geriatrics week 1 summary.pdf

1.10 Physiological Impact of Exercise on Multiple Systems Impact of Exercise on Physiologic Aging - Need to look at exercise or PA as aging stimulus - Decreases chronic physiological changes w/ age - Cardiovascular, metabolic, muscle physiology - A...

1.10 Physiological Impact of Exercise on Multiple Systems Impact of Exercise on Physiologic Aging - Need to look at exercise or PA as aging stimulus - Decreases chronic physiological changes w/ age - Cardiovascular, metabolic, muscle physiology - Acute bout - Increased challenge acts as aging stimulus - Produces instances that mimic age related dysfunction - Recovery Phase - Body adapts to changes brought on by exercise - Repeated bouts then present w/ reduced physiological response - Regular exercise could bring transient physiological stressors to induce positive changes Overall Look - Exercise has clear microscopic impact on DNA & cellular fxn, structure & communication - Significant impact on aging effects in body Impact of Exercise on Skin - Integumentary System - Induces improved skin structure - Exercise increases AMP activated protein kinase - Facilitates release of interleukin-15 - AMP (Adenosine Monophosphate) - Increased amount iL-15 into bloodstream improves fxn - Results in increase cell proliferation & collagen synthesis - Improved tissue health Impact of Exercise on Immunity - Single bout of exercise has positive effects - Increased leukocytes, white blood cells - Increased anti-pathogen activity & anti-oxidation - Chronic Exercise - Decreased inflammation & decrease oxidative stressors - Leads to enhanced immune surveillance & competence Impact of Exercise on Neuroendocrine Fxn - Research - Shown to increase testosterone & DHEA levels for both male/female - Slight increase in insulin growth factor - Increase in sex hormone binding globulin - Increase insulin sensitivity in high intensity training - Exercise linked to rise in anabolic hormones in older adults - Should be main defense against dysfunction in aging Impact of Exercise on Metabolic Fxn - Studies - Decreased resistance to insulin in periphery - Increase metabolism of glucose & fatty acids - Decrease blood sugar levels - Ideal for helping manage type 2 diabetes - Release of AMPK, facilitates glut4 translocation - Increases cellular uptake of glucose Menopause - Exercise counters effects of decreased estrogen - PA activates cycle - Leads to increased endothelial cell nitric oxide synthesis - Leads to plaque reversal, arterial remodeling - Post Menopause - Decreases irritability, anxiety, & stress Impact of Exercise on Renal Fxn - Studies - PA reduced age related decline in glomerular filtration rates - Could prevent chronic kidney disease Impact on GastroIntestinal Fxn - Increase variety of gut microbiota - Leads towards increased bacterial diversity - Produces short chain fatty acids - Improves digestion, immunity, metabolism, cardiovascular fxn - Decrease risk of IBS, IBD  1.11 Anticipated Upright Mobility Changes with Age Changes in Motor Control with Aging - Impacts the somatosensory, musculoskeletal, neurological systems - Causes deterioration in activation, initiation, coordination - Decreases overall mood behavioral performance - Degradation leads towards differentiation of motor responses - Decreases variety of appropriateness of motor reactions - Lowers ability to prioritize & integrate sensory info - Impacts selection, coordination, implementation of appropriate balance reactions during mobility/gait - Compensates - May need increased reliance on sensory prediction - Increased recalibration, minimize muscle effort, or over activation of corticol areas Anticipated Postural Changes (Merck Manual) - Should minimally change during normal aging - Increased anterior pelvic tilt - Causes increased lumbar lordosis - Tight hip flexors & increased abdominal fat - General Stance - Slight increase in bilateral LE hip ER 5 degrees Anticipated Postural Changes (Neck, Thorax, Knee) - Delay in timing of activation in tib ant compared to younger individual - Same pattern of latency in the quads - Latency Issues - Unable to fire in timely fashion, contributes to postural instability - Ineffective balance righting reactions Anticipated Postural Control Changes - Have increased postural sway under 6 conditions - CTSIB test thingy - Greatest discrepancy during last 2 - No vision & unstable surface - Have difficulty when multiple inputs are not available - Difficulty making quick & efficient movements Anticipated Changes in Gait Pattern - Decreased gait velocity - Remains stable until age 70, 15-20% decline/decade - Shortened step length - Increased step width - Double stance time increased from 18% to 26% - Foot clearance does not change - Ankle PF decreases, contributes to decreased forward progression Impact of Dual Tasking - Study - Minimal difference on impact of variables compared to younger population - Fallers - Significant decrease in gait velocity - Increase in swing time variability w/ added task - All had MMSE score greater than 24 Dual Task Gait Screening - Assessment of gait performance should be done w/ dual tasking - Better captures cognitive changes - Captures effect on motor performance - Can tease out early changes in prefrontal cortex & basal ganglia fxn - Research - Target cognitive flexibility would be better for basal ganglia - Target inhibitory control would be better for Alzheimer’s Vital Sign: Gait Velocity - Increases likelihood of capturing functional capacity - How to do test it consistently?? - Add cognitive dual task component?  1.12 Primary Care Screening Geriatric Screening - Consist of 4 areas of health - Physical, Fxnal Movement, Cognitive, Psychosocial Physical Health 4AT - Capture multiple factors that can create issues as we age - Screen for them & bring light to the individual - Simple Question to ask - Have you fallen in the last 12 months or have difficulty w/ balance or walking? - Yes - Query need for balance/walking assessments - Or refer out - Screen - Vitals, BP, HR, RR - Falls Risk - Urinary Incontinence - Somatosensory Changes - Nutrition - ADL Performance Social Health - Includes socioeconomic status, social support, estate planning - Prompt individuals to be mindful to express healthcare wishes when they become incapacitated - Wishes are protected Cognitive Health - Look at orientation, alertness, memory, mental health - 4AT or delirium/cognitive impairment - Useful when working with older adults - SN: 89.7%, SP: 84.1% - Study - MoCA - Mote tome intensive, thorough assessment - 4AT - Consists of alertness, orientation, attention, cognition - Scores - 1-3 indicates possible impairment - 4+ indicates possible delirium or cognitive impairment Cognitive Health - Memory/Depression - Geriatric Depression Scale - Identify presence of depression, not SN enough for tracking - SN: 89%, SP: 65% - Memory can be assessed by tracking # of words during immediate recall - Delayed recall after 3-5 min Movement - Observe patients performing 6 core tasks - Sitting, STS, Standing, Walking, Step Up/down, grasp, reach, manipulate UE Functional Health - Short Physical Performance Battery - Consists of 3 items assessing movement & fxn - Scores - Scored on a 0-4 scale, total of 12 points - Higher scores linked to higher functional lvl - 10-12 (no or limited future disability) - 7-9 (1.6-2.1x risk of future disability) - 4-6 (2.9-4.9x risk of future disability) - Study shows it valid & reliable - Other studies - Demonstrates excellent predictive value for onset of ADL difficulty at 12 months - 1 point increases from baseline associated w/ 12% decrease in risk of death - 21% risk of needing placement - 5% decrease in risk of hospitalization Rapid Geriatric Assessment - Includes 4 screening tools w/ 3 other Q’s - Frailty - Inquires about fatigue, walk upstairs, walk a block, 5+ illnesses, unintended weight loss - Sarcopenia - Impaired muscle strength - Nutritional Intake - Cognition - Additional Q's - Constipation, incontinence, personal directive - Mobile App - Takes about 5 min to administer - Rapid Geriatric Assessment is useful/effective - Demonstrates capacity to identify undiagnosed conditions to potentially set stage for education, intervention & prevention Summary - Primary care screening for aging population is key in gathering info to guide needed targeted assessment & treatment