Geriatric (Ph. Th.) Rehabilitation Lecture 1 PDF

12/21/2024 Geriatric (Ph. Th.) Rehabilitation Geriatric Physical Therapy 1  12/21/2024 Obje...

12/21/2024 Geriatric (Ph. Th.) Rehabilitation Geriatric Physical Therapy 1  12/21/2024 Objectives At the end of this lecture the student will be able to: 1) To define aging, geriatric and gerontology. 2) To identify and describe different theories of aging. 3) To identify classification of old age. 4) Differentiate between successful aging & optimal aging. 5) To understand role of geriatric physical therapist. Introduction what is the difference between geriatrics and gerontology? “Geriatrics” is the branch of medicine concerned with the medical problems and care of the aged people and deals with study of disease and their treatment. “Gerontology” is the scientific study of the process and problems (physical, mental and psychological changes which are incident to old age and its impact on the society. 2  12/21/2024  Aging is defined as a progressive decline and deterioration of functional properties at the cellular, tissue, and organ levels that lead to loss or decreased ability to adapt to internal or external stimuli and increased vulnerability to disease and mortality. (the process of growing old, specially by failure of replacement cells in sufficient number to maintain full functional capacity).  Aging is a fundamental process that affects all of our systems and tissues. The rate of change in each system is different from person to person, but total body decline is an inevitable part of life for everyone. Aging is a progressive , predictable process in which gradual changesnot caused by disease or accident occur over time.  Ironically, we spend about 75% of our entire life span undergoing the process of decline.  Aging is a wonderful and unique experience. No two people age identically  Aging starts in the uterus at the time of conception.  It represents the passage of time, not pathology. 3  12/21/2024 When working with the older adult, it is also important to understand the concept of aging. Successful aging is considered to have three core elements: Absence of disease and disability,  High cognitive and physical functioning,  Active engagement with life. Classifications of old age Three ranges of biological age groups in elderly  The young – old : individuals between 65 and 75 years old.  The Middle (The old- old) : individuals between 75 and 85 years old.  The oldest old : individuals over than 85 years old. The Population of Ageing: Highest rates of chronic diseases and physical disabilities. Highest rates of hospitalisation and institutionalisation. 4  12/21/2024 Definitions of Life Span (A lifetime) The average or maximum length of time an organism or object can be expected to survive or last, The maximum number of years that a person has been known to live. Variations in life expectancy: Causes: differences in public health medicine and nutrition from country to country, Variation in ethnicity and gender. Factors: -Genetic disorder -Exercise -Smoking -Excessive drug and alcohol use. -Poverty -Air pollution -Occupation -Diet -Access to health care Why do we age? When do we start aging? What is the aging marker? 5  12/21/2024 Theories of Aging Many theories have been proposed to explain the process of aging, but neither of them appears to be fully satisfactory Modern biological theories of aging in humans fall into two main categories:  A) Programmed theories  B) Damage and Error theories.  A) The programmed theories assert that the human body is designed to age and there is a certain biological timeline that bodies follow. All of these theories share the idea that aging is natural and "programmed" into the body. perhaps a continuation of the one that regulates childhood growth and development. This regulation would depend on changes in gene expression that affect the systems responsible for maintenance, repair and defense responses. 6  12/21/2024 The programmed theory has 2 sub-categories: 1) Endocrine Theory (physiological theories):  Deal entirely with the endocrine system and the role of hormones in regulating the rate of cellular senescence. Biological clocks act through hormones to control the pace of aging. Recent studies confirm that aging is hormonally regulated. 2) Immunological Theory: which states that the immune system is programmed to decline over time, which leads to an increased vulnerability to infectious disease and thus aging and death. It is well documented that the effectiveness of the immune system peaks at puberty and gradually declines thereafter with advance in age. For example, as one grows older, antibodies lose their effectiveness, and fewer new diseases can be combated effectively by the body, which causes cellular stress and eventual death. 7  12/21/2024 B) The Damage or Error theories or (Error Catastrophe Theory): First proposed in the 1960s, suggest that over time , the number of errors build up to a catastrophic leading to death of the cell and possibly the entire organism Error theories assert that aging is caused by environmental damage to the body's systems, which accumulates over time. The damage or Error theories include: 1) Wear and tear theory. This is what happens to most familiar things around them, Cells and tissues have vital parts that wear out resulting in aging. Like components of an aging car, parts of the body eventually wear out from repeated use, killing them and then the body. 8  12/21/2024 2) Cross-linking theory: According to this theory, an accumulation of cross-linked proteins damages cells and tissues, slowing down bodily processes resulting in aging. Aging process is associated with decline in cellular functions , which are attributed to errors in protein synthesis that can result in an accumulation of mis–synthesised proteins. The repetition of these errors in protein synthesis and accumulated mis-synthesised proteins may be greater enough to impair cellular function and participate in its aging. The process is slow and complicated, but over time, more and more proteins, DNA and other structural molecules in the body develop inappropriate attachments, called cross-links, to one another. 9  12/21/2024 3- Genetic Theory: Aging is the result of a sequential switching on and off of certain genes, age-associated deficits are manifested with genetic instability in aging and dynamics of the aging process. Deal with accumulation of errors in aging genes machinery and telomeres. Genes and Programmed Aging 10  12/21/2024 4 - Generation of Free Radicals theory: This theory, proposes that superoxide and other free radicals cause damage to the macromolecular components of the cell, giving rise to accumulated damage causing cells, and eventually organs, to stop functioning. The macromolecules such as nucleic acids, lipids, sugars, and proteins are susceptible to free radical attack. 11  12/21/2024 Free radicals (oxidative damage):  They are atoms that contain an unpaired electron, Due to this lack of a stable number of outer shell electrons, they are in a constant search to bind with another electron to stabilize themselves—a process that can cause damage to DNA and other parts of human cells. This damage may play a role in the development of cancer and other diseases and accelerate the aging process. Free radicals  The oxygen free radical,(oxidative phosphorylation) Attack the structure of cell membranes, including DNA, RNA, proteins , and the lipids in the cell membrane. 12  12/21/2024  The body has a multi-layed defense system that reacts and detoxifies the damaging radicals.  Defenses include: - natural antioxidants in the body as bilirubin. – enzymes such as superoxide dismutase (SOD) catalase & glutathione peroxidase. - Dietary antioxidants such as beta carotene , and vit. C & E. 5- Rate of living theory. The rate of living theory of aging states that people (and other living organisms) have a finite number of breaths, heartbeats, or other measures, and that they will die once they've used those up. that supports the theory that the greater an organism’s rate of oxygen basal, metabolism, the shorter its life span The rate-of-living theory of aging while helpful is not completely adequate in explaining the maximum life span. 13  12/21/2024 6- The membrane theory of aging  According to this theory it is the age – related changes of the cells ability to transfer chemicals , heatand electrical processes that impair it.  As we grow older the cell membrane becomes less lipid (less watery and more solid).  The cells declining efficiency also means that the essential and regular transfer of sodium and potassium is impaired. It is also believed that electrical and heat transfer is alsoimpaired. 14  12/21/2024 7- The mitochondrial decline theory  The mitochondria are the power producing organelles found in every cell of every organ. Their primary job is to create ATP. Mitochondrial theory of aging, a variant of free radical theory of aging, proposes that accumulation of damage to mitochondria and mitochondrial DNA (mt DNA) leads to aging of humans and animals. SUCCESSFUL VS. OPTIMAL AGING  The concept of successful aging encompassed three elements:-  1- Avoiding disease and disability,  2- Maintaining high physical and cognitive function,  3- Sustaining engagement in social and productive activities. 15  12/21/2024  long-term effects of diet, exercise, and lifestyle are characterized the successful aging of many who had escaped the usual decline and disability of average aging.  Physical therapists can assist the promotion of successful aging by encouraging modification of some extrinsic factors, particularly in teenagers and young adults, which lead to less disease and disability in the later years.  - For those with disease and disability, the physical therapist should work within the concept of “optimal aging,” which allows an individual to achieve life satisfaction in multiple domains—physical, psychological, and social—despite the presence of disabling medical conditions.  - Physical therapists can promote optimal aging by reducing the disabling effects of disease and stopping a vicious cycle of “disease–disability–new incident disease” to improve quality of life. 16  12/21/2024 The role of geriatric physical therapist includes two aims: 1- preventive through maintenance of the physical and physiological capacities of different body systems. 2- Rehabilitation of the well present chronic disease e.g. cardiopulmonary, neurological, or degenerative problems to make the elderly person independent as much as possible. References: 1) Joseph Panno: Aging: theories and potential therapies, Facts On File, Inc. 1st Edition. 2005. 2) James A. Blackburn and Catherine N. Dulmus: Handbook of Gerontology: Evidence-Based Approaches to Theory, Practice, and Policy, John Wiley & Sons, Inc. 2007. 17 12/21/2024 18