Aging

1
Aging the Musculoskeletal System

• Content for this module provided by
• The John A. Hartford Foundation, Institute for
  Geriatric Nursing, Online Gerontological Nursing
  Certification Review Course http//www.nyu.edu/edu
  cation/nursing/hartford.institute/course/
• Basia Belza, PhD, RN, Associate Professor,
  Biobehavioral Nursing Health Systems, School of
  Nursing University of Washington

Support for this project provided to School of
Nursing, University of Washington by the John A.
Hartford Foundation, Geriatric Nursing Education
Grant and Nursing School Geriatric Investment
Program Grant.
2
Normal Musculoskeletal Changes

• Bones anatomical changes
• ? mineral content
• ? mass
• Collagen formation
• gt viscous synovial fluid
• gt fibrotic synovial membranes
• ? joint cartilage
• ? water content elasticity of cartilage

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Normal Musculoskeletal Changes

• Muscles anatomical changes
• ? mass
• ? tendon size sclerosis
• ? elasticity of ligaments and tendons
• ? myosin adenosine triphosphatase (ATP) activity

4
Normal Musculoskeletal Changes

• Physiologic changes
• Narrowing of joint spaces
• Bones make contact with bone
• ? muscle strength
• ? bone formation and ? bone reabsorption, leading
  to osteoporosis

5
Normal Musculoskeletal Changes

• ? flexion/extension of spine

Posture gait changes
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Normal Age-Related Changes
? mobility
Joint stiffness ? muscle strength
Pain
Disability, falls loss of independence, frailty
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Falls

• ? mobility
• MSK-related posture gait changes
• Neuro-related gait proprioception changes
• Environmental hazards

? Bone weakness
? fall risk
Fractures
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Musculoskeletal Assessment

• ROM limitations
• Mobility/walking difficulties
• Evidence of diffuse or localized joint pain
• Signs of motor or sensory dysfunction (weakness,
  spasticity, tremors, or rigidity)
• Gait changes caused by joint problems (as opposed
  to those resulting from neurological problems)
• Change in level of functioning

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Gait

• Gait refers to the style or method of walking
• Problems with the gait may be due to
• loss and recovery of balance
• the inability to maximize momentum
• the loss of use of gravity

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Gait Changes

• Biological
• loss of flexibility, strength, posture,
  proprioception, sensory deficits
• neurological impairments such as Parkinson's
  disease
• Functional
• ill-fitting shoes or bony changes in the foot
  that influence the normal biomechanics of the
  foot
• Pathological
• prosthesis (the older person is at a higher risk
  for problems in association with a prosthesis)

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Mobility

• Mobility includes
• Transfer between objects or areas
• Walking
• Wheelchair and motorized transportation

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Mobility Problems Deconditioning

• Predisposing risk factors
• Prolonged bed rest because of an acute illness
• Disability that limits or temporarily eliminates
  mobility
• Chronic disease that causes a ? in activity
• Use of certain medications
• Psychosocial factors

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Mobility Problems

• Medical
• arthritis, cardiovascular, pulmonary disorders,
  deconditioning
• Psychological
• depression, cognitive impairment, poor
  motivation,
• fear of falling
• Sociological
• isolation, fear of crime, loss of friends
• Environmental
• multiple or uneven steps to maneuver or
• an unsafe home

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When Immobile

• ? Risk for noticeable decline in ROM within 48
  hrs
• Daily loss of muscle strength

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Immobility Acute Consequences

• Joint contracture
• Decreased endurance
• Muscle weakness and atrophy
• Bone loss

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Treatment/Prevention of Acute Consequences of
Immobility

• Active or passive range of motion
• Regular repositioning of joints
• Neutral positioning of limbs
• Resting splints

• Therapeutic exercises
• Bed mobility training
• Standing or weight bearing

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Examples of Drug Induced Mobility Impairment

• Supporting structure
• Arthralgias, myopathies
• corticosteroids, lithium
• Osteoporosis, osteomalacia
• corticosteroids, phenytoin, heparin
• Movement disorders
• EPS/tardive dyskinesia
• neuroleptics, metoclopramide, amoxapine,
  methyldopa
• Owen NJ, et al. in Lueckenotte (2000)

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Examples of Drug Induced Mobility Impairment

• Balance
• Neuritis, neuropathies
• metronidazole, phenytoin
• Tinnitus, vertigo
• aspirin, aminoglycosides, furosemide, ethacrynic
  acid
• Hypotension
• ?-blockers, CCB, neuroleptics, antidepressants,
  diuretics, vasodilators, benzodiazepines,
  levodopa, metoclopramide
• Psychomotor retardation
• neuroleptics, benzodiazepines, antihistamines,
  antidepressants

Owens NJ, Sillman RA, Fretwell, MD. (1989). The
relationship between comprehensive functional
assessment and optimal pharmacotherapy in the
older patient. DICP the annals of
pharmacotherapy, 23, 847-854.
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The Aging Process Summary

• Changes with aging result from gradual loss
• Losses often begin in early adulthood
• Decline varies considerably from person to person
• Decrement does not become significant until the
  loss is fairly extensive
• Think in terms of thresholds loss of function
  does not become significant until it crosses a
  given level (might be ok in normal situations,
  but unable to adapt under stress)

20
Remain Physically Active

• Adverse changes can be slowed or negated by
  engaging in regular exercise
• Beneficial effects on multiple systems
• What works relative to physical activity exercise
  programs set goals, plan a program, address
  barriers, cross train