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Aging

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Neuro-related gait & proprioception changes. Environmental hazards. fall risk. Bone ... loss of flexibility, strength, posture, proprioception, sensory deficits ... – PowerPoint PPT presentation

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Title: 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

3
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
6
Normal Age-Related Changes
? mobility
Joint stiffness ? muscle strength
Pain
Disability, falls loss of independence, frailty
7
Falls
  • ? mobility
  • MSK-related posture gait changes
  • Neuro-related gait proprioception changes
  • Environmental hazards

? Bone weakness
? fall risk
Fractures
8
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

9
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

10
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)

11
Mobility
  • Mobility includes
  • Transfer between objects or areas
  • Walking
  • Wheelchair and motorized transportation

12
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

13
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

14
When Immobile
  • ? Risk for noticeable decline in ROM within 48
    hrs
  • Daily loss of muscle strength

15
Immobility Acute Consequences
  • Joint contracture
  • Decreased endurance
  • Muscle weakness and atrophy
  • Bone loss

16
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

17
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)

18
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.
19
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
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