle quality • Older persons in good physical condition can match or exceed the aerobic capacity of unconditioned younger persons. . CHANGES IN VO2MAX WITH AGE Cardiovascular Changes During Exercise • Aerobic capacity decreases about 1% per year after age 25 • Maximum heart rate decreases due to decreased sympathetic nervous system activity and changes in cardiac conduction. Maximal Heart Rate = 220 beats/min − age in years • Maximum stroke volume decreases can be10-20% less in elderly patients compared to younger adults, primarily due to increased total peripheral resistance (increased afterload). • Maximum cardiac output decreases • Muscle blood flow decreases • VO2max decreases due to reduced blood flow to active tissues Benefits of Cardiac Rehabilitation • Improve quality of life. • Decrease risk fatal heart attack. • Decrease severity of angina • Decrease the need of medication. • Decrease blood pressure. • Increase the ability to exercise longer. • Decrease cholesterol level. Normal Physiologic Changes Associated with Aging in Musculoskeletal System Physiologic Changes Associated with Aging in Musculoskeletal System • A. Muscular • B. Skeletal System Physiologic Changes Associated with Aging in Muscular system • A. Muscular • Loss of muscle strength • Loss of skeletal muscle mass (atrophy): both size and number of muscle fibers decrease. • Changes in muscle fiber composition: selective loss of Type II, fast twitch fibers, with increase in proportion of Type I fibers. Physiologic Changes Associated with Aging in Muscular System • Changes in muscular endurance: muscles fatigue more readily due to: 1. Decreased peripheral blood flow, oxygen delivery to muscles. 2. Decreased myosin ATPase activity. 3. Collagen changes: denser, irregular due to cross-linkages, loss of water content and elasticity; affects tendons, bone, cartilage Clinical implications • Movements become slower. • Movements fatigue easier; increased complaints of fatigue. • Clinical risk of falls. Clinical implications • Connective tissue becomes denser and stiffer. (1) Increased risk of muscle strains, tendon tears. (2) Loss of range of motion. (3) Increased tendency for contractures. Clinical implications • Gait changes: (1) Stiffer, fewer automatic movements. (2) Decreased amplitude and speed, slower cadence(steps per minute). (3) Shorter steps, wider stride, increased double support to ensure safety, compensate for decreased balance. Clinical implications • Gait changes: (4) Decreased trunk rotation, arm swing. (5) Gait may become unsteady due to changes in balance, strength; increased need for assistive devices. (6) Decrease vertical displacement Decrease vertical displacement Physiologic Changes Associated with Aging in skeletal System • B. Skeletal System • Cartilage changes: decreased water content, becomes stiffer, fragments and erodes • Loss of bone mass and density • Intervertebral discs: flatten, less resilient due to loss of water content (30% loss by age 65) and loss of collagen elasticity; trunk length, overall height decreases. Physiologic Changes Associated with Aging in skeletal System • Senile postural changes. (1) Forward head. (2) Kyphosis of thoracic spine. (3) Flattening of lumbar spine. (4) With prolonged sitting, tendency to develop hip and knee flexion contractures. Clinical implications • Maintenance of weight-bearing is important for cartilaginous/joint health. • Clinical risk of fractures. Physical therapy Interventions to slow changes in Musculoskeletal System • Increase levels of physical activity: • (1) Gradual increase in intensity of activity to avoid injury. • (2) Adequate warm ups and cool downs. Physical therapy Interventions to slow changes in Musculoskeletal System • Provide strength training: • Significant increases in strength noted in older adults with isometric and progressive resistive exercise regimes. • (2) High-intensity training programs (70-80% of one-repetition maximum) produce quicker and more predictable results than moderate intensity programs; both have been successfully used with the elderly. Physical therapy Interventions to slow changes in Musculoskeletal System • Provide flexibility, range of motion exercises: (1) Utilize slow, prolonged stretching, maintained for 20-30 seconds. (2) Tissues heated prior to stretching e.g., warm pool. (3) Maintain newly gained range: incorporate into functional activities. (4) Mobility gains are slower with older adults. Physical therapy Interventions to slow changes in Musculoskeletal System • Postural exercises: stress components of good posture. • Weight bearing (gravity-loading) exercise can decrease bone loss in older adults, e.g.,walking;stair climbing. flexibility, range of motion exercises Thank you